1
Q
What are activities of Daily living (ADL)?
A
Bathing, dressing, going to the bathroom, getting in or out of a bed/chair, walking in house, feeding
2
Q
What are instrumental activities of daily living (IADL)?
A
Preparing meals, shopping, managing money, using the telephone, doing light housework, doing heavy housework
3
Q
Decline in function overall is common in older adults but there are differences in…
A
- Age at which decline occurs
- degree of impairment/limitaiton in activity and participation producing decline
- success of some to maintain function in light of chronic conditions
4
Q
What changes with sit to stand with older adults?
A
- OAs take longer to rise
- OAs need more transitional positions
- OAs need more trunk flexion (not hip flex)
- OAs need to push on thighs to assist
sit-to-stand requires adequate hip, knee, ankle ROM; requires adequate hip and knee extensor and ankle strength
5
Q
How does driving change with age and how to we change cars to combat them?
A
biggest failure with signalling errors
* Wider 15 in. rearview mirror to reduce blid spots
* swivel seat: portable cushion to guide you into the vehicle
* strap hanger or grip bar to door frame to hold on to as get in and out
vision deficits are responsible for most driving-related accidents in old age; its still okay to drive w/ early dementia
6
Q
What is important to consider about transfering up from the floor for older adults?
A
- depends on strenght, Range, balance, and coordination, endurance, and pain
- A task not practiced often in daily life-motor control
- important to assess in history of falls
- may be unable to perform task from any position
- need assist of furniture
7
Q
How do you teach an older adult to fall?
A
- fall on something w/ more fat/padding
- roll to 1 side, then all 4s, then half kneel, then stand up
- or scoot over to stair/chair to help or get in better position
- using steps is also easier if they can go up enough stairs since it puts them closer to standing
8
Q
How does gait change as we get older?
A
- stride length: gets shorter bc less comfortable w/ BOS
- support time: less time in single leg stance
- velocity decreases
- stride lengths become less symmetric
- step width increases due to BOS
- Toeing out occurs to widen BOS
- increase in energy, more trunk movements occur, less arm swing, harder time multi/dual-tasking
- decreased power in lower extremities
- decreased plantar flexion/dorsiflexion
- increased stance pahse
want walking speed of 1.2-1,3
all leads to increased chance of falls
9
Q
How does sleep change in older adults?
A
- Less time in deep sleep
- sleep deprivation leads to decreased attention
- sleep apnea: stop breathing when sleeping, sessation of sleep, lack of oxygen to brain so don’t feel rested, brain not stend signals when asleep
- Myoclonus: leg jumping/jerking during sleep
10
Q
What is the definition of a fall?
A
An unintentionally coming to rest on the ground, floor, or ther lower level
11
Q
How does falling influence older adults?
A
- 30% of OA fall each year: 49% in home
- women higher fall rates then men
- if hospitalized, only 50% able to return home
12
Q
What effects of old age lead to falls?
A
vision, cognition, balance, muscle strength, environment, polypharmacy, orthostatic hypotension, muscle mass, fat, bone strength, mechanics of falls
13
Q
What is presbystasis?
A
change in balance due to aging
due to
- vestibular: dizziness, increased body sway
- somatosensory: decreased joint proprioception
- vision
- can be asymmetrical
- impacts walking and driving
- increased risk of falling
- normal age changes not related to: postural hypotension, medications, endocrine issues, malnutrition, CVP insufficiencies
measure balance through psoture/postural sway, dynamic gait intex, verg balance scale or environmental demands
14
Q
How does postural control change in older adults?
A
older adults use antagonist muscles more in co-activitation with agonist muscle
- ankle dorsiflexion weakness is also a factor in balance dysfunction in older adults
- older adults have more dificulty balancing when sensory inputs are reduced
15
Q
What are the requirements we look for for an older adult to be able to live at home and participate in the community?
A
- walk 1000 ft: navigate 2 flights of stairs
- navigate variety of floor surfaces
- change directions
- reach in multiple directions
- maintain gait speed of 2 miles/hour
- carry a 7 lb package (average
16
Q
How does working play a part in OAs lives?
