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By Beth Henry

Feb 2010
Types of ageing
Ageing
Chronological
Biological
Chronological age is how
old you are in calendar
years.
Biological age is how old
your body presents based
on lifestyle, medical
history or genetics.
Chronological age can
differ from biological age!
Why do we age?
Most likely to be a combination of intrinsic and
extrinsic factors.
Ageing is inevitable.
>300
theories
exist!
Intrinsic
factors
Genetically
controlled?
Changes in
endocrine
system?
Cell mutations
from altered
replication?
Free radicals?
Extrinsic
factors
Radiation
exposure?
Effects of UV
rays?
Consideration of age
Ageing has an effect on all of the bodies systems - skin,
senses, locomotor, nervous (CNS and PNS),
cardiovascular, respiratory, endocrine and genito-urinary.
The current inpatient population is mostly elderly -
averages of ~65 years in acute wards, ~73 years in
rehabilitation wards and ~81 in continuing care.
Muscle fibres
2 types
Type 1 = slow fibres that
contract and relax slowly
Do not fatigue easily and are
involved in postural support.
Type 2 = fast fibres that
contract and relax quickly
Used for short periods as
they quickly fatigue.
Large, fast movements such
as correcting balance or
sprinting.
Locomotor changes
Muscular:
muscle mass
no. and size of muscle
fibres
no. and size of
mitochondria
proprioception in
muscles and tendons
repair due to enzyme
activity and protein
turnover
connective tissue and
fat
injury and damage
Sarcopenia
A major cause of muscle loss (also known as
sarcopenia) is through disuse and a more sedentary
lifestyle as we age.
Ageing effects the tone, elasticity and strength of the
muscles.
The average person will lose muscle mass by 70
years of age and another by 90 years.
~10 ounces of muscle can be lost per year due to a
sedentary lifestyle.
Directly related to reduced mobility and increased falls
risk in the elderly.
Combating the effects of ageing on
muscle
Studies have shown the importance of:
exercise (resistive / weights)
higher protein diets
creatine supplements
Strength training can make an active 60 year old as
strong as a sedentary 30 year old.
Improvements of strength training have been seen
within 12 weeks.
Locomotor changes
Bone:
bone mass/ density
decalcification
height/stooped posture
(vertebrae affected)
fracture risk
pain
disability and discomfort
postural instability
Bones reach maximum mass between the ages of 25 and 35.
Osteoporosis
brittle bones.
Most common in women after menopause.
Affects 50% of people 50 years and older.
Responsible for more than 1.5 million fractures annually
including >300,000 hip fractures, 700,000 vertebral
fractures and 250,000 wrist fractures.
Osteoporotic fractures cost the NHS 1.6 billion a year!
Deterioration of vertebral support
Combating the effects of ageing on
bones
Studies have shown that exercise (weight bearing and
resistive e.g. with theraband) is most effective and can
increase bone density in older people.
Strong muscles are important to maintain good bone
density and strength.
Balanced diet rich in calcium and vitamin D
Bone density testing and medication where appropriate.
Locomotor changes
Joints:
stability
comfort
ease of movement
proprioception
stiffness
energy cost
Joint structures
Joint
Bone
Joint
capsule
Synovial
Tissue
Tendons
Ligaments
Cartilage
Osteoarthritis (OA)
OA becomes more common with ageing (not an inevitable part of
ageing).
Can often begin in 40s/50s and almost all people are affected to
some degree by 80 years.
Characterised by pain, swelling, bony overgrowth and stiffness
(particularly in the morning or when inactive for long periods).
In the long term joints become enlarged and misshapen.
Irregular surfaces causes grinding or crackling of joints when they
move.
Risk factors include obesity or occupations (e.g. bus driver) which
repeatedly stress/injury to the joints.
Commonly affects fingers, base of thumb, neck, lumbar spine, hips
and knees.
Dealing with OA in the elderly
Gentle exercise (stretching, strengthening, postural
control)
Acupuncture and massage
Heat application
Avoidance of weight gain
Walking aids/supports
Supportive shoes/orthotics
blood pressure
fatty deposits on artery
walls (arteriosclerosis)
Cardiovascular changes (blood, blood
vessels and heart)
erythrocyte production
and red bone marrow
white blood cell activity
elasticity and width of
blood vessels
baroreceptor activity
valve functioning
cardiac output and
circulation
stroke volume

Results in...
Greater risk of anaemia, aneurysms and thrombus
formation. Thus also increased risk of heart attack and
stroke.
Slower response to infection.
Recovery from bleeding episodes is slower.
Slowed adjustments to changes of position = increased
dizziness and falls risk. Older people will tire more
quickly and take longer to recover.
Postural Hypotension
The drop in blood pressure which usually occurs on
standing.
Symptoms: dizziness temporary loss of consciousness
fall
Called a syncope and is caused by reduced venous return.
Can also happen after exercising and is more likely if
valves and veins are impaired.
Standing up slowly or gently contracting leg muscles
before mobilising can help prevent this.
Why is knowledge of ageing
important for health professionals?
A high proportion of hospital
patients have MDT needs
(69%).
A good knowledge of normal
ageing provides a baseline
against which a thorough
examination of elderly
patients can be carried out.
Studies have shown that
exercise can extend survival
even for previously sedentary
85 year olds. Exercise can
extend life span by at least a
few years. >4hrs weekly =
active.
Stereotypical views of the
elderly may be that they are
too old to learn or improve.
Many older people accept this
stereotype.
Continued involvement in
learning helps maintain the
ability to learn.