GERIATRIC PHYSIOTHERAPY

This website contains Physiotherapy materials pertain to Geriatrics but may contain contents related to adults, infants and children. 

 

 

Geriatric physiotherapy became a specialty of physiotherapy study in 1989. Since then, physiotherapists have worked to understand the problems of the aging. There is a long list of problems dealt with in geriatric physiotherapy.

Alzheimer's, arthritis, balance disorders, cancer, cardiovascular disease, incontinence, joint replacement, pulmonary disease, stroke, and osteoporosis are only a few of the problems covered by geriatric physiotherapy. Physiotherapists have a whole range of therapies for these ailments.

The types of problems faced in geriatric physiotherapy are grouped into three different categories. One category is the problems that happen because the patient simply does not use their limbs or does not exercise. These problems can be addressed by reconditioning through range-of-motion exercises and other exercises.

Another category geriatric physiotherapy deals with is cardiovascular disease, like heart disease and stroke. The physiotherapy professional has an array of tools at her disposal to work with these conditions. Exercise, aqua therapy, electrical stimulation, and more can be used.

The third category is skeletal problems. Geriatric physiotherapy helps people who have these disorders, such as osteoporosis and osteoarthritis. These problems require special attention as osteoporosis makes patients frailer, and osteoarthritis is very painful.

Because falls are such a problem, the osteoporosis therapy is crucial. Along with that, geriatric physiotherapy is responsible for preventing many falls because of work with balance and gait. Some clinics focus entirely on balance issues for the elderly.

Much of the work of geriatric physiotherapy is not aimed at returning patients to their earlier states of health. The most important goals are to be able to function at their best abilities. Doing everyday tasks and living an unconfined life are valuable assets.

Another role of geriatric physiotherapy is to help with rehabilitation after knee or hip replacement surgeries. People who have these operations are likely to walk differently. It affects their abilities to do daily chores, and their quality of life. Physiotherapists can help.


 

Age Associated Physiological changes:

 

Age-Associated Cardiovascular Changes

A.Definitioion: Isolated systolic hypertension: systolic BP >140 mmHg and diastolic BP <90 mmHg.

B. Etiology

1. Arterial wall thickening and stiffening, decreased compliance.
2. Left ventricular and atrial hypertrophy.
3. Sclerosis of atrial and mitral valves.

C. Implications

1. Decreased cardiac reserve.

a. At rest: No change in heart rate, cardiac output.
b. Under physiological stress and exercise: Decreased maximal heart rate and cardiac output, resulting in fatigue, SOB, slow recovery from tachycardia.

2. Risk of isolated systolic hypertension; inflamed varicosities.
3. Risk of arrhythmias, postural and diuretic-induced hypotension. May cause syncope.
4. Strong arterial pulses, diminished peripheral pulses, cool extremities.

Age-Associated Changes in the Pulmonary System

1.Etiology

1. Decreased respiratory muscle strength; stiffer chest wall with reduced compliance.
2. Diminished ciliary & macrophage activity, drier mucus membranes. Decreased cough reflex.
3. Decreased response to hypoxia and hypercapnia.

B. Implications

1. Reduced pulmonary functional reserve.

a. At rest: No change.
b. With exertion: Dyspnea, decreased exercise tolerance.

 

2. Decreased respiratory excursion and chest/lung expansion with less effective exhalation. Respiratory rate 12 to 24 bpm.
3. Decreased cough and mucus/foreign matter clearance.
4. Increased risk of infection and bronchospasm with airway obstruction.

Age-Associated Changes in the Renal and Genitourinary Systems 

A.Definitions:Cockroft-Gault Equation: Calculation of creatinine clearance in older adults:

For Men

 

For Women, the calculated value is multiplied by 85% (0.85).

B. Etiology

1. Decreases in kidney mass, blood flow, glomerular filtration rate (10% decrement/decade after age 30). Decreased drug clearance.
2. Reduced bladder elasticity, muscle tone, capacity.
3. Increased post-void residual, nocturnal urine production.
4. In males, prostate enlargement with risk of benign prostatic hyperplasia (BPH).

C. Implications

1. Reduced renal functional reserve; risk of renal complications in illness.
2. Risk of nephrotoxic injury and adverse reactions from drugs.
3. Risk of volume overload (in heart failure), dehydration, hyponatremia (with thiazide diuretics), hypernatremia (associated with fever), hyperkalemia (with potassium-sparing diuretics). Reduced excretion of acid load.
4. Increased risk of urinary urgency, incontinence (not a normal finding), UTI, nocturnal polyuria. Potential for falls.

Age-Associated Changes in the Oropharyngeal and Gastrointestinal Systems

A.Definition:
BMI: Healthy: 18.5–24.9 kg/m2; overweight: 25–29.9 kg/m2; obesity: >30 kg/m2.

B. Etiology

1. Decreases in strength of muscles of mastication, taste, and thirst perception.
2. Decreased gastric motility with delayed emptying. Atrophy of protective mucosa.
3. Malabsorption of carbohydrates, vitamins B12 and D, folic acid, calcium.
4. Impaired sensation to defecate. 5. Reduced hepatic reserve. Decreased metabolism of drugs.

