Therories of Aging

What are the theories of aging?

Hint: 18

Hayflick Limit theory

Evolutionary theory

Stress Theory

Neuroendocrine Theory

Theory of Intrinsic Mutagenesis

Immunological Theory

Free Radical Theory

Calorie Restriction Theory

Redundant DNA theory

Somatic Mutation Theory

Transcription Theory

Cross Linkage

Sleeping and Age theory

The Hormonal Imbalance Growth Factor Exposure theory

Telomeres

Progress of Cell Culture Aging models

Implication of the Genome Project

Werner Syndrome

Which theory believes that

There is a limited amount of cell population doublings, the average being fifty per life cycle of the cell

Example: making copies of a copy and then a copy of that copy. It degrades over time.

Hayflick Limit Theory

Hayflick & Moorehead

Which theory Believes in

natural selection and states that each successive generation is more resistant to mutations and when mutations occur, they occur at a later age.

Evolutionary Theory of Aging

Darwin

Which theory believes that

Survival into old age is enhanced by high vitality and resilience (ability to adapt) due to an underlying resistance to stress by the genes. How stress effects ones life.

Stress theory

Parson

Which theory believe that

Functional decrements in neurons and their associated hormones are central to the aging process

Neuroendorcrine theory 

Denckla

Which theory believes that

 Each species has specific characteristics of its genes that regulate the rate of errors, thereby affecting the life span.

Theory of Intrinsic Mutagenesis

Burnette

Which theory Indicates that

The functional capacity of the immune system declines with age as a result of reduced T-cell function.

Immunological  Theory

Walford

Which theory believes that

aging changes are caused by free radicals?

What are they neutralized by?

Free Radical Theory

Harman

Antoxidants

Which theory indicates that

a life comitted to high nutrition and low calorie diet is beneficial  and leads to a longer life

Calorie Restriction Theory

Walford

Which theory indicates that 

Any accident or error is either the machinery or the process of making proteins would cascade in multiple effects that would be incompatible with proper function and life.

Error Theory

Orgel

What theory states that:

Biologic age changes are a result of errors accumulating in genes.  An accumulation of these takes over the system until it is exhausted.

Redundant DNA Theory

Medvedev

Which theory states that

Mutations or genetic damage result from radiation and these accumulate and create functional failure and death.

Somatic Mutation Theory

Szilard

Which theory states that

A control mechanism responsible for the appearance and the sequence of aging exists in the nuclear chromatin complex.

Transcription theory

Hayflick

Which theory states that

The large reactive proteins such as collagen cross-link and are responsible for aging.

Cross Link Theory

Bjorksten

Which theory states that:

Prolonged sleep loss effects homeostasis and the species’ ability to repair tissue

Sleeping & Aging

Leproult

Which theory state that

There is too much growth hormone and not enough insulin, which leads to a less healthy and shorter life

The Hormonal Imbalance-Growth Factor Exposure

Parr

What does the length of the telomere predict?

 the life span for that cell and ultimately of that organism

A telemore is like the little plastic on a shoe lace only on the ends of a chromosome.

When is comes undone and unravels ( as seen with aging), What can occur?

Hint: 2

acceleration of aging

more prone to disease and sickness

What can also speed up the destruction of the telomeres?

Stress

Which theory suggest that

Dysregulation on non-traumatic and non-inflammatory cell death has been implicated in the development of diseases more prevalent in older persons.

Progress of Cell Culture Aging Model

Perez

Which theory believes that there is strong relationship b/w genetic influence and longevity

If your grandfather lived to be 100 you have a strong chance of living that long

Implication of the genome Project

Which Syndrome states that 

Normal people carry variants of the gene that influence their life spans or predispose them to an early death.  

Werener's Syndrome

Barzilia

Age related changes in Cardiovascular system

What decreases as age increase

hint: 4

What may need modification for therapeutic consideration

Max HR

Diastolic filling rate

Venticular compliace

Declined Responce to stress

The maximal heart rate achievable declines linearly with age at peak exercise levels.

