all the theories of aging

1. GERIATRIC

2. •Aging: The process of growing old, describes a wide array of
physiological changes in the body systems, complex and
variable.
•Geriatrics: The branch of medicine concerned with the
illnesses of old age and their care.
•Categories of elderly:
• Young elderly: ages 65-74
• Old elderly: ages 75-84
• Old, old elderly or old & frail elderly: ages > 85

4. Theories of Aging
1. Aging is developmental, occurs across the life span.
2. Theories of aging changes-
Complicated physiological, psychological & economic
challenges that every individual faces during their life span
are unavoidable
It is essential to understand the crucial process of aging
various theories which explains the aging processes have
been described by sociologist,psychologist & biologist

5. • Developmental theory
• Sociological theories
• Psychological theory
• Biological theory
• Cellular, tissue & organ theory

6. Developmental theory
• As individual age increases their level of functioning in each stage of development is
influenced by interrelate biological, psychological & social factors which help them
with new experience in later adult hood
• Aging includes many processes & possible outcome it may be either positive or
negative
• The issue in developmental theory is that the diversity of aging studies & perspective
has described aging as strength & weakness so the developmental theory of aging
assumes a positive relationship between developmental time & adult longevity
• The DT believes that aging occurs by virtue of developmental genes selected for
species survival
• Developmental genes are the genes responsible for dynamic transformation of soma
from conceptus to a reproductive competent adult
• Theory states after reaching reproductive competence the influence of natural
selection diminishes
• The developmental genes cause unremitting & undirected somatic changes which
increases physiological chaos & internal disorder beyond young adulthood

7. • Cellular changes
• Increase in amount of fatty acid
• Decreased fluidity of plasma
• reduced transportation across membrane
• Aging of nuclear cells condenses the DNA, which decreases RNA synthesis & reduce the ability to
repair enzymes
• Cytoplasmic changes like increase in vol
• Ribosome amount decrease with age & reduces protein synthesis
• Mitochondrial cells also decreases in number leading to reduction in the cells ability to produce
energy
• Lysosomes become less able to break down waste protein, nucleic acids, carbs,& fats reoutlining
in buildup of waste within the cell
• Tissue changes
• Accumulation of pigmented materials, lipofuscins progressively increase with age
• Accumulation of lipids and fats
• Decrease elastic content, degradation of collagen, presence of psuedoelastins- leads
to wrinkles
• Synovial membrane undergoes chronic degeneration,bursa becomes inflamed &
calcified – tendons ligaments show inflammation & even calcification
Cellular, tissue & organ theory

8. • Organ changes
• Decrease in functional capacity
• Decrease in homeostatic efficiency
• Various changes at organ levels are due to
• Oxidative stress
• Fatty replacement of tissue
• Aging cells demonstrate decreased proliferative
potential many cumulative changes gradually
leads to liver cirrhosis, pulmonary fibrosis, and
increased risk of cancer which has been
implicated in cellular aging

9. Biological theories-
Progressive & gradual change in physical function that occurs in all species starting in
adulthood & ending in death
• The process that occurs during this period includes both
a) Stochastic or chance theory- states that aging events occur randomly as genetic
mutation & accumulate with time
b) Nonstochastic or programmed theory- says aging is predetermined & is a function of
structured genetic expression
Genetic theory OR biological clock theory of aging-
• States lifespan of any individual is determined by the genes
• Telomere which are repeated segment of DNA occurring in the end part of chromosomes
determine the max life span of a cell since each time a cell divides multiple repeats are
lost
• In the end a certain reduction in telomere size & cell reaches a crisis point & is prevented
from dividing further & lastly cell dies
• Mutation theory- as cell divides & grow a small proportion of cell undergoes mutation
which changes genetic code
• Mutation theory assumes that aging is due to the gradual accumulation of mutated cell
that do not perform normally

10. E) Hormonal theory:
• Hypothalamus, Pituitary gland, Adrenal gland are primary regulators of aging
• Decrease in protective hormones like Estrogen, GH
• Increase in stress hormones (Cortisol) can damage brain’s memory and destroy immune cells.
MOLECULAR THEORIES- The aging is controlled by genetic materials that are
encoded to predetermine both growth and decline.
.• The error theory
• The somatic mutation theory

