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Neuro Dev/Control II > Geriatrics I > Flashcards

Geriatrics I Flashcards

1
Q

Define gerontology

A
  • Greek “Heron” for old man, scientific study of the process of aging & the particular problems of old people
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2
Q

Define geriatrics

A
  • A healthcare specialty field focusing on care & treatment of older persons
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3
Q

While greater life expectancy is good resource for families, it can be thought of as a burden on the healthcare system (True/False)

A

True

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4
Q

Define physical limitation

A
  • Difficulty with any of the 8 activities
  • Walk a 1/4 mile, walk up 10 steps w/o rest, stand/be on feet for 2 hrs, sit for ~2 hrs, stoop/bend/kneel, reach up over head, use fingers to grasp/handle small objects, lift/carry something as heavy as 10 lbs
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5
Q

Why do older adults have difficulty seeking out preventive medicine/receive preventive care

A
  • Lack of knowledge amounts elderly & healthcare providers
  • Lack of drive
  • Lack of family support
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6
Q

What 2 generations is our current knowledge of geriatrics based on

A
  • Maturists and baby boomers
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7
Q

Describe successful aging

A
  • Avoiding disease & disability
  • Maintaining high physical & cognitive function
  • Active engagement i social & productive activities
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8
Q

Describe usual aging

A
  • Living with intrinsic unavoidable components of aging & pathological conditions
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9
Q

Describe optimal aging

A
  • Maximizing functional capacity despite having chronic conditions
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10
Q

Describe the slippery slope of aging

A
  • Fun -> Function -> Frailty -> Failure
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11
Q

What are the functional age categories for those ≥75

A
  • Physically Elite: compete in high risk & power sports
  • Physically Fit: participate in most endurance activities & sports
  • Physically Independent: walking, gardening, low demand sports, social dancing
  • Physically Frail: can perform some IADLs (grocery shopping) & all ADLs
  • Physically Dependent: some ADLs, may need caregiving
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12
Q

Modifiable factors related to decline in all body structures/functions from aging

A
  • Physical activity
  • Nutrition
  • Stress (inflammatory effects on tissues)
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13
Q

Why do people age differently

A
  • Potentially enough tissue reserve in each system to get through 80-90 years without infirmity
  • No unifying theory of aging
  • ~ 50% of the decline with age has a genetic basis the remainder is the consequence of lifestyle, physical inactivity
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14
Q

Physical activity and its effect on aging

A
  • Level of physical training may determine pattern of decline in health status even in individuals with same genetic potentials
  • Improvements in physical activity (cardiorespiratory + muscular) might be a primary goal for geriatric rehab
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15
Q

Slides 17-20

A
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16
Q

Underlying age related physiologic changes affecting CV function

A
  • Heart: electrical = frequency/regularity for people >65 can become abnormal; mechanical = heart becomes fatty, larger, less efficient, which alters force, velocity & length tension relationships
  • Decreased elasticity of blood vessels result in chronic increase in vascular diameter & vessel wall rigidity, prone to HTN
  • Autonomic dysregulation of HR at rest or with activity
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17
Q

Pathologies that can aggravate decline in the cardiovascular system

A
  • A-fib
  • CAD (atherosclerosis)
  • Diabetic neuropathy (affecting autonomic nerves supplying the heart)
  • CHF
  • MI
  • HTN
  • Limb paralysis
  • Disrupted peripheral flow (PAD)
  • Reconditioning (effect on ANS)
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18
Q

Anatomic changes to pulmonary tissue due to aging

A
  • Alveolar size increases
  • Surface area for gaseous exchange decreases
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19
Q

In what ways is the effects of aging on pulmonary tissue similar to emphysema

A
  • Increased distance b/w airspace walls
  • Decreased surface area of airspace wall
  • Decreased elastic recoil
  • Increased expiratory airflow resistance
  • Decreased diffusing capacity
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20
Q

