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"To know how to grow old is the masterwork of wisdom and one of the most difficult chapters in the great art of living."

—Henri Frederic Amiel, 19th-century Swiss philosopher and poet


By the end of this chapter, readers will be able to:

  1. Describe the features (signs, symptoms, risk factors) of some of the more common neuromusculoskeletal health conditions that affect older adults.

  2. Differentiate between osteoarthritis and osteoporosis.

  3. Identify the tests that can be used in the objective assessment of older adults with osteoporosis.

  4. Describe the management of common musculoskeletal causes of disability among older adults, specifically osteoporosis and osteoarthritis.

  5. Describe the management of an older adult after amputation due to diabetes.

  6. Describe the management of common neurological causes of disability among older adults, specifically stroke and Parkinson's disease.

  7. Discuss some of the literature that describes evidence-based interventions for older adults with osteoporosis, osteoarthritis, amputation, stroke, and Parkinson's disease.

Clinical Vignette

Mr. Bruno Tadesco is a 69-year-old man who recently retired from his position as a construction manager after 40 years. Mr. Tadesco tells you he has deep aching pain and stiffness in both of his knees, especially after getting out of bed in the morning, progressive stiffness, and difficulty walking and going down stairs. The pain and stiffness began approximately 2 months earlier and has gotten progressively worse to the point where he is no longer able to walk his dog. Mr. Tadesco's medical history includes diabetes, hyperlipidemia, obesity, and asthma. His medication includes metformin 500 mg twice daily, glyburide 10 mg daily, simvastatin 10 mg daily, albuterol 2 puffs as needed, and acetaminophen 325 mg daily for the past 3 months for pain. Mr. Tadesco's face is expressionless when he is speaking. He reports that he nipped a piece of skin around his big toe when he was clipping his toenails. Mr. Tadesco thought the skin would have healed by now as he has been applying antibiotic ointment, but the edges haven't closed. In fact, the edges of the cut seem to be increasing.

  1. On the basis of the information in the clinical vignette, what might be causing Mr. Tadesco's knee pain and stiffness?

  2. What concerns are most important about Mr. Tadesco's past and medical history? Why?

  3. What else might be going on with Mr. Tadesco? What facts contribute to this assessment? What additional information or assessments might be useful?

This chapter focuses on some of the more common health conditions that affect the neuromusculoskeletal system in older adults. The two most prevalent musculoskeletal health conditions in older adults, osteoarthritis (OA) and osteoporosis, are described. Because lower limb amputation may occur in older adults, often due to diabetes and vascular disease-related complications (see Chapters 13 and 17), limb amputation in the context of the age-related changes is described. Last, two neurological health conditions, stroke and Parkinson's disease, are discussed.

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