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