Geri Unit 2: Biophysiological Changes with Aging

Question 1

What are the biophysiological Changes of the Skeletal System?

Answer 1

Throughout our lifespan, the physiological remodeling of bone occurs both on the surface, as well as within the bone

• Generally 85% - 90% of adult bone will be aquired by age 18 for females and 20 for males, however bone can continue to grow until 25 years of age and then further continues to remodel throughout the lifespan
• Remodeling removes old bone and replaces it with new bone known as bone metabolic units
• Within each bone metabolic unit, the bone formation by osteoblast and bone resporption by osteoclasts is coupled tightly in a balance to maintain bone mass and strength to resist deformity. Osteoclast resorb in 1 month; Osteoblast takes 3 months to replenish
• So with aging, there is more bone resportion and less bone formation, bone loss starts at age 30-35 for females and 50-55 for males

Question 2

Skeletal system changes

With bone loss, at approximately do we begin to lose porous bone?

Answer 2

This begins at approximately 30 years of age

• Porous bone is our cancellous or trabecular bone

Question 3

Skeletal system changes

With bone loss, at approximately do we begin to lose cortical bone?

Answer 3

This begins a little later at about 40 years of age

• Cortical bone is referred to as Compact bone, this makes up the majority of our skeletal mass

Question 4

Skeletal System changes

What are the overall consequences of these bone related changes?

Answer 4

The cortical thinning and the increased cortical porpsity, the thinning of the trabeculae, and the loss of trabecular connectivity, all of this will reduce bone quality and bone strength

• The progressive reduction in bone formation is mostly due to a shift from osteoblastogenesis to predominant adipogenesis in bone marrow. The shift has a lypotoxic effect that affects the matrix formation and mineralization

Question 5

Skeletal System Changes

According to the WHO, what is the definition of Osteoporosis?

Answer 5

This is the most common type of systemmic skeletal disorder, also referred to as a “silent disease”

• Definition: A BMD score (“T-Score”) that lies 2.5 standard deviations or more below the average value for young healthy adults

Question 6

Skeletal System Changes

What are the Characteristics of Osteoporotic bone?

Answer 6

The bone matrix is more open and spaced becuase there is a lot of trabecular bone and a widening of the bone cavity

• This is due to reabsorption of the minerals within the bone cavity itself, as well as the cortical bone. Basically the bone gets less dense and more thick, and is very brittle

Question 7

Skeletal System Changes

Those with Osteoporosis, where are the most common sites of fractures?

Answer 7

Hip, Spine, and Wrist

Question 8

Skeletal System Changes

What does the “T-Score” ≥ - 1 mean?

Answer 8

This is normal

Question 9

Skeletal System Changes

What does the “T-Score” Between -1 and -2.5 mean?

Answer 9

Osteopenia

Question 10

Skeletal System Changes

What does the “T-Score” ≤ - 2.5 mean?

Answer 10

Osteoporosis

Question 11

Skeletal System Changes

What does the “T-Score” ≤ - 2.5 (with severe fracture(s)) mean?

Answer 11

Severe Osteoporosis

Question 12

Skeletal System Changes

The combination of Hypocalcemia and Hypophosphatemia are hallmarks of what?

Answer 12

Osteomalacia

• This is a metabolic bone disorder by means of abnormal mineralization and results in skeletal deformity
• It is a state of high bone turnover and is characterized primarily by excessive amounts nof unmineralized bone tissue.

Question 13

Muscular System Changes

What are the biophysiological Changes of the Muscular System?

Answer 13

In general strength declines can begin as early as during the third decade of life. Declines accelerate during the sixth and seventh decades

• At the age of 80 years, 40-50% of muslce strength, mass, alpha motor neurons, and muscle cells are lost
• Changes in muscle composition that occur during aging consist of increased infiltration of fat and connective tissue and a net loss of fibers and functional units become dispersed throughout a larger territory.
• With age we lose Type 2B muscle fibers (this is for generation of power) and this can increase risk of falls and decreases their ADLs
• Thos adults with decreased muscle power were at risk of signifiant mobility impairments compared to those with decreased muscle strength

Question 14

Muscular System Changes

What is Sarcopenia?

Answer 14

A common condition among older adults. Defined as loss of muscle mass associated with aging. Accompanied by impairments of strength, power, and functional performance

Question 15

Muscular System Changes

With the stages of Sarcopenia, what is Pre-Sarcopenia?

Answer 15

This is where there is a loss of muscle mass but no impact on muscle strength or performance

Question 16

Muscular System Changes

With the stages of Sarcopenia, what is Sarcopenia?

Answer 16

This is where muscle mass in addition to loss of muscle strength and most physical performance

Question 17

Muscular System Changes

With the stages of Sarcopenia, what is Severe Sarcopenia?

Answer 17

There is loss of muscle mass, low muscle strength and poor physical performance existing

Question 18

Muscular System Changes

What is the difference between Primary and Secondary Sarcopenia?

