It is a universal phenomenon in the lives of humans from conception, and according to most biologists the aging begins from the fourth decade of life and ends with death, the end of biological life.
It is the progressive decline in the function and performance .aging is the process of growing old, resulting in part from the failure of body cells to function normally or to produce new body cells to replace them that are dead or malfunctioning.
Due to the growing age there is a reduction in bodily functions and various changes in systems and organs. With the limits imposed, retirement age is assumed by the following;
• Calendar (chronological, determined by years of age)
• Biological (functional, determined in individual characteristics)
• Law (statutory retirement age limit)
• Economics(lack of activity, a reduction of income)
• Social( related to the loss of prestige and social roles)
• Psychological(determined by the study of intellectual function)
Old age is divided into periods, according to World Health Organization old age is divided into 3 periods;
1. Aging (early old age):young old =60-70 years
2. Old age (late age) old-old =70-90 years of age
3. Longevity (long-lived)= 90 years and older
Physiological changes occurring during aging run unevenly in the various organs and systems of the body, and may also take place at different rates in individual. With increasing lifespan; older adults are living with multiple co-morbidities. Due to the ageing effect on the health status of older adults and their disease pattern of presentation, it is advisable to older people for physiotherapy in order to train their musculoskeletal, neurological and cardiovascular conditions.
Some of the conditions in elderly people and the role of Physiotherapy
1. Cardiovascular disease (CVDs)
CVDs are a group of disorders of the heart and blood vessels. They include coronary heart disease, peripheral arterial disease, congenital heart disease,cerebrovascular disease, aortic atherosclerosis.
Aging can cause changes in the heart and blood vessels. Changes that happen with age may increase a person’s risk of heart disease. Major cause of heart disease is a buildup of fatty deposits in the walls of arteries over many years.
People with age 65 and much older are more likely to suffer a heart attack than the younger people. Patient with CVDs will feel pain or discomfort in the center of the chest, arms , left shoulder, elbows jaw or back and shortness of breath ,nausea, vomiting ,pallor and cold sweat
Physiotherapy role
• Cardiac rehabilitation programmes have been shown to be effective with physiotherapist playing a key role in these programmes. It has shown reduce length of hospital stays as well as the number of cardiovascular related admissions, cardiac mortality and improved quality of life.
• Cardiac rehabilitation include exercise , education and support
• Physical activity performed at an intensity of >40% of maximal aerobic capacity has shown the greatest benefits in reducing the development or progressing of CVD. Aerobic exercise increase peoples cardiac output, maximum heart rate endurance and arterial blood flow.
• Physiotherapists can help to reduce long term risk.
2. Cerebrovascular disease (stroke)
Stroke is a neurological condition, occurs when there is an interruption of the blood supply to particular area of the brain, ultimately leading to cell injury and cell death. Stroke is common in older people and the progressive increase in life –expectancy observed in recent decades in many countries which resulted in an increase in no. of people at risk for stroke. It occurs in all age group but double risk group is between the ages of 55-85 years. Stroke may cause due to High blood pressure or hypertension, cigarette smoking, heart disease, diabetes, cholesterol imbalance and physical inactivity and obesity.
The warning signs of stroke are sudden numbness or weakness of face, arm, and leg especially on one side of the body. Sudden confusion, trouble talking or understanding speech, trouble seeing in one or both eyes, troubling walking, dizziness or loss of balance or coordination, severe headache with no known cause. Other signs are double vision, drowsiness and nausea or vomiting. Sometimes the signs may last only a few moments and disappear.
Role of Physiotherapy
• Prevent ignorance or unawareness of the affected/ hemiplegic side
• Decrease tendency to develop synergy in the chronic stage
• Prevention of any joint restriction or stiffness
• Prevention of complication like chest complication, deconditioning of bone and muscles
• Early weight bearing
• Psychological counseling and education to family
• Prevents pressure sores by proper positioning of the patient
• Prevent from deconditioning by early mobilization in the bed
• Improve sensory function by repeated sensory stimuli from distal to proximal or by using different neurological approaches.
• Improve flexibility and joint integrity
• Helps to manage spasticity by stretching
• Improve motor control,&motor learning
• Postural control and functional mobility
• Improve upper extremity functions, and lower limb function
• Managing shoulder pain
• Improve balance, locomotion and aerobic function by balance training & gait training.