A
- increased # of OA in work force
- may need job redesigned
- more sever injuries compared to younger workers
- high job performance
- low turnover rate
17
Q
How is frailty measured?
A
clinical syndrome w/ 3 or more of the following indicators:
- weakness in grip strength
- slow walking speed
- low physical activity
- self-reported exhaustion
- unittentional weight loss (10lbs in 1 year)
18
Q
What are warning signs of frailty?
A
- avoids walking on uneven surfaces and inclines
- looks down when walking
- walks close to walls
- only wears tennis shoes
- uses shopping cart or furniture for support
- sits for all standing taskts
- sits to put on pants and socks
- when stands up has to “get bearings”
- cannot multitask
- avoids escalators
- hold railing for stairs and can’t carry anything w/ opposite arm when on stairs
19
Q
What is an example of a functional assessment for OAs?
A
- timed movements, distance: gait speed
- quality of performance: way they move
- level of independence
- effort (vitals and RPE)
- safety
- pain
- environmental impact
- is it new task or familiar one
20
Q
What are ways to moderate and better evaluate an adult?
A
- adapt testing positions and methods
- fewer tests at one time
- rest periods between tests
- more than one day/visit to evaluate
- variety of tests
- monitor vitals
- incluse: grip and quad strength and walking speed
also consider co-morbilities and pain expectations
21
Q
What are benefits of balance training?
A
- live longer and better
- reduce risk of developing diseases and disabilities
- improves postural stability
- prevents falls: re-establish balance, and reduce disorientation
fall-prevention exercises that work: balance and functional exercise, resistance training, walking programs
22
Q
What are common changes in older adults?
A
- decrease in physical activity
- increase in dependence/disability
- increased social isolation
- increased disease
- inappropriate/excessive/poor food intake
- chronic medication use
23
Q
What are natural age-related changes that occur with nutrition/GI?
A
- decreased enzyme production and mucosal changes in digestive system: not as easy to digest food
- loss of nephrons and altered kidney function: decreased thirst
- blood vessel change and decreased maximum cardiac output: decreased endurance so dont go as out or as far as long
- altered lung function: tasks become higher energy
- glucose intolerance and insulin response decline: metabolizes sugars differently
- less total body water and protein
- loss of lean body mass; changes in body composition: harder to manage weight
- fragile temperature regulation
- sensosry loss
- chewing and swallowing less effectively
- decrease in taste and smell
24
Q
What caloric intake do we recommend for older adults?
A
requires fewer calories than those who are younger but require the same level of ntrients
- older males: 2000-2600
- older females: 1600-2300
45 chemical compounsd and single elements from food are required for a healthy body
25
What does RDA stand for?
recommended daily allowance
26
What does AI stand for in nutrition?
adequate intake
27
What does Ul stand for in nutrition?
tolerable upper intake level
28
what does EAR stand for in nutrition?
estimated average required indices: max level of total intake that 50% of age is taking
29
What is the recommended water intake for OA and why are they prone to dehydration?
6-8 glasses daily
- older adults more prone to dehydration due to decreased thrist, frequent urination and poor body regulatio temperature - can't tetect need for fluids
30
What does protein do and what is the recommended amount?
function: preserve lean body mass, organ performance and immune system
recommended: 12-15% of total caloric intake
31
What are the functions of carbohydrates and fibers and what is the reccommended amount?
* function: muscle contractions, brain and lung function, assists in moving food through digestive system (fiber)
* recommened: 55-60% of daily caloric intake
but decreased glucose tolerance
32
What are the functions of fats and what is the reccomended amount?
* function: energy, formulation of cell membranes, cushions and protects
* recommened: 25-30% of caloric intake
--increased cholesterol levels so want unsaturated fats
33
What is the function and recommended amount of vitamins?
* function: multiple functions, help prevent disease, immunity
* recommended: adequate foods from each food group, best to get from natural sources, fortified foods can help
34
how does vitamin B in older adults change w/age?