Conventional HR formulas may need modification

Age related changes in Cardiovascular system

What increases as age increases

hint: 2

Systolic BP

Peripheral resistance

Are there changes in cardiac muscle fibers and electrolytes as it relates to aging?

Yes

Pulmonary Changes Associated With Aging

 What Decreases 

hint: 4

chest wall compliance

Muscle Strength (diaphragm, intercostals, abdominals, ventilatory)

Max Voluntary contractions

Vital capasity

Pulmonary Changes Associated With Aging

 What Increases

hint:2

Calcification of ribs

Residual Volume

What are other age related changes in Pulmonary System

hint:2

Lung cilia less and less strong

Changes in spinal curvature can cause impairments in Pulmonary sys

Musculoskeletal Changes Associated With Aging

What occurs to Cartilage

 Deteriorates

Decreased hydration

Reduced elasticity

Increased fibrous growth around bony prominences

Musculoskeletal Changes Associated With Aging

What happens to muscle?

What occurs to Skeletal?

(Decrease 4)

Atrophy

Decreased:

Calcium

Circulation level of Vit D

Bone Strength

reserve to quickly accelerate the production of red blood cells when needed

Peripheral Nervous System Changes Associated With Aging

Hint: Dreases 2

Decreased nerve cells

Decreased blood flow to the nerve

Central Neurological Changes Associated With Aging

HInt:3

Loss of brain mass

Plaques and tangles w/ Alzheimer's

Neurotransmitters

Sensory Changes Associated With Aging

Touch

3

Receptors and nerve fibers decline 

Skin changes (dermal thinning, decreased elasticity, and vascularity)

The number and size of sweat glands are diminished

Sensory Changes Associated With Aging

Vision

7

Decrease in muscle tone

Loss of elasticity and orbital fat around the eye

Diminished tear production

Ocular pupil is smaller

Tendency toward intraocular pressure

Increased density of the lens

Loss of visual receptors in the retina or macula

Sensory Changes Associated With Aging

Hearing

4

Sclerotic changes in the tympanic membrane

Cochlear otosclerosis

Decreased receptors in the corti

Degeneration of the auditory nerve

Sensory Changes Associated With Aging

Vestibular

Less cellular availability for sensory interpretation, less position and movement sense

Sensory Changes Associated With Aging

Taste & Smell

4

80% of taste buds atrophy

Decreased saliva

Decreased cells in the olfactory bulb

Chemosensory decrements

Gastrointestinal Changes Associated With Aging

4

Difficulty swallowing (decreased motility of esophagus)

Lower esophageal resting pressure

Decreased motility in stomach & intestines

Decreased blood supply to the gut

Urinary Changes Associated with Aging

            Decreased unrine concentrating abilities

Increased residual urine

Increased reflux into ureters

Hypertrophy of the prostate squeezes the urethra, and they have a hard time urinating

Why are extended warm-up and cool-down periods necessary with the older adult when exercising?

warm up should be prolonged and include a form of stretching routine and slower performance of aerobic activity.

• allows time for the peripheral vasculature and coronary arteries to dilate and carry larger volumes of arterial blood

Cool down

• avoids abrupt end of the exercise session 
• can reduce the return of blood to the myocardium. 
• Homeostasis is maintained at a lower level.

Older adults need more time to adjust to physiological changes during exercise. 

Appropriate Exercise for an older adult

FITTE Formula

Frequency:3x/week

Intensity: 70-85% of their HR (Modreate)

Time or duration: 

Skill & balance = 20-30 min;

Aerobic = 30 min, short warm up & cool down

Stretching = 60 sec

Strength = 10-15 repetitions max; sets = 1-3

Type of training

Aquatic 

Strengthening - 60% RM (equals 15 reps) minimum; RPE 11-15 on a 20 pt scale

Stretching – contraindication = joint instability; indications = ROM limitations

Enjoyment

Recommended Frequency for Types of Exercise (p74)

Aerobic

Skills & Balance

Stretching

Strengthening

How can you accomadate a Brochure or HEP for an older adult?

