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Medical Complexity Part 1: Defining Frailty and Age-Related Changes

presented by Jennifer Bottomley, PT, MS, PhD

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Disclosure Statement:

Financial: Jennifer Bottomley receives compensation from MedBridge for this course. There is no financial interest beyond the production of this course.

Non-Financial: Jennifer Bottomley has no competing non-financial interests or relationships with regard to the content presented in this course.

Satisfactory completion requirements: All disciplines must complete learning assessments to be awarded credit, no minimum score required unless otherwise specified within the course.

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This course is part of our GCS Prep-Program. Learn more about the full prep-program here: MedBridge GCS Prep-Program.

This seminar focuses on changes specific to the aging process that lead to frailty in the elderly. A systems approach strategy is presented for assessing anatomic, physiologic and functional changes associated with aging and pathologies that result in frailty, changes in postural control, balance and falls in the elderly. This course examines medical complexity and the implications leading to frailty in the elderly providing the course participants with the most advanced and up to date information on the evaluation and treatment of the elderly individual with multi-system involvement. This is Part I of a series of Medbridge courses that will present the basic definitions and pathological conditions that lead to frailty, such as sarcopenia, loss of flexibility, and osteoporosis, and the role of nutrition and hydration in this syndrome.

Meet Your Instructor

Jennifer Bottomley, PT, MS, PhD

Jennifer M. Bottomley, PT, MS, PhD, embodies the characteristics of leadership, having worked on committees and task forces and behind the scenes to advance the goals and vision of the profession of physical therapy for 40 years. Bottomley is an independent geriatric rehabilitation program consultant, advisor, and educator. Previously, she held clinical roles at Sunspectrum…

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1. Defining Frailty in the Elderly & Aging Changes Leading to Frailty

The older adult experiences system-wide changes related to aging. However, the active older adult can slow or halt the progression of many of these changes. Inactivity, conversely, can accelerate aging and lead the older adult down the slippery slope leading to frailty. “Use it or lose it” is the mantra for successful aging. Frailty in the older adult is a complex clinical syndrome. Understanding the physiologic and anatomic underpinnings of this condition and the relationship of multiple systems to function and quality of life is of great importance to assist in creating a path for effective intervention.

2. Age-Related Changes in Muscle Strength

Understanding the physiologic changes in muscle related to aging and inactivity has great relevance when working with the older adult. Concepts such as sarcopenia, muscle fiber type changes with aging and generation of muscle force, body stability, and ability to maintain activity over time (endurance), as well as body composition, are all important concepts to consider when assessing and prescribing exercise.

3. Flexibility

Flexibility for the aging adult is critical for optimal functioning, and for the treating therapist, understanding the underlying physiologic components that optimize tissue health, joint mobility, and posture is vital, appreciating that, “extension equals function”. These physiologic components, which include the fibroblast, glycoproteins, hyaluronic acid, contractile proteins, and fibrinogen, all play varying roles in the maintenance of flexibility in the older adult. Malfunctioning of these components can lead to inflexibility, and ultimately contribute to the syndrome of frailty.

4. Bone Mass

Age related changes in bone mass have important relevance for the clinician. Understanding the normal and pathologic changes in bone related to aging and inactivity is important in helping the older adult maximize posture and facilitate function. As with all aging systems, activity level and nutritional status play vital roles in ensuring adequate bone mass that will help prevent falls and fractures that can lead to frailty.

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