Lecture26

Effects of Aging on Mobility and Independence

Anthony Poggio, DPM,MS

Cal ‘79

Affects of Aging

• Muscle• Tendon• Bone• Skin• Neurology• Vascular• Psych

Muscle/Tendon

• Support Skeletal system; Posture

• Facilitate motion• Heat Production

• 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

• 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 movement-joint (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

With aging less able to keep out substances; chemicals, microorganisms

athletes foot, fissures

ROLE: Provides Protective Covering & Generates New Cell Growth

D Dermis ERMIS

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

ROLE: Provide the Skin with Strength & Elasticity

• With aging– decreased fat: decreased cushion, callous/corns– less skin support: increased sheer force

• ***Typically the subcutaneous tissue is poorly vascularized.

Subcutaneous tissueUTANEOUS TISSUE

ROLE: Provides protection & insulation for the underlying tissue

Skin

• Decubitus ulcers-bed sore– 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

• 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

COSTS OF 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

PRESSURE ULCERS

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

• Peripheral arterial disease

• venous disease• diminished healing

ability, defense• micro-circulation to

muscle, nerves, etc• amputation

Function:Transportation

Venous disease

• Return blood to heart

• slower blood flow-clot formation

• venous stasis dermatitis- skin damage

• Capillaries have thin,

single-cell thickness

walls

• Venous hypertension

causes capillary walls to

stretch, creating gaps

between cells

CAPILLARY HYPERTENSION

Neurology

• Function– 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

musculoskeletal neurologic dermatologic vascular

AGING

mobility independence

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

• 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!!!