Physiologic changes to expiratory pulmonary function due to aging

A
  • Decline in forced expiratory volume per second (FEV)
  • Takes longer & more effort to get air out of lungs
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21
Q

Underlying age related physiologic changes affecting lung function

A
  • Stiffer chest wall
  • Increased lung tissue compliance
  • Lower max expiratory flows
  • Lower max inspiratory flow
  • Increased FRC and RV, lower VC, but stable TLC
  • Lower diffusing capacity
  • Lower PO2 and SpO2/SaO2 as a consequence of V/Q mismatch
  • 70 y/o associated with pathology
  • Lower respiratory muscle strength & endurance
  • Increased airway reactivity
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22
Q

Clinical symptoms of COPD

A
  • Shortness of breath (SOB)
  • Increased respiratory rate (RR)
  • DOE
  • Pink puffers
  • Barrel chest
  • Hypoxia
  • Inspiratory crackles
  • Becomes clinical after 20-30 pack years of smoking
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23
Q

What is the most common obstructive disease in older adults

A
  • COPD: harder to breathe out due to obstruction of airway by inflammation or mucus production
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24
Q

What is used to assess COPD severity

A
  • GOLD criteria (Global initiative for obstructive lung disease) Must of <0.7 ratio to be defined as COPD for all stages***
  • Severity of COPD measured by spirometric pulmonary function test
  • Stage I = Mild; Stage II = Moderate; Stage III = Severe; Stage IV = Very severe
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25
Q

What is the most common restrictive disease in older adults

A
  • Idiopathic pulmonary fibrosis (IPF)
  • Harder to breathe in due to restriction of lung expansion
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26
Q

Symptoms of IPF

A
  • Shortness of breath
  • DOE
  • All lung volumes are smaller
  • FEV1/FVC >0.8 in spirometry
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27
Q

Effects of age on muscle performance

A
  • Progressive denervation & impaired regeneration muscle: 50% decline in alpha motor neurons and motor units >65 years, Enlargement of remaining motor units, Decreased availability of satellite cells
  • Deficits in absolute force & specific force generation (per cross sectional area)
  • Muscle activation deficits: Reduced central drive to agonist muscles, Increased co-activation of antagonists
  • Deteriorating muscle quality & metabolism: Infiltration of fat and other connective tissue, Insulin resistance
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28
Q

Define sarcopenia

A
  • Primarily defined as age related loss of muscle mass & strength but now considered a clinical condition with genetic & lifestyle/environmental contributors (nutrition/activity/inflammation)
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29
Q

Whole muscle changes related to sarcopenia

A
  • Decreased muscle mass, replaced by increased fat mass
  • Decreased muscle strength (particularly lower extremities)
  • Slowing of muscle contractile properties and rate of force development
  • Reduced rate of cross-bridge cycling
  • Alterations on excitation and contraction coupling
  • Increased compliance of muscle’s tendinous attachment
30
Q

Muscle fiber changes related to sarcopenia

A
  • Type II (fast twitch) are lost more than type I (slow twitch)
  • Fiber necrosis
  • Fiber type grouping – enlargement of motor units
  • Reduction in type II muscle fiber satellite cell content
31
Q

Functional consequences of sarcopenia

A
  • Harder to perform daily activités
  • Decreased participation in community activities
  • Difficulty with IADLS, ADLs, increasing need of help from caregivers
32
Q

Sarcopenia’s role in the vicious cycle to frailty

A
  • Sarcopenia -> lack of protein reserves -> disease -> decreased ability to meet protein requirements to recover from disease (loss of physiological reserve) -> further sarcopenia -> frailty
33
Q

Frailty is defined as a clinical syndrome in which 3 or more of what 5 factors are present

A
  • Unintentional weight loss (10 lbs in the past year)
  • Self reported exhaustion
  • Weakness (grip strength)
  • Slow walking speed
  • Low physical activity
34
Q