Answer 18

Primary

• when there is no cause evident besides advancing age

Secondary

• where there may be one or more causes contributing to the condition along with the advancing age

Question 19

Muscular System Changes

What is Sarcopenia Obesity?

Answer 19

This has been found to occur in an older adult who experiences an increase in fat mass with the loss of skeletal muscle mass
- This results in normal or new normal body weight and BMI

Question 20

Muscular System Changes

What is Dynapenia?

Answer 20

This describes age-related loss of strength and power independent to lower body mass levels

Question 21

Muscular System Changes

With Sarcopenia, what are the negative effects on metabolism?

Answer 21

Its been associated with adverse glucose metabolism for those under 60 years old

• Its been a contributing factor in the development of fraility (a complex geriatric syndrome) with social, physical, and psychological component leading to an increased mortality
• Studies found that being overweight induces a progressive protein breakdown that leads to muscle wasting

Question 22

Muscular System Changes

Accoring to the European Working Group on Scaropenia on Older People (EWGSOP), what is a good measurement for msucle strength?

Answer 22

Grip strength

Question 23

Muscular System Changes

Accoring to the European Working Group on Scaropenia on Older People (EWGSOP), What screen has been recommended in both clinical and research settings?

Answer 23

6 Meter Gait speed test

• A gait speed of less than 0.8 m/s has been suggested by the group as the easiest and most reliable way to begin screening based on physical function in a clinical setting
• Gait speed is a component of the short physical performance battery, which has been described by the EWGSOP
• Normal walking speed is 1.2 to 1.4 m/s

Question 24

Vascular System Changes

What are the biophysiological Changes of the Vascular System?

Answer 24

• Changes occuring in our adventitia and media include an increase in clacifications, loss of elastin, an increased in collagen and mucinous substrate, and microscopic calcifications of substrates that being to accumulate

Question 25

# Vascular System Changes What is the Adventitia most affected by?

Answer 25

Affected by a decrease in the number of elastic fibers and an increase in collagen, resulting in a loss of distensibility and a reduction in elastic recoil - This is essential in accommodating blood volume and propelling the blood into the vascular system. The increased number of collagen cross-links contribute significantly to the stiffening of arteries

Question 26

# Vascular System Changes As individuals reach middle or advanced age, what happens to the smooth muscle cells in the media?

Answer 26

The smooth muscle cells in the media degenerate and decrease in number through apoptosis - The apoptosis of smooth muscle cells and the media results in the formation of matrix vesicles, from which microcalcification occurs

Question 27

# Vasular System Changes With aging, what happens to the artery walls?

Answer 27

The intima-media thickness increases 2-3 fold. It also changes the micro-circulation that results in the age-associated endothelial dysfunction - The endothelial cells become irregularly shaped and the permeability becomes increased, and this disrupts the selective transport system and can result in factors such as plaque formation

Question 28

# Vasular System Changes With aging, what happens to the capillaries?

Answer 28

The capillary density decreases with age and further limits blood supply to working muscle - There exists a decrease in arterial venous oxygen difference, which indicates that less oxygen is being extracted.

Question 29

# Vasular System Changes With aging, what do conjunctival capillaries show? Also how can age affect venous vessels?

Answer 29

- Conjuctival capillaries shows irregularities in their size, and inter-capillary coagulation of red blood cells. - Age-related changes can also affect venous vessels. There is an overall increase in stiffness and an associated decrease in the compliance. Fibrous thickening of the venous intima is prominent in most elderly individuals. The venous valves begin to lose their integrity, and the unidirectional flow can become disrupted. This can become more difficult to maintain our venous return.

Question 30

# Vascular System changes What is the effect of the Autonomic control that declines with age?

Answer 30

There is a decrease in beta-adrenergic receptor responsiveness. - This is important for vasodilation of our blood vessels, and the reactivity of our cardiopulmonary reflexes. The reflex activity of the vascular walls, such as the aorta and the carotid arteries, is mediated by baroreceptors. - This is essential to prevent orthostatic hypotension, posing an increased risk for older adults. The ability to adapt and respond to the changing needs of the body during exercise is an essential function of the vascular system. Fatigue may occur more rapidly due to demands placed on the cardiovascular system for older adults

Question 31

# Vascular System changes Do older patients have more or less of an ability to vasodilate?

Answer 31

Compensation for this loss may occur by more cardiac output to the skin for heat loss regulation. - The aging heart's attempt to maintain cardiac output can then lead to left ventricular hypertrophy, and account for the onset of myocardial ischemia on a physiologic basis. - Older adults are already predisposed to myocardial ischemia due to additional age related changes, including increasing myocyte size, increased stiffness, and prolonged time for ventricular relaxation, which requires more energy and oxygen to supply and demand.

