Upload
medicineandhealthneurolog
View
632
Download
0
Tags:
Embed Size (px)
DESCRIPTION
Citation preview
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!!!