Pathologies that can progress age related decline in muscle performance

A
  • Diabetes – loss of anabolic action on muscle
  • Metabolic syndrome – abd obesity, insulin resistance, dyslipidemia, HTN
  • Chronic obstructive pulmonary disease (COPD)
  • Cancer
  • Congestive heart failure (CHF)
  • Arthritis
  • Kidney disease
  • Stroke
  • Parkinson’s disease
35
Q

Decline in ______________ & _____________ with or without disease can be reversed in older adults to a large extent with physical rehab

A
  • Cardiopulmonary
  • Muscle performance
  • Cardiorespiratory fitness training (aerobic endurance), strength training, and functional activity training can help reverse
36
Q

Risks associated with starting exercise/physical activity in older adults

A
  • Sudden cardiac death and/or acute MI
  • Higher risks for sedentary older adults, older adults with CV/pulmonary/metabolic comorbidities and vigorous levels of exercise
  • Overall risks are still very low
37
Q

1 MET is equal to how many ml of O2

A
  • 1 MET = 3.5 ml O2/kg body weight/min
38
Q

Even though absolute MET for the same kind of activity remains same regardless of age, the relative exercise intensity (% VO2 max) required for that activity will __________ with age.

A
  • Increase
39
Q

Older people need to work at a _________ % VO2 max than younger people to perform an activity of same absolute MET value

A
  • Higher
40
Q

What heart related values decline with age and which remain equivalent

A
  • VO2max or HRmax decline with age
  • HRR and VO2R remain equivalent
41
Q

Assessment of geriatric patient with impaired aerobic endurance/cardiorespiratory fitness

A
  • Pre-participation: PAR-Q; CV/pulmonary/metabolic risk factor assessment
  • Pre-exercise evaluation: Vital signs, lipid profile, pulmonary function, meds/Beer’s list
  • Health related fitness testing
42
Q

Major signs/symptoms of CV, pulmonary, metabolic disease

A
  • Pain and/or anginal equivalent: ‘constricting’ feeling in neck, jaw, arms, etc
  • SOB at rest or mild exertion (DOE): LV dysfunction or COPD
  • Dizziness or syncope: CAD, aortic stenosis
  • Orthopnea or PND: LV dysfunction
  • Ankle edema: HF, chronic venous insufficiency, kidney/liver problems (generalized edema)
  • Palpitations/tachycardia: fever, anemia, anxiety states
  • Intermittent claudication: atherosclerosis, CAD, diabetes
  • Known heart murmur: may be innocent, exclude hypertrophic cardiomyopathy, aortic stenosis
  • Unusual fatigue/SOB with usual activities
43
Q

Positive risk factors for CVD

A
  • Age: Men >45yr, women >55yr
  • Family hx: MI, sudden death before 55
  • Cigarette smoking
  • Sedentary lifestyle (not participated in moderate ex, 3d/wk, last 3months)
  • Obesity: BMI (>30 kg/m2) or waist girth (>40in for men, >35in for women)
  • HTN: systolic >140mmhg and/or diastolic >90mmHg
  • Dyslipidemia: High LDL (LDL >130) or low HDL (<40) or total cholesterol (>200)
  • Prediabetes: Impaired FG (>100 and <125) or impaired GTT (2 hour values)
44
Q

Negative risk factors for CVD

A
  • High HDL: ≥60 mg/dl
45
Q

Slide 52 clinical decision making based on risk category

A
46
Q

Conditions for which exercise testing is recommended

A
  • Unstable or new or possible Sx of CVD
  • Diabetes and at least one of the following: Age 35, Type II DM >10 yr duration, Type I DM >15 yr duration, Hypercholesterolemia, HTN, Smoking, Family Hx of CAD in 1st relative <60 yr, Presence of microvascular disease, PAD, Autonomic neuropathy
  • End stage renal disease
  • Pts with symptomatic/Dx pulmonary disease: COPD, asthma, interstitial lung disease, or cystic fibrosis
47
Q

