Chapter 8: Geriatric Physical Therapy

Question 1

What are the leading causes of death in persons over 65?

Answer 1

1. Coronary heart disease
2. Cancer
3. Stroke
4. Chronic pulmonary disease
5. Unintentional injuries, motor vehicle accident
6. Diabetes

Question 2

What are the leading causes of morbidity in persons over 65?

Answer 2

1. Heart disease
2. Cancer
3. HTN
4. High serum cholesterol
5. Obesity
6. Cigarette smoking
7. Inactivity lack of exercise

Question 3

Older persons account for what percentage of total health care expenditures?

Answer 3

36%

Question 4

What is gene regulation theory?

Answer 4

senescence results from changes in gene expression

Question 5

What is cell senescence/telomere theory?

Answer 5

there are a limited number of cell divisions normal human cells can undergo

Question 6

Premature aging during childhood is called:

Answer 6

Hutchinson-Gilford syndrome

Question 7

Premature aging of young adults is called:

Answer 7

Werner’s syndrome

Question 8

Describe the age-related changes associated with muscle

Answer 8

muscle mass peaks at age 30, remains fairly constant until age 50, after which there is an accelerating loss (20% –40% loss by age 65 in the nonexercising adult)

*33% of muscle mass is lost by age 70

Question 9

Loss of power in the aging adult is a result of:

Answer 9

• speed of contraction

- changes in nerve conduction and synaptic transmission

Question 10

What percentage of adults have degenerative joint changes and cartilage abnormalities by age 60?

Answer 10

60%

Question 11

Describe the age-related changes associated with bone mass

Answer 11

peak bone mass occurs at age 40; between ages 45 and 70, bone mass decreased (in women, by about 25%; in men, by 15%); decreased another 5% by age 90

Question 12

Describe the age-related changes associated with nerve cells in the cerebral cortex

Answer 12

overall loss of cerebral mass/brain weight of 6% – 11% between ages of 20 and 90; accelerating loss after age 70

Question 13

Impaired or fuzzy vision may result with what classes of medications?

Answer 13

• antihistamines
• tranquilizers
• antidepressants
• steroids

Question 14

What are the types of hearing loss?

Answer 14

• conductive: mechanical hearing loss from damage to external auditory canal, tympanic membrane, or middle ear ossicles; results in hearing loss (all frequencies); tinnitus (ringing in the ears) may be present
• sensorineural: central of neural hearing loss from multipe factors; noise damage, trauma, disease, drugs, arteriosclerosis
• presbycusis: sensorineural hearing loss associated with middle and older ages; characterized by bilateral hearing loss, especially at high frequencies at first, then all frequencies; poor auditory discrimination and comprehension, especially with background noise; tinnitus

Question 15

How is pulmonary gas exchange affected by age?

Answer 15

oxygen tension falls with age, at a rate of 4 mmHg/decade; PaO2 at age 70 is 75, compared to 90 at age 20

Question 16

What is the difference of aerobic training in older adults as compared to younger adults?

Answer 16

greater improvements in peripheral adaptation, muscle oxidative capacity then central changes; major difference from training effects in younger adults

Question 17

Osteopenia vs. osteoporosis

Answer 17

Osteopenia: t score = 1.0 - 2.5 SD below normal
Osteoporosis: t score = >2.5 SD below normal

Question 18

What medications affect bone loss?

Answer 18

• corticosteroids
• thyroid hormone
• anticonvulsants
• catabolic drugs
• some estrogen antagonists
• chemotherapy

Question 19

What areas of the body are most commonly affected by osteoporosis?

Answer 19

• vertebral column
• femoral neck
• distal radius/proximal humerus

Question 20

What are the approved pharmacological options for osteoporosis?

Answer 20

• bisphonates (alendronate, ibandronate, risedronate, and zoledronic acid)
• calcitonin
• estrogens and/or hormone therapy
• parathyroid hormone (teriparatide)
• estrogen agonist/antagonist

Question 21

What is the recommended daily calcium intake for individuals age 50 or older?