Should have contrast between the background color of the paper and the text (white & black).

Font size should be large and bolded enough to be read 

Paper should have a matte finish and not be glossy,b/c of glare

HEP: Pics, Lage, Color contrast, Simple diretions

 Macular Degeneration?

what part of the eye can't they see through

Does peripheral vision remain intact

Is it progressive, can it lead to blindness

Do not see in the middle

Causes loss or blurriness of central vision

Creates a blind spot

Peripheral vision remains intact

Yes

[image]

What ocurrs in Cateracts?

 How do they see

What do they replace

What is the preffered Tx

What do they complain of

Is it painless and Progressive

See hazy like a film over the eyes

Can replace the lens

Sx doesn't always work (tx of choice)

Complain of glares

YEs

[image] 

What occurs in Glaucoma?

At what age

Is it hereditary

what happens as to the pressure in the eye

What is the onset

how does is progress

[image]

any age

yes, loss if peripheral view due to damage to optic nerve

increased intraocular pressure

insidious, asymptomatic

slow loss if visual field

How can you help with vision loss?

Educate them on being able to adapt for what is happening

At home

clear pathway, do not move things around too much

HEP: large picture, large prints, white backgrounds

Keep the glasses clean

make sure pts have a check up at least every year 

Teaching compensatory techniques:

loosing peripheral vision - pts have to turn head more

Talking books, clocks, special telephones

Good lighting at home

Make appropriate referrals 

How can we help with hearing loss during intervention?

Adjust the way you as PT communicate

Make eye contact

Speak in a lower tone of voice

Speak at a reasonable rate

Don’t assume all older adults are deaf 

do not talk with mouth full

take pt to a private area

supplement with material 

What conditions promote constipation in the elderly?

Meds

Stress of Urinary incontinence

inadequate fluid/fiber intake

Inadequate exercise

Stress

resisting the urge

overuse of laxitive

Irritable bowel syndrome

Depression

What physiological changes in the elderly are associated with increased risk for hyperthermia?

Hypothalamic thermostat declines

Basal metabolic rate decreases (gain weight & happens middle age)

Reactivity of the autonomic nervous system declines

Vasomotor system is less responsive to warming and cooling

Decreased hormonal balance

Decreased blood flow to the brain

Decreased THERMOREGULATION

What are the keys to sucessful aging?

Avoid disease

Maintain high cognitive and physical function

Stay engaged in life

What are neurobics?

How do they relate to helathy aging?

aerobics for the brain / mental exercise

can enhance the brain’s performance by:

learning something new

Doing something differently

include physical function

What are the benefits of exercise and physical activity to an aging adult?

Strengthening can specifically improve joint integrity, which reduces pain from osteoarthritis

Aerobic exercise can improve cardiovascular efficiency

Tai Chi can improve balance and reduce risk of falls

most powerful intervention for maintaining well-being

huge role in the prevention and treatment of chronic diseases and mobility disability and in maintaining quality of life

How does sleep architecture change with aging?

Increased time to fall asleep

Less time spent in deep (delta) stages of sleep

Decline in REM sleep

Increased sleep fragmentation

Changes in circadiac rhythm

Increased prevalence of sleep disorders 

What are some sleep disorders

 insomnia, obstructive sleep apnea, restless leg syndrome, and gastro esophageal reflux disease

What should you do to increase sleep hygiene?

Establish a reg bedtime and rise time

Exercise in the late afternoon or early evening

Take a hot shower a couple of hours before bedtime

Establish a comfortable sleep environment (e.g. bed and bedding)

Sleep in a dimmed, quiet area that is temp and humidity controlled

What should you NOT do for good sleep hygiene?