11. • 1.THE ERROR THEORY
• The error theory proposes that errors in ribonucleic acid protein synthesis
cause errors to occur in cells in the body, resulting in a progressive decline in
biologic function.
• Error theory Aging is a result of internal or external assaults that damage
cells or organs so they can no longer function properly.
THE SOMATIC MUTATION THEORY
• The somatic mutation theory proposes that aging result from
deoxyribonucleic acid (DNA) damage caused by exposure to chemicals or
radiation and this damage causes chromosomal abnormalities that lead to
disease or loss of function later in life.
• Exposure to x-ray radiation and or chemicals induces chromosomal
abnormalities

12. F) Immunity Theory:
• Thymus size decreases and Bone marrow cell efficiency decreases,
resulting in decreases immune response.
• Immune cells, T- Cells become less able to fight foreign organisms.
• B-Cells become less able to make antibodies
• Auto immune disease increase with age.
• With the age the body becomes less capable of resisting the effect of
infinite no of foreign antigens invading it
• This dysregulation in immune system may account for the development
of disease that have increased incidence with aging
G) The run out of program theory:
• Every person has a limited amount of genetic material that will run
out over time.
• All events are specifically programmed into genome and are
sequentially activated.
• After maturation genes have been activated there are no more
programs to be played and as cells age there may be chance of in
activation of genes that cannot be turned on.

13. Cell mutation theory –
States that the accumulation of mutation in genetics of somatic cells results in
decrease in cellular function
Random mutation inactivates genes that are useful for the functioning of the
somatic cell of various organs of the adult
This results in alteration of organ function
When the organ function is affected below a critical level death occurs
• The free radical theory
• The crosslink or connective tissue theory
• Clinker theory
• The wear and tear theory

14. 1)Free Radical theory:
• free radical are highly reactive and toxic form of oxygen
produce by cell mitochondria, the released radicals.
• Cause damage to cell membrane and DNA cell replication
• Interfere with cell diffusion and transport resulting in o2
delivery and tissue death
• Decrease cellular integrity
• Result in cross linkage
• Result in accumulation of aging pigments
• With aging there will be gradual accumulation of damage
cells & tissue that begins early and due to multiple
processes including genetic as well as non genetic factors
• Progressive changes ultimately interfere with functional &
can cause death

15. • 2.THE CROSSLINK OR CONNECTIVE TISSUETHEORY/ GLYCOSYLATION THEORY
OF AGING
• • Cell molecules from DNA and connective tissue interact with free radicals
to cause bonds that decrease the ability of tissue to replace itself.
• The results in the skin changes typically attributed to aging such as dryness,
wrinkles, and loss of elasticity.
• Fibrous tendons, loosening teeth, diminished elasticity of arterial wall and
decreased efficiency of lungs and Gi tract.
• It is the binding of glucose (simple sugars) to protein, (a process that occurs
under the presence of oxygen) that causes various problems.
• Senile cataract and the appearance of tough, leathery and yellow skin.
3-THE CLINKER THEORY
• The clinker theory combines the somatic mutation, free radical and cross
link theories to suggest that chemicals produced by metabolism accumulate in
normal cells and cause damage to body organs such as the muscles, heart,
nerves and brain.

16. • 4. THE WEAR AND TEAR THEORY
• Body is similar to a machine, which loses function when its parts
wear out.
• As people age, their cells, tissues and organs are damaged by internal
or external stressors.
• Good health maintenance practices will reduce the rate of wear and
tear, resulting in longer and better body function.

