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  1. 1. Effects of Aging on Mobility and Independence Anthony Poggio, DPM,MS Cal ‘ 79
  2. 2. Affects of Aging <ul><li>Muscle </li></ul><ul><li>Tendon </li></ul><ul><li>Bone </li></ul><ul><li>Skin </li></ul><ul><li>Neurology </li></ul><ul><li>Vascular </li></ul><ul><li>Psych </li></ul>
  3. 3. Muscle/Tendon <ul><li>Support Skeletal system; Posture </li></ul><ul><li>Facilitate motion </li></ul><ul><li>Heat Production </li></ul><ul><li>Weakness </li></ul><ul><li>Contracture </li></ul><ul><li>Gait changes </li></ul><ul><li>decrease in energy supply (ATP, creatine phosphate and glycogen </li></ul><ul><li>decreased circulation to bring in O2 and clear lactic acid </li></ul><ul><li>Changes at the motor end plate, therefore decrease in stimulation potential </li></ul>
  4. 4. Muscle/Tendon <ul><li>Changes at the motor end plate, Sarcolemma are fewer, shorter, become smoother </li></ul><ul><li>decrease in surface area therefore decrease in stimulation potential </li></ul>
  5. 5. Muscle/Tendon <ul><li>reduction in size and number of mitochondria hence decrease in available energy </li></ul><ul><li>decrease in substances to supply energy (ATP, creatine phosphate and glycogen) </li></ul>
  6. 6. Muscle/Tendon <ul><li>Decreased circulation to bring in O2 and nutrients </li></ul><ul><li>breakdown of other substances creating build up of lactic acid </li></ul>
  7. 7. Muscle/tendon <ul><li>Increase in fat/fibrinous tissue within muscle </li></ul><ul><li>decreased ability or muscle repair </li></ul><ul><li>increased scar tissue </li></ul><ul><li>therefore there is slower, weaker, irregular contraction with longer recovery period </li></ul>
  8. 8. Bone <ul><li>skeletal structure </li></ul><ul><li>Attachment for muscle, tendons. ligaments, etc </li></ul><ul><li>Blood cell production </li></ul><ul><li>Osteoporosis </li></ul><ul><li>Osteopenia </li></ul><ul><li>fracture, hip </li></ul><ul><li>delayed healing </li></ul>
  9. 9. Bone <ul><li>Cortical bone: </li></ul><ul><ul><li>Dense packed bone, very compact and hard </li></ul></ul><ul><ul><li>forms outer shell of bone </li></ul></ul><ul><li>Trabecular bone: </li></ul><ul><ul><li>loosely packed matrix, “spongy” </li></ul></ul><ul><ul><li>head and base of long bones </li></ul></ul><ul><ul><li>majority of irregular bones </li></ul></ul>
  10. 10. Joint <ul><li>Arthritis </li></ul><ul><ul><li>Joint Stiffness </li></ul></ul><ul><ul><li>loss of cartilage </li></ul></ul><ul><ul><li>loss of joint contour </li></ul></ul><ul><ul><li>angular deformities </li></ul></ul><ul><li>Synovial membrane less elastic as are adjacent ligament structure </li></ul><ul><li>with less movement-joint (ligaments) contract to position </li></ul><ul><li>Hyaline vs fibrocartilage </li></ul>
  11. 11. Joints <ul><li>Loss of hyaline cartilage </li></ul><ul><li>decreased water content with increased calcium salts, crosslinking of fibers therefore more stiff and less elastic </li></ul><ul><li>can reform fibrocartilage </li></ul>
  12. 12. Joints <ul><li>Synovial fluid decreased in volume secondary to decreased blood flow, </li></ul><ul><li>Synovial membrane less elastic as are adjacent ligament structure </li></ul><ul><li>with less movement-joint (ligaments) contract to position </li></ul>
  13. 15. Skin <ul><li>Provides barrier </li></ul><ul><ul><li>organisms, </li></ul></ul><ul><ul><li>chemicals, </li></ul></ul><ul><ul><li>water, </li></ul></ul><ul><ul><li>light, </li></ul></ul><ul><ul><li>trauma </li></ul></ul>
  14. 16. E Epidermis PIDERMIS With aging less able to keep out substances; chemicals, microorganisms athletes foot, fissures ROLE: Provides Protective Covering & Generates New Cell Growth
  15. 17. D Dermis ERMIS <ul><ul><li>Major Structures : Blood Vessels, Nerve Endings, Hair Follicles, & Sebaceous Glands that secrete sebum to prevent skin from drying out </li></ul></ul><ul><li>With aging less h20 more crosslinking of collagen therefore thinner and less elastic- fissures </li></ul>ROLE : Provide the Skin with Strength & Elasticity
  16. 18. <ul><li>With aging </li></ul><ul><ul><li>decreased fat: decreased cushion, callous/corns </li></ul></ul><ul><ul><li>less skin support: increased sheer force </li></ul></ul><ul><li>***Typically the subcutaneous tissue is poorly vascularized. </li></ul>Subcutaneous tissue UTANEOUS TISSUE ROLE: Provides protection & insulation for the underlying tissue
  17. 19. Skin <ul><li>Decubitus ulcers-bed sore </li></ul><ul><ul><li>weaker skin </li></ul></ul><ul><ul><li>thinner skin </li></ul></ul><ul><ul><li>decreased blood supply </li></ul></ul><ul><ul><li>skin hygiene </li></ul></ul><ul><ul><li>poor nutrition </li></ul></ul><ul><ul><li>decreased ability to repair </li></ul></ul>
