Lecture26
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Lecture26 Presentation Transcript

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