Transcript Physiology of Aging: Clinical Aspects

Effects of Aging on Mobility
and Independence
Anthony Poggio, DPM,MS
Cal ‘79
Affects of Aging
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Muscle
Tendon
Bone
Skin
Neurology
Vascular
Psych
Muscle/Tendon
• Support Skeletal
system; Posture
• Facilitate motion
• Heat Production
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Weakness
Contracture
Gait changes
decrease in energy supply
(ATP, creatine phosphate
and glycogen
• decreased circulation to
bring in O2 and clear
lactic acid
• Changes at the motor end
plate, therefore decrease
in stimulation potential
Muscle/Tendon
• Changes at the motor
end plate, Sarcolemma
are fewer, shorter,
become smoother
• decrease in surface
area therefore decrease
in stimulation
potential
Muscle/Tendon
• reduction in size and number of
mitochondria hence decrease in available
energy
• decrease in substances to supply energy
(ATP, creatine phosphate and glycogen)
Muscle/Tendon
• Decreased circulation
to bring in O2 and
nutrients
• breakdown of other
substances creating
build up of lactic acid
Muscle/tendon
• Increase in fat/fibrinous tissue within
muscle
• decreased ability or muscle repair
• increased scar tissue
• therefore there is slower,
weaker, irregular contraction
with longer recovery period
Bone
• skeletal structure
• Attachment for
muscle, tendons.
ligaments, etc
• Blood cell production
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Osteoporosis
Osteopenia
fracture, hip
delayed healing
Bone
• Cortical bone:
– Dense packed bone,
very compact and
hard
– forms outer shell of
bone
• Trabecular bone:
– loosely packed
matrix, “spongy”
– head and base of
long bones
– majority of
irregular bones
Joint
• Arthritis
– Joint Stiffness
– loss of cartilage
– loss of joint contour
– angular deformities
• Synovial membrane
less elastic as are
adjacent ligament
structure
• with less movementjoint (ligaments)
contract to position
• Hyaline vs
fibrocartilage
Joints
• Loss of hyaline cartilage
• decreased water content with increased
calcium salts, crosslinking of fibers
therefore more stiff and less elastic
• can reform fibrocartilage
Joints
• Synovial fluid decreased in volume
secondary to decreased blood flow,
• Synovial membrane less elastic as are
adjacent ligament structure
• with less movement-joint (ligaments)
contract to position
Skin
• Provides barrier
– organisms,
– chemicals,
– water,
– light,
– trauma
E Epidermis PIDERMIS
ROLE:
Provides Protective
Covering &
Generates New Cell
Growth
With aging less able to keep out substances; chemicals,
microorganisms
athletes foot, fissures
D Dermis
ERMIS
ROLE:
Provide the Skin with
Strength & Elasticity
Major Structures: Blood Vessels, Nerve Endings,
Hair Follicles, & Sebaceous Glands that secrete
sebum to prevent skin from drying out
With aging less h20 more crosslinking of collagen
therefore thinner and less elastic- fissures
Subcutaneous tissue
UTANEOUS TISSUE
ROLE:
Provides protection &
insulation for the
underlying tissue
• With aging
– decreased fat: decreased cushion, callous/corns
– less skin support: increased sheer force
• ***Typically the subcutaneous tissue is poorly
vascularized.
Skin
• Decubitus ulcers-bed sore
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weaker skin
thinner skin
decreased blood supply
skin hygiene
poor nutrition
decreased ability to repair
COMMON LOCATIONS
Bony Prominences
• Occiput
• Scapulae
• Elbows
• Sacrum
• Trochanter
• Ischium
• Knees
• Ankles
• Heels
COSTS OF PRESSURE ULCERS
• Annual US healthcare costs are over
$1.3 billion
• Average cost per ulcer = $27,000
• Quality of life issues
• Increased length of stay
• Tissue and bone infections
PRESSURE ULCERS
• Pressure ulcers occur in 11%
of all hospital admissions
• Pressure ulcers occur in over
25% of long term care
residents
• Certain patient groups have
even higher groups have even
higher incidences - 66% of
femoral fracture patients, 60%
of quadriplegic patients
DEFINITION OF A PRESSURE ULCER
• Localized area of
tissue breakdown
resulting from
compression of soft
tissue between a bony
prominence and an
external surface
SKIN BREAKDOWN: DIABETIC ULCERS
Skin breakdown due
to loss of sensation
coupled with
repetitive pressure
and shear
Vascular
Function:
Transportation
• Peripheral arterial
disease
• venous disease
• diminished healing
ability, defense
• micro-circulation to
muscle, nerves, etc
• amputation
Venous disease
• Return blood to heart
• slower blood flow-clot formation
• venous stasis dermatitis- skin damage
CAPILLARY HYPERTENSION
• Capillaries have thin,
single-cell thickness
walls
• Venous hypertension
causes capillary walls to
stretch, creating gaps
between cells
Neurology
• Function
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monitoring,
communicating
stimulation
coordination
Neurologic
• Nerve Loss
– sensory
– motor
• Coordination
• reflexes
Neurology
• Sensory
– requires more stimuli
to elicit response
– awareness of position
• reflexes
• Somatic
– decreased transmission
speed down axon
resulting in slower and
weaker contraction
ability
– prolonged refractory
period before next
contraction
– less coordinated
motion
Misc
• Vision
– obstacle
• cardiac
• pulmonary
– stamina
Putting it all together
function
mobility
independence
AGING
musculoskeletal
neurologic
dermatologic
vascular
Psychological Factors
• Loss of
independence
– fear of losing
independence
– rely on
family/friends for
simply tasks
– must be done at
their convenience
– isolation
Psychological Factors
• Assistive devices
– realization they are old
– embarrassment in public
– limitation in activities
Psychological Factors
• Self Care
– inability to bend to reach items
– open bottles, apply dressing
Psychological Factors
• Fear of Falling
• Decreased stamina
• Cycle of decreased
activity
– more stiffness
– decreased vasc supply
and overall health
– less coordination
– increased isolation
– depression
Prevention/Treatment
• In home support vs nursing home
• improvement in function
– physical therapy, medication
• Age related or not??
• Social agencies
– paratransit, special equipment (scooters)
Prevention/Treatment
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Put in perspective
Enlist family support
active participation-feel in control
speak to them, not down to them
patience
THANK YOU!
Good Luck in Your Future
Careers
GO BEARS!!!