• Physiotherapy also helps in fatigue management
In the past decade it has seen an exponential growth in the no. Randomized trials in relation to physiotherapy intervention utilized in stroke. Some of techniques uses for stroke rehabilitation are ;Constraint induced movement therapy, Mirror therapy, Motor imagery and Mental Practice, Virtual reality, Functional electrical stimulation, Robot assisted arm training, Bilateral arm training, Electro-mechanical assisted gait training, Bobath technique, PNF Technique, Motor relearning program, Hydrotherapy .
3. Neurodegenerative disease
Neurodegenerative disease is an umbrella term for a range of conditions which primarily affect the neurons in the human brain. These age- dependent disorders are becoming increasingly prevalent, in part because the elderly population has increased in recent years. This cause problem with movement and affect a person’s ability to move, speak and breathe. Neurodegenerative disease are; Alzheimer’s disease, Parkinson’s disease, Prion disease, Motor neuron disease, Huntington disease, Spinocerebellar ataxia and Spinal muscular atrophy.
Role of physiotherapy
Neurodegenerative disorders are a group of progressive neurological disease that causes worsening motor, cognitive and autonomic dysfunction over time.
• Maintain and improve levels of function and independence which will help to improve a person’s quality of life
• Use exercise and movement strategies to improve mobility
• Correct and improve abnormal movement patterns and posture, where possible
• Maximize muscle strength and joint flexibility
• Correct and improve posture and balance and minimize risk of falls
• Maintain a good breathing pattern and effective cough
• Educate the person and their care-giver or family members
• Enhance the effects of drug therapy
4. Arthritis
Arthritis is defined as an acute or chronic joint inflammation that often co-exists with pain and structural damage. It is a set of symptoms that includes pain, stiffness and joint deformities subsequent to an inflammatory process. The two common type of arthritis are Osteoarthritis (OA) and Rheumatoid arthritis (RA).
Osteoarthritis (OA) - OA is one of the most chronic conditions of the joint.It happens when the tissue that cushions the joints wear away, causing pain and stiffness, often occurs in knee, hips, lower back and neck, small joints of fingers and the bases of thumb and toes. OA is one of the most prevalentconditions resulting in disability particularly in elderly population. It usually emerges in people aged over 40 and prevalence rises with increasing age. It is more common in women.
OA causes decrease muscle strength, decreased flexibility, weight gain, limitation in the ability to do activities of daily living and often compromise mobility.
Rheumatoid arthritis (RA) - RA is an autoimmune disease causes joints to become inflamed.it usually affects more than one joint. In RA, joints complaints are in foreground, polyarthritis in small joints of hands, other affected joints include wrist, elbows, shoulder, hip, knee and ankle. The peak onset age is between 30-50 years with increasing prevalence with age. Common signs are morning stiffness multiple joint pain, swelling, fatigue and weight loss and difficulty in doing activities of daily living.
Role of physiotherapy in arthritis
• Physiotherapy plays an integral role in the non-pharmacologic management of arthritis.
• Helps client’s cope with chronic pain and disability through the design of programs that address flexibility, endurance, aerobic condition, to increase range of motion, strength, bone integrity, coordination, balance and risk of falls.
• Physical exercise helps to increase the physical capacity and improves general muscular endurance and strength without detrimental effect on disease activity or pain in arthritis.
• Exercise therapy aimed in improving daily functioning and social participation by means of improving strength, aerobic condition, the range of motion, stabilization and coordination.
5. Low back pain in Elderly people
Low back pain is one of the major disabling health conditions among older people aged 60 years or older. Most of the causes of low back pain among older people are non-specific and self-limiting; old age people are prone to develop certain low back pain pathologies like osteoporotic vertebral fractures- which is common fragility fractures of the spine due to osteoporosis present with pain and loss of mobility that affect up to 50% of people over 80 years old,
Lumbar spinal stenosis- it is degenerative disease encountered in older adults is a leading cause of low back pain and lower extremity pain in people aged 65 years and older. Sensory and proprioceptive changes due to lumbar nerve root involvement are believed to cause pain and balance problems leading to decreased walking capacity and function and impaired spinal proprioception potentially leading to increased postural sway and risk of falls
Spinal degeneration/ disc degenerative disease - represents with the wide category of back pain resulting from or associated with the degeneration of intervertebral discs. When it occurs the discs are unable to fulfill their primary functions of cushioning and providing mobility between vertebrae. Although the exact cause is unknown, it is thought to be associated with ageing process during which intervertebral discs dehydrate, lose elasticity, and collapse.