C. Implications

1. Risk of chewing impairment, fluid/electrolyte imbalances, poor nutrition.
2. Gastric changes: altered drug absorption, increased risk of gastroesophageal reflux disease (GERD), maldigestion, nonsteroidal anti-inflammatory drug-induced ulcers.
3. Constipation not a normal finding. Risk of fecal incontinence with disease (not in healthy aging).
4. Stable liver function tests. Risk of adverse drug reactions.

Age-Associated Changes in the Musculoskeletal System

A. Definition:

Sarcopenia: Decline in muscle mass and strength associated with aging.

B. Etiology

1. Sarcopenia with increased weakness and poor exercise tolerance.
2. Lean body mass replaced by fat with redistribution of fat.
3. Bone loss in women and men after peak mass at 30 to 35 years.
4. Decreased ligament and tendon strength. Intervertebral disc degeneration. Articular cartilage erosion. Changes in stature with kyphosis, height reduction.

C. Implications

1. Sarcopenia: increased risk of disability, falls, unstable gait.
2. Risk of osteopenia and osteoporosis.
3. Limited ROM, joint instability, risk of osteoarthritis.

Age-Associated Changes in the Nervous System and Cognition

A. Etiology

1. Decrease in neurons and neurotransmitters.
2. Modifications in cerebral dendrites, glial support cells, synapses.
3. Compromised thermoregulation.

B. Implications

1. Impairments in general muscle strength; deep-tendon reflexes; nerve conduction velocity. Slowed motor skills and potential deficits in balance and coordination.
2. Decreased temperature sensitivity. Blunted febrile response to infection.
3. Slowed speed of cognitive processing. Some cognitive decline is common but not universal. Most memory functions adequate for normal life.
4. Increased risk of sleep disorders, delirium, neurodegenerative diseases.

References

2. Kenny, R. A. (2003). Syncope. In W. R. Hazzard, J. P. Blass, J. B. Halter, J. G. Ouslander, & M. E. Tinetti (Eds.), Principles of geriatric medicine and gerontology (pp. 1553–1562).NY: McGraw-Hill. Evidence Level V: Literature Review.

4. Watters, J. M. (2002). Surgery in the elderly. Canadian Journal of Surgery, 45, 104–108. Evidence Level V: Literature Review.

5. Zeleznik, J. (2003). Normative aging of the respiratory system. Clinics in Geriatric Medicine, 19, 1–18. Evidence Level V: Literature Review.

28. Conn, V. S., Minor, M. A., Burks, K. J., Rantz, M. J., & Pomeroy, S. H. (2003). Integrative review of physical activity intervention research with aging adults. Journal of the American Geriatrics Society, 51(8), 1159–1168. Evidence Level I: Systematic Review.

29. Conn, V. S., Valentine, J. C., & Cooper, H. M. (2002). Interventions to increase physical activity among aging adults: A meta-analysis. Annals of Behavioral Medicine, 24(3), 190–200. Evidence Level I: Meta-analysis.

30. Fielding, R. A., LeBrasseur, N. K., Cuoco, A., Bean, J., Mizer, K., & Singh, M. A. F. (2002). High-velocity resistance training increases skeletal muscle peak power in older women. Journal of the American Geriatrics Society, 50(4), 655–662. Evidence Level II: Single Experimental Study.

31. Netz, Y., Wu, M. J., Becker, B. J., & Tenenbaum, G. (2005). Physical activity and psychological well-being in advanced age: A meta-analysis of intervention studies. Psychology & Aging, 20(2), 272–284. Evidence Level I: Meta-analysis.

32. Carter, N. D., Kannus, P., & Khan, K. M. (2001). Exercise in the prevention of falls in older people: A systematic literature review examining the rationale and the evidence. Sports Medicine, 31(6), 427–438. Evidence Level I: Systematic Review.

33. U.S. Department of Health and Human Services. (2004a). Bone health and osteoporosis: A report of the Surgeon General. Retrieved February 13, 2007, from http://www.surgeongeneral.gov/library/bonehealth. Evidence Level I: Systematic Review.

34. U.S. Preventive Services Task Force. (1996). Guide to clinical preventive services: Report of the U.S. Preventive Services Task Force. Baltimore, MD: Williams & Wilkins. Evidence Level I: Systematic Review.

35. U.S. Preventive Services Task Force. (2002). Guide to clinical preventive services: Report of the U.S. Preventive Services Task Force. Retrieved January 23, 2007, from http://www.ahrq.gov/uspstfix.htm. Evidence Level I: Systematic Review.

36. Craft, S., Cholerton, B., & Reger, M. (2003). Aging and cognition: What is normal? In W. R. Hazzard, J. P. Blass, J. B. Halter, J. G. Ouslander, & M. E. Tinetti (Eds.), Principles of geriatric medicine and gerontology (pp. 1355–1372).NY: McGraw-Hill. Evidence Level V: Literature Review.

 

Disclaimer: This website contains Physiotherapy and clinical contents that are taken from various websites that are free to use for educational and physiotherapy professional use only.This wesite may contain other content other than Physiotherapy materials. The contents presented here are for reference only and the author will not be responsible for any errors or omissions. Any patient refering this website should not take this as sole treatment method and must always discuss with their own doctor for treatment options.

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