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How the Body Changes with Aging, the Resulting Comorbidities, and Functional Implications Suzanne Greenwalt, PT, DPT, CCS, GCS TPTA State Meeting April 9, 2016 Objectives 1. Explain two contributing factors to decreased bone density that occurs in older adults. 2. Describe the type of exercises that are most beneficial to an individual with spinal stenosis. 3. Explain 3 components of treatment for a patient with osteoporosis 4. .Identify two changes that occur to the muscular system with aging. 5. Describe three changes that occur in the cardiovascular system with normal aging. 6. Identify two changes to the respiratory system with aging and explain how they impact the physical functioning of an older adult. 7. Describe why there is an increased incidence of hypertension in older adults. 8. List 3 components to the assessment of a patient with peripheral neuropathy. 9. List 3 way s in which dementia is different from normal cognitive changes that occur with aging. Why do we age? • 50% of age related decline is due to genetics • certain cells are programmed to undergo apoptosis and are more susceptible to certain conditions • 50% of age related decline is due to lifestyle choices or modifiable risk factors • Physical inactivity • Inadequate nutrition • Excess body weight: stresses tissues, increases inflammation, predisposes one to diseases • Smoking • Excessive alcohol intake • Environment • Stress Changes to the Skeletal System Skeletal System Cartilage Articular cartilage With aging articular cartilage changes: Loses water content More susceptible to breakdown Wear and tear Becomes thinner, can’t protect the bones Impact of obesity How does this affect function? Range of motion is decreased Less ability to absorb shock At risk for Osteoarthritis Skeletal System Cartilage How does this impact exercise prescription? Work towards end range in order to prevent ROM loss Avoid jarring exercises, example: jumping from a high surface It is important to choose exercises that will stimulate the bones without being too stressful on an older body that cannot absorb the impact anymore Strengthening of surrounding muscles lessens strain on joints Skeletal System Collagen Collagen Protein that makes up 1/3 of the body Found in skin, bone, tendon, ligaments, and fascia Provides structural support, strength and elasticity (in combination with elastin) With aging changes occur to collagen: Loss of water Crosslinking of the fibers Loss of elastic fibers Skeletal System Collagen Loss of water Results in the body shrinking because of water loss from the intervertebral discs Crosslinking of fibers Decreased joint range of motion ROM should still be sufficient to accomplish all ADLS Does not limit basic daily activities Increased stiffness of joints Greater tension is found in the joints which means that greater muscle effort is required so this contributes to less muscle endurance with age Skeletal System Collagen Loss of elastic fibers Causes skin to sag Tendons, ligaments, and fascia also lose elasticity Internal organs are no longer held in place as well What is the effect of the changes in collagen? Conditions such as uterine prolapse, bladder issues, constipation, and hernias are more common in the older years due to this Skeletal System Changes to the Spinal Column Intervertebral Discs Lose water Compress Decrease height In conjunction with spine fractures, creates wedging of vertebrae Begin to become kyphotic Also may have spinal stenosis Skeletal System Changes to the Spinal Column Spinal Stenosis narrowing (stenosis) of spinal canal; leads to compression of nerve roots (lumbar) or spinal cord (cervical) Treatment Planning Strength, endurance, flexibility, core stability, balance, pain management Focus on Flexion based exercises to open up spinal canal and decrease pressure on spinal cord & nerve roots Progression/Implementation As symptoms worsen, may need to utilize cane or walker for mobility which allows you to bend forward while walking/standing Core stabilization exercises(focus on transverse abdominis & multifidus) Hooklying (dead bug exercises) Quadruped (raise opposite arm/leg) Skeletal System Cartilage & Bone Skeletal System Bone Skeletal maturity (closure of epiphyseal plates) occurs in the first 2 decades of life Bone mineral density begins to decline in the 3rd decade Peak bone density – late 20’s to early 30’s Bone resorption begins to exceed bone formation which causes bone density to decline Fifth decade for women Sixth decade for men Women lose more bone mass then men Accelerated loss occurs during