Ch 5: Aging

Question 1

Biological changes with aging (3)

Answer 1

• cellular changes (fragmentation of Golgi apparatus and mitochondria; decrease in cell capacity to divide and reproduce; arrest of cell division)
• tissue changes (accumulation of pigmented materials, lipofuscins, lipids and fats; decreased elasticity of connective tissue; presence of pseudoelastins).
• organ changes (decrease in functional capacity and homeostatic efficiency).

Question 2

Premature aging syndromes are called….

Answer 2

progeria

Question 3

Hutchinson-Gilford syndrome is…

Answer 3

progeria of childhood

Question 4

Werner’s syndrome is…

Answer 4

progeria of young adults

Question 5

atherosclerosis is…

Answer 5

buildup of WBC’s in arteries

Question 6

Type I fibers vs Type II fibers (muscle)

Answer 6

Type I = slow twitch

Type II= fast twitch

Question 7

Age-related changes in muscles

Answer 7

• loss of strength
• loss of power
• loss of skeletal muscle mass
• changes in muscle fiber composition (more slow fibers)
• muscles fatigue more rapidly (lower endurance)

Question 8

clinical implications of changes in muscles

Answer 8

• movements become slower
• increased complains of fatigue
• connective tissue becomes denser and stiffer (risk of muscle sprains, strains, tendon tears; loss of ROM, increased tendency for fibrinous adhesions/contractures)
• decreased functional mobility, limitations to mvmt
• gait may be unsteady (changes in balance, strength)
• increased risk of falls

Question 9

strategies to slow or reverse muscular aging changes

Answer 9

• improve health (correct medical problems that cause weakness like hyperthyroid, excess steroids, hyponatremia= low sodium; improve nutrition).
• increase physical activity
• provide strength training to increase/maintain muscle strength required for functional activity.
• provide flexibility and ROM exercises to increase ROM needed for functional activity.

Question 10

Age-related changes in skeletal system

Answer 10

• cartilage changes (decreased water content, stiffer, fragments, and erodes)
• loss of bone bass and density
• intervertebral discs flatten, less resilient (loss of water and collagen)
• senile postural changes (forward head, kyphosis, flattening of lumbar spine, hip/knee flexion contractures with prolonged sitting)

Question 11

clinical implications of skeletal changes with aging

Answer 11

maintenance of weight bearing is important for cartilaginous/joint health and mobility.
Increased fall/fracture risk

Question 12

strategies to slow/reverse skeletal changes with aging

Answer 12

• postural exercises (stress components of good posture)
• weight bearing exercise can decrease bone loss in older adults
• nutritional, hormonal, and medical therapies

Question 13

Age-related changes in neurological system

Answer 13

• atrophy of nerve cells in cerebral cortex
• changes in brain morphology (gyral atrophy, ventricular dilation, generalized cell loss in cerebral cortex esp frontal and temporal, lipofuscins, plaques and tangles, cell loss in basal ganglia cerebellum hippocampus locus coeruleus, NOT brain stem).
• decreased cerebral blood flow and energy metabolism
• changes in synaptic transmission (decreased synthesis and metabolism of neurotransmitters, slowing of many neural processes)
• changes in spinal cord/peripheral nerves (neuronal loss/atrophy, loss of motorneurons, slowed nerve conduction velocity, loss of sympathetic fibers).
• age-related tremors (usually essential tremor)

Question 14

clinical implications of neurological aging changes

Answer 14

• effects on movement: overall speed/coordination decreased; difficulty w/ fine motor control; slowed recruitment of motorneurons so loss of strength; reduced reaction/movement time; errors in faster movements; more cautionary behaviors.
• general slowing of neural processing (learning and memory may be affected)
• problems in homeostatic regulation (heat, cold, exercise could cause harm)

Question 15

strategies to slow/reverse neurological aging changes

Answer 15

• correct medical problems… improve cerebral blood flow
• improve health: diet, stop smoking
• increase levels of physical activity (may slow rate of neural decline and improve circulation)
• provide effective strategies to improve motor learning/control (allow increased reaction/mvmt time; allow limitation of memory; allow increased cautionary behaviors and give more time when teaching new mvmt skills; stress familiar well-learned skills