17. 4. Environmental Theories:
- Aging is cause by an accumulation of insults from the
environment.
- Environmental toxins like ultraviolet, unsaturated fats,
metal ions - Mg, Zn, Radiation and viruses – can result in
errors in protein synthesis & in DNA synthesis.
5. Psychological Theory of aging :
1)Full life development theories
2) Mature life theories

18. 1) Full life developmental theories
• Proposed by eric eriksons was one of the first psychological theorist to
develop a personality theory that extend to told age
• The ego is a positive driving force for development
• The egos job is to establish & maintain identity
• A lack of identity leads to lack of direction & non productivity
• There are stages of personality & ego development
• The last stages are adulthood & late life stage
Adulthood is characterized by a struggle between generativity & stagnation
• Generativity-
• Giving back to society by rasiisng children
• Being productive at work
• Being involved in a community
• Guiding parenting & monitoring the next generation

19. • Stagnation-
• Being unproductive
• Feeling anger, hurt & self absorption
•As one becomes mature , there is a struggle between ego
integrity & despair
• Ego integrity-
• Exploring life as a retired person who is not identified with an occupation
• Contemplating accomplishment
• Feeling life is successful
• Despair
Feeling guilt about the past
Not accomplishing life goals
• The final pathway
• Dissatisfied despair depression hopelessness

20. • Mature life theories –
• The elderly go through 3 developmental stages to reach full psychological
development
•1- ego differentiation vs work role preoccupation
•2- body transcendence vs body preoccupation
•3- ego transcendence vs ego pre occupation
• Stage 1-
Ego differentiation vs work role preoccupation
• Ass a person matures that person moves from work role preoccupation which
is a concept that describes defining oneself through work or an occupation
• A person finds new meaning & value in his or her life this process is called
ego differentiation

21. • Stage 2-
Body transcendence vs body pre-occupation
• A person either accepts the limitations that accompanies the aging process
(body transcendence) or dwells on diminishing abilities (body pre-
occupation)
• Stage3-
Ego transcendence vs ego preoccupation
Self examination occurs
• if a person believes his or her life has worth & life contributes will live on
after death the person experience ego or transcendence
• Otherwise the person may feel that he or she has lived are useless life &
experience ego pre occupation

22. Mature life theories naugarten
• Bernice neugarten describes task must be accomplishes or succceful
aging some of this task include
• Accepting the reality & imminence of death
•Coping with physical illness
• Accepting the necessity of being dependent on outside support while
still making independent choices that can give satisfaction.
• A person must remain as active as possible. This falls under the
category of'"activity theory.

23. 6. Sociological Theories:
A) Activity Theory:
• Older people who are socially active exhibit improved
adjustment to Aging process
• Aging should be involved with activities to gain life satisfaction
• Active participation in physical & mental activities help in
maintain functioning well into old age
• Purposeful activity & interaction promotes self esteem improve
overall satisfaction with life
B) Disengagement Theory:
• Withdrawal from society, reduction in social roles leads to
further isolation and life dissatisfaction.
• Disengagement from the society & relationship to maintain
social equilibrium
• This frees the aged from their social responsibilities & gives
them time to reflect internally

24. C) Dependency Theory:
• Increase in reliance on others for physical and emotional needs
D) age stratification theory-
• society is stratified among various group
E) Continuity theory
• personality remains the same & the behavior become more predictable as
people ages
• Response to aging is different among individual based on their personality
type
• Personality & behavior pattern developed during lifetime determine the
degree of engagement & activity in older adulthood

25. F) Subculture theory
• Theorized that the older adult from a unique subculture within
society to defend against society’s negative attitude towards aging
and accompanying loss of status
• Older adults are own subculture with their own norms & beliefs
• The subculture occurs as a response to loss of status in subculture.
individual status is based on mobility & health , instead of an
education, occupation,& economic achievement
G)Person environment theory-
With age there is a decline in the ability to function in a dynamic
environment & leads to inability to adpt to demands

26. Principles of Geriatric
Rehabilitation
1. Recognize variability of older adults
• Uniqueness of the individual
• Developmental issues unique to elderly
2. Focus on careful and accurate clinical assessments
- Determine effects of normal aging versus disease pathologies.
3. Focus on functional goals
• Determine priorities
• Develop goals and plan of care

27. 4. Promote optimal health and prevention of disability
5. Restore or maintain individual’s highest level of function
and independence within careful environment.
• Determine patient autonomy by appropriate assistance and
environmental manipulations.
• Be sensitive to culture and ethnicity issues, losses, fears and
insecurities
• Enhance coping skills
6. Holism approach should be there.

