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Flashcards in Chapter 8: Geriatric Physical Therapy Deck (36):
1

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

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

2

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

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

3

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

36%

4

What is gene regulation theory?

senescence results from changes in gene expression

5

What is cell senescence/telomere theory?

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

6

Premature aging during childhood is called:

Hutchinson-Gilford syndrome

7

Premature aging of young adults is called:

Werner's syndrome

8

Describe the age-related changes associated with muscle

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

9

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

- speed of contraction
- changes in nerve conduction and synaptic transmission

10

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

60%

11

Describe the age-related changes associated with bone mass

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

12

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

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

13

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

- antihistamines
- tranquilizers
- antidepressants
- steroids

14

What are the types of hearing loss?

- 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

15

How is pulmonary gas exchange affected by age?

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

16

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

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

17

Osteopenia vs. osteoporosis

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

18

What medications affect bone loss?

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

19

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

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

20

What are the approved pharmacological options for osteoporosis?

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

21

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

1200 mg per day

22

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

800 - 1000 IU per day

23

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

true

24

Where do vertebral compression fractures usually occur?

T8 - L3

25

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

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

26

What are the risk factors for Alzheimer's disease?

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

27

How is Alzheimer's disease diagnosed?

- 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

28

What are the stages of AD?

- 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

29

What is the pathophysiology of chronic traumatic encephalopathy?

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

30

What are the s/Sx associated with CTE?

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

31

Creutzfeld-Jakob disease

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

32

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

< 24 out of 30

33

What are the signs of depression?

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

34

Advance Care Medical Directive (Living Will)

- 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

35

What factors contribute to poor dietary intake?

- 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)

36

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

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