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Effects of Aging on Mobility and Independence Anthony Poggio, DPM,MS Cal ‘79 Affects of Aging • • • • • • • Muscle Tendon Bone Skin Neurology Vascular Psych 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 Muscle/Tendon • Changes at the motor end plate, Sarcolemma are fewer, shorter, become smoother • decrease in surface area therefore decrease in stimulation potential 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) Muscle/Tendon • Decreased circulation to bring in O2 and nutrients • breakdown of other substances creating build up of lactic acid 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 Bone • skeletal structure • Attachment for muscle, tendons. ligaments, etc • Blood cell production • • • • Osteoporosis Osteopenia fracture, hip delayed healing 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 Joint • Arthritis – Joint Stiffness – loss of cartilage – loss of joint contour – angular deformities • Synovial membrane less elastic as are adjacent ligament structure • with less movementjoint (ligaments) contract to position • Hyaline vs fibrocartilage Joints • Loss of hyaline cartilage • decreased water content with increased calcium salts, crosslinking of fibers therefore more stiff and less elastic • can reform fibrocartilage 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 Skin • Provides barrier – organisms, – chemicals, – water, – light, – trauma E Epidermis PIDERMIS ROLE: Provides Protective Covering & Generates New Cell Growth With aging less able to keep out substances; chemicals, microorganisms athletes foot, fissures D Dermis ERMIS ROLE: Provide the Skin with Strength & Elasticity 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 Subcutaneous tissue UTANEOUS TISSUE ROLE: Provides protection & insulation for the underlying tissue • With aging – decreased fat: decreased cushion, callous/corns – less skin support: increased sheer force • ***Typically the subcutaneous tissue is poorly vascularized. Skin • Decubitus ulcers-bed sore – – – – – – weaker skin thinner skin decreased blood supply skin hygiene poor nutrition decreased ability to repair COMMON LOCATIONS Bony Prominences • Occiput • Scapulae • Elbows • Sacrum • Trochanter • Ischium • Knees • Ankles • Heels COSTS OF PRESSURE ULCERS • 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 PRESSURE ULCERS • 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 DEFINITION OF A PRESSURE ULCER • Localized area of tissue breakdown resulting from compression of soft tissue between a bony prominence and an external surface SKIN BREAKDOWN: DIABETIC ULCERS Skin breakdown due to loss of sensation coupled with repetitive pressure and shear Vascular Function: Transportation • Peripheral arterial disease • venous disease • diminished healing ability, defense • micro-circulation to muscle, nerves, etc • amputation Venous disease • Return blood to heart • slower blood flow-clot formation • venous stasis dermatitis- skin damage CAPILLARY HYPERTENSION • Capillaries have thin, single-cell thickness walls • Venous hypertension causes capillary walls to stretch, creating gaps between cells Neurology • Function – – – – monitoring, communicating stimulation coordination Neurologic • Nerve Loss – sensory – motor • Coordination • reflexes 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 Misc • Vision – obstacle • cardiac • pulmonary – stamina Putting it all together function mobility independence AGING musculoskeletal neurologic dermatologic vascular Psychological Factors • Loss of independence – fear of losing independence – rely on family/friends for simply tasks – must be done at their convenience – isolation Psychological Factors • Assistive devices – realization they are old – embarrassment in public – limitation in activities Psychological Factors • Self Care – inability to bend to reach items – open bottles, apply dressing Psychological Factors • Fear of Falling • Decreased stamina • Cycle of decreased activity – more stiffness – decreased vasc supply and overall health – less coordination – increased isolation – depression Prevention/Treatment • In home support vs nursing home • improvement in function – physical therapy, medication • Age related or not?? • Social agencies – paratransit, special equipment (scooters) Prevention/Treatment • • • • • Put in perspective Enlist family support active participation-feel in control speak to them, not down to them patience THANK YOU! Good Luck in Your Future Careers GO BEARS!!!