menopause Women are more susceptible to osteopenia and osteoporosis Decrease in mass causes bone to be fragile – not able to withstand as great of forces: compressing, bending Skeletal System Bone Throughout life, body must maintain adequate calcium levels Intestinal absorption of calcium begins to decline with age Body retrieves calcium from the bones in order to meet its needs Many teenagers do not drink milk, are sedentary, not going outside for sun exposure, and have a poor nutritional diet (diet lacks calcium, protein, and vitamin D) Bone mass increases dramatically from the years 12-18, but if the above lifestyle is followed then they can emerge from the teen-age years with a skeleton of a 60 year old Skeletal System Bone Nonmodifiable Risk Factors for Bone Loss Genetics (small frame women) Caucasian Hispanic Female older than 50 Family hx of OP Premature at birth Low estrogen levels as in menopause Skeletal system Bone Modifiable Risk Factors for Bone Loss Calcium intake: 1200 mg/day or more is required Smoking cigarettes Excessive alcohol intake Low body mass index (<18.5) Low estrogen – can occur with anorexia Inactivity Drinking soda instead of milk Insufficient protein intake Inadequate vitamin D Use of steroids: prednisone, cortisone Skeletal System Bone Immobilization also contributes to bone loss When an individual is in a cast or immobilized the loss of bone is estimated to 0.5%-1.05% per day because muscle contractions are not placing demands on the bone The natural pull of contracting muscles is what maintains bone mineral density Inactivity robs bones of the needed stimulus for osteoblastic activity (bone formation) Skeletal System Bone Estrogen – slows bone resorption During menopause there is a loss of estrogen and therefore increased bone resorption occurs Women can lose up to 20% of their bone mass during the first 5-7 years following menopause Testosterone and estrogen are essential to bone health in men Any condition affecting sex hormones (prostate cancer, breast cancer) automatically affect bone health END RESULT – BONES BECOME MORE POROUS AND BRITTLE Skeletal System Bone Osteoporosis Decrease in bone mass and density Most common type of bone disease Increase susceptibility to fractures Especially compression fractures Loss of height over time Kyphotic posture Skeletal System Bone Osteoporosis is treatable: Women over 50 should have 1200 mg Calcium/day Vitamin D Weight bearing exercise Resistance exercise Emphasize extension; avoid forward flexion exercises Biphosphonates Exercise Skeletal System Bone Effect on Rehab Process: Assessment Strength, flexibility, pain Posture, body mechanics Balance, Gait, Fall risk Treatment Planning Avoid forward flexion & twisting/jerking of spine Focus on weight bearing & muscle strengthening exercises; posture & body mechanics, and fall prevention Increase weights for muscle strengthening once patient can perform > 12 reps in 1 set Ensure proper body mechanics during exercise Skeletal System Bones Consequences of skeletal changes with aging: Kyphosis and forward flexion creates changes in the COM, limits stability and muscle efficiency (have to work harder to stand up) Arthritis creates pain, decreased ROM, misalignment Osteoporosis Changes to the Muscular System Muscular System Sarcopenia – age related loss of muscle mass Muscle wasting associated with sarcopenia can be a contributing factor to an older individual’s deteriorating functional status and can cause deficits in mobility and metabolic function An individual is defined as sarcopenic if their lean body mass is less than 2 SD below the mean compared with healthy young adults Muscle mass loss starts at age 30 10-15% loss of strength each decade starting in the 30’s if do not exercise In those older adults who are lifelong trained, muscle mass and strength may be relatively preserved – but not to the extent that muscle mass loss is completely prevented with aging The level of loss reaches functional significance in the 60’s Muscular System Sarcopenia Higher rates of disability are noted in those with sarcopenia 22% of men and women older than 70 have sarcopenia 50% of men and women older than 80 have sarcopenia Decline in muscle strength, rate of force development and muscle power occur with sarcopenia These muscle impairments contribute to a greater risk of falling in the older adult and frailty Muscular System There are many changes to the muscles with aging that contribute to sarcopenia: Decreased muscle mass, replaced by fat mass Decreased muscle strength Slowing of muscle contractile properties Type II (fast twitch) fibers atrophy more than type