Fundamentals - Gerontology, part 3: Neurological and Musculoskeletal Changes in Aging Adults
by Ellis Parker February 16, 2023 Updated: August 09, 2023 4 min read
- 0:00 What to expect - Aging Changes
- 0:20 Nervous system changes
- 3:05 Musculoskeletal system changes
- 4:51 Quiz Time!
Hi. I'm Ellis, and in this video, I'll be discussing the physiological changes of the older adult, and I'll be covering the nervous system and musculoskeletal system. So these cards can be found in our gerontology section of our fundamentals flashcard deck, so if you have that deck, go ahead and grab these cards, and you can follow along with me.
When it comes to the nervous system, older adults experience some cerebral atrophy, meaning that the size and the number of neurons decreases, and there is a decrease in cerebral blood flow, which combined is going to decrease the cognitive function a little. Right? There's some forgetfulness, like day-to-day mild memory issues. Right? So to be clear, if it is a significant change in cognitive function, that's not normal. Dementia is not a normal part of aging and should not be treated as, "Well, that's just what happens. They're just older, and that's kind of what happens to you." Just a little bit of change is what is normal. The other part of the nervous system that's going to be affected is going to be reflexes, so they have delayed reaction times, slower reflexes, a decrease in senses, and that's all of them: vision, taste, hearing, smell, touch. Everything is just a little slower, a little less effective.
They also have an increased issue with sleep-wake alterations, so they usually have less sleep and less quality sleep. So they sleep for shorter periods of time, and they may not feel as rested, maybe, as they once did. And they have a higher risk for chronic pain. The problem with chronic pain with people that have cognitive disorders is that it's really difficult to get a reliable or accurate assessment and measurement of it. Right? I can't use the assessments that I might use on an adult or a person that doesn't have a cognitive disorder. They're not going to be able to rate their pain on a scale of 1 to 10, so we have to make sure that we're using other factors. Look at their facial expressions, their appetite. Right? Are they eating how they've been eating, how they used to eat? Has their appetite changed? Their sleep disturbances. Are they having more trouble sleeping than they used to? Their mood or their behavior. And a lot of those assessments and questions can be really helpful to ask a caregiver or a loved one because I may not know what their baseline mood or behavior or appetite is, and so I might attribute how they're acting to their cognitive disorder and just think that that's part of their cognitive disorder. But it's really important to ask their loved one or their caregiver or someone who knows, "Is this their baseline? Is this normal for them?" Because if it's not, then something else might be going on, and we need to make sure that we're assessing that and addressing all of those issues.
The musculoskeletal card has a number of things that are in bold and red, so make sure you check those out so that you can remember them because those are key points to remember. So we'll start with bone density. The older adult has a decreased bone density, and that's going to increase their risk for osteoporosis and increase their risk for fractures. Older adults also have a higher chance of falls and falling, and there are a lot of contributing reasons to that, one of those being if they've had previous falls, they're more likely to fall again. If they have impaired vision or impaired balance, if they are experiencing polypharmacy, if they are experiencing incontinence or cognitive decline, if they have pain or orthostatic hypotension. Those are just some but the more common reasons that somebody might fall. And so there is a lot of nursing considerations when it comes to older adults and falling, and we want to make sure that we're implementing all of the appropriate safety measures appropriate to that patient to hopefully prevent and decrease that risk of falls. Other musculoskeletal changes in the older adult includes muscle atrophy, so the muscle decreases in size and strength and endurance, joints have a tendency to stiffen, which will decrease the range of motion, and older adults that are a higher risk, they're at a higher risk for arthritis. Another significant musculoskeletal change is kyphosis. Kyphosis is a curvature or a rounding of the thoracic spine, so this top part of my spine here. It has a tendency to curve, and it does actually decrease that person's height a little bit.
What are two age-related changes in the nervous system that may lead to a decrease in cognitive function? Cerebral atrophy and a decrease in cerebral blood flow. What are three of the risk factors that I mentioned that may contribute to an increased risk for falling in an older adult? The risk factors I mentioned are having prior falls, impaired vision, impaired balance, polypharmacy, incontinence, cognitive decline, pain, and orthostatic hypotension. Define kyphosis. Kyphosis is an abnormal forward curvature of the thoracic spine.
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