28. Physiological changes
• Aging is the result of progressive changes in various physiological system of
the body through intrinsic & extrinsic factors
• Aging leads to the clinical feature of aging face ,wrinkles, dyschromia
dermatochalasis ,bone resorption, protruding lower eyelid ,volume loss
• The changes associated with aging are common the rate & pattern of
change vary depending on individuals behavior, genetic composition
,anatomic structure

29. Musculoskeletal system
• Changes may be due more to decreased activity levels and
disuse than from aging process.
• Bone degeneration, aging articular cartilage, intervertebral
disc-pain-mobility-other symptoms
• Changes in muscle fiber composition – Selective loss of Type
2, fibre than Type 1 fibres. There vl be reduction in no & size
of type 2 fibres- atrophy-Loss of muscle strength
• Gradual reduction in density of bone leads to osteoporosis
• The rates of skeletal muscle protein synthesis decline with age and may also
contribute to muscle atrophy and repair process after injury.

30. • Changes in muscular endurance: muscles fatigue more
readily.
• Decreased muscle tissue oxidative capacity
• Decreased peripheral blood flow, oxygen delivery to
muscles
• Decreased myosin ATPase activity, and contractile
proteins
• Collagen changes:
• Denser, irregular due to cross linkages,
• Loss of water content and elasticity

31. • Cartilage changes:
• Decreased water content,
• Become stiffer, fragments and erodes
• Loss of bone mass and density
• Loss of calcium
• Loss of bone strength
• Decreased bone marrow RBC production
• Intervertebral disc:
• Flatten
• Loss of water content
• Loss of collagen elasticity
• Loss of trunk length and overall height.
• Senile Postural changes:
• Forward head
• Kyphosis of thoracic spine *Flattening of lumbar spine
• With prolong sitting, tendency to develop hip and knee flexion

32. • Strength Training and the Older Adult-
• Skeletal Muscle
• Increases in resting levels of anaerobic substrates (ATP, CP,
glycogen)
• Increase in fiber size (fast-twitch type II fibers)
• Increase in activity of anaerobic enzyme function (glycolysis)
• Increased capacity for levels of blood lactic acid • Improved
motivation • Improved pain tolerance
• Aerobic exercise- Skeletal Muscle Increases in capacity to generate
ATP aerobically Increase in the number of mitochondria
• Increase in the size of mitochondria Increase in activity of aerobic
enzyme function
• Increase in skeletal muscle myoglobin content (increase quantity of
oxygen available)
• Increase in blood flow within the muscle
• Selective skeletal fiber hypertrophy (slow-twitch type I fibers)
Increase in muscle's capacity to mobilize fat, oxidize carbohydrate

33. Neurological System
• The central nervous system consists of cells and lavers that
control many aspects of function such as memory, speech,
verbal, and visual functions, as well as sensory and motor
functions.
• The total surface areas of the synapses decrease significantly.
• reduced calcium influx might reduce acetylcholine release
by aged synapses.
• There can be a decline in fine motor task performance
accuracy due to the enlargement of motor units with aging %
Older adults experience short sleep cycles.
• Aging motor and peripheral sensory nerves show myelin
degeneration and decreased axon diameter.

34. • The loss of motor neurons is accompanied by a reduction in both the
numbers and diameters of motor axons. There is an age-related reduction
in the numbers of large and intermediate myelinated ventral root fibers
•Changes in Spinal cord:
• Neuronal loss and atrophy (anterior and posterior horn
cells)
• Loss of motoneurons results in increase in size of
remaining motor units.
•Age related tremors:
• Particularly in hands, head and voice
• Postural and kinetic, rarely resting
• Exaggerated by movement and emotion.

35. Cardiovascular system
• Changes may be due more to decreased activity levels and disease
than from aging process.
• Degeneration of heart muscle
• Mild cardiac hypertrophy
• Decreased coronary blood flow
• Cardiac valves thicken and stiffen
• Changes in blood vessels: arteries thicken, less distensible,
increased peripheral resistance
• Resting blood pressure rise: systolic greater than diastolic
• The SA node which is the natural pacemaker loses some of its cells,
resulting in bradycardia.