I (slow twitch) Muscle fiber necrosis Muscular System Strength declines are noted with age Due to muscular and neural function Loss of number of motor units (alpha motor neuron and all muscle fibers it innervates) - particularly after age 60 By age 90, there is a 70% decrease Denervation of fast twitch with reinnervation by slow twitch Motor units become slow Rapid velocity contractions are more affected than slow- velocity contraction- due to selective loss of type II reinnervation with slower motor units Muscular System Implications Loss of muscle strength = decreased function/mobility Slower rate of muscle contraction and slower relaxation significantly impact postural control/balance and fall risk Need to be doing strengthening exercises “use it or lose it” Progressive resistive exercises Aerobic training Changes to the Cardiovascular System Cardiovascular Changes With aging, changes are seen in the cardiovascular system Initially these do not affect function Functional loss is most evident in the 7th decade of life The effect of cardiovascular aging changes are difficult to differentiate from the effects of diseases commonly seen with aging and deconditioning Cardiovascular Changes - Heart Myocytes (cardiac cells) - decrease in number Increase in non-contractile tissues (fat, collagen) in the myocardium Cross linking of collagen in myocardium Increased stiffness and decreased compliance of the ventricles Slower ventricle filling time with reduced cardiac output Thickening of ventricle wall Decreases ventricle contractility Cardiovascular Changes - Heart Valves are thicker and more calcified May limit the valves from closing completely Stenosis and regurgitation of valves This can lead to shortness of breath, pulmonary edema, decreased activity tolerance Decrease in SA node cells Increased arrhythmias Most common is atrial fibrillation Lower heart rate max Exercise does not prevent this decline Cardiovascular Changes - Heart Atrial Fibrillation Rapid and irregular heart arrhythmia, caused by chaotic electrical impulses in the atria of the heart The AV node and the ventricles are bombarded with frequent, irregular impulses which results in a fast and irregular heart rate The normal coordination between the atria and ventricles is lost HR is irregular and increased Effect on Rehab: Monitor vital signs • SOB/weakness and fatigue are common symptoms – these patients will need frequent rest breaks • Must be aware of symptoms of heart failure – a-fib can progress to this • Pt’s are at increased risk for stroke, clots, TIAs – long term Coumadin use Cardiovascular Changes The basement membrane in the capillary wall thickens with age Exchange of oxygen and nutrients occurs more slowly from the vasculature to the working tissues Increased BP - Hypertension Connective tissue changes (crosslinking of collagen and the loss of elastin) cause the entire cardiovascular system (heart and peripheral vessels included) to be stiffer and less compliant. Directly contributes to increased BP with aging Cardiovascular Changes Hypertension HTN is most common cause of heart failure Contributes to renal and cerebrovascular disease Most patients experience no symptoms so adherence to medications is poor 90% of hypertension is essential hypertension – no known etiology Complications: • • • • • • • • • Enlarged heart Heart Failure (HTN is leading cause) Aneurysms Kidney Failure Decreased arterial blood flow leading to MI CVA Kidney Failure Amputation Blood vessel damage in the eyes (decreased vision and blindness) • Aerobic exercise program can effectively reduce high blood pressure Cardiovascular Changes Atherosclerosis Build up of lipid material under the surface of the epithelium (i.e. plaque buildup in arteries) Coronary artery disease (CAD): atherosclerosis in the coronary arteries Peripheral vascular disease: atherosclerosis in the vessels in the periphery Arteriosclerosis – Increased thickness of connective tissue in the blood vessels What is the result of both of these? Cardiovascular Changes Coronary Artery Disease (CAD) a buildup of plaque in the arteries of the heart which reduces blood flow to the heart muscle Most common type of heart disease Leading cause of death in the US for men and women CAD can lead to heart failure, clot formation, angina, cardiac arrest and arrhythmias Symptoms: SOB, exertional dyspnea, angina – increases with activity Monitor vitals signs before, during and after treatment Know the signs and symptoms of cardiac arrest, heart failure and arrhythmias – those with CAD are at an increased risk for all of these. Consider patient tolerance to exercise