Question 16

Age-related sensory system changes

Answer 16

• loss of function of sense…
• may lead to sensory deprivation, isolation, disorientation, confusion, appearance of senility and depression
• may strain social interactions
• may lead to decreased functional mobility and increased risk of injury
• alters quality of life

Question 17

Vision changes with aging

Answer 17

• general decline in visual acuity (gradual to age 60, rapid b/w 60-90)
• presbyopia: visual loss characterized by inability to focus properly and blurred images
• decreased ability to adapt to dark/light
• increased sensitivity to light/glare
• loss of color discrimination (esp blue/green)
• decreased pupillary responses
• decreased sensitivity of corneal reflex
• diminished oculomotor responses

Question 18

Cataracts

Answer 18

opacity, clouding of lens due to changes in lens proteins; results in gradual loss of vision (central first, then peripheral), problems with glare; general darkening of vision; loss of acuity. Surgery!!

Question 19

Glaucoma

Answer 19

increased intraocular pressure, with degeneration of optic disc, atrophy of optic nerve; results in loss of peripheral vision. If untreated, can progress to blindness. Surgery and medication can be effective if tx early.

Question 20

Macular degeneration

Answer 20

loss of central vision associated with age-related degeneration of the macula compromised by decreased blood supply or abnormal growth of blood vessels under retina; typically retain some peripheral vision; increased sensitivity to glare, and difficulty adjusting to light change; may progress to blindness.

Question 21

Diabetic retinopathy

Answer 21

damage to retinal capillaries, growth of abnormal blood vessels and hemorrhage leads to retinal scarring and finally retinal detachment; central vision impaired, vision blurred; complete blindness is rare.

Question 22

CVA, homonymous hemianopsia

Answer 22

loss of 1/2 visual field in each eye (toward same side- 1 nasal 1 temporal); produces an inability to receive info from right or left side; corresponds to side of sensorimotor deficit.

Question 23

Medication can impair vision or make it fuzzy… these meds would be….

Answer 23

antihistamines antipsychotics, antidepressants, steroids

Question 24

Clinical implications/compensatory strategies for vision loss

Answer 24

• assess for visual deficits (acuity, peripheral vision, light/dark, depth perception, diplopia, eye fatigue, eye pain)
• maximize visual function (assess for use of glasses and needed enviro adaptations)
• sensory thresholds are increased (allow extra time for visual discrimination/response)
• work in adequate light and reduce glare
• use large, high contrast print for writing
• provide magnifying glasses
• eye patch for diplopia
• decreased peripheral vision may limit social interactions, so stand in front and at eye level
• assist patient with color discrimination (use warm colors- yellow, orange, red)
• provide other sensory cues when vision is limited (verbal descriptions, touching, talking clocks)
• provide safety education to reduce fall risk.

Question 25

Hearing changes with aging

Answer 25

- occur as early as 30's. affects a lot of elderly. - outer ear- buildup of cerumen (ear wax) can result in hearing loss - middle ear- minimal degenerative changes of bony joints - inner ear- significant changes in sound sensitivity, understanding speech, and maintenance of equilibrium; atrophy of cochlea and vestibular structures; loss of neurons

Question 26

What is conductive hearing loss?

Answer 26

mechanical hearing loss from damage to external auditory canal, tympanic membrane or middle ear ossicles; results in hearing loss; tinnitus maybe.

Question 27

What is sensorineural hearing loss?

Answer 27

central or neural hearing loss from multiple factors (noise damage, trauma, disease, drugs, arteriosclerosis, etc)

Question 28

What is presbycusis hearing loss?

Answer 28

sensorineural hearing loss associated with middle and older ages; characterized by bilateral hearing loss, esp at high frequencies at first, then all frequencies; poor auditory discrimination and comprehension, esp with background noise; tennitus.

Question 29

What is otosclerosis?

Answer 29

immobility of stapes (bone in middle ear) resulting in profound conductive hearing loss.