* lack of jaundice/energy
* vitamin B deficiency
35
What happens to vitamin A, C, and E with age?
no age change
36
What happens to vitamin D with age?
need 2x as much, helps with delerium
37
What happens to vitamin K with age?
if change due to pathology
38
How much of Calcium is in the body and how does it change with age?
most abudant mineral in body
- 30% remains in body
- absportion decrease w/ age
39
How does iron change with age?
poor uptake secoundary to digestive changes so older adults become more anemic
40
What is included in malnutrition?
* undernutrition: eating to little
* overnurition: eating too much
41
What is failure to thrive?
older person giving up
- common cause: depression, delirium, dementia, drug reaction, chronic inflammation disease
42
WHat are the psychosocial components of eating?
* social event: lack of invatation as social interactions decrease, go out to eat/social/christmas
* coping: coping mechanism around food
* culture: set of food for culture, but when alone wouldn't make all that
43
How does nutrition and immunity change with age?
* malnutrtion can lead to decreased immunity: decreased access to food, change in hunger and thirst, glucose interolerance, decreased social interaction, decreased taste and smell
* need balanced meals: my plate, vitamin A, B6, B12, C, E
* minerals - zinc and iron
44
Why is education, referral and time important for nutrition and physical therapy?
* education: feeding position (don't eat in bed), exercise, community programs
* referral: dietition, OT, ST
* time: allow sufficient time to eat, plan PT accordingly
45
what are the levels of organization of biology in the body from smallest to largest?
* molecule
* organelle
* cells
* tissues
* organs
* systems
* organism
46
What are nucleic acids?
RNA
- DNA: largest molecule in body, sequence unique to each individual
- both cell nucleus and ribosomes have DNR and RNA
- gene is basis of DNA
- 2 bases joined by hydrogen bond = DNA
47
HOw does cell growth occur?
Cell growth depends on using information in genes of DNA to make structural and functional proteins necessary for cell survival.
48
What does protein synthesis include?
structureal and functional components
- Transcription: ocurs in neucleus
- translation: occurs outside of neucleus
- the process between transcription adn translation allows protein to survive which keeps us thriving
49
What is a fixed postmitotic cells?
functionally mature cells that lost ability to divide
50
What are reverting postmitotic cells?
after 1st mytoic change stop and become fixed or if injured stop prolifferation till healed and then starts dividing again
51
What are continuously proliferating cells?
stem cells, mall muscle
- always dividing
52
What are epithelial tissues?
* covers exposed areas
* lines passageways
* found in glands
53
What are connective tissues?
* adipose, tendons, ligaments
* blood and lymph
* cartilage and bone
54
What are muscular tissues?
movement, posture, body temp
55
What are neural tissues?
electrical impulses
56
What is the genetic theory of aging?
DNA has to replicate to maintain itself to preserve the genetics which happens through cell division
- can result in alterations of genetic code by anything that can damage DNA: physical, chemical, biological
- these changes can lead to changes in function through tissue or organ deficiencies
- difficult to measure or quantify age caused changes at a cellular level
| **there is a maximum lifespan for cells which leads to aging**
57
Why should we study theories of aging?
* to know if there is evidence behind products
* provides framework for attempting to identify/manage "normal" vs "pathologic age changes
58
What do we know about aging theories?
* over 300 theories exist to explain aging
* no theory of aging is universally accepted
* no single biologic theory of aging is accepted as an adequate explination for the complex process of aging
* genetic theories say that aging is a genetically predetermined process
59
What is hayflick's limit theory?
* limit to how long a cell can divide (50-60 times) once it stops is when we see a decline which results in aging
* cells can only regenerate a certain number of times (they have a limita) and eventually leads to decline in function of organs
60
What is the free radical theory of aging?
* most popular currently
* free radicals are highly charged ions with an outer orbiting unpaired electron, unpaired electrons combine with unsaturated fats which damages cell membranes
* associated with specific diseases
* free radicals: high fat, cigaretts, mercury, air/water pollutants, ultraviolet light, heavy exercise, radiation
* antioxidants combate free radicals: vitamin C, E; selenium, beta carotene, zinc
| **age changes are due to damage caused by free radicals**
61
what is the immune system theory of aging?
