CHAPTER 5: 

EFFECTS OF AGING
ON MUSCULOSKELETAL
FUNCTION

Made By:
Quiña, Rhea Mae B.
Parot, Regla Mae
Retirement is often accompanied by reduced
activity as one no longer has to prepare for,
travel to, and engage in work; social and
recreational activities that could offer
opportunities for some exercise may be
restricted due to financial limitations or poor
health.
The relocation from the house in which the
older person raised his or her family to a
smaller home, apartment, or retirement
community reduces housekeeping and
maintenance functions that provided some
opportunity for movement.
In addition to the effects of aging and disease,
activity can be impacted by psychosocial
factors. The loss of one’s spouse and/or friends
can limit the older adult’s participation in social
and recreational activities, thereby reducing
opportunities for physical activity. 
The decline in the number and size of muscle
fibers and subsequent reduction in muscle
mass decrease the body strength; grip
strength endurance declines. Connective
tissue changes reduce the flexibility of joints
and muscles.
An increasing challenge associated with the
decreased muscle mass and/or function facing
individuals as they age:
Sarcopenia - a decline in walking speed or
grip strength.
It can be caused by disease, immobility,
decreased caloric intake, poor blood flow to
muscle, mitochondrial dysfunction, a decline
in anabolic hormones, and an increase in
proinflammatory cytokines.
The following musculoskeletal changes result from the aging
process: 

▪ Muscle mass and elasticity diminish, resulting in decreased strength,

endurance, coordination, and increased reaction time. 
▪ Bone demineralization (osteoporosis) occurs, causing skeletal
instability and shrinkage of intervertebral discs. The flexibility of the
spine lessens, and spinal curvature kyphosis) often occurs. Height
may decrease 1 to 4 inches throughout the aging process. 
▪ Joints undergo degenerative changes, resulting in pain, stiffness, and
loss of range of motion.
GENERAL
OBSERVATION
Assessment of the musculoskeletal system can begin even before the formal examination by noting
the patient’s actions, such as transfer activities, ambulation, and use of hands. Note observations
regarding the following: 
▪ Abnormal gait (Table 23-4)
▪ Abnormality of structure 
▪ Dysfunction of a limb 
▪ Favoring of one side 
▪ Tremor 
▪ Paralysis 
▪ Weakness 
▪ Atrophy of a limb 
▪ Redness, swelling of a joint 
▪ Use of cane, walker, wheelchair
INTERVIEW
Although it may seem tedious, it is best to go from head to toe and question the patient about limited
function or discomfort in specific parts of the body. Examples of questions could include the following: 
▪ “Does your jaw ever get stiff or hurt when you chew?” 
▪ “Do you get a stiff neck?” 
▪ “Does your shoulder ever tighten?” 
▪ “Do your ribs ache or feel tender?” 
▪ “Do your hips hurt after you have walked for a while?” 
▪ “Are your joints stiff in the morning?”
▪ “Do you have back pain or stiffness?” 
▪ “Do you have muscle cramps?” 
▪ “How far are you able to walk?” 
▪ “Are you able to take care of your home, get in and out of a bathtub, and climb stairs?” 
Also make specific inquiry into how the patient manages musculoskeletal pain, particularly in reference to
the use of analgesics, heat, and topical preparations.
PHYSICAL EXAMINATION
Examine the active and passive range of motion of all joints. Note the
degree of movement with and without assistance. Specific areas to review
include the following: 
Shoulder.  The patient should be able to lift both arms straight above the
head. With arms straight at the sides, the patient should be able to lift them
laterally above the head (i.e., 180 degrees) with hands supine and 110
degrees with hands prone. The patient should be able to extend the arms
30 degrees behind the body from the sides. 
Neck.  The patient should be able to turn the head laterally and to flex and
extend the head approximately 30 degrees in all directions. 
Elbow.  The patient should be able to open the arms fully and flex the joint
enough to allow the hand to touch the shoulder. 
Wrist.  The patient should be able to bend the wrist 80 degrees in the
palmar direction and 70 degrees in the dorsal direction. With a hand-
waving motion, the patient should be able to bend the wrist laterally 10
degrees toward the radial or thumb side and 60 degrees in the direction of
the ulnar side. The patient should be able to move the hand to 90 degrees in
the prone and supine positions.
Finger.  The patient should be able to bend the distal joint of the finger
approximately 45 degrees and the proximal joint 90 degrees.
Hyperextension of 30 degrees should be possible. 
Hip.  While lying down, the patient should be able to abduct and adduct the
leg 45 degrees. With the patient lying on the back, the leg should be able to
be lifted 90 degrees with the knee straight and 125 degrees with the knee
bent. 
Knee. While lying on the stomach, the patient should be able to flex the
knee approximately 100 degrees. 

Ankle. The patient should be able to point the toes 10 degrees toward the
head and 40 degrees toward the foot of the bed or examining table. There
should be a 35-degree inversion and a 25- degree eversion. 

Toe. The patient should be able to flex and hyperextend the toes

approximately 30 degrees. Note the patient’s active and passive range of
motion, as well as any weakness, tightness, spasm, tremor, or contracture
that may be evident.
MUSCULOSKELETAL HEALTH
PROMOTION
Promotion of Physical Exercise in All Age
Groups 
Maintaining a physically active state is an
increasingly difficult task not only for older
adults but also for many younger people.
Educating and encouraging persons of all ages
to exercise regularly is an important way that
gerontological nurses can influence the health of
today’s and future generations of older people.
All exercise programs should address:
 Cardiovascular endurance.  The ability of the heart, lungs, and blood vessels
to deliver oxygen to all body cells is enhanced by aerobic training. Aerobic
exercises include walking, jogging, cycling, swimming, rowing, tennis, and
aerobic dancing. For cardiac endurance, these exercises must be performed
long enough to require a continuous supply of oxygen, which puts a demand
on the cardiopulmonary system to reach at least 55% of its maximum heart
rate. Ideally, the heart rate should fall within the target heart rate range during
exercise. Depending on the exercise, these should be done for at least 20
minutes, at least 3 days a week.
 Flexibility.  The ability to freely move muscles and joints through their range
of motion is another part of physical fitness. Gentle stretching exercises help
maintain flexibility of joints and muscles; stretching exercises for about 5 to
10 minutes before and after other exercises can reduce muscle soreness.
 Strength training. Strength and endurance are enhanced by exercises that
challenge muscles.
Key elements of strength training are: resistance and
progression.
Resistance is achieved by lifting weights and the use of weight
machines; isometric exercises or the use of one’s own body
weight through calisthenics, such as push-ups and pull-ups, are
also good means of strength training.
Progression involves increasing the workload on the muscles,
such as by lifting heavier weights. The recommendation for most
adults is to exercise a muscle through a set of 8 to 12 repetitions
at least twice weekly..
EXERCISE PROGRAMS
TAILORED FOR OLDER
ADULTS
The fitness craze is popular in our society, and
older adults are not untouched by this movement.
Regular physical activity in older adults shows
• delay or prevent some of the age-related losses
in cardiovascular function and improve
maximal oxygen uptake.
• lower resting systolic and diastolic blood
pressure.
• increase muscle strength and flexibility and
slow the rate of bone loss. Exercise can improve
body tone, circulation, appetite, digestion,
elimination, respiration, immunity, sleep, and
self-concept.
• opportunities for socialization and recreation 
In addition to the effects
of aging on
musculoskeletal function
described previously,
age-related changes
affect a person’s ability
to exercise.

Box 23-2 describes some

of the guidelines that can
assist older adults to
obtain maximum benefit
from exercise programs.