reabilitare geriatrica ii pdf

7/28/2019 Reabilitare Geriatrica II PDF

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Reabilitare Geriatric II

Daiana PopaSpitalul Clinic de Recuperare Medical B ile-Felix


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Aging is a multidisciplinary field: Biology, sociology, and psychology public policy and economics

Gerontology is the study of the aging: the study of physical, mental, and social changes in older people as

they age the investigation of the changes in society resulting from our aging

population the application of this knowledge to policies and programs

Geriatrics is: the study of health and disease in later life the comprehensive health care of older persons


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Aging

As people age, some physiologic changes areinevitable

Other changes, while not universal, are far morecommon than among younger people

Older people also face unique psycho-socialchallenges

These changes and challenges can lead to a varietyof geriatric syndromes and issues

These in turn can lead to: Poor health outcomes Functional decline, Frailty, Disability and dependence


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Social Problems More Commonwith Aging

Loss of income Loss of close family

Loss of community Social isolation


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Geriatric Interdisciplinary Team

Medicine Nursing Social Work Psychiatry Psychology Case Management

Physical Therapy Occupational Therapy Speech Pathology Pharmacology Chaplaincy Recreation Therapy


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Fiziologia Imbatranirii "

Tegumente "

Compozitiacorporala "

Tulburarisenzoriale "

Sistem"

Nervos"

Musculoscheletal "

Renal "

GI"

Cardiovascular "

Pulmonar "


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Rezerva Functionala

Redundanta un numar mai mare de celule decat strictul necesar

Odata cu imbatranirea rezerva functionala sereduce - orice injurie poate avea consecintemult mai grave


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Fiziologia Imb trnirii

Sc derea capacit ii de rezerv a organelor si sistemelor

Sc derea controlului intern homeostatic Sc derea adaptarii la diferi i factorii de mediu

(temperatura, pozi ia ortostatic , schimbareaposturii)

Sc derea capacit ii de a r spunde la stress


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Modific ri SNC

Tulbur ri cognitive (memorie, vitez deprocesare,etc)

Tulbur ri de conducere nervoas (n. motor,senzitiv) Modific ri de postur , proprioceptie si mers


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Declinul Sensorial:

Vederea si auzul

Gustul si mirosul

Somestezia: tactila , terminca, dureroasa

Proprioceptia

Kinesthesia


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Tulburarile de vedere

afecteaza 20-30% dintre persoanele peste75 de ani.

Cele mai frecvente la varstnici: Cataracta Glaucomul Degenerarea Maculara

Retinopatia diabetica Orbirea


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Cataracts


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Glaucoma


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Macular Degeneration


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Diabetic Retinopthy


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Imbatranirea pielii

Susceptibilitate crescuta la leziuni Vindecarea intarziata Scaderea raspunsului inflamator Scaderea protectiei UV Scaderea elasticitatii riduri Sensibilitate la alergii Scaderea sensibilitatii tactile, termice, dureroase Scaderea termoreglarii


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Modific ri musculo-scheletale

Sc derea For ei Musculare: (factorimetabolici, celulari, neurali) MI cu 14-16% / decad MS cu 2% (femei) 12% (barbati) / decad

Osteoporoza Osteartita (artroza) / modific ri degenerative

peste 60 ani La articula iile portante Scade rezisten a cartilajului articular


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Scaderea performantei neuro-musculare: Scade forta musculara Scade viteza de reactie Oboseala precoce

Inactivitate Tulburari de echilibru Limitari functionale


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Modific ri musculo-scheletaleScade masa musculara Modificarea compozitiei muschiului Scade numarul fibrelor musculare tip II Reducerea nr. celulelor musculare SARCOPENIE Scade IMS (sub 5,75kg/m2 femei; 8,50kg/m2 barbati) Reducerea proteinelor contractile Scaderea fortei musculare:

Incepe in decada a III a Se accelereaza in decada a VI-a si a VII-a Rata pierderii = 8% pe decada Scade si mai mult in caz de boli cronice


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Scade anduranta Creste fatigabilitatea musculara

Scade afluxul sanguin Scade densitatea capilarelor Scade transportul glucozei Scade activitatea enzimelor oxidative Scade sinteza PC


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Alterarea unitatilor motorii

Reducerea motoneuronilor din c. anterioareale MS

Scade viteza de conducere nervoasa Scade transmiterea joctionale Scade neurotransmitatorii

Scade recrutarea unitatilor motorii


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Aparat respirator

Scade capacitatea pulmonar : Scade rezerva func ional Acumularea noxelor Scade elastictatea cutiei toracice Scade for a mu chilor respiratori

Scade circula ia pulmonar Cre te riscul de infec ii


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Sistemul Genito-urinar

Hiperplazia de prostat Incontinen a urinar

Hipereactivitatea detrusorului Prolapsul genital Obstuciile uretrei

Vezica neurogena Cancerele genitale


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Modificari articulare

Mobilitate Articulatii sinoviale

(diartroze)

Stabilitate Articulatii nonsinoviale

(sinartroze)


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Modificarile Articulatiilor Sinoviale

Scade flexibilitatea capsulei Creste rigiditatea ligamentelor scade numarul fibrelor de colagen Se reduce cantitatea si calitatea lichidului sinovial


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Calcificare

Rigidizare

Articulatii Fibroase -- Suturi


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Articulatii Cartilaginoase -- Simfize

