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Medicine 1 > Anatomy - Falls in older adults > Flashcards

Anatomy - Falls in older adults Flashcards

1
Q

What is sarcopenia?

A

Age-related loss of muscle mass and function

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2
Q

How is sarcopenia defined?

A

Skeletal muscle mass <2 standard deviations below mean of reference group

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3
Q

What changes occur to slow and fast-twitch muscle with ageing?

A

Slow-twitch = no change

Fast-twitch = 35% loss

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4
Q

What happens to cardiac output and mitochondrion with ageing?

A

Quality of both decreases

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5
Q

What are the 4 potential mechanisms that lead to sarcopenia?

A
  • Insufficient protein intake
  • Anabolic blunting
  • Loss of motor function
  • Glucose tolerance
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6
Q

What is anabolic resistance?

A

Reduced stimulation of synthesis of muscle protein with a given protein intake, leading to reduced muscle mass

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7
Q

What detemrines glucose tolerance?

A

Balance of insulin secretion and insulin action

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8
Q

How does glucose tolerance lead to sarcopenia in the elderly?

A
  • Beta cell function declines with age
  • Insulin secretion remains unchanged
  • Insulin resistance occurs in the elderly
  • Hyperinsulinaemia is reduced by maintaining physical fitness
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9
Q

What is the role of resistance exercise in sarcopenia?

A
  • Partly reverses sarcopenia
  • Increases muscle protein synthesis and satellite cell activation
  • Restores muscle insulin sensitivity
  • Increases muscle capillarisation and mitochondrial mass
  • Reduces muscle fat mass
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10
Q

What other confounding variables can lead to sarcopenia, linked with ageing?

A
  • Sense of taste and smell diminish
  • Chewing problems
  • Salivary glands shrink and less saliva secreted
  • Digestive tract degenerates
  • Food choices
  • Muscle co-ordination
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11
Q

What changes occur to vision with ageing?

A
  • Farsightedness
  • Reduced blood flow - enlarged retinal blind spot - reduced field of vision
  • Pupil size and dilation reduced - loss of focussing ability
  • Weaker ciliary muscle - less flexible and more opaque lens
  • Yellowing of lens
  • Clouding of lens (cataracts)
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12
Q

What changes occur to hearing with ageing?

A
  • Presbycusis (hearing loss)
  • High frequency sound loss - impaired word discrimination
  • Left ear more effected generally by hearing loss
  • Tinnitus
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13
Q

What changes occur to touch with ageing?

A
  • Less responsiveness to hot and cold
  • Loss of subcutaneous adipose tissue - reduced thermal insulation
  • Increased pain threshold - decreased pressure perception
  • Danger from reduced ability to feel hot and cold
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14
Q

What changes occur to taste and smell with ageing?

A
  • No change in detecting between sweet, salt, bitter and sour
  • Impaired smell so reduced taste
  • Reduced appetite
  • Increased salt and sugar intake to imporve taste of food
  • Risk of food poisoning
  • Failure to notice changes in environment (i.e. gas leaks)
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15
Q

What changes occur to the brain with ageing?

A
  • Brain volume decreases
  • Slower synaptic speed
  • Loss of synaptic plasticity
  • Less efficient connections between brain regions
  • Reaction time sharply increases after age 60
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16
Q

What changes occur to memory with ageing?

A
  • Impaired recolleciton of everyday events
  • Increase in ‘tip-of-the-tongue’ phenomenon
  • Slower recognition memory
  • Delayed working memory
17
Q

What are the 4 interventions for the elderly?

A
  • Increasing neuroplasticity
  • Psychosocial interventions
  • Reminiscence therapy
  • Cognitive stimulation therapy
18
Q

What is involved in increasing neuroplasticity?

A
  • Use transcranial direct current stimulation
  • Aids adaptive neuroplasticity
  • Reduces cognitive decline from early or insufficient reorganisation of neural networks
19
Q

What is involved in reminiscence therapy?

A
  • Use memory triggers to provide focus for reminiscence
  • Reminiscence rooms
  • Maintain person’s identity and assist in social interaction
20
Q

What are the implications of falls in the elderly?

A
  • Fall
  • Fear of falling again
  • Less activity
  • Decreased muscle strength and balance
  • Increased risk of falling
  • Fall
21
Q

What is involved in the multifactorial assessment for falls?

A
  • Home hazard assessment
  • History of falls
  • Medication review
  • Continence assessment
  • Neurological function and cognition
  • Perceived function and fear of falling
  • Gait, balance, mobility and strength assessment
  • Osteoporosis risk
  • Visual impairment
  • Cardiovascular status
22
Q

What exercises are used prevent falls?

A
  • Strength training
  • Balance
  • Gait training
  • Coordination training
  • Multifactorial intervention
  • Specialist support
23
Q

What are the 8 absolute contraindications to exercise in patients with falls?

A
  • New or uncontrolled arrhythmia
  • Resting or uncontrolled tachycardia
  • Resting SBP > 180mmHg or DBP > 100 mmHg
  • Symptomatic hypotension
  • Unstable / crescendo angina
  • Acute or unstable heart failure
  • Unstable diabetes
  • Acute febrile illness
24
Q

What is the effective frequency of exercise to prevent falls?

A
  • At least 2 hours per week
  • 3 times per week
  • At least 4 month period
  • 50 hour total
25
Q

What are the health benefits of physical activity?

A
  • Reduced hypertension
  • Prevents weight gain
  • Improved sleep
  • Reduces falls risk
  • Improves bone health
  • Improves cardiorespiratory function
26
Q

Why is retirement a risk factor for alcoholism?

A
  • More free time
  • More financial resources
  • Loss of identity
  • Frustration with expectations vs reality of retirement
27
Q

What are the stages of feelings of greif?

A
  • Sadness
  • Anger
  • Guilt
  • Shock
  • Numbness
  • Yearning
28
Q

What are the stages of physical sensations of greif?

A
  • Hollowness
  • Tightness
  • Unreality
  • Weakness
29
Q

What are the stages of cognition of grief?

A
  • Disbelief
  • Confusion
  • Pre-occupied
  • Sense of presence / hallucinations
30
Q

What are the stages of behaviour of grief?

A
  • Crying
  • Poor sleep or excessive sleep
  • Loss of appetite
  • Withdrawn or overactive
  • Dreams
  • Searching or avoidance
31
Q

What are the risk factors for atypical grief?

A
  • Difficult relationship
  • Violent or sudden death
  • Unusual involvement
  • Previous loss issues
32
Q

What are the 3 themes of grief in the elderly?

A
  • Feelings of isolation
  • Sense of loneliness and depression
  • Perceived inner representation and development of a dialogue with the deceased
33
Q

What is the Kubler-Ross stage theory of terminal illness?

A

D enial

A nger

B argaining

D epression

A cceptance

Medicine 1 (28 decks)

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