Question 32

# Vascular System Changes How does hydration affect the vascular system?

Answer 32

- The direct cardiovascular effect of dehydration can include ventricular filling that is reduced due to volume. It can also impair the cardiac performance resulting in hypertension. - We should be assessing for hydration when we are working with our older adult patients during, before, and after exercise, as well as when we're assessing vitals would be a good time to be able to check in with them and their hydration.

Question 33

# Vascular System Changes What is the primary cause of heart failure in elder patients?

Answer 33

Diastolic Dysfunction - This non-modifiable risk factor is associated with pathophysiological changes that were previously described, such as arterial stiffening and myocardial fibrosis

Question 34

# Vascular System Changes With adults, what can uncontrolled hypertension increase?

Answer 34

Uncontrolled hypertension can increase the risk of myocardial ischemia, stroke, aneurysm, kidney failure, and heart failure.

Question 35

# Vascular System Changes With age, what tends to increase and decrease with Cardiac Tissue changes?

Answer 35

Question 36

# Vascular System Changes With age, what tends to increase and decrease with Vascualar Tissue changes?

Answer 36

Question 37

# Vascular System Changes With age, what tends to increase and decrease with Cardiovascular Function?

Answer 37

Question 38

# Pulmonary System Changes What are the biophysiological Changes of the Pulmonary System?

Answer 38

- The thoracic cage can experience changes such as loss of mineral and bone matrix and an increased cross-lining of collagen fibers - The skeletal changes contribute to characteristic partial kyphosis, as well as a barrel chest appearance or an increased anteroposterior thoracic diameter for the order adult patient. - This can negatively affect pulmonary function. Lung performance begins to decline due to a decreased thoracic mobility, and its less efficient resting position for the muscles of respiration. The changes can make it difficult to cough, and decreased cough effectiveness, as well as an increased closing volume, can contribute to an increased risk of developing pneumonia in older adults. Changes in the airway also include increased rigidity of the trachea and bronchi, decreased elasticity of the bronchial walls, as well as age-related changes that can be found in the lung tissue, such as decreased lung tissue compliance resulting from structural changes in the alveoli.

Question 39

# Pulmonary System Changes With aging, what do the changes in Alveolar Size affect?

Answer 39

- The alveolar changes impairs the important process of ventilation that allows for gas distribution to and from the alveoli. - Effective diffusion of oxygen and carbon dioxide rely on the integrity of the alveolar membrane. Mismatching of the ventilation perfusion that is normally found in younger individuals also worsens with advancing age. And declines in older adult pulmonary function is also due to thickening of mucus layer that occurs, the loss of cilia and change in ciliary function.

Question 40

# Pulmonary System Changes With aging, what do the changes in Pulmonary Function include?

Answer 40

- Measures in pulmonary function include the increased residual volume, decreased functional residual capacity, decreased total lung capacity, decreased maximum voluntary ventilation, a decreased vital capacity, decreased force expiratory volume, decreased arterial pressure of oxygen, decreased oxygen saturation, and decreased diffusing capacity of carbon monoxide

Question 41

# Integ. System Changes What are the biophysiological Changes of the Integumentary System?

Answer 41

- These changes can include dermal thickness, that is going to further decrease due to flattening of the dermal-epidermal junction, altered permeability, decreased collagen and elasticity resulting in skin that appears less firm, decreased vitamin D production, delayed wound healing, decreased number of hair follicles, decreased subcutaneous fat-- this is important for thermoregulation and shock absorption-- decreased sebaceous glands-- which are the oily matter, or sebum, as it's referred to-as well as decreased eccrine glands, or sweat glands, that result in our skin becoming more dry in appearance as we age.

Question 42

# Integ. System Changes With age, the reduction of sweat glands increases the risk of what?

Answer 42

Increases the risk of heat stroke

Question 43

# Visual and Auditory System Changes When patients do an annual Vision Assessment, what should this include?

Answer 43

- Visual Acuity ~ Snellen Chart - Peripheral Vision, may be lost due to glaucoma - Central vision, may result from macular degeneration - Light sensitivity - Motion detection - Sensitivity to contrast, which can lead to challending spatial awareness for older adults - Sensitivity to glare All of these assessments can be important for fall risk

Question 44

# Visual and Auditory System Changes What can result in decreased elasticity of the lens?

Answer 44

Decreased ability to focus - This is referred to as presbyopia, decrease focusing ability of the eye beginnning around the ages of 40 may cause patient to get reading glasses

Question 45

# Visual and Auditory System Changes With age-related changes, what is the most frequent cause of untreatable visual impairment and leading cause of blindness worldwide?

Answer 45

Macular Degeneration - Those with the exudative form will start to experience partial or complete loss of their central vision in the affected eye and they may scor more poorly during their visual assessment, such as visual acuity and contract sensitivity which will decrease QOL

Question 46

# Visual and Auditory System Changes With aging, what changes happen in the inner ear?

Answer 46

Adverse changes may affect the inner ear structures, and that can include the semicircular canals, the vestibule, and the cochlea.