36. • Resting BP increases
• Cardiovascular response to exercise:
• blunted, decrease in heart rate acceleration,
• decrease maximal oxygen uptake and heart rate,
• reduced exercise capacity,
• increased recovery time
• Decreased stroke volume due to decreased myocardial
contractility
• Maximum heart rate declines with age
• Orthostatic hypotension: due to reduced baroreceptor
sensitivity
• Increased fatigue
• Overall, body fluids reduce with age. There is a decrease
in blood volume, which causes less fluid in the
bloodstream
• Reduced red blood cell count causes anemia. Most of
the white blood cell levels remain the same except
neutrophils, which reduce ability to resist infections.

37. • There is a progressive degeneration of the cardiac structures with aging,
including a loss of elasticity, fibrotic changes in the valves of the heart, and
infiltration with amyloid
• The heart's left ventricular wall affects the heart's pumping capacity
• An age-related increase in the left ventricular posterior wall thickness of
approx. 25%
• Adipose deposition between muscle cells is also common, resulting in fattier
heart tissue in the ventricles and the interatrial septum. Fat deposits in the
interatrial septum may displace conduction tissue in the sino-atrial node and
lead to conduction disturbances.
• Age-Related Structural Changes in the Blood Vessels-
• The amount of red bone marrow decreases with age so the capability for blood
cell formation decreases

38. Pulmonary System
• Chest wall stiffness
• Loss of lung elastic recoil
• Changes in lung parenchyma: alveoli enlarge, become thinner; fewer
capillaries for delivery of blood
• Changes in pulmonary blood vessels: thicken, less distensible
• Residual volume increases
• Vital capacity decreases
• Forced expiratory volume decreases
• Altered pulmonary gas exchange: oxygen tension falls with age
• Decreased homeostatic responses
• Blunted defense/immune response: decreased ciliary action to clear
secretions, decreased secretory immunoglobins, alveolar phagocytic
function
• The ventilatory responses to both hypoxia and hypercapnia have
also been shown to decrease with age

39. • Clinical Implication:
• Respiratory response to exercises
• Increase work of breathing
• Increased likelihood of breathlessness
• Increased perceived exertion
• Cough mechanism is impaired
• Recovery from respiratory illness is prolonged
• Significant changes in function with chronic smoking

40. • Strategies to slow or reverse changes in cardiopulmonary systems:
• Complete assessment is essential prior to commencing an
exercise program is essential in older adults due to high
incidence of cardiopulmonary pathologies.
• Selection of appropriate stress testing protocol is important
• Submaximal testing commonly used
• Testing and training method should be similar.

41. • Individualized exercise prescription essential
• Choice of training program is based on
• Fitness level
• Presence or absence of cardiovascular diseases
• Musculoskeletal limitations
• Individual’s goals and interests
• Prescriptive elements (frequency, intensity, duration and mode) are the same as for younger adults.
• Walking, chair and floor exercises, modified strength/flexibility calisthenics well tolerated by most
elderly.
• Consider swimming, water exercises and cycling with bone and joint impairments
• Consider multiple modes of exercise on alternate days to reduce likelihood of muscle injury, joint
overuse, pain and fatigue.

42. • Aerobic training programs can significantly improve functions in elderly:
• Decreases heart rate
• Improve VO2 max
• Significant improvement in peripheral adaptation, muscle oxidative capacity
• Improves recovery heart rates
• Decreases SBP, may produce a small decrease in DBP.
• Increases Vital capacity
• Reduces breathlessness, lowers perceived exertion.
• Psychological gains: improved sense of well-being, self image.

43. • Improve overall daily activity levels for independent living:
• Lack of exercise is an important risk factor for cardiopulmonary diseases and also contributes
to problems of immobility and disability in elderly.

44. Sensory Systems
•Older adults experience a loss of function of the senses:
alters the QOL, ability to interact with environment.
•May lead to decreased functional mobility, risk of injury
• As the age progresses, sensations become reduced or
changed. There is a reduction in blood flow to the nerve
endings.
•Symptoms of altered sensation vary based on the
etiology of the disease.
•Common injuries are frostbite, hypothermia,
burns,pressure ulcer, etc.