2 oase unite printr-unfibrocartilaj Simfiza pubiana Discul interrvertebral

grad minim de mobilitate Deshidratare Degenerescenta Rigidizare Reducerea mobilitatii


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Ligamentele periarticulare


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Modificarile cartilajului articulatiior sinoviale

Scade continutul hidric /imbibitia cu lichid sinovial

Scade cantitatea decondroitina, glucozamina,proteoglican

Creste rezistenta la alunecare Apar neregularitati ale

suprafetelor

Scade grosimea cartilajului Scade ROM Scade propripceptia


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Stg: aspect normal Dr. artoza avansata


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Modificari articulare

Noduli Heberden

Noduli Bouchard


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Sindroame Geriatrice

Deficite Senzoriale Deficite de mers Caderi

Incontinenta Dementa Depresie Delir

Polipragmazie Tulburari de somn Leziuni de decubit (escare)


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Vulnerabilitatea varstnicului

Declinul biologic al tuturor tesuturior si functiilor organismului

Prezenta comorbiditatilor Tulburari cognitive, dementa, delir Opreste, intarzie sau modifica programul de

recuperare


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Deconditionarea

Deconditionarea declinul andurantei cardiovasculare Declinul fortei musculare

Activitatile uzuale zilnice: Ajuta la mentinerea mobilitatii si a fortei

musculare Nu au efect de antrenare a anduranteicardiovasculare


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Imobilizarea cauza majora a

deconditionarii Pierderea rapida a fortei musculare: 2-3% pe zi

/ 25-30% in 2 saptamani

Accelerarea pierderii de Masa Osoasa Contracturi cauzate de aderenta colagenului din

muschii flexori si positionarea inadecvata Edemul

Risc de TVP Scaderea volumului pulmonar Incontinenta urinara

R di i


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Re-conditionarea

Antrenametul Cardiovascular este eficientdar trebuie supravegheat

Exercitii de grup ca Tai Chi amelioreazaforta musculara a MI, echilibrul, stareapsihologica, dar nu are efecte demonstrateasupra andurantei cardiovasculare

Combinate cu exercitii rezistive pot aveaefecte asupra rezistentei fizice


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Aerobic Exercise Prescriptionfor Elderly

Prescription Active elderly Sedentary Elderly

HR max 60-80% 40-60%

Duration 20 min 10 min

Frequency 3 x / week 5 x / week

Period 14 weeks 14 weeks

Star with low intensity

Intervalize shorter exercise

Keep total session time at > 30 min


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Training threshold for the elderly

Is there a lower threshold below which there is nobenefit effect at all?

For unconditioned elderly, submaximal exerciseeven at 40-50% max HR can benefit.

This is also the rationale for reconditioning trainingin patients with chronic renal failure or congestiveheart failure.

ecommen a ons or ys ca c v y


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ecommen a ons or ys ca c v yin Older Adults

Minimum activity for achieving important health benefits Two hours and 30 minutes (150 minutes) of moderate-intensity aerobic activity (e.g.,

brisk walking) a week, plus muscle-strengthening activities on at least two days of the week or

One hour and 15 minutes (75 minutes) of vigorous-intensity aerobic activity (e.g., jogging, running) a week, plus muscle-strengthening activities on at least two days of the week or

A combination of moderate- and vigorous-intensity aerobic activity equivalent to therecommendations above, plus muscle-strengthening activities on at least two days of the week

Increased activity for achieving additional health benefits Five hours (300 minutes) of moderate-intensity aerobic activity a week, plus muscle-

strengthening activities on at least two days of the week or Two hours and 30 minutes (150 minutes) of vigorous-intensity aerobic activity a

week, plus muscle-strengthening activities on at least two days of the week or A combination of moderate- and vigorous-intensity aerobic activity equivalent to the

recommendations above, plus muscle-strengthening activities on at least two days of

the week

KEY RECOMMENDATIONS FOR PRACTICE American


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KEY RECOMMENDATIONS FOR PRACTICE AmericanHeart Association

To promote and maintain health, older adults should participate in moderate-intensityaerobic activity for at least 30 minutes on five days of the week , or vigorous-intensityaerobic activity for at least 20 minutes on three days of the week.

Moderate- and vigorous-intensity activity can be combined to meet the minimumrecommendation for aerobic activity.

To promote and maintain health and physical independence, older adults should performmuscle- strengthening activities on at least two days of the week.

Participation in more than the minimum recommended amount of aerobic and muscle-strengthening activities leads to additional health benefits and higher levels of fitness.

To reduce the risk of falls and related injuries, community-dwelling older adults withsubstantial risk of falling should perform exercises that maintain or improve balance.

To maintain the flexibility necessary for regular physical activity and daily life, older adultsshould perform activities that maintain or increase flexibility for at least 10 minutes on atleast two days of the week.

Health Benefits of Physical Activity in Adults


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Health Benefits of Physical Activity in Adults

Strong evidence Decreased risk of early death, heart disease, stroke, type 2 diabetes mellitus,

high blood pressure, adverse blood lipid profile, metabolic syndrome, and colonand breast cancers

Prevention of weight gain, weight loss, when combined with healthy diet Improved cardiorespiratory and muscular fitness Fall prevention

Reduced depression Improved cognitive function (older adults)Moderate to strong evidence Improved functional health (older adults) Reduced abdominal obesity

Moderate evidence Weight maintenance after weight loss Decreased risk of hip fracture Increased bone density Improved sleep quality

reabilitare geriatrica ii pdf

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