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Geriatrics Flashcards

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1
Q

Demographics for geriatrics

A 
65+ accounts for 13% population
85+ accounts for 4% population by 2050
women live longer than men
2% ages 65-74 in nursing home
20% 85+ in nursing home
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2
Q

Why are women prone to poverty in old age

A

low wages
fringe benefits
interrupted careers
reduction in benefits when they become widowed

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3
Q

3 most common causes of death in elderly

A

heart disease
cancer
stroke

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4
Q

Chronic disease statistics

A

more than 50% males and 70% females over 80 have 2+ chronic conditions

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5
Q

Most common self reported chronic diseases

A 
arthritis
HTN
diabetes
hearing impairments
heart disease
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6
Q

Common causes of disability

A 
cardiovascular disease
diabetes
obesity
stroke
hip fractures
osteoarthritis
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7
Q

Recovery statistics after hip fracture

A

more recovery of walking/ADL occurred within 6 months.

Poor recovery associated with old age, pre-fracture dependency, longer hospital stay, dementia, etc.

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8
Q

Intense rehab program for stroke pt statistics

A

improvement in weight shifting, balance, and ADL ability 1 year post stroke.

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9
Q

Psychosocial factors that can modify disability

A 
income
smoking
social isolation
depression
education
alcohol use
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10
Q

Decline in physical fx caused by

A

reduced physical activity.

can possibly reversed by exercise

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11
Q

Cardiovascular aging changes

A

ADL ability to depends on cardio system
physiological capacity and reserve are reduced
Older=closer to maximum limit

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12
Q

Structural changes in myocardium, conduction system, and endocardium

A

Result in reduction of heart’s pumping capacity

1 degree in L ventricle

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13
Q

Arterial vessels lose elasticity resulting in:

A

chronic increase in vessel diameter and vessel wall rigidity.
Increased resistance to blood leaving L ventricle=increase afterload
(doesn’t pump as much blood out)

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14
Q

Accumulation of lipids in arteries results in:

A

impedance of blood flow

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15
Q

Walls of veins become thicker resulting in:

A

valves become stiff and incompetent

increased risk of phlebitis and thrombus (blood clot) formation

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16
Q

Stroke volume and CO at rest is

A

unchanged

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17
Q

Maximum heart rate raises or lowers with age?

A

lowers

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18
Q

Aging on systolic and diastolic BP

A

Systolic BP tends to increase with age

Diastolic BP increases until ~60 and then stabilizes or falls

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19
Q

Structural changes in skeletal muscle with aging

A 
Muscle mass is reduced
mm fiber and size are reduced
Type 2 mm fibers reduced (fast twitch)
less precise grading/control of mm force (decrease in motor units)
Diameter of motor axons reduced
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20
Q

How much reduction in maximal isometric strength by 7th and 8th decade?

A

20-40%

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21
Q

Loss of extremity strength is greatest in:

A

LE mm strength loss is greater than loss of arm mm strength

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22
Q

Power

A

Reduced by 20%

Ability to respond quickly decreases

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23
Q

Two types of immobility

A

acute/accidental:accident/illness

chronic: long standing problem

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24
Q

Deconditioning

A

multiple changes in organ system physiology that are induced by inactivity and reversed by activity