Answer 21

1200 mg per day

Question 22

What is the recommended daily vitamin D intake for individuals age 50 or older?

Answer 22

800 - 1000 IU per day

Question 23

T/F: Protein inhibits the body’s ability to absorb calcium

Answer 23

true

Question 24

Where do vertebral compression fractures usually occur?

Answer 24

T8 - L3

Question 25

Where are the most common areas for insufficiency fractures in older adults?

Answer 25

- pelvis - proximal tibia - distal fibula - metatarsal shafts - foot

Question 26

What are the risk factors for Alzheimer's disease?

Answer 26

- advanced age - family history - cardiovascular risk factors - limited social and cognitive engagement - fewer years of formal education - apolipoprotein E (APOE)-E4 gene

Question 27

How is Alzheimer's disease diagnosed?

Answer 27

- medical history and clinical examination - cognitive tests - biomarker tests on lumbar punctures see elevated levels of tau and phosphorylated tau; low amyloid levels - MRI scan to identify brain changes

Question 28

What are the stages of AD?

Answer 28

- Preclinical AD: individuals have measurable changes in brain CSF and blood biomarkers without noticeable symptoms - Mild AD: characterized by mild but measurable changes in cognitive abilities noticeable to the person affected and family members; able to carry out everyday activities - Moderate AD: characterized by noticeable memory, thinking, and behavioral symptoms that impair a person's ability to function in daily life - Severe AD: characterized by loss of ability to communicate, recognize others, and complete dependence

Question 29

What is the pathophysiology of chronic traumatic encephalopathy?

Answer 29

- tau-positive neurofibrillary tangles - neutrophil threads and neocortical diffuse amyloid plaques, with or without neuritic plaques - the hippocampus is spared (unlike AD)

Question 30

What are the s/Sx associated with CTE?

Answer 30

- recurrent headaches and dizziness - aggression, depression, anxiety, suicide - impaired judgment and impulse control - memory loss and confusion - progressive dementia (late) - movement disorders (late)

Question 31

Creutzfeld-Jakob disease

Answer 31

rare and rapidly fatal disorder with memory, behavior changes, and incoordination; results from protein (prion) disorder

Question 32

What score on the Mini-Mental State Examination (MMSE) is indicative of mental decline/dementia

Answer 32

< 24 out of 30

Question 33

What are the signs of depression?

Answer 33

1. nutritional problems 2. sleep disturbances 3. psychomotor changes 4. fatigue or loss of energy 5. feelings of worthlessness 6. inability to concentrate, slowed thinking, impaired memory, indecisiveness 7. withdrawal from family and friends, self-neglect 8. recurrent thoughts of death, suicidal ideation 9. a decline in cognitive function 10. standardized test: Geriatric Depression Scale

Question 34

Advance Care Medical Directive (Living Will)

Answer 34

- established by Federal Patient Self-Determination Act of 1990 - Health Care Proxy (Durable Power of Attorney): identifies a valid agent who is granted authority to make health care decisions for an individual, should that individual become incapacitated Requirements: 1. regulated by individual states; specific requirements vary by state 2. must be in writing, signed by principal, witnessed by two adults 3. empowers health care agent: includes specific guidelines on which treatment options will and will not be allowed (i.e. artificial life support, feeding tube) 4. defines conditions/scope of agent's authority

Question 35

What factors contribute to poor dietary intake?

Answer 35

- decreased sense of taste and smell - poor teeth or poorly fitting dentures - reduced gastrointestinal function (i.e decreased saliva, gastromucosal atrophy, reduced intestinal mobility; reflux - loss of interest in foods - lack of social support, socialization during meals - lack of mobility (i.e. inability to get to grocery store, shop; inability to prepare foods)

Question 36

Older adults have diets that are often deficient in what vitamins and nutrients?

Answer 36

vitamins A, C, B12, thiamine, protein, iron, calcium/vitamin D, folic acid, and zinc