Question 30

clinical implications/compensatory strategies for hearing loss

Answer 30

- assess acuity, speech discrimination/comprehension, tinnitus, dizziness, vertigo, pain. - asses for use of hearing aids; check if working! - minimize auditory distractions - speak slowly and clearly at eye level - use nonverbal communication - provide written and demonstrated directions - orient person to topics of conversations he can't hear to reduce isolation/fear - provide assistive devices to compensate and ensure safety (flashing fire alarms, telephones, doorbells).

Question 31

Vestibular/balance control changes with aging

Answer 31

- degenerative changes in otoconia of utricle and saccule; loss of vestibular hair-cell receptors; decreased number of vesitbular neurons; VOR gain decreases; begins at age 30! - diminished acuity, delayed reaction times - reduced function of vestibular ocular reflex (VOR); affects retinal image stability with head movements and produces blurred vision - altered sensory organization (older adults more dependent on somatosensory inputs for balance) - less able to resolve sensory conflicts when presented with inappropriate visual or proprioceptive inputs due to vestibular losses - postural response patterns for balance are disorganized (increased postural sway)

Question 32

what is Meniere's disease?

Answer 32

episodic attacks characterized by tinnitus, dizziness, and a sensation of fullness or pressure in the ears; may also have sensorineural hearing loss.

Question 33

what is benign paroxysmal positional vertigo (BPPV)?

Answer 33

brief episodes of vertigo (less than 1 minute) associated with position change; common in older adults.

Question 34

what medications cause potential loss in vestibular sensitivity?

Answer 34

antihypertensives; anticonvulsants; tranquilizers, sleeping pills; aspirin, NSAIDS

Question 35

other things that can cause loss of vestibular sensitivity are cerebrovascular disease, cerebellar dysfunction, migraine, and cardiac disease

Answer 35

just know that :)

Question 36

Somatosensory changes with aging

Answer 36

- decreased sensitivity of touch associated with decline of peripheral receptors (LE more than UE) - proprioceptive losses (beginning age 50; greater in LE than UE) - loss of joint receptor sensitivity (in LE could cause fall) - cutaneous pain thresholds increased (greater in UE/face than LE)

Question 37

pathology that could cause loss of sensation...

Answer 37

- diabetes (peripheral neuropathy) - CVA (central sensory losses) - peripheral vascular disease (peripheral ischemia)

Question 38

clinical implications/compensatory strategies for somatosensory issues in aging

Answer 38

- assess carefully- check for sensory losses - allow extra time for responses - use touch to communicate - provide augmented feedback through appropriate sensory channels (ex. extra grip silverware) - teach compensatory strategies to prevent injury - provide AE and enviro modifications for fall prevention - provide biofeedback devices as appropriate

Question 39

Taste and Smell changes in aging

Answer 39

- gradual decrease in taste sensitivity | - decreased smell sensitivity

Question 40

Conditions resulting in additional loss of taste/smell sensation

Answer 40

- smoking - chronic allergies, respiratory infections - dentures - CVA, involvement of hypoglossal nerve

Question 41

clinical implications/compensatory strategies for taste/smell changes

Answer 41

- asses for identification of odors, tastes, somatic sensations (temp, touch) - decreased taste/enjoyment of foods can lead to poor diet/nutrition - older adults frequently increase use of taste enhancers (salt/sugar!) - decreased home safety (gas leaks, smoke)

Question 42

Age-related cognitive changes

Answer 42

- no uniform decline in intellectual abilities throughout adulthood - no changes typically until mid 60's; signif declines around early 80's - terminal drop= most signif changes in years preceding death - tasks involving perceptual speed show early declines (by age 39); longer times to complete tasks - numeric ability peaks in mid 40's; stable until 60's - verbal ability peaks at age 30; maintained until 60's. - memory impairments typically short-term memory; task dependent (typically problems with new tasks) - learning... all ages can learn!