and prescribe appropriate rest breaks Cardiovascular Changes Peripheral Vascular Disease Condition that develops when the blood supply to the internal organs, upper and lower extremities becomes partially or totally blocked secondary to atherosclerosis Intermittent claudication (pain in legs with activity) Tired, cramped feeling in legs Leg pain at night Buttock pain Numbness, tingling and weakness in legs Burning or aching pain in foot or toes at rest Wounds on lower extremities that heal slowly One or both feet are cold to touch and change color Loss of hair on legs Weak or absent pedal pulse Cardiovascular Changes Peripheral Vascular Disease Treatment: Emphasize balance training including proprioceptive training if sensation is decreased. Minimize fall risk Pain management: keep legs below heart level tends to lessen pain Modalities: avoid cryotherapy Longer warm-up needed in cooler temperatures (cold outside or AC) Exercise at levels of maximum tolerable pain This has long term benefits – may be due to enhanced collateral circulation Exercise at short intervals: 1-5 minutes with alternating rest periods Progress length of exercise and decrease rest breaks Most functional mode of exercise is walking Cardiovascular Changes Heart Failure (aka: CHF) It is characterized by the inability of the heart to maintain adequate cardiac output Ischemia (CAD) HTN Diabetes Myocardial Infarction Symptoms: Shortness of breath/Dyspnea Fatigue & Decreased exercised tolerance Fluid retention: Urinary frequency Weight gain Cough (worse when lying flat) Edema: Lower extremities (right sided failure) Pulmonary (left sided failure) Abdomen (right sided failure) Bounding veins in neck (rare) Cardiovascular Changes Decrease in HR and vascular system responses to physiologic stimuli Baroreceptor sensitivity is decreased leading to decreased adaptability Receptors in the walls of the blood vessels Heart takes longer to reach a steady state or to recover from exercise Cardiovascular Changes • Many older adults are on medications to regulate their blood pressure (anti-hypertensives) • These medications place the patient at risk for dizziness, hypotension, and falls • What does this mean for clinicians? Vital signs must be monitored during treatment sessions! What for hypertension as well as adverse affects of mediation such as hypotension. Cardiovascular Changes Orthostatic Hypotension Decrease in systolic blood pressure by 20 mmHg when a patient moves from supine to sit or sit to stand Up to 50% of elderly will experience orthostatic hypotension Causes: Adverse effects of medication Dehydration Anemia Arrhythmias Immobility Autonomic dysfunction related to diseases like diabetes, Parkinson’s disease and CNS impairments Heart not able to immediately pump blood to head Cardiovascular Changes Orthostatic Hypotension Not all patients with orthostatic hypotension are symptomatic Those with symptoms report: lightheadedness, dizziness, weakness, syncope, and angina Patients with this are at risk for falls, fractures, myocardial infarctions, and cerebral injuries Clinicians should monitor BP closely when changing positions and assess patients for this due to its risks. Changes to the Respiratory system Respiratory Changes Normal aging process in the pulmonary system is slow and the changes are not felt functionally until the 6th or 7th decade Aging process is exacerbated or complicated by other factors: Pollution Occupational exposures Inhaled drugs Cigarette smoking Respiratory Changes Compliance decreases The ease with which the lungs inflate Vital capacity decreases maximum volume expired after maximum inspiration Peripheral chemoreceptors are not as responsive to hypoxemia Central receptors are not as responsive to hypercapnia Ventilatory response mediated by the CNS is significantly depressed Respiratory Changes Changes to the thorax: Calcification of the ribs Calcification of the costal cartilage Arthritic changes in the joints of the ribs and vertebrae Thoracic kyphosis Increased anterior-posterior chest diameter Respiratory Changes What is the significance to the changes in the thorax? The chest wall is less compliant so there is increased work for breathing Respiratory Changes Other changes: Strength and endurance of the inspiratory muscles decreases Results in decreased maximum ventilatory effort Alveolar surface area decreases Elastic recoil of alveoli decreases Lungs do not empty as well – residual volume increases and dynamic volumes decrease Respiratory Changes More resistance to airflow through the conducting tubules calcification of tracheal rings increased thickness of mucous