  18. 20. COMMON LOCATIONS <ul><li>Bony Prominences </li></ul><ul><li>Occiput </li></ul><ul><li>Scapulae </li></ul><ul><li>Elbows </li></ul><ul><li>Sacrum </li></ul><ul><li>Trochanter </li></ul><ul><li>Ischium </li></ul><ul><li>Knees </li></ul><ul><li>Ankles </li></ul><ul><li>Heels </li></ul>
  19. 21. <ul><li>Annual US healthcare costs are over $1.3 billion </li></ul><ul><li>Average cost per ulcer = $27,000 </li></ul><ul><li>Quality of life issues </li></ul><ul><li>Increased length of stay </li></ul><ul><li>Tissue and bone infections </li></ul>COSTS OF PRESSURE ULCERS
  20. 22. <ul><li>Pressure ulcers occur in 11% of all hospital admissions </li></ul><ul><li>Pressure ulcers occur in over 25% of long term care residents </li></ul><ul><li>Certain patient groups have even higher groups have even higher incidences - 66% of femoral fracture patients, 60% of quadriplegic patients </li></ul>PRESSURE ULCERS
  21. 23. DEFINITION OF A PRESSURE ULCER <ul><li>Localized area of tissue breakdown resulting from compression of soft tissue between a bony prominence and an external surface </li></ul>
  22. 26. SKIN BREAKDOWN: DIABETIC ULCERS Skin breakdown due to loss of sensation coupled with repetitive pressure and shear
  23. 27. Vascular <ul><li>Peripheral arterial disease </li></ul><ul><li>venous disease </li></ul><ul><li>diminished healing ability, defense </li></ul><ul><li>micro-circulation to muscle, nerves, etc </li></ul><ul><li>amputation </li></ul>Function: Transportation
  24. 30. Venous disease <ul><li>Return blood to heart </li></ul><ul><li>slower blood flow-clot formation </li></ul><ul><li>venous stasis dermatitis- skin damage </li></ul>
  25. 31. <ul><li>Capillaries have thin, single-cell thickness walls </li></ul><ul><li>Venous hypertension causes capillary walls to stretch, creating gaps between cells </li></ul>CAPILLARY HYPERTENSION
  26. 32. Neurology <ul><li>Function </li></ul><ul><ul><li>monitoring, </li></ul></ul><ul><ul><li>communicating </li></ul></ul><ul><ul><li>stimulation </li></ul></ul><ul><ul><li>coordination </li></ul></ul>
  27. 33. Neurologic <ul><li>Nerve Loss </li></ul><ul><ul><li>sensory </li></ul></ul><ul><ul><li>motor </li></ul></ul><ul><li>Coordination </li></ul><ul><li>reflexes </li></ul>
  28. 34. Neurology <ul><li>Sensory </li></ul><ul><ul><li>requires more stimuli to elicit response </li></ul></ul><ul><ul><li>awareness of position </li></ul></ul><ul><li>reflexes </li></ul><ul><li>Somatic </li></ul><ul><ul><li>decreased transmission speed down axon resulting in slower and weaker contraction ability </li></ul></ul><ul><ul><li>prolonged refractory period before next contraction </li></ul></ul><ul><ul><li>less coordinated motion </li></ul></ul>
  29. 36. Misc <ul><li>Vision </li></ul><ul><ul><li>obstacle </li></ul></ul><ul><li>cardiac </li></ul><ul><li>pulmonary </li></ul><ul><ul><li>stamina </li></ul></ul>
  30. 37. Putting it all together
  31. 38. Psychological Factors <ul><li>Loss of independence </li></ul><ul><ul><li>fear of losing independence </li></ul></ul><ul><ul><li>rely on family/friends for simply tasks </li></ul></ul><ul><ul><li>must be done at their convenience </li></ul></ul><ul><ul><li>isolation </li></ul></ul>
  32. 39. Psychological Factors <ul><li>Assistive devices </li></ul><ul><ul><li>realization they are old </li></ul></ul><ul><ul><li>embarrassment in public </li></ul></ul><ul><ul><li>limitation in activities </li></ul></ul>
  33. 40. Psychological Factors <ul><li>Self Care </li></ul><ul><ul><li>inability to bend to reach items </li></ul></ul><ul><ul><li>open bottles, apply dressing </li></ul></ul>
  34. 41. Psychological Factors <ul><li>Fear of Falling </li></ul><ul><li>Decreased stamina </li></ul><ul><li>Cycle of decreased activity </li></ul><ul><ul><li>more stiffness </li></ul></ul><ul><ul><li>decreased vasc supply and overall health </li></ul></ul><ul><ul><li>less coordination </li></ul></ul><ul><ul><li>increased isolation </li></ul></ul><ul><ul><li>depression </li></ul></ul>
  35. 42. Prevention/Treatment <ul><li>In home support vs nursing home </li></ul><ul><li>improvement in function </li></ul><ul><ul><li>physical therapy, medication </li></ul></ul><ul><li>Age related or not?? </li></ul><ul><li>Social agencies </li></ul><ul><ul><li>paratransit, special equipment (scooters) </li></ul></ul>
  36. 43. Prevention/Treatment <ul><li>Put in perspective </li></ul><ul><li>Enlist family support </li></ul><ul><li>active participation-feel in control </li></ul><ul><li>speak to them, not down to them </li></ul><ul><li>patience </li></ul>
  37. 44. THANK YOU! Good Luck in Your Future Careers G O B E A R S ! ! !