Question 43

clinical implications of age-related cognitive changes

Answer 43

older adults utilize different strategies for memory: context based strategies vs memorization (young adults)

Question 44

strategies to slow or reverse cognitive changes

Answer 44

- improve health (correct medical problems... imbalances b/w oxygen supply & demand in CNS; assess pharmacological changes; reduce tobacco and alcohol use; eat right!) - increase physical activity - increase mental activity (keep mentally engaged; maintain engaged social life; use cognitive training activities) - provide multiple sensory cues to compensate for decreased sensory processing and sensory losses - provide stimulating, enriching enviro; avoid enviro dislocation - reduce stress; provide counseling and family support

Question 45

Age-related cardiopulmonary system changes

Answer 45

-changes due more to inactivity and disease than aging -degeneration of heart muscle with accumulation of lipofuscins -decreased coronary blood flow -cardiac valves thicken and stiffen -changes in conduction system (loss of pace maker cells in SA node) -changes in blood vessels (arteries thicken, less distensible; slowed exchange capillary walls; increased peripheral resistance) -resting blood pressures rise (systolic greater than diastolic) -decline in neurohumoral control (decreased responsiveness of end-organs to beta-adrenergic stimulation of baroreceptors) -decreased blood volume, hemopoietic activity of bone increased blood coagulability

Question 46

clinical implications for cardiovascular changes in aging

Answer 46

- changes at rest are minor (resting heart rate and cardiac output relatively unchanged; resting BP increase) - CV responses to exercise are blunted, decreased heart rate acceleration, decreased maximal O2 uptake and heart rate; reduced exercise capacity; incr recovery time - decreased stroke volume due to decreased myocardial contractility - max heart rate declines with age - cardiac output decreases, 1% per year after age 20! - orthostatic hypotension is common - increased fatigue; anemia common - systolic ejection murmur common - possible ECG changes

Question 47

pulmonary changes in aging

Answer 47

- chest wall stiffness, declining strength of respiratory muscles, increased work of breathing - loss of lung elastic recoil - changes in lung parenchyma (alveoli enlarge, become thinner; fewer capillaries for delivery of blood) - pulmonary bv's thicken, less distensible - decline in total lung capacity - forced expiratory volume (air flow) decreases - decreased homeostatic responses - blunted immune responses (decreased secretory immunoglobulins and ciliary action)

Question 48

clinical implications for pulmonary changes

Answer 48

- respiratory responses to exercise similar to younger adult at low/mod intensity; more difficult at higher intensity - blunted clinical signs of hypoxia (look for mental changes instead) - cough mechanism impaired - gag reflex decreased (incr risk of aspiration) - recovery from respiratory illness prolonged - signif changes in function w/ chronic smoking and enviro toxins

Question 49

strategies to slow/reverse changes in cardiopulmonary systems

Answer 49

- assessment (careful about maximal testing) - individualized exercise prescription is essential. program based on fitness, cv disease, musculoskeletal limits, and goals. walking/exercises/yoga/swimming all good. consider multiple modes of exercise to keep interest. - aerobic training programs can signif improve cardiopulmonary function. - improve overall daily activity levels for indep living

Question 50

Age-related integumentary changes

Answer 50

- dermis thins with loss of elastin - decreased vascularity (easy bruising) - decreased sebaceous (oil) activity and in hydration - dry, wrinkled, yellowed, and inelastic; age spots - general thinning and graying of hair due to vascular insufficiency and decr melanin - nails grow more slowly, brittle and thick - loss of skin effectiveness as protective barrier (decreased touch sensitivity, heals more slowly, decr sweat production)

Question 51

Age-related GI changes

Answer 51

- decreased salivation, taste, poorer swallowing reflex may result in poor nutritional intake - esophagus reduced motility and control of lower sphincter (acid reflux) - stomach reduced motility, delayed gastric emptying, decreased digestion/absorption; indigestion common - decreased intestinal motility; constipation common

Question 52

Age-related renal, urogenital changes

Answer 52

- kidney loss of mass and total weight with nephron atrophy; decreased renal blood flow; blood urea rises; decreased excretory and reabsorptive capacities - bladder muscle weakness; urinary frequency; increased retention (difficulty with emptying); incontinence common; increase in UTI's.