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25
Degree of deconditioning depends on
degree of inactivity | prior level of fitness
26
Acute changes associated with immobility
``` distortion of time perception decrements in intellectual tests mood changes balance increase resting HR greater increase in HR and BP at submaximal activity levels lower maximal O2 uptake loss of lean body mass accelerated bone erosion decrease in joint ROM constipation ```
27
Chronic changes associated with immobility
``` poor sense of well being balance prolonged reaction time increase resting HR greater increase in HR and BP at submaximal activity (moreso than acute) lower maximal O2 uptake (more than acute does) loss of lean body mass accelerated bone erosion decrease in joint ROM ```
28
Why are PROM and AAROM important?
exercise reverses physiological changes of inactivity
29
Causes for falls
hip weakness poor balance postural sway exercise training is important to prevent falls!
30
Effects of aerobic exercise
extent of change depends on baseline fitness level changes occur in both skeletal and cardiac mm Glucose tolerance improves
31
Exercise interventions for geriatrics
should contain aerobic and resistance training | Resistance can cause elevated BP, but if proper technique is used it should be minimal
32
Risk of sudden death
Occurring either during activity or 1 hour after is most serious but least commong.
33
Risk of Injury
Due to 1 degree of overuse ankle most likely to be injured lower rates are associated with low impact exercise
34
Risk of stimulating arthritis
OA affects 85% of population inactivity may promote OA weight bearing may prevent OA by improving mm strength and increasing bone density and reducing obesity
35
Dietary risks
May need to increase dietary protein than when younger
36
Changes in periarticular tissue (PCT with age
(Ligaments, joint capsule, aponeurosis, tendon, muscle, and skin) Increased stiffness of PCT mobility is severely compromised in tissue
37
Changes in elastin with age
elastin is designed for mobility returns to shape after deformation reduces with age
38
Predominance of collage with old age
designed for immobility excellent tolerance to tensile forces no tolerance to compression forces INCREASES with age
39
What is hyaluronic acid
naturally occurs in humans for joint and eye lubrication | decreases with age
40
What is fibrin?
protein involved in clotting of blood forms a mesh increases with age
41
Aging effects on stretch
loss of elastin= loss of ability to respond over time to prolonged stretch. Does not respond well to large force Oscillations are best way to increase ROM
42
What happens to hyaline cartilage with age?
dehydrates and splits into fragments resulting in decreased ability to tolerate compression and tensile forces
43
Arthrokinetics for elderly
older joints have subtle decrease in angular velocity and displacement due to structural and sensorimotor changes.
44
Standing normal ROM of hips (line of gravity)
line of gravity falls just post. to axis for flex/ext. | Is balanced by natural stiffness in the taut iliofemoral ligament
45
Line of gravity with hip flexion contracture
Line of gravity falls just anterior to the axis for flex/ext. Must be countered by hip extensor mm Lumbar spine hyperextension and knee flex. occur to help trunk and pelvis
46
Senile kyphosis
common in elderly can cause external gravitational torque on spine with increases intervertebral joint forces They use increased back extensor mm force to hold head and trunk up
47
Senile kyphosis can result in:
``` arthritic changes compression fx disc injury loss of height bony remodeling ```
48
Sensorimotor changes in brain
subtle deterioration of executive order fx
49
Sensory changes in visual acuity
Visual acuity (seeing fine details) decreases gradually before the 6th decade Increases rapidly from 60-80 Affects ability to read
50
Presbyopia
Difficulty focusing on near object | Most common vision problem in elderly
51
Color discrimination in elderly
Difficulty identifying blues and greens
52
Changes in ocular motor systems
``` convergence difficulty ptosis (drooping eyelids) decreased smooth pursuit saccades (fast eye movements) optokinetic nystagmus ```
53
When is fx impairment to hearing typically seen?
70 years old
54
Presbycusis
age related decline in auditory fx gradual loss of bilateral hearing loss Lose high frequency tones first, then the rest
55
Presbyastasis
age related disequilibrium when no other pathological condition is seen. May result in vertigo, nystagmus, and postural imbalance.
56
Hyposmia
diminished sensitivity to smell
57
Hypogeusia
diminished sensitivity to tast
58
What is Somatosensory system?
Multiple systems for reception and processing Proprioception declines and LE is more affected than upper
59
Paucity
small movements hesitant and slow movements delays
60
What happens to control of muscular forces output?
less precisely graded | increased cocontraction of paired antagonist muscles
61
Postural changes that occur due to somatosensory changes
forward head increases upper thoracic kyphosis increases overall height decreases (falling arches, reduced intervertebral disc hydration)
62
Balance
rapid movements=loss of balance Lateral stability is more affected healthy elderly can maintain bilateral standing balance for 30 seconds w/open or closed eyes
63
Gait changes
``` step length decline Time in double support increases speed decreases ankle motion decreases BOS increases decreased pelvic rotation increased should. extension increased toeing out ```
64
How can gait changes be improved?
exercise and physical activity
65
Aging associated cognitive decline (AACD)
Gradual cognitive decline for at least 6 months | Has to result in one standard deviation below age and education norms
66
Age-associated memory impairment (AAMI)
Memory loss in elderly not sufficient to warrant diagnosis for dementia One standard deviation below norms
67
Benign senescent (age related causes) forgetfulness (BSF)
Term for memory loss associated with normal older person | Not severe enough to interfere with ADLs
68
Fluid Intelligence
involves capacity to use unique kinds of thinking to solve unfamiliar problems and is believed to decline wit age
69
Crystal Intelligence
acquired through education and acculturation and remains stable through age 70
70
What is executive functioning?
Complex behavior comprised of memory, cognitive planning, initiating activity
71
Effects of aerobic exercise on cognition
aerobic exercise leads to increased cardiorespiratory fitness-->Increased max 02 uptake
72
Exercise has greatest effects on what?
motor function auditory attention memory
73
Exercise has moderate effects on what?
cognitive speed | visual attention
74
What is dementia?
Group of disorders characterized by multiple cognitive defects. Impairment of short/long term memory, abstract thinking, judgement, Interferes with daily life and relationships
75
Alzheimer's type of dementia account for how much?
60% of those with dementia Diagnosis made post mortem (brain tissue autopsy) Memory impairment, aphasia, apraxia, disturbance in executive function
76
Multi-infarct dementia
organic mental disorder | result of infarcts that produce loss of brain tissue
77
Signs/symptoms of multi-infarct dementia
Problems with memory, abstract thinking, impulse control, personality, emotional lability
78
Reversible dementia
10-30% of those with dementia can be treated to correct a metabolic or structural condition
79
Pseudodementia
dementia behavior that is the result of major depressive episode Psychomotor retardation, disinterest, memory impairment
80
Anxiety
Common in elderly can be present in early stage dementia can be caused by pulmonary embolus, COPD, alcohol withdrawal
81
Coping behavior
depends on personality | no evidence that coping ability declines with age
82
Treatment methods
``` similar to TBI simple commands sensory cues rest breaks stay positive use fx activities rather than exercise programs ```

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