Effects of Aging on Mobility and Independence

1. Effects of Aging on Mobility and Independence Anthony Poggio, DPM,MS Cal ‘79

2. Muscle Tendon Bone Skin Neurology Vascular Psych Affects of Aging

3. 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

4. Changes at the motor end plate, Sarcolemma are fewer, shorter, become smoother decrease in surface area therefore decrease in stimulation potential Muscle/Tendon

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. Decreased circulation to bring in O2 and nutrients breakdown of other substances creating build up of lactic acid Muscle/Tendon

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. skeletal structure Attachment for muscle, tendons. ligaments, etc Blood cell production Osteoporosis Osteopenia fracture, hip delayed healing Bone

9. 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 Bone

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

15. Provides barrier organisms, chemicals, water, light, trauma Skin

16. EEpidermisPIDERMIS ROLE: Provides Protective Covering & Generates New Cell Growth With aging less able to keep out substances; chemicals, microorganisms athletes foot, fissures

17. D DermisERMIS 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

18. 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.

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. 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

22. 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

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

26. SKIN BREAKDOWN: DIABETIC ULCERS Skin breakdown due to loss of sensation coupled with repetitive pressure and shear

27. Peripheral arterial disease venous disease diminished healing ability, defense micro-circulation to muscle, nerves, etc amputation Vascular Function: Transportation

30. Venous disease • Return blood to heart • slower blood flow-clot formation • venous stasis dermatitis- skin damage

31. CAPILLARY HYPERTENSION • Capillaries have thin, single-cell thickness walls • Venous hypertension causes capillary walls to stretch, creating gaps between cells

32. Neurology • Function • monitoring, • communicating • stimulation • coordination

33. Nerve Loss sensory motor Coordination reflexes Neurologic

34. 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 Neurology

36. Misc • Vision • obstacle • cardiac • pulmonary • stamina

37. Putting it all together

38. Loss of independence fear of losing independence rely on family/friends for simply tasks must be done at their convenience isolation Psychological Factors

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. Fear of Falling Decreased stamina Cycle of decreased activity more stiffness decreased vasc supply and overall health less coordination increased isolation depression Psychological Factors

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 GO BEARS!!!