Ageing

Question 1

Definition

Answer 1

time dependent loss of structure and function that proceeds slowly and in such small increments it appears to be the result of the accumulation of small, imperceptible injuries

Question 2

Respiratory System - Structural Changes

Answer 2

Reduced chest wall compliance
- thoracic cage joints and attachments calcify and become less mobile
- vertebral column deformities result in kyphoscoliosis
- intercostals and diaphragmatic muscles atrophy
= reduced chest wall compliance

Increased lung compliance

• destruction of elastin = lost elastic recoil
• compliance reciprocal to elasticity

Increased FRC and RV

• lost elastic recoil = increased closing capacity
• results in gas trapping and hyperinflation

Decreased surface area for gas exchange
- destruction of elastin = changed structure of alveoli
= lost surface area for gas exchange

Question 3

Respiratory System - Functional Changes

Answer 3

Altered mechanics of ventilation

• gas trapping causes increased residual volumes which results in
• reduced vital capacity
• reduced expiratory flow rates
• reduced inspiratory and expiratory force generation

Changes to perfusion, ventilation and gas exchange = reduced PaO2

Reduced exercise capacity due to reduced VO2 max

Altered regulation of ventilation - body has reduced responsiveness to hypoxaemia and hypercapnia

increased susceptibility to sleep apnoea and hypopnea

Altered lung defence mechanisms = increased susceptibility to aspiration, pneumonia and ifnection

Question 4

CV System Structural Changes - myocardial changes

Answer 4

increased mass of the myocardium

• due to collagen deposition into arterial walls causing thickening = reduced compliance
• means the LV has to work harder to pump blood
• myocardium hypertrophies in order to compensate
• myocardium also has increased collagen deposition - less compliant, greater load placed on the atria

Question 5

CV System Structural Changes - valvular changes

Answer 5

• aortic and mitral valves increase in thickness
• increased circumference of all valves
• calcification of the valve leaflets
  Results in increased workload of the atria - causing them to make compensatory changes

Question 6

CV System Structural Changes - arterial changes

Answer 6

• increased arterial wall thickness
• increased collagen content in the arteries
  results in vessels becoming thicker and having reduced compliance

Question 7

CV System - Functional Changes

Answer 7

Changes to HR - decrease in resting HR
- significant decrease in max HR due to reduced responsiveness to sympathetic stimulation

Left Ventricle

• reduced compliance and reduced relaxation = reduced rate of filling
• relies on the atria for adequate filling
• hypetrophies in order to compensate so has enough force for systole and overall CO remains the same

Cardiac Fibres - reduced responsiveness to sympathetic stimulation

Vascular Changes
- reduced compliance due to structural changes
Results in
- increased BP
- increased pulse pressure
- increased systemic vascular resistance
- increased afterload on the left ventricle

Question 8

Clinical Implications

Answer 8

impaired airway clearance 
impaired gas exchange 
dyspnoea 
decreased exercise tolerance 
respiratory muscle dysfunction 
musculoskeletal dysfunction

Question 9

Physiotherapy Management

Answer 9

PHYSICAL ACTIVITY

• slows the physiological effects of ageing that impair exercise capacity
• optimises age related changes in body composition
• promotes physiological and cognitive well being
• manages chronic diseases
• reduces risk of physical disability
• increases longevity

Question 10

Exercise Prescription

Answer 10

AEROBIC
Frequency - at least 5 days a week at mod intensity
- 3-5 days a week at high intensity
Intensity - 5-6/10 for mod intensity
- 7-8/10 for high intensity
Time - 30-60mins mod intensity overall (at least 10 mins at a time)
- 20 - 30 mins high intensity
Type - anything that doesn’t bring about excessive orthopaedic stress

STRENGTHENING
Frequency - at least 2 days per week
Intensity - 60-70% of 1RM
- beginners start at 40-50% of 1RM
Type - progressive weight training program or body weight calisthenics
- depends on what resources they have available

FLEXIBILITY
Frequency - at least 2 days per week
Intensity - stretch to point of tightness
Time - hold for 30-60 seconds
Type - any physical activity that maintains/increases flexibility