Effects of disease processes on activity
If, in addition to normal changes, the aging person has health problems that affect the critical body systems, his or her ability to participate in activity is further impaired. Organic brain syndrome, Alzheimer’s disease, and stroke can affect both the high-level thinking functions and the motor functions of the brain. Persons suffering from severe forms of these diseases may not recognize the need for the most basic activities such as moving, eating, dressing, bathing, or toileting. Even if they do recognize these needs, their altered motor function may prevent them from meeting basic needs.
Neurologic damage resulting from head injury, infection, degenerative disease, Parkinson’s disease, or toxic drug reactions can interfere with normal nerve impulse transmission. Older persons suffering from these conditions may recognize a need and have the desire to perform an activity yet are unable to carry out the activity. The nervous system does not transmit appropriate messages to the muscles to enable them to perform the activity. Abnormal nerve transmission can result in difficulty getting started with movement or in uncoordinated muscle activity (e.g., a staggering gait), which further limits the ability to participate in normal activities.
Diseases or injury to the musculoskeletal system can interfere with the ability to perform activity. Fractures can lead to limited or extensive mobility restriction, depending on the part or parts of the body affected. Fracture of a small bone such as a finger results in limited loss of mobility. Fracture of a large bone such as the femur results in severe limitation of mobility. Not only does the fracture itself restrict mobility, but also the treatment further limits mobility. Even after surgical repair, the person with a fractured hip is not permitted to participate in certain activities (e.g., weight bearing on the extremity) until healing has occurred. While waiting for healing to occur, strength and joint mobility can be lost if preventive nursing interventions are not instituted.
Diseases such as gout and arthritis cause joint pain, which leads to restricted activity. A person with severe gout or arthritis is likely to avoid use of the painful joints to reduce discomfort. Unfortunately, this inactivity can lead to further loss of joint mobility and muscle strength, which even further reduces the person’s ability to perform activities. Joint degeneration with aging severely restricts mobility, particularly in the weight-bearing joints in the knees and hips. Joint replacement surgery is an increasingly common option for older adults. After a period of rehabilitation, most older adults achieve a greatly improved activity level.
Foot conditions commonly seen in older adults (e.g., bunions, hammertoes, and calluses) may interfere with ambulation, particularly if footwear does not fit properly. Painful feet are a common reason for decreased activity in older adults.
Any disease condition that interferes with the intake or distribution of oxygen to body tissue significantly interferes with a person’s ability to participate in activity and exercise. These conditions include diseases of the respiratory system that prevent adequate gas exchange in the lungs (e.g., asthma, emphysema, bronchitis, and pneumonia) and diseases of the cardiovascular system that prevent adequate distribution of oxygen to body tissues and heart muscle (e.g., myocardial infarction, congestive heart failure, heart block, arteriosclerosis, and hypertension).
Inadequate oxygenation places additional stress on the cardiovascular and respiratory systems. Pulse and respiratory rates increase in an attempt to compensate for the decreased amount of oxygen. If additional demands for oxygen occur, as they do with even moderate activity, older adults may experience additional symptoms. Fatigue with minimal activity is common with oxygen deprivation. Pain may be reported with activity. Most common are angina (when the heart muscle does not receive adequate amounts of oxygen) and intermittent claudication (when the tissues of the lower extremities are deprived of oxygen). Initially, this pain occurs with activity only; in severe cases of deprivation, it also occurs at rest. Severe oxygen deprivation can result in cardiac or respiratory distress.
To compensate for these symptoms, older adults spontaneously restrict their activities. Individuals may become housebound because the effort of dressing is too much for them. Some are unable to eat or perform basic hygiene because it is too exhausting. Sometimes the activity limitation is so severe that individuals are able to maneuver around the house only by placing chairs at 10-foot intervals. They move that short distance, then sit and rest until they are able to move to the next chair.
Malnourishment can also contribute to the reduced ability to perform activity. Inadequate intake of nutrients can result in muscle atrophy. Malnourished individuals lack adequate protein to build muscle tissue, an adequate supply of glucose to fuel the muscles, and adequate iron to form hemoglobin. Inadequate iron intake can result in anemia, which leads to a decrease in the oxygen available to tissues and further reduces the ability to perform activity.
Although not physiologic in origin, emotional disorders such as severe grief, anxiety, or depression can lead to decreased participation in normal activity. Individuals who are emotionally disturbed may be directing all of their energy inward and may not be willing or able to summon the energy required for physical activity. It is important to remember that these people need to continue to use their bodies to prevent loss of physical function.