Take daytime naps

Drink alcoholic beverages, caffine, nicotene

Go to bed hungry or full

Take meds that might be stimulants

What is the importants of the TUFTS food pyramid?

The pyramid stresses the importance of fluid intake (water) since the sense of thirst is diminished with age. Encourage older adults to drink water

How can the physical therapist use the Mini-Nutritional Assessment to evaluate a patient?

Designed to provide a single rapid assessment of nutritional status

(Detect malnuttrtion)

What is the max screening score of MNA?

What is Normal ?

What score may need further testing?

14

 > 12

< 11

What is the Max Assessment score?

What is considered normal?

What is a malnutrition indicator?

What score determies malnurished?

Total score 30

> 17

17 - 23.5

< 17

How would having severe osteoarthritis in both knees impact the patient’s nutritional status?

can impair their physical capacity to prepare food, grocery shop, do household chores because of mobility

What is the purpose of the Senior Fitness Test?

Help delay physical frailty and improve functional mobility:

determines fitness level

identifies risk & areas of weakness

helps create individualized exercise program

What are the components of the Senior Fitness Test

(actual test)

Chair stand = lower body strength

Arm Curl = Upper body

6 min walk test = aerobic endurance

2 min step test = aerobic endurance with space limitation

Chair Sit & Reach Test = upper body flexibility

Men - >4 inch

Women - >2inch

8 foot up & go = agility and dynamic balance

Height & Weight = body composition

Case Study: When performing the Senior Fitness Test, your patient did only 5 unassisted stands during the 30 - second chair stand component which puts him in the risk zone.  Why is this significant and what impact does this information have on your physical therapy intervention.

a risk for falls and further decline = loss of independence

   give the pt an exercise program to improve lower extremity strength in order for pt to complete numerous tasks such as climbing stairs, walking and getting out of a chair, tub or car independently without the risk of falls.

What are the critical components of a good Examination?

Hx & Medical Status

Subjective complaints

Pt & family goals

Home situation

Onset or triggered event

Co-Morbities

Meds & Drug Interactions

Substance abuse

Adherence issues

Exercise activity response 

Mental status

Learning style

Psychological function

Stress Management

Vitals

ROM, Strength, Tone, Reflexes

Skin Integrity

Sensation

Postural Assessment

ADL's

Functinoal Activities: Transfers, Gait, WC mobility

Balance

What is the scoring of the Mini Mental Exam

Max

Cognitive Impairment

Mild Intellectual impairment

Moderate impariment

Severely impaired

30

<24

21-24

16-20

<15

What does the mini mental assess?

Memory

Language

How would you modify PT tx if the pt scored a 20

20 = moderate impairment

Tx:

Speak clearly & slowly

Make task simple small steps

Few commands

Allow more time to process

Eliminate destractions

What is the scoring of the Holmes & Rahe Life Events Scale

Mild stress

Moderate stress

Severe Stress

< 180

180 - 300

>300

If you pt scored a 320 on the Holmes  & Rahe Life Events scale how would you as a PT proceed?

320 is Severe = can develop medical problems

Identify barriers & stress level

Refer  out

What are the scores for the Tinetti Gait & Balance

< 18

19 - 24

If your pt scored a 17 what would that indicate

< 18 = High risk for falls

19-24 = moderate risk

High risk for falls

What does the Berg Balance scores indicate?

What is the scoring?

What does a score 48/56 idicate?

Dynamic balance ability and risk of falls

41-56 = low fall risk

21-40 = medium fall risk

0 –20 = high fall risk

Low risk of falls

What does the Fullerton Advanced Balance (FAB) scale measure?

Max points

at risk for falls

not at risk for falls

Fall risk and Sensory impaorments

 40 

< 26

33

If your pt scores a 33 on the FAB assessment what would this indicate?

Pt is not at risk for falls

FOUR SQUARE STEP TEST Measures?

(4 canes or pipe box on the ground)

Scoring?

higher order complex task assessing dynamic balance and cognition

 > 15 indicates 

How does grip strength relate to predicted functional decline? 