45. Vision
• Aging Changes:
• Changes includes:
• Presbyopia
• The lens becomes yellow, cloudy, and less flexible.
• Decreased ability to adapt to dark and light
• Increased sensitivity to light and glare
• Loss of color discrimination
• Decreased pupillary responses, size of resting pupil increases
• Decreased sensitivity to corneal reflex

46. • Additional vision loss with:
• Cataracts
• Glaucoma
• Diabetic retinopathy
• Medications : Antihistamines, anti-depressants, steroids

47. • Clinical Implications/ compensatory strategies:
• Assess for visual deficits: acuity, peripheral vision, light and
dark adaptation, depth perception, diplopia, eye fatigue,
eye pain
• Maximize visual function:
• Use of glasses
• Environmental adaptations
• Allow extra time for visual discrimination and response
• Work in adequate light
• Reduce glare
• Avoid abrupt changes in light
• Decreased peripheral vision may limit social interactions,
physical function : stand directly in front of patient at eye
level when communicating with patient.
• Assist in color discrimination: use warm colors for
identification and location
• Use other sensory cues when vision is limited: verbal cues

48. Hearing
• Aging Changes:
• Outer ear: buildup of earwax
• Middle ear: degenerative changes of bony joints
• Inner ear: significant changes in sound sensitivity, degeneration and
atrophy of cochlea and vestibular structures
• Other changes include reduced ability to detect high-frequency
sounds and differentiate between certain sounds or difficulty in
hearing a conversation when there is environmental noise.
• Tinnitus, a persistent, abnormal ear noise, is another common
problem. The cause of tinnitus may include wax buildup or
medicines that damage structures inside the ear. Accumulated
ear wax can also cause trouble hearing and is common with age.
• Types of hearing loss:
• Conductive
• Sensorineural
• Presbycusis

49. •Clinical Implications/ compensatory strategies:
• Assess for hearing: acuity, Speech discrimination, tinnitus,
dizziness, vertigo, pain
• Measure air and bone conduction: Rinne’s test, Weber test
• Assess for use of hearing aids, check for proper functioning
• Minimize auditory distractions: work in quiet environment
• Speak slowly and clearly, directly in front of patient at eye
level
• Use nonverbal communication e.g., gesture, demonstration

50. Vestibular/balance control
• Aging Changes:
• Degenerative changes in otoconia of utricle and saccule
• Loss of vestibular hair-cell receptors
• Decreased no of vestibular neurons
• Altered sensory organization: older adults more dependent
upon somatosensory inputs for balance
• Postural response for balance are disorganized: Decreased
ankle torque, hip torque, increased postural sway.

51. •Clinical Implications:
• High risk of fall
•Strategies to slow or reverse changes:
• Keep moving
• Wear sensible shoes
• Remove home hazards
• Light up your living space
• Use assistive devices

52. Somatosensory
•Aging changes:
• Decreased sensitivity to touch
• Proprioception reduces
• Loss of joint receptor sensitivity
• Cutaneous pain thresholds increased.
•Clinical Implications/ compensatory strategies:
• Assess carefully
• Allow extra time for responses with increased thresholds
• Maximize physical contact e.g. rubbing , stroking
• Assistive devices

53. Taste and Smell:
•Aging Changes:
• Gradual decrease in taste and smell sensitivity
• The taste buds shrink with aging along with an associated
decrease in number of taste buds.
• % Salivary production also reduces in the mouth, which
affects the sense of taste. Loss of nerve ending and less
mucus production

54. Cognitive
• Age related changes:
• Impairments in short-term memory
• Impairments are task dependent, e.g. deficits primarily
with novel conditions, new learning
• Learning in older adults is affected by:
• Increased cautiousness
• Anxiety
•Clinical implications:
• older adult utilize different strategies for memory,
context based strategies vs. memorization.