Absolute exercise contraindications

A
  • Unstable angina
  • Uncontrolled cardiac dysrhythmia
  • Uncontrolled CHF
  • Acute infection
  • Recent change in resting ECG
48
Q

Relative exercise contraindications

A
  • Known significant cardiac diseases
  • Tachy/Brady dysrhythmia
  • Chronic infection
49
Q

Absolute indications to stop exercise

A
  • Drop in SBP >10 mmHg with increase in workload with signs of ischemia
  • Signs of poor perfusion
  • Moderately severe angina
50
Q

Relative indications to stop exercise

A
  • Drop in SBP >10 mmHg with increase in workload w/o signs of ischemia
  • Increasing chest pain
  • Fatigue
  • Shortness of breath
  • Wheezing
51
Q

Normal ranges for pre-exercise evaluation of vital signs

A
  • Resting HR: 60-100 bpm
  • Resting BP: 100-140/70-90
  • SpO2: ≥ 90%
52
Q

Possible causes of abnormal findings in pre-exercise evaluation of vital signs

A
  • Resting Brady: beta blockers, AV block, cardiac dysrhythmia
  • Resting tachy: hypotension, A-fib, ventricular tachy
  • Systolic HTN: uncontrolled HTN, Systolic hypotension: orthostatic hypotension, A-fib, HF
  • O2 desaturation: impaired O2 diffusion through alveolar capillary
53
Q

Purposes of health related physical fitness testing

A
  • Baseline data about pt’s present health.fitness level
  • Educate pt about their current health status
  • Data for developing individualized exercise prescriptions, reasonable goals, plan of care
  • Baseline for follow up data to evaluate progress
54
Q

Components of health related physical fitness testing

A
  • Anthropometric testing – to measure body fat: BMI, Circumferences, Densitometry
  • Cardio-respiratory fitness testing
  • Muscular fitness testing
  • Flexibility testing
55
Q

What are the BMI cutoffs

A
  • Normal: 18.5-24.9
  • Overweight: 25-29.9
  • Obese: ≥30 (increased risk of CV, diabetes, mortality
  • Obesity paradox: people with CHF have improved survival rate when BMI is ≥30
  • BMI <18.5 increases mortality risk
  • Does NOT distinguish b/w fat, muscle, bone
56
Q

Circumference measurements to determine android or gynoid obesity

A
  • Android = around abdomen
  • Gynoid = around hips/thighs
  • Waist to hip ratio (WHR): for older adults, high risk for men = >1.03 and women = >0.90
  • Increased risk for HTN, Type II Dm, CVD
57
Q

Describe skinfold measurements

A
  • Skinfold thickness correlates well with % body fat
  • Dependent on clinician expertise
  • Sites: abdomen, triceps, chest, tight, medial calf
  • 7 and 3 site formulas to measure body density
  • Formula to measure % body fat: % fat = (457/body density) - 414.2
58
Q

Describe cardiorespiratory fitness testing

A
  • Ability to perform large muscle, dynamic, moderate-vigorous intensity exercise over prolonged period of time
  • Performed by VO2max directly but not always feasible due to equipment, space, risks, training needs
  • VO2max plateau may not be observed in CVD or pulmonary disease
  • Submit exercise tests usually performed/preferred for older adults
  • Modes of testing include field tests, treadmill tests, cycle ergometer tests
59
Q

Purpose for submit exercise testing and parameters to monitor

A
  • Purpose is to determine HR response to exercise to estimate max work rate or VO2max/peak
  • Parameters: HR, BP, RPE, dyspnea, angina, claudication, ECG, expired gas if available
60
Q

Steps fro performing cycle ergometer test

A
  • Obtain resting HR & BP
  • Pt positioning on ergometer – 25 degrees flexion at maximal leg extension
  • 2-3 min warm up
  • 2-3 min stages with appropriate increments in workload.
  • HR recorded in the last minute as it reaches steady state
  • Test termination: when pt reaches 70%HRR (or 70-85% HRmax) or shows adverse symptoms (moderately severe angina or dyspnea or intense claudication pain) – more in handout
61
Q

