Special Populations: Geriatrics




Abstract


By 2030, approximately 20% of the U.S. population will be older than 65 years of age. Research has proven that regular exercise in the elderly population provides many health benefits. Appropriate exercise is safe in the elderly population and provides numerous health benefits. It is recommended that elderly patients have 30 minutes of exercise at least 5 days each week. Although physiologic changes occur with aging, the capacity for the elderly patient to exercise and improve strength, endurance, flexibility, and performance is maintained. Age-related changes in physiology affect metabolism of many medications, especially medications used to treat pain related to acute, chronic, or postoperative musculoskeletal conditions. With the increasing elderly population, every health care provider must be familiar with the physiologic changes with aging, as well as common musculoskeletal conditions and the impact of comorbidities on these conditions. Physicians can support healthy lifestyles in the elderly with an exercise prescription.




Keywords

Activities of daily living, exercise prescription, age-related physiology, Beer’s criteria, elderly, geriatrics

 







ICD-10-CM Codes







































M15.0 Osteoarthritis (OA)
M67.90 Tendonoses
S46.019A Rotator cuff strains
M77.0 Medial epicondylitis
M76.60 Achilles tendinitis
M23.309 Degenerative meniscus tears
T14.8XXA Muscle strains
M84.40XA Spontaneous fracture
M84.50XA Non-traumatic fracture
M85.80 Osteopenia
M81.0 Osteoporosis




Key Concepts





  • By 2030, approximately 20% of the U.S. population will be older than 65 years of age.



  • Geriatric medicine is medicine focused on patients older than 65 years.



  • Research has proven that regular exercise in the geriatric population provides many health benefits.



  • Appropriate exercise is safe in the geriatric population and provides numerous health benefits.



  • It is recommended that geriatric patients have 30 minutes of exercise at least 5 days each week.



  • Although physiologic changes occur with aging, the capacity for the geriatric patient to exercise and improve strength, endurance, flexibility, and performance is maintained.



  • Age-related changes in physiology affect metabolism of many medications, especially medications used to treat pain related to acute, chronic, or postoperative musculoskeletal conditions.



  • With the increasing geriatric population, every health care provider must be familiar with the physiologic changes with aging, as well as common musculoskeletal conditions and the impact of comorbidities on these conditions.



  • Physicians can support healthy lifestyles in the geriatric patient with an exercise prescription.





Physiologic Changes Associated With Aging





  • Elderly adults have a decline in coordination, balance, and reaction time, as well as impaired vision, hearing, and short-term memory.



  • Elderly adults have a decrease in bone mineral density, with losses as high as 3% per year in postmenopausal women and 0.5% per year in men older than 40 years.



  • Elderly adults can develop sarcopenia, with an average 30% reduction in strength from age 50 to age 70 secondary to atrophy of type II muscle fibers, with associated decrease in tensile strength and increased stiffness of tendons and ligaments.



  • Elderly adults also have weakening of articular cartilage and a decrease in elastic properties of intervertebral disks.



  • Geriatric patients do not have increases of antidiuretic hormone (ADH) with activity to signal thirst and need for hydration.



  • Body composition changes with age, leading to increased total body fat distribution that leads to increased retention of fat-soluble medication, such as those that cross the blood-brain barrier, as well as increased risk for dose stacking.



  • With normal aging, there is a decrease in renal function (both number of functioning nephrons and incoming blood flow) in the geriatric population. Hepatic metabolism is not affected by normal aging. This change in renal function affects the types and doses of safe medications.



  • Functional changes with aging can lead to impairment that can be assessed by determining a patient’s ability to perform their activities of daily living (ADLs) ( Box 5.1 ).



    Box 5.1

    Activities of Daily Living





    • Dressing



    • Eating



    • Ambulating



    • Toileting



    • Hygiene





  • As a person is less able to independently do their ADLs, their all-cause mortality risk increases with this functional decline.


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Sep 17, 2019 | Posted by in ORTHOPEDIC | Comments Off on Special Populations: Geriatrics
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