* they tymus physcially shrinks with age so the production of tymodin decreases. This decrease in T cells leads to lower response to antigens and allows for an increased risk of infection
* immune system declines with age as a result of decreased T cell function which reduces resistance
* : as we age, we see more people with autoimmune disease
62
What is the energy restriction theory of aging?
* diet restirction is advertised as extending life and reducing disease: lowers metabolic rate, increases metabolic efficiency, decreases heat and free radical production, enhances natural killer T-cells
* however, body can't deal with hypothermia, wounds can't heal as fast, loss of body fat more susceptible for pressure areas, digestive system can be constantly upset
63
What is the telomere theory of aging?
* located at the end of chromosomes
* length of telomeres is set at birth
* telomeres decrease in length with each cell doubling
* tshortening of telomeres associated with disease
* stopping of telomere and so no longer divide and get shorter which leads to aging
* cells will not divide forever but eventually enter a viable non-dividing state (senescence)
*** accumulation of the senescent cells causes aging**
64
are changes in cardiovascular and pulmonary systems as we age a result of lifestyle disease or aging?
all of the above
* lifestyle: level of activity, nutrtion, and smoking
* disease: pulmonary disease, hypercholesterolemia
* aging: cellular changes, and wear and tear
65
What does typical cellular aging look like
a) At a cellular level there are changes that occur as excess inflammation that builds up over time
b) There are fibrotic changes that come from collagen more than elastin – so look and feel more like scaring, harder
c) Autophagy: recycling and removing cells that have become damaged
i) Process slows down and gets less responsive as we age
d) Oxidative stress and dysfunction in mitochondria changes how body uses and produces energy
66
What are vascular changes with age?
* Aorta and large arteries: Dilate (increase diameter) but Walls thicken - Stretch but get smaller opening
* Small arteries and arterioles – constrict and dilate and regulate BP
i) More atherosclerosis, plaque deposits: damage inner lining of blood vessel walls, accelerates and gets worse
ii) Loss of elastin, replaced by collagen (fibrosis)
iii) Endothelial dysfunction
* Capillaries (oxygen into tissue and Co2 out): Increased tissue thickness
d) Some changes happen in coronary and pulmonary arteries: happens all around in arteries through entire body
e) Decrease in overall blood volume: lower blood volume and higher dehydration
67
How do aging changes impact the heart muscle?
a) Age-related cardiac hypertrophy
i) Myocytes increase in size, decrease in number: cells decrease in number but gets stretched out and bigger causing age-related cardiac hypertrophy
ii) Fibrosis
iii) Chage in shape (more sphere, less elliptical)
iv) Increased thickness of heart wall: so overall chamber size gets smaller
68
How does age realted changes impact the heart valves?
a) Increased collagen/fibrosis
b) Calcium deposits in and around valve cusps: form in coronary artery and cusps around valves of heart so become fragile and don’t move as well and more fibrotic changes happen in and around
69
How does age related changes impact the electrical conduction and control system of the heart?
a) Loss of pacemaker cells in SA node: starts signal
b) Degeneration of electrical conduction pathway: paths breakdown and deteriorate
c) Decreased responsiveness of androgenic receptors: less receptive to SNS (epinephrine and norepinephrine)
d) Decreased sensitivity and responsiveness of baroreceptors (pressure changes)
70
How does aging effect the lung and airways of the pulmonary system>
i) Fewer epithelial cells
ii) Decreased Cilia (both number and function): don’t work as well (move mucus thorough airway), not as many and don’t work as well, paralyzed and damaged by smoking
iii) Decreased “tone” of airway smooth muscle: airways loose structural support and integrity so collapse more easily
b) Lungs and interstitial tissue
i) Fibrosis
ii) Loss of elastin, increase in collagen: stiffer and less stretchy
71
How is the alveoli of the pulmary system change with aging?