Describe relationship of 6MWT and assessing cardiorespiratory fitness

A
  • Predicts VO2 & survival rate in heart failure (HF) & COPD
  • Alternative is a 6 min step test (6MST), 20cm high single step w/o hand rails: correlates with VO2max results from an exercise test
62
Q

Assessment of muscular strength

A
  • 1 RM
  • 10-1 RM: more appropriate for older adults with CVD, pulmonary, metabolic disease
  • Functional tests for older adults: 2 components of senior fitness test includes - 30 sec chair stand (LE) and single arm curl (UE)
63
Q

Assessment of muscular endurance

A
  • Ability too execute repeated muscle actions at a specific intensity for a prolonged period of time
  • Normative values for push-ups and curl-ups available
64
Q

Other functional tests for assessing cardiorespiratory fitness, strength, endurance, flexibility, balance in older adults

A
  • Senior fitness test (SFT)
  • Short physical performance battery (SPPB)
  • Continuous scale physical performance test
  • SF 36 (RAND)
  • Duke activity status index: rough estimate of pt’s peak O2 uptake, applicable for older adults with known CVDs where there might be additional risks of stressing pt’s CV system with exercise tests
65
Q

Exercise interventions to improve CRF, strength, & functional mobility

A
  • Aerobic endurance ex
  • Resistance training ex
  • Functional training
  • Assistive devices
66
Q

Principles of exercise training

A
  • Overload principle
  • Reversibility principle
  • Specificity principle
  • Adaptation principle
  • Variation principle
67
Q

Components of exercise training (FITT)

A
  • Mode
  • Intensity
  • Duration
  • Frequency
  • Progression
68
Q

Recommendations for aerobic ex training for the older adult or geriatric patient (having conditions like arthritis, DM, HTN, etc)

A
  • Moderate intensity ex for ≥ 150 min per week (30min for 5 days)
  • Vigorous intensity ex for ≥75 min per week (25min for 3 days)
  • In terms of METs: > 500-1000 MET-min/week recommended
  • Light ex (<40% HRR/VO2R) or <20 mins may be beneficial for deconditioned individuals int eh beginning (can perform multiple sessions of ≥10 min per day)
  • Can progress using any component, may need longer for older/deconditioned individuals
69
Q

Recommendations for resistance ex training for older adult

A
  • General recommendations: for each muscle group, 2-4 sets with 2-3min rest, 60-80% 1RM (8-12 reps per set) for 2-3 days/wk (separated by at least 48 hours). All major muscle groups in one session or ‘split’ session
  • 40-50% 1RM (10-15 reps-light intensity) for older/sedentary adults
  • For improving endurance, <50% 1RM (15-20 reps per set), < 2sets
  • Progression by increasing number of sets, resistance
  • No ‘duration’ recommendations
  • For oldest adults (>80 years), high intensity (70-80% 1RM) once per week may be beneficial
70
Q

For older adults with obstructive/restrictive diseases, to improve respiratory muscle strength and endurance

A
  • Respiratory muscle training (max inspiratory pressure <60cm H2O): use inspiratory/expiratory threshold trainer; 30-60% of MIP for 15-30min 1-2x/day
  • Breathing strategies: pursed lip breathing
  • Airway clearance techniques: postural drainage, percussion, vibration, oscillating positive expiratory pressure device (Acapella flutter)
71
Q

What is the goal of functional mobility training

A
  • Improve functional activity level
72
Q

Describe task specific training for function mobility training for older adults

A
  • Pedometer for goal of walking longer
  • Increase gait speed for goal of crossing street safely
  • Correct Ad for optimal energy conservation for goal of staying active throughout the day
  • If aerobic improvement is less likely, educate pt about energy conservation techniques: break up large tasks, pace yourself, & breathe out during hardest pat of task

Neuro Dev/Control II (19 decks)

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