These changes cause a decrease in diameter of the conducting tubules which cause an increase resistance to gas flow Therapy Interventions Trunk and UE ROM exercises Lay with towel roll along spine Emphasize full UE ROM Postural interventions Breathing exercises Emphasize diaphragmatic breathing Teach PLB when having dyspnea Emphasize good hydration Changes to the Nervous System Nervous System Changes occur in both the central nervous system and the peripheral nervous system during adulthood Much of the brain mass loss that is seen with aging is due to decrease in white matter and due to loss of myelin White matter decreases 30% with aging Areas of the brain stem that deal with vital functions are stable and show minimal changes with aging Central Nervous System Cerebellum shows age related changes that could be associated with declines in posture, balance and gait Cerebellum is a highly myelinated area. Aging effects the frontal and temporal lobes more than the parietal Studies have shown a decline with age in frontal lobe executive function abilities Higher-order association areas of the brain lose more neurons during aging Peripheral Nervous System Changes Decrease in myelination Contributes to the gradual loss in muscle strength and muscle mass seen with aging Slows nerve conduction Decreased NCV of peripheral sensory and motor neurons Loss of motor neurons – affects muscle strength Loss of sensory neurons – decreased ability to detect hot, cold, vibration, and pain Slowed response time – increased risk of falls Peripheral Neuropathy Damage to the nerves of the peripheral nervous system leading to sensory changes, pain, and weakness Rehab Implications: Assess Tactile Sensation light touch, sharp/dull, temperature, vibration Proprioception Skin integrity/wounds – assess skin each treatment session Pain management Strength Balance assessment and training Gait Training of adaptive equipment to increase proprioception & safety Nervous System Changes & Function How do all of these changes in the nervous system impact function? Reaction time – measure of nervous system efficiency during movement Cognition- function of the brain that allows interaction with the environment Nervous System Changes & Function Reaction Time The amount of time between presentation of a stimulus and the motor response Adults have better reaction time than children Reaction time peaks in young adulthood and then declines It is slowed 15-30% in older adults Slower reaction time is recognized as a universal change with aging Nervous System Changes & Function Reaction Time has 3 parts: Sensory transmission of input Motor execution time Central processing It’s the central processing that makes up 80% of reaction time Reaction time requires attention – sensory information can not get into the working memory without attention Nervous System Changes & Function Reaction time involves cognitive processing as well as motor execution. With aging the cognitive processing component slows in all individuals The motor component depends on the type of task, particularly how much muscular force is required. The more complicated the task the more likely it is to show age related decline. Nervous System Changes & Function Health and exercise may modify changes that are seen with aging in reaction time Active older adults have faster reaction times than sedentary older adults What kinds of exercises could you do with a patient to improve reaction time? Nervous System Changes & Function What causes the reaction time to slow? 4% due to decreased motor nerve conduction velocity 10% due to decreased sensory nerve conduction velocity Cognitive processing has the greatest impact: Stimulus identification Response selection Response programming Cognition Cognition includes selective attention, learning, and memory. With aging there is a decease in complex cognitive skills involving memory. Memory is made up of short term, long term and immediate memory. Certain aspects of short term memory are impaired with age Immediate and long term memory remain intact The aspects of short term memory that are affected are: free recall, episodic, explicit and working memory. Cognition Working memory is most affected by aging because information not only has to be retained but also manipulated or changed in order to be retrieved Requires information storage at the same time as acquisition of new data - very difficult for older adults Dementia Collection of symptoms & disorders that impair higher cortical functions including: Memory Capacity to solve problems of day-to-day living Performance of perceptual-motor skills Control of