a) Overall number remains unchanged
b) Loss of separate: increase in size but decrease In surface area – lose areas between so get bigger clusters with fewer because lose walls
c) Fibrosis: less stretch
d) Thickening of alveolar-capillary membrane: separate alveoli from pulmonary capillaries
e) decreased pulmonary capillary density: less around Alveli
72
How does the musculoskeletal of the pulmonary system change with aging?
a) Increased stiffness of bones, joints and soft tissue
i) Impacts chest wall, spine, shoulder girdle…
(1) More thorastic kyphosis (inward angling of sternum) so less area/space and restricts area and movement of lung space and effects starting position which impacts efficiency and length tension relationship
b) Decreased strength of respiratory muscles
c) Impaired position and efficiency of diaphragm
73
How does control and protection of pulmonary system change with aging?
i) Don’t receive feedback as quickly and don’t respond as quickly/as much
b) Decreased sensitivity and responsiveness to chemoreceptors that sense abnormal O2, CO2
c) Respiratory control center in CNS (medulla and pons): decreased availability or receptivity to neurotransmitters
d) Decline in reflexes that produce cough, gag
e) Immune systems: decreased # and effectiveness of cells
74
What do these electrical conduction changes mean for older adults?
decrease adaptability to exercise since baroreceptors/ delayed HR and BP with activity, arrhythmia increase in frequency and severity as we age signal not making it through all the way or no signal, loss of pacemaker cells and less sns stimulation means HR won’t get as high
75
What do these cardiac muscle changes mean for older adults?
thicker muscles and smaller chambers effect less preload and contractility (loss of strength and contraction force), can’t squeeze as effectively and gets less blood, ejection fraction stays the same but stroke volume becomes reduced, maybe not at rest but significantly reduced during exercise, aerobic exercise capacity significantly reduced, increased orthostatic hypotension since baroreceptors don’t work as well since emergency response symptoms can’t respond as well so more likely to faint/fall/pass out
76
What do these vascular changes mean for older adults?
dilate and walls get thicker, less receptive of blood so BP increases and more likely to have hypertension, higher systolic BP and lower diastolic BP so distance between gets bigger.
77
What do these valve changes mean for older adults?
gets stiffer so can have problems with them opening and closing. If don’t open appropriately wont move from one chamber to the next like it’s supposed to increasing the after load so stroke volume decrease and heart can fail or if it doesn’t close all the way blood can flow backwards into the chamber it came from. Can stretch out areas of the heart more then the other
78
What do these alveoli changes mean for older adults?
walls thicker so gas exchange can’t happen as easily due to less surface area and thicker membranes (arterial blood xogyen levels decrease), so oxygen tansport decreases, amount of oxygen tissues can extract decreases because harder for tissues to pull out oxygen they need
79
What do these lungs and airway changes mean for older adults?
lung compliance decreases (can’t stretch as much) compounded that chest wall is less compliant compounded that muscles are weaker so harder time getting air into lungs, loss of elastic recoil and airways themselves so hard to get air out effectively, celia don’t work as well so pulmonary defenses are lower (also effected by decreased reflexes) so aspirate food and liquids in lungs more so more likely to get pneumonia and infections due to stuff in lungs that shouldn’t be, less effective cough
80
What do these cardiovascular changes mean for older adults?
more hypertension, more valve problems, more orthostatic hypotension, more arrhythmias and decrease in things that should increase with activity (feel worse doing lower level activity)
81
What do these musculoskeletal changes mean for older adults?
Aerobic capacity decrease, less compliance of lungs and chest wall, increased likelihood of pulmonary infections, total lung capacity isn’t effective but residual is so vital capacity gets smalls, restrictive and obstructive lung issues occur
82
What is the serum albumin lab value and waht does it indicate?
* 3.5-5 g/dl
* indicates real and kidney failure
83
institutionalization and fall risks
* 30-40% in nursing homes fall each year
* 44% of all falls related accidents in hospitals involve elderly
* 30% fall in 1st week of hospitilization
*** high incident of falls**
human growth & development
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