Role of Physiotherapy
As times low back pain may be diagnosed and treated with elaborate treatments but now physiotherapy is fast becoming a safe, efficient and effective way to relax the muscles.
• There are four phases of overall treatment; 1) pain relief 2) restoring normal range of motion and strengthening the muscles 3) restoring full function and then finally 4) preventing recurrence lower back
• It is important to understand that physiotherapy is a stepwise process to restore muscular movement and strength and hence requires consistent exercising first with the physiotherapist and then on your own to promote easier and better recovery.
6. Frozen shoulder (FS)
Frozen shoulder also known as adhesive capsulitis is a very common painful shoulder disorder. It has been reported that about 2% -5% general populations experience this condition. It commonly affects people between the age group of 40 and 60 years and occurs in women more than men. In addition diabetes is at an increased risk for developing frozen shoulder. It is one of the most serious painful disorders in the musculoskeletal system. Patient who experience this condition often suffer from poor quality of life because of the restriction of both active and passive range of their shoulder mobility. Frozen shoulder progress in 3 stages – freezing (painful), frozen (adhesive) and thawing.
Role of Physiotherapy
• Physiotherapy has been reported to treat frozen shoulder effectively. A variety of clinical trials have assessed its effectiveness and safety for frozen shoulder. Most of the studies utilized the combination of PT with other treatments for treating FS and achieved satisfied effectiveness. Physiotherapy and home exercise can be the first line treatment for frozen shoulder with consideration of the patient’s symptoms and stage of the condition.
• Freezing stage (painful) –can last between 3 and 9 months, gentle stretching exercises can be done but should be kept within a short duration (1-5 seconds) and not go beyond the patients pain threshold
• Frozen stage (adhesive)- can last between 9-15 months, strengthening exercises such as scapular retraction, posterior capsule stretch and isometric shoulder external rotation can be added to patient’s exercises for maintenance of muscle strength.
• Thawing stage- can last between 15-24 months, the patient experience a gradual return of range of motion; both stretching and strengthening exercises can increase in intensity, with a longer holding duration.
Apart from surgery or just waiting it out, physiotherapy can effectively treat frozen shoulder to speed up the recovery process immensely.
7. Cervical spondylosis
Cervical spondylosis is wear and tear of the vertebrae and discs in the neck. It is a natural process of aging and presents in the majority of the people after the fifth decade of life. It may appear in persons as young as 30 years but are found most commonly in individuals aged 40-60 years. Chronic degenerative process affects the intervertebral discs and facet joints and may progress to disk herniation, osteophyteformation, and vertebral body degeneration, compression of the spinal cord or cervical spondylotic myelopathy.
Symptoms of cervical spondylosis manifest as neck pain and neck stiffness and spasms (worsen in the morning) altered posture (poking chin) and in severe cases weakness or numbness into upper limb, poorly localized tenderness, limited range of motion and can be accompanied by radicular symptoms when there is compression of neural structures.
Role of Physiotherapy
• Physiotherapy is very important in the treatment of cervical spondylosis. A physiotherapist can assess and diagnose the problem. Following initial assessment physiotherapy will write a treatment plan specifically from mild to severe.
• Physiotherapy treatment for cervical spondylosis often comprises of a home exercise programmed to increase the range of movement and muscle control of the neck. Other physiotherapy treatments may include;Postural/ergonomic advice, Manipulation/mobilization, Electrotherapy, Heat and cold therapy, Soft tissue treatment
• Physiotherapy on cervical spondylosis has proven to be effective in restoring the mobility, flexibility and the core strengthening through a specific set of spondylosis exercises demonstrated by a physiotherapist. The benefit of spondylosis physiotherapy is that, it not only helps in relieving pain but also helps in preventing recurrent pain.
Providing physiotherapy to older people is a challenge, patients with musculoskeletal, neurological, and cardiovascular problems may all be found in a single caseload and often in the same patient.
The effects of biological ageing reduce the efficiency of the body’s systems.Physiotherapists have a key role in enabling older people to use a number of the body’s systems fully to enhance mobility and independently.When neither improvement nor even maintenance of functional mobility is a reasonable goal,physiotherapists can contribute to helping older people to remain comfortable and pain-free. And also prevents in the development of problems in later life through health promotion.
Article issued by
Physiotherapy Rehabilitation Team,
Nagaland Multispeciality Health and
Research Centre, Dimapur