emotional reactions Types of dementia: Alzheimer's dementia Lewy body dementia Vascular dementia Mixed dementia All types of dementia are NOT a normal part of the aging process Alzheimer’s Dementia Slow decline in memory, cognition and functional abilities beyond what normal aging changes Hallmark changes in the brain: neurofibrillary tangles inside the neurons and neuritic plaques outside the neurons Most common cause of dementia age 65+ 60-80% of dementia cases Normal Aging vs. Dementia Normal Aging No language impairment No change in implicit memory or learning Word recall declines Semantic memory stable List making is a good memory strategy Estrogen deficiency speeds aging effects on memory in women Dementia Neurofibrillary tangles and neuritic plaques in all limbic structures Loss of ability to learn new information Word recall declines greater than normal Semantic memory declines Rehearsal is a good memory strategy Women have 2-3x greater prevalence Dementia Treatment Planning Break down tasks to reduce memory load Practice each component repetitively Teach correctly from the start; difficult to erase incorrect motor patterns once performed Avoid errors so they are not learned (errorless learning) Minimize distractions (auditory & visual) during treatment Progression/Implementation As dementia progresses, fall risk increases If progress is limited or behaviors increase; consider pain management (UTI, sinus infection, musculoskeletal) Changes to the Somatosensory System Somatosensory System Structural changes in the skin contribute to a decline in ability to detect touch, temperature, pain and vibration with aging. Loss of dermal thickness – up to 20% Decline in nutrient transfer Loss of collagen and elastin fibers The growth rate, healing rate, sensory perception, and thermoregulation of the skin decline with aging Somatosensory System The skin receptors responsible for the perception of pressure and light touch (pacinian and Meissner’s corpuscles) decline in number with age By the 9th decade they are only at 1/3 of their original density Older adults can lose up to 90% of these receptors Somatosensory System Proprioception or joint position sense declines with age, especially in the lower extremities This can have a significant impact on balance in older adults Changes to the visual system Visual Changes Visual Acuity – clarity or sharpness of vision Declines rapidly between 60-80 years of age By age 85 there is an 80% decline in acuity from 40 years of age Cornea and lens thicken Lens curvature decreases Yellowish pigment accumulates Decreased ability to negotiate environment and anticipate problems; need more light to detect objects Visual Changes Contrast sensitivity - a measure of the limit of visibility for low contrast patterns Difficulty negotiating obstacles – curbs, uneven sidewalks, stairs Depth perception – ability to recognize the spatial relationship between objects Changes occur 60-75 years of age Stairs, inclines, declines Age-Related Vision Problems Cataracts Glaucoma Macular Degeneration Eye Floaters Cataracts A clouding of the normally clear lens of the eye. Vision with Cataracts • Cloudy, blurry or dim vision • Difficulty seeing at night • Sensitivity to light and glare • Fading or yellowing of colors • Glare from headlights when driving Glaucoma A group of diseases that are associated with abnormally high pressure inside the eye. This pressure can damage the optic nerve and optic disc. As the optic nerve deteriorates, blind spots develop in the visual field. Loss of peripheral vision Tunnel vision Age-Related Macular Degeneration (AMD) Occurs when tissue in the macula deteriorates The macula is a small spot near the center of the retina and the part of the eye needed for sharp, central vision, and seeing objects that are straight ahead. More than 1.6 million Americans over age 60 have AMD. Vision with AMD • AMD can cause: • Distortion of straight lines or printed words • A gradual haziness of overall vision • A blind spot to form in the center of the visual field. Can develop slowly or rapidly Blind spot will grow in size as disease progresses • Difficulty recognizing faces • Need for increased bright light to read • Increased blurriness of printed words Challenges of Visual Changes Inappropriate prescriptions Predisposes older adults to risk for falls Multifocal lenses increase risk for falls Vestibular Vestibular System The vestibular system relays input about the body’s relationship to gravity, head position, and head movement Vestibular receptors in the inner ear provide information about head position and head movement in space This