55. • Strategies to slow or reverse changes:
• Improve Health:
• Correction of medical problems
• Pharmacological changes
• Reduce the use of tobacco and alcohol
• Correction of nutritional deficiencies.
• Keep mentally engaged “Use it or Lose it” e.g. chess,
crossword puzzles, high level of reading
• Engaged lifestyle: Socially active e.g. clubs, travel, work.
• Cognitive training activities
• Reduction of stress
• Counselling
• Family support

56. Gastrointestinal System
• Chewing power is diminished, probably because of the decreased
bulk of the muscles of mastication
• Minor alterations may occur such as delayed relaxation of the upper
esophageal sphincter, and reduction in the amplitude of esophageal
contraction.
• Increased gastric acid production
• Reduced gastric emptying rate
• Reduced gut blood flow
• Reduce basal metabolic rate
• Reduced absorption surface

57. Immune system
• this leads to an increased frequency of infections, increased
prevalence of neoplasm, and autoimmune disorders.
• Thymic involution is a hallmark of aging, although there are
independent thymic pathwavs for the development of the immune
system.
• Response to vaccines is also decreased.
• There is a decrease in the ability of hematopoietic stem cells to
replicate with aging.
• Natural killer cells have been shown not to have altered
functioning of age

58. Excretory system
• the loss of renal mass is mainly due to the renal cortex's progressive
atrophy, with relative sparing of the medulla.
• By 80 years of age, between 10 and 30% of the glomeruli are
completely sclerozed. The most affected area of kidney is glomeruli.
• Renal blood flow decreases about 10% per decade and the renal
plasma flow is reduced by 50%.

59. Reproductive system
• It may lead to a gradual decline in female reproductive capability by reducing
the quality of the oocytes
• dysregulating reproductive tissues such as the corpus luteum, oviduct, and
uterus. This leads to increased complications during pregnancy as the maternal
age increases. Infertility is also commonly seen with advancing age.
• The effects of aging On men's fertility and offspring remain poorly defined. Age
related alterations lead to gradual changes in hormone levels and
spermatogenesis in men.
• progressive changes result in a decrease in both the quality and quantity of
spermatozoa
• declining testosterone levels in aging men

60. Endocrine system
• Aging is associated with anatomic changes of the endocrine glands as a result
of programmed cell death autoimmune destruction of the gland, or neoplastic
transformation of glandular tissue
• • Altered bioactivity of hormones,
• Altered transport of hormones to binding receptor sites.
• Altered hormone-receptor interactions, or Post receptor changes

61. Integumentary System
• the typical signs of aging include wrinkling and sagging of the skin. Extrinsic
aging is more prominent in the hands, neck, and face and is. attributed to sun
exposure.
• Intrinsically aged skin is thin, pale, and finely wrinkled
• Keratinocyte proliferative capacity reduces as the age progresses.
• Keratinocyte proliferative capacity reduces as the age progresses.
• The dermoepidermal junction flattens due to the retraction of the epidermal
papillae. This leads to a skin structural unit which is less resistant to shear
forces than younger skin.
• Atrophy and hypertrophy of the subcutaneous tissue are common in aged
individuals.
• Atrophy and hypertrophy of the subcutaneous tissue are common in aged
individuals.

63. NORMAL VERSUS PATHOLOGICAL AGING
• Without any pathology, the modest declines in certain aspects of cognitive
function (processing speed, memory, executive function) occur and many
cognitive domains can remain relatively stable until late in life
• Pathological aging such as dementia, Alzheimer's disease (AD) affects global
cognitive function--impairing memory, language, thinking, and reasoning
with daily living.
• In healthy aging, mild functional changes affecting various areas of the brain
like the prefrontal cortex and basal ganglia are seen
• In pathological aging, pathology initially accumulates and disrupts function
in the medial temporal lobe, progresses to cortical structures, and eventually
globally impacts the brain
• Cognitive decline with normal and pathological aging is by the complex
interaction of multiple factors that include genetic and nongenetic risk
factors.

64. Assessment
•AIMS OF GERIATRIC ASSESSMENT:
•Geriatric assessment is carried out to:
• better recognize common geriatric disorders
• plan an effective treatment program
• improve overall health and functional outcomes
• reduce vulnerability to subsequent illness
• provide better quality of life

65. THE TEAM FOR GERIATRIC ASSESSMENT
• Interdisciplinary or multidisciplinary approach is a key to geriatric
assessment.
• Members:
• Physician to assess medical fitness,
• Physical therapist to assess physical fitness,
• Occupational therapist to assess vocational status,
• Speech therapist to assess speech problems,
• Psychologist to assess the level of depression,
• Dentist to assess oral hygiene,
• Audiologist to assess hearing loss,
• ophthalmologist to assess eyesight,
• Nurse to assess the status of personal care,
• Dietician to assess nutritional status and
• Social worker to assess the involvement of a patient with family or the community.

