MES 1 | AGING AND REHABILITATION

AGING AND REHABILITATION

- Life expectancy has generally increased due to improvement in health system in countries
- It is important to maintain their health and productivity
- Take note of precautions during therapy

OBJECTIVES

• Identify physiologic changes in aging

• Discuss common conditions that are associated with aging
• Discuss geriatric rehabilitation and ACSM
• Discuss factors in the elderly that may affect driving ability

Elderly

- defined as people 65 or over

- elderly dependency rate is defined as ratio between the elderly population and the working age
(15-64 years) population
- treat with a goal of maintaining safe mobility

Geriatric Rehabilitation

Components: Rehabilitation should address all of these.

• accommodation of irreversible changes - make sure they are physically strong

of aging and prevent deconditioning
• restoration of function for those - to increase confidence and have
reversible impairments positive outlook for recovery
• prevention of disability - explore family/community support and
• medical tx of existing conditions financial barriers

Goal: to keep the elderly ambulatory of mobile

for as long as possible, make them independent
to prevent onset of depression, dementia or
deleria (presence of these may lead to death)

Factors affecting rehabilitation

*GR is not limited to elderly with existing

conditions ONLY. It is also applicable to those
who want to maintain their overall health.

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 MES 1 | AGING AND REHABILITATION

PHYSIOLOGIC CHANGES WITH AGING

- occurs on all organ systems, most can be delayed by having an active and healthy lifestyle but
few are inevitable
o conductive hearing loss c a
1. Muscle narrow range of audibility
- overall decrease in lean body mass c o inability to hear high-frequency
increased in fat content sounds
o loss of type II mm fibers with o the earlier hearing aid given the
predominance of type I mm better
fibers
- decreased number of motor units
- they may tolerate low weight with few 2. Cardiovascular
repetitions - progressive decline in mHR at 6-10
Cachexia Sarcopenia BPM/decade after the age of 25
- changes in aging
weakness and mm condition of weakness o decrease arterial compliance
wasting d/t a disease and loss of skeletal o increased systolic pressure
mm mass d/t aging
o left ventricular hypertrophy c
impaired filling
1. Neurologic o decreased beta-adrenergic
- decreased brain volume on the CT scan receptor simulation response
- loss of frontal gray matter and o decreased SA node automaticity
decreased cerebral blood flow o decreased number of myocytes
o cognitive deficits
o decline in episodic (food eaten
at breakfast or what day was the 3. Pulmonary
last visit to the doctor) and long- - inefficient gas exchange d/t the ff
term memory with personal - lung surface area decreases d/t alveolar
context and ducts enlargement
o stable and is even improved - loss of elastic recoil and lung stiffening
procedural (how things are resulting in increased lung compliance
done) and semantic (long term and decreased thoracic wall mobility
events with no personal - decreased respiratory strength
connection) memory - in elderly, during limited o2 supply, the
- vision declines d/t changes in compensation is to increase the RR
ophthalmic tissues, one of major causes
in driving cesstion
o retinal aging assoc with macular
degeneration and loss of central
vision d/t retinal aging
o optic nerve damage can result
in glaucoma and visual field loss
o lens aging may result in
cataracts
- age related hearing loss (presbycusis) is
bilateral and symmetrical process, the
degree can be affected by rate of
hearing decline by the apparatus
o affected by intrinsic and
extrinsic factors; noise pollution
or medication

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4. Gastrointestinal
- increased Cholecystokinin and Leptin
o Cholecystokinin stimulates
satiety center in the brain and
delays gastric emptying time
o Leptin inhibits hunger
- decreased gastric acid production
o impaired absorption of Vit B12,
calcium, iron, zinc and folic acid
o change in microbial flora within
GI tract
5. Genitourinary
- reduction in bladder capacity and
urethral & bladder compliance
o inability to postpone voiding
- postmenopausal changes include
increased vaginal wall fragility and
decreased vaginal lubrication →
increased vaginal infection
- benign prostatic hyperplasia develops
under hormonal influence and is almost
universal in men over 40 years of age →
impinges on the urethra and makes
urination difficult
- incontinence and erectile dysfunction
are not a consequence of aging
(presence may warrant a further medical
exam)
6. Endocrine
- decreased anabolic hormones such as
testosterone, GH, insulin-like growth
factor, estrogen
o changes in body composition
o impaired glucose tolerance
o collagen loss and thinning of the
skin
o bone loss
MES 1 | AGING AND REHABILITATION
7. Skin
- consider changes d/t normal aging as
well as environmental factors
o thinning of the epidermis
o decreased cell turnover
o impaired immune response and
wound healing
o decreased moisture content,
elasticity, blood supply and
sensory activity
- as we age, moisturize to prevent drying
→ makes skin vulnerable to injury
8. Medication Metabolism
- increase in adipose tissue increases the
volume of distribution of fat-soluble
drugs and prolongs their half-life
o reduce frequency of medication
o ex: if drug is given thrice a day,
give BID
- total body water decreases, which
decrease volume of distribution of water-
soluble drugs resulting in higher serum
concentration
o reduce DOSE of medication
o ex: if 100mg, give at 50mg for
elderly
- hepatic and renal clearance could also
be decreased by 30-50% in elderly
9. Gait
- characteristics of gait
o decreased speed
o increased double limb support
o shorter stride length
o broader BOS
- assoc c falls and fear of falling
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 MES 1 | AGING AND REHABILITATION

