2. Learning Outcomes
1. Explain normal changes in the
musculoskeletal system associated
with aging.
2. Identify risk factors for the older
person related to common
musculoskeletal problems.
3. Apply nursing diagnoses of older
persons related to common
musculoskeletal problems.
Gerontological Nursing, Third Edition
Patricia A. Tabloski
3. Learning Outcomes
4. Compare the pharmacological
management and nursing
responsibilities related to the older
person with common musculoskeletal
problems, including osteoporosis,
osteomalacia, Paget’s disease,
osteoarthritis, rheumatoid arthritis,
gout, pseudogout, and hip fractures.
Gerontological Nursing, Third Edition
Patricia A. Tabloski
4. Learning Outcomes
5. Discuss the nonpharmacological
management of the older person with
common musculoskeletal problems,
including osteoporosis, osteomalacia,
Paget’s disease, osteoarthritis,
rheumatoid arthritis, gout,
pseudogout, and hip fractures.
6. Implement the nursing management
principles related to the nursing care
of older patients with arthritis.
Gerontological Nursing, Third Edition
Patricia A. Tabloski
5. The Normal Musculoskeletal
System and Joints
• The musculoskeletal system consists of
the body’s skeleton, muscles,
ligaments, bursae, and joints.
• The skeleton provides form and support
for the body.
Gerontological Nursing, Third Edition
Patricia A. Tabloski
6. The Normal Musculoskeletal
System and Joints
• Bones provide protection for delicate
body parts and are an important source
of minerals as well as blood cells.
• The skeletal muscles provide
movement of various body parts.
Gerontological Nursing, Third Edition
Patricia A. Tabloski
7. The Normal Musculoskeletal
System and Joints
• Normal changes of aging often bring
about complaints of musculoskeletal
pain and various joint limitations, and
aging appears to predispose an
individual to the development of
diseases such as osteoporosis and
arthritis.
Gerontological Nursing, Third Edition
Patricia A. Tabloski
8. The Normal Musculoskeletal
System and Joints
• The older person may then be forced to
give up an independent lifestyle and
become increasingly dependent on
others for assistance.
Gerontological Nursing, Third Edition
Patricia A. Tabloski
9. Skeletal System: Structure and
Function
• The adult body has 206 bones.
• There are two major categories: the
axial skeleton and the appendicular
skeleton.
• Bones are also classified by shape:
– Long bones
–Short bones
– Flat bones
– Irregular bones
Gerontological Nursing, Third Edition
Patricia A. Tabloski
10. Joints: Structure and Function
• Joints, the area where two bones are
attached, provide stability and mobility
to the skeleton.
• A joint may be:
– freely movable,
– immobile,
– only slightly movable.
Gerontological Nursing, Third Edition
Patricia A. Tabloski
11. Muscles: Structure and Function
• Skeletal muscles are the largest organs
of the body and account for 50% of
lean body mass in a healthy young
person.
• The more than 600 muscles in the body
vary in size and shape.
Gerontological Nursing, Third Edition
Patricia A. Tabloski
12. Function of Skeletal Muscles
• The motor unit is the functional unit of
the neuromuscular system. A motor
unit consists of muscle fibers
innervated by a single motor nerve, its
axon, and an anterior horn cell.
Gerontological Nursing, Third Edition
Patricia A. Tabloski
13. Normal Changes of Aging
• Significant alterations in human
structure, function, biochemistry, and
genetic patterns are responsible for the
changes in the muscles, tendons,
bones, and joints of the older person.
Gerontological Nursing, Third Edition
Patricia A. Tabloski
14. Skeleton
• The bone loss of normal aging has been
described in two distinct phases:
– Type I, or menopausal bone loss
– Type II, senescent bone loss
Gerontological Nursing, Third Edition
Patricia A. Tabloski
15. Common Musculoskeletal Illnesses
• Osteoporosis, osteomalacia, and
Paget’s disease are metabolic bone
diseases.
• The three most common inflammatory
joint diseases affecting the older person
are rheumatoid arthritis, gout, and
pseudogout.
Gerontological Nursing, Third Edition
Patricia A. Tabloski
16. Falls and the Older Person
• Falls are a major health problem for the
older person, with serious implications
for medical as well as financial
outcomes.
• In the United States, falls are the
leading cause of accidental death in
persons over 65 years of age.
Gerontological Nursing, Third Edition
Patricia A. Tabloski
17. Falls and the Older Person
• An important part of nursing care of the
older person is to maintain safety and
prevent falls and fall-related deaths.
Gerontological Nursing, Third Edition
Patricia A. Tabloski
18. Falls and the Older Person
• The goals are to recognize older
persons at risk for falling; to identify
and correct fall risk factors; to improve
balance, gait, mobility, and functional
independence using a structured
interdisciplinary approach; to reduce or
eliminate environmental factors that
contribute to fall risk; and to evaluate
outcomes with revision of the plan as
needed.
Gerontological Nursing, Third Edition
Patricia A. Tabloski
19. Hip Fracture
• Hip fractures are a serious problem for
the older person.
Gerontological Nursing, Third Edition
Patricia A. Tabloski
20. Common Diagnostic Findings for
Musculoskeletal Illnesses
• A variety of tests (urine, blood,
synovial fluid) and procedures may be
done to diagnose and monitor the
treatment of any musculoskeletal
problem.
Gerontological Nursing, Third Edition
Patricia A. Tabloski
21. Pharmacology and Nursing
Implications
• The physiological changes of aging and
resulting altered drug metabolism
frequently cause serious side effects as
well as drug toxicities. The older person
often has more than one clinical
problem and may be taking over-the-counter
drugs as well. A complete
history and physical as well as baseline
tests should be done to determine
baseline function.
Gerontological Nursing, Third Edition
Patricia A. Tabloski
22. Nonpharmacological Treatment of
Musculoskeletal Problems
• Lifestyle changes such as increase in
exercise, weight loss, and eating a
healthy diet are important for all elderly
adults.
Gerontological Nursing, Third Edition
Patricia A. Tabloski
23. Falls and Fall-related Injuries
• Assessment of functional mobility, such
as gait, balance, and position changes,
provides valuable clues regarding a
person’s risk for future falls.
Gerontological Nursing, Third Edition
Patricia A. Tabloski
24. Falls and Fall-related Injuries
• Balance exercises are one way for the
older person to increase confidence in
their balance and take an active part in
preventing falls and fractures.
• Many functional and performance
assessment tools are available that will
provide quantitative data (a score) on
an older person’s limitation in mobility
and risk for falls.
Gerontological Nursing, Third Edition
Patricia A. Tabloski
25. Treatment of Hip Fractures
• The goals of joint replacement surgery
are to decrease pain and increase joint
function.
Gerontological Nursing, Third Edition
Patricia A. Tabloski
26. Treatment of Hip Fractures
• Excellent nursing care, including
knowledge of the procedures and
specific assessment and critical thinking
skills for the joint replacement patient,
will help the older person have the best
possible outcome, and return to
function and activities with increased
mobility and reduced pain.
Gerontological Nursing, Third Edition
Patricia A. Tabloski