66. COMPONENTS OF GERIATRIC ASSESSMENT
•Performing comprehensive assessment in the form of
different components is way to Increase the efficiency of
geriatric assessment.
•These components are:
• A. History taking
• B. Physical examination
• C. Functional status
• D. Mental status
• E. Emotional status
• F. Investigations

67. History Taking
• Subjective information and personal history:
• Age, sex, education, occupation, socio-economic status, etc.
• Chief complaints:
• There may be more than one complaint reflecting the presence of
multiple pathologies.
• Present physical illness:
• The speed of onset of illness, precipitating events.
• Previous physical illness:
• The presence of chronic diseases, previous surgeries or
hospitalization.

68. • Drug history:
• List of prescribed and non prescribed drugs taken by a patient, drug
allergies.
• Nutritional history:
• Number of meals/day, contents of diet.
• Family history:
• The presence of major diseases in family, causes of death of family
members.

69. Physical Examination
• It is an integral part of geriatric assessment. Physical therapist should make sure to
check:
• Height and weight
• Orthostatic BP and pulse
• Edema
• Skin integrity, pallor
• Range of motion
• Muscle strength
• Sensory status
• Coordination
• Vision and hearing
• Oral cavity – no of teeth, loose teeth, caries
• Snellen eye chart or Jaeger Card can be used for vision whereas to detect hearing
loss, the therapist may whisper short sentences at the distance of 6 to 12 inches
from behind the head. If needed, patient may be referred to a specialist for detailed
check-up.

70. Functional Status
• Four elements of physical functional status are needed to be evaluated
thoroughly and carefully:
1. Basic ADLs
2. IADLs
3. Balance
4. Gait

73. Mental Status
• Physical therapist has a key role as a member of the geriatric
rehabilitation team and as a resource for other caregivers for
the older patient with cognitive impairments.
• The therapist needs to have adequate knowledge to assess
mental status, so that she can work with maximal efficiency
and also enjoy clinical interactions with elderly. The term
“dementia” is commonly used to describe the impairments in
mental status.
• The Mini-Cog assessment instrument is briefer and has
reasonable test characteristics to indicate the presence of
dementia

74. Emotional Status
• Many people get depressed at some time in their lives.
However, in elderly, depression is the most common
psychological problem.
• Geriatric depression scale (GDS) is used to assess the
level of depression in elderly.

75. Laboratory Testing
• Clinical use of laboratory testing for geriatric assessment is a
useful tool when combined with physical assessment.
• It should be remembered that because the laboratory values
given in usual reference ranges are traditionally derived from
middle-aged populations, some “abnormal results” are actually
normal for elderly populations.
• For example, bacteriuria in the absence of infection is a common
laboratory finding in the elderly which would be considered
pathological in younger adults.
• The reasons why reference ranges change with age could be
• Age-related decline in the most organ systems
• Nutritional deficiency
• Thus, to properly assess the results of laboratory testing, the
effects of aging on expected values must be considered.

76. Goal-Setting
•Functional independence is the ultimate goal of physical
therapy intervention.
•To achieve this long-term goal, a physical therapist should
establish several short-term goals:
• To improve or maintain ROM of different joints. For example, a
geriatric patient should have enough ROM at shoulder to dress
up or to reach dishes in the cupboard.
• To improve or maintain strength and endurance of muscles. For
example, the patient should have sufficient muscle strength to
lift a jug of milk, to make a bed, to make chapatti or to wash
clothes.

77. • To improve or maintain cardiovascular endurance so that a
geriatric patient is able to do strenuous activities such as fast
walk, cycling or swimming.
• To improve or maintain ambulatory status of a patient so
that a patient can go to toilet or for shopping independently.
• To relieve pain. It has been estimated that over 85 percent of
older adults have at least one chronic disease that may give
rise to the feeling of discomfort or pain. Acute pain following
surgery is also becoming quite common in geriatric patients.

78. reference
• Physiotherapy in general medicine & surgical condition (megha seth)
• Geriatric physical therapy – Andrew guccoine

79. Thank you..