information is used to update postural tone and equilibrium and ensure gaze stability as the head moves The vestibular system is completely myelinated Vestibular System A 20-40% reduction in hair cells occurs in the semicircular canals and the utricle and saccule Loss of myelinated vestibular nerve fibers Decreased by 40% at age 75 Microvascular changes in the inner ear These changes all lead to equilibrium deficits in the older adult which increases fall risk Falls One out of 3 older adults fall each year but less than half talk to their healthcare provider about it The frequency increases to nearly 40% for those individuals over 80 years of age and affects women more than men Falls are the leading cause of fatal and nonfatal injuries in older adults 20-30% of people who fall suffer moderate to severe injuries such as lacerations, hip fractures, and head traumas. These injuries can make it hard to get around or live independently, and increase the risk of early death. Falls are the most common cause of traumatic brain injuries. Falls Most fractures in older adults are caused by falls Many people who fall, even if they are not injured, develop a fear of falling. This may cause them to limit their activities, which leads to reduced mobility and loss of physical fitness, and in turn increases their actual risk of falling. People age 75 and older who fall are 4-5x more likely than those age 65-74 who fall to be admitted to a long-term care facility for a year or longer Other Factors That Increase Risk For Falls What else have we talked about today that would contribute to fall risk in older adults? Are The Changes With Age Inevitable? World’s oldest marathon runner at 101- retired Feb 2013 Take Home Points Changes with aging are inevitable but the degree to which they occur and how much them impact function is not inevitable Example: with cardiac changes, pulmonary changes and loss of muscle mass: Maximum exercise capacity is decreased Recovery period is lengthened Decreased endurance For those that exercise Declines are not as dramatic Improved strength and mobility Exercise prescription should be specific and at an appropriate intensity! Take Home Points All of the systems of the body experience changes with aging The changes that occur impact balance and function Each patient must be thoroughly assessed in all major systems of the body to ensure that you are aware of what changes are occurring Example: does you patient have visual changes, examine proprioception, joint ROM, breathing technique Every treatment plan should be unique Geriatrics is not cookie cutter! Geriatric adults are at an increased risk for falls – PTs and PTAs have the potential to decrease this risk by addressing modifiable risk factors and addressing age related body changes – we can make a difference! Thank You! Suzanne Greenwalt, PT, DPT, CCS, GCS [email protected] References Arias, E. (2014). United States Life Tables, 2010. National Vital Statistics Reports, 63(7): 1-62. Cech, D. and Martin, S. (2012). Functional movement development across the lifespan (3rd ed.). St. Louis: Elsevier. Centers for Disease Control and Prevention (2015). Older Adult Falls: Get the Facts. Retrieved from: http://www.cdc.gov/homeandrecreationalsafety/falls/adultfall s.html Centers for Disease Control and Prevention. The State of Aging and Health in America 2013. Atlanta, GA: Centers for Disease Control and Prevention, US Department of Health and Human Services; 2013. Central Intelligence Agency (2014). The World Fact Book. Retrieved from: https://www.cia.gov/library/publications/the-worldfactbook/rankorder/2102rank.html References Guccione, A. A. (2012). Geriatric physical therapy (3rd ed.). St. Louis: Elsevier. Hillegass, E. (2011). Essentials of cardiopulmonary physical therapy (3rd ed.). St. Louis: Elsevier. Kallstrand-Eriksson, J., Baigi, A., Buer, N. & Hildingh, C. (2012). Perceived vision- related quality of life and risk of falling among community living elderly people. Scandinavian Journal of Caring Sciences. doi: 10.1111/j.1471-6712.2012.01053.x Merriwether, E. N., Host, H.H., & Sinacore, D. R. (2012). Sarcopenic indices in community-dwelling older adults. Geriatric Physical Therapy 35(3): 118-125. Shubert, T. E. (2011). Evidence-based exercise prescription for balance and falls prevention: a current review of the literature. Journal of Geriatric Physical Therapy 34(3): 100-108. Singh, H., Kim, D., Kim, E., Bemben, M. Anderson, M. Seo, D., & Bemben, D. A. (2014). Jump test performance and sarcopenia status in men and women, 55 to 75 years of age. Journal of Geriatric Physical Therapy 37(2): 76-82.