Indicates the individuals ability to sustain a squeeze for 3sec that is functional for grabbing and hold heavy objects

What is Polypharmacy?

Having too Many medications released by more than 1 pharmacy

Cocktail of meds

What are some of the barriers to medication adherence in the elderly?

Adverse drug reactions

Knowledge: if they are asymptomatic they stop taking it

Literacy of how to take meds

Vision inpairments

Dosing parameters - complex

Physical limitation - unable to open the bottles

Multiple pharmacy Rx's

Cost

How can you help them overcome these barriers?

help come up with ways to adhere to schedule

Refer them to pharmacist or physician about the multiple meds

Maybe INS can help

GI symptoms

Sedation

Confusion

Depression

Orthostatic Hypotension

Fatigue & Weakness

Dizziness & Falls

Antichollinergic

How drugs impact PT intervention

What are some issues that should be taken into consideration before beginning PT intervention.

(5)

All drugs beign taken

Side affects of those drugs

Drup drug interaction

Substance abuse

Adherence

How can Psychotrophic drugs impact PT

(Sedatives, Antidepressants, Tx for Bipolar disorder)

May cause Decreased motivation

Dizziness & falls

Orthostatic Hypotension

How can Neurological Agents impact PT

Tx for PD?

Tx for Seizures?

Tx of pain & inflammation?

PD:  PT should be performed during peak effect to maximize participation ability

Seizures: Need to be aware of side effects as they can interefere with ability to perform (headaches, GI distress, lack of coordination, dizziness)

Pain & Inflammtion: Ortho hypotension, sedation, decreased RR, Lack of motivation

How can Corticosteroids impact PT

these drugs if taken for a long period of time can cause tissue breakdown (bone, ligs, tendons, skin, and muscles)

HTN

Glucose

Increased risk for infection

How can Cardiovascular Drugs impact PT

HTN

CHF

Angina

Statins

Coagulation

HTN: decreased BP or no change in BP during exercise

CHF: May have to use the bathoom more frequently, fluid imbalnce, Beta blockers can cause syncope

Angina: dizziness casused by hpotension (Ortho Hypo)

Statins: be aware that muscle pain is not caused by PT but by meds reffer to physician 

Coagulation: risk of hemorrhage due to tissue traume, DVT's

How can Respiratory & GI drugs impact PT?

RR depression

PT's should discourage long tem use of these and refer back to physician, and advise on proper nutrition (refer)

How can Hormonal Agents impact PT

DVT's

How can Insulin impact PT

Look out for signs of Hypoglycemia

Make sure they had a meal before exercising

Have taken glucose reading prior to exercise

Have glucose tablets

How can Chemo impact PT intervention?

may not be able to participate

motivation may be needed

Look over Adrea's PDF on different drug classes!!!!

Chapter 4

How would you recognize depression in an elderly patient?  

Cognitive symptoms

Somatic Symptoms

Affective symptoms

Cognitive: Poor concentration, low self esteem, guilt, hopelessness, suicidal ideation

Somatic: fatigue, sleep patterns, weight loss/gain, tearfulness, agitation, <3 palpitations

Affective: Sadness, Anxiety, Irritability, Fear, Anger, Depersonalization, Isolation

What are the types of Isolation

Geographical

Presentation

Behavioral

Attitudinal

Geographical: no family close by, restricted fro movement or getting around, fearful of environment

Presentation: socially unacceptable appearance

Behavioral: become eccentric

Attitudinal: change values, beliefs, and activities

How can Depression impact PT intervention

Unmotivated: we need to motivators, find something they enjoy or want to do

Suffering from OCD, PTSD, Panic disorder, Anxiety: we need to help with stress management techniques, stress reduction

Provide Psychotherapy = talking to them

Help with adjustmant of appearance, family role, and independence

Use Alturism and humor stimulation

Help with coping mechanisms