geriatrics 2 Flashcards
(71 cards)
1
Q
polypharmacy
A
the excessive and inappropriate use of medications
2
Q
adults over __ purchase __% of all prescription medications
A
65yrs, 30%
3
Q
older adults are ______ to experience adverse drug reactions (ADR’s)
A
more likely
4
Q
___ of older people take at least one unnecessary drug
A
half
5
Q
average older adults take at least _ medications
A
5
6
Q
average nursing home residents take _ medications
A
7
7
Q
characteristics of polypharmacy in older adults
A
- use of medications for no apparent reason
- use of duplicate medications
- concurrent use of interacting medications
- use of contraindicated drugs
- use of inappropriate dosage
- use of drug therapy to treat adverse drug reactions
8
Q
Pharmacokinetics of aging, absorption
A
- decreased gastric acid
- decreased stomach emptying
- decreased gastric motility
9
Q
Pharmacokinetics of aging, distribution
A
- decreased body H2O
- increased body fat
- decreased plasma proteins
- decreased lean body mass
10
Q
Pharmacokinetics of aging, metabolism
A
- decreased liver mass
- decreased blood flow to liver
- decreased enzyme activity
11
Q
Pharmacokinetics of aging, excretion
A
- decreased kidney mass
- decreased blood flow to kidneys
- decreased to nephron function
12
Q
most commonly overprescribed medications (for older adults)
A
- laxatives
- BP meds
- diuretics
- diabetes drugs
13
Q
common side effect of NSAIDs
A
GI symptoms
14
Q
common side effect of opiods
A
sedation
15
Q
common side effect of antidepressants, analgesics, lithium
A
confusion
16
Q
common side effect of barbiturates, antihypertensives
A
depression
17
Q
common side effect of antihypertensives
A
orthostatic hypotension
18
Q
common side effect of diuretics and glucocorticoids
A
fatigue/weakness
19
Q
Prevention of polypharmacy
A
review pts medication lists
- contraindications?
- dosage?
- pt education?
- do they make sense?
20
Q
__% of people over age __ reported at least 1 fall in the past year
A
29%, 65yrs
21
Q
medical treatment for falls costs more than ___ each year
A
$50 billion
22
Q
falls can occur ___ or ___ injury
A
with or without
23
Q
____ are the leading cause of hospitalization from injury in older adults
A
falls
24
Q
falls are associated with:
A
- pain
- loss of confidence
- functional decline
- institutionalization
25
fall risk factors
- prior falls
- fear of falling
- recent hospitalization
- poor sensation
- pain
- difficulty with ADLs
- age over 65
- use of an AD
- impaired balance, gait
- LE weakness
- frailty
- orthostatic hypotension
- polypharmacy
- CVA or neuro diagnosis
- incontinence
- depression or anxiety
- foot problems
- cognitive impairment
- benzodiazepine, diuretics, sedatives
26
environmental fall risk factors
- slippery/uneven surfaces
- rugs
- poor lighting
- obstacles in path (cords, clutter)
- lack of grab bars or handrails
- poorly arranged furniture
27
gait speed is correlated with multiple outcomes:
- re-hospitalization
- adl performance
- # of meds
- depressive symptoms
- discharge location from hospital
- history of multiple falls
28
cut off for community ambulation:
0.8-1.2m/s
29
cut off for fall risk:
1m/s
30
cut off for independent in ADLs
1m/s
31
cut off for less likely to be hospitalized:
1m/s
32
max cut off for more likely to be hospitalized
0.6m/s
33
limited community ambulator
0.4-0.8m/s
34
cross street and normal walking speed:
1.2m/s+
35
d/c to SNF speed
<0.1m/s
36
household walker speed
0-0.4m/s
37
interventions for fall prevention
- balance training
- cardiovascular endurance training
- assistive device training
- home environment modification
38
blance outcome measures
- BERG
- Sharpened Romberg
- 4 square step test
- functional reach test
- miniBEST
39
self report outcome measures
- MFES: modified falls efficacy scale
- fear of falling avoidance behaviors questionaire
40
functional outcome measures
- 5x sit to stand
- 30 sec sit to stand
- TUG
- 10m walk test
41
endurance outcome measures
- 6 meter walk test
- 2 min step test
42
sharpened Romberg screening
10 sec EO and 10 sec EC in each position:
- feet together
- semi tandem
- tandem
43
TUG fall risk cut off
- 13.5s
- 8.5s for community dwelling adults
44
5x STS fall risk cut off
11.4s
45
BERG fall risk cut off
45/56
46
disablitiy:
a mental or physical impairment that limits major activities in one or more ways
47
types of disabilites
- ambulation
- cognitive
- visual
- hearing
- medical
48
__% of people age __ live with a disability
34%, 65+
49
requirements for independent living/community:
- ambulation of 400m
- gait speed of 1.2m/s
- carrying objects (1g milk is 8lbs)
- ambulate of variable terrains
- must be able to encounter obstacles
- etc.
50
IPR:
- 3hr/day of rehab (PT, OT, SLP)
- high prior function
- not safe to go home
- mod complexity
51
SNF:
- unable to preform 3hr/day of rehab
- mod functional prognosis
- variable prior level of function
52
___ is the most powerful intervention for maintaining well being
exercise
53
exercise for geriatrics (PT intervention)
- anything is better than nothing
- make it attainable for the pt
- encourage them to meet their goals (playing with grandkids, cooking)
- consider family support and what is available in the community
- make it something they can eventually do on their own
54
types of exercise for older adults
- group
- resistance
- aquatic
- balance
- power!!!
55
adults loose as much as __% of their strength between age __-__
40%, 60-90yrs
56
__% of women 65-74 meet ACSM guidelines
14%
57
__% of women 75+ meet ACSM guidelines
7%
58
__% of women 55-64 meet ACSM guidelines
17%
59
__% of men 55-64 meet ACSM guidelines
21%
60
__% of men 65-74 meet ACSM guidelines
18%
61
__% of men 75+ meet ACSM guidelines
11%
62
low, moderate, and high intensity loading in power training are ____ for older adults
equally as beneficial
63
intensity levels for power training
- low: 20% 1RM
- mod: 50% 1RM
- high: 80% 1RM
64
resistance training recommendations for older adults
Beginners:
- 1-2 d/wk
- low-mod intensity
- 1-2 sets
- 60-120sec rest intervals
trained:
- 3+ d/wk
- mod, mod-high intensity
- 3+ sets
65
power training recommendations for older adults
Beginners:
- 1-2 d/wk
- low, low-mod, or mod intensity
- 1-2 sets
- 60-120sec rest intervals
trained:
- 3+ d/wk
- low, low-mod, mod, or high intensity
- 3+ sets
66
osteoporosis intervention
- loading!!!
- under-dosing is a current problem
67
interventions for pts with decreased visual acuity
- large print books/computer software
- color: bright, warm colors
- depth: avoid patterned floors, use warm colors to highlight handrails and steps
- contrast: bright details on dark backgrounds
68
interventions for pts with hearing loss
- minimize background noise
- say their name before starting conversation
- try rephrasing if repeating is not effective
69
interventions for pts with taste/smelling loss
- use additional spices and colors to enhance foods
70
interventions for pts with sensory loss (envirmonment)
- avoid temperature extremes from AC or heating
71
IADL stands for:
instrumental activities of daily living