HEALTH CONCERNS IN THE ELDERLY

1. Frailty History of previous falls = best predictor for

- age and disease related loss of future falls
adaptation, such as events of previously
minor stress that results in
disproportionate biomedical and social
consequences

- can be addressed c supplementation,

improving endurance and strength, tx of
existing conditions

2. Falls
- falls and near-falls occur in more than
30% of people aged 65 years or older - Fall ax is done at the initial visit
- causes significant injury
o 90% of fx in the hips, pelvis, and
forearms result from fall 3. Osteoporosis
o most common cause of TBI - extremely prevalent
o primary etiology of accidental o affects 1/3 of postmenopausal
deaths in those older than 65 women
y/o o ½ of population older than 75
- PT should prevent fall incidence as best years
as they can - important consequence of osteoporosis
is fracture

4. Malnutrition
- risk factors:
o PHYSIOLOGIC
▪ decreased total body
protein level
▪ decreased taste and
smell sensation
▪ increased levels of
neurotransmitters that
decrease appetite and
promote early satiety
o PHYSICAL CONDITIONS
▪ reduced physical
activity

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 MES 1 | AGING AND REHABILITATION

▪ poor dentition - MMSE is helpful in determining delirium

▪ digestive disorders o MMSE <24 us abnormal c
- consequences attention, concentration, and
o decreased immunity recall subscales being the most
o delayed wound healing sensitive for detecting delirium
o increased skin fragility → - even amb patients can have delirium
pressure ulcers
o increased risk of complications
from existing comorbidities 7. Dementia
- WHO definition
o memory decline, esp in the
5. Depression learning of new info, lasting
- most common mood disorder in elderly longer than 6 months
- risk of suicide is 5x higher than other - not a normal part of aging
age group - dx is based on the gradual onset of
- early dx and mgt can help achieve cognitive impairment and continuing
positive outcomes decline, when all other causes have
- risk factors been excluded
o poor self-rated ealth - Alzheimer’s disease = most common
o poor cognitive function cause of dementia
o impaired ADLs o 60-70% of geria pts c dementia
o 2 or more medical visits in the o risk factors include
past month ▪ advanced age and FHX
o frequent falls (constantly challenge
your mind such as
answering crossword
6. Delirium puzzles to delay onset)
- DSM V criteria ▪ down syndrome
o disturbance in attention and ▪ head trauma
awareness ▪ clinical depression
o usually of acute onset and ▪ low educ level
temporary ▪ small head
- frequently d/t physical disease or drug circumference and brain
effects size have been assoc c
- risk of delirium is higher in severely ill early onsent AD
patients with comorbidities

DRIVER’S EVALUATION

- ability to cont to drive is important to elderly as this is a proof for their independence and freedom
- elderly have the highest accident rate per mile driven
o failure to yield the right-of-way
o not abiding signs or signals because probably they don’t see it well
- account for 13% of all traffic fatalities

Factors affecting driving ability

• Physiologic factors
o vision is the most important sensory change in predicting driving impairment
• Cognition
o distraction while driving

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 MES 1 | AGING AND REHABILITATION

• Psychomotor functioning
o Limited cervical ROM
• Medical conditions
o risk of collision resulting in injury is substantially increased among older diabetic drivers
who are taking insulin or oral agents for more than 5 years because of lowering blood
sugar while driving affecting cognition

Example of a virtual driving Reaction time = how fast one can act in
preventing accidents

Cessation of driving

• Common factors assoc c driving cessation

o increasing age
o female
o functional impairment
o neurologic diseae
o visual impairment
• Those who stop driving are at risk for social isolation, depression and functional impairment

SUMMARY

- aging decreases the capacity of most organ systems

- the goals of geria rehab are to accommodate irreversible changes of aging, prevent disability,
restore function as much as possible and treat medical conditions
- preservation of mobility is the key in prevention of most conditions in the elderly