Geriatrics II Flashcards
(51 cards)
1
Q
Changes in connective tissue due to aging
A
- Decreased proliferation of fibroblasts (lack of collagen, elastin)
- Increased cross-linkages in collagen & elastin (brittle)
2
Q
Changes in chondroid structures due to aging
A
- Calcification of cartilage, decreased viscoelasticity, decreased water content, cracks
- Inferior loading dispersing capacity, altered response of articular cartilage to cycle loading
- Disc degeneration
3
Q
Changes in fibrous structures due to aging
A
- Increased stiffness
- Reduced elasticity
4
Q
Changes in bones due to aging
A
- Decreased bone density (osteopenia = increased osteoclast activity & decreased osteoblast activity)
- Increased risk of fractures
5
Q
Whole joint changes due to aging
A
- Decrease joint space, increased laxity, altered load dispersion
- Decreased joint ROM (age is single most significant predictor of degeneration changes)
- AROM vs PROM: neuromuscular changes add to passive structural changes
- Patterns of decline in ROM: decrease in cervical ext./lateral flexion > flex/rotation
6
Q
Influence of reduced joint mobility in activity/participation
A
- Cartilage thinning: correlated with patient-reported disability
- Intervertebral disc degeneration: with back pain
- Reduced ankle DF: correlated with decreased postural control/balance, forward reach
- Reduced hip extension: with patient-reported falls…and reduced gait speed
7
Q
What multi-joint muscles shorten with age
A
- Ankle PF
- Hamstrings
- Hip flexors
8
Q
Interventions to improve joint mobility
A
- Static stretching: AROM/PROM, longer holds better up to 60 sec, minimum 15 sec
- Dynamic stretching: slow progressive reaching
- Ballistic stretching: risky/contraindicated for elderly
- PNF stretches
- Tai Chi: beneficial for flexibility & balance
- Yoga: beneficial for flexibility, balance, strength, stress levels, & gait speed by increasing hip ext. and stride length
9
Q
Describe the benefits of each grade of joint mob
A
- Grade I-II: safe for older adults
- Grade II: improve joint limitations even after 2 yrs of THA
- Grade III/IV: resulted in improved pain & QOL
- Manipulation contrainidacated for older adults with spinal osteoporosis
10
Q
Stretching recommendations for older adults
A
- 2-3 d/wk, daily is most effective, each muscle 2-4 times
- Stretch to the point of slight discomfort, not pain
- Static stretch hold 10-30 secs
- For older adults 30-60secs offers greater benefit
- Series of any type for all major muscles
- For older adults static stretches
11
Q
Postural impairments are an inevitable part of aging (True/False)
A
- False
12
Q
Common postural changes with aging with habitual postures
A
- Forward head pasture (FHP)
- thoracic kyphosis
- Decreased lumbar lordosis
13
Q
Ways to measure forward head posture
A
- Angle measurement: angle decreases with age, 49º for 65-74 age, 41º for 75-84 age, 36º for ≥85 age
- Tragus to wall measure: norm = 10-12cm; important to not extend cervical spine
- Occiput to wall measure: anything more than zero classified as flexed posture, increases likelihood of vertebral fractures, needs further assessment
14
Q
How to measure spinal curves
A
- Measurement from radiographs (cob angle)
- Inclinometers
- Using a flexible curve ruler to measure kypholordoosis: KI = TW/TL x 100; more than 13 is clinically kyphotic
15
Q
Ways to measure the lower extremity alignment
A
- Can have significant effect on posture & weight distribution
- Frontal plane: knee valgus/varus
- Sagittal plane: flex/ext. deformities
- Assess foot arch sufficiency: can aggravate knee valgus; Navicular drop measurement (abnormal is drop >1cm, orthotic arch indicated if 3.5cm drop)
16
Q
Trunk flexion exercises are relatively contraindicated in presence of osteoporosis (True/False)
A
- True
17
Q
Effects of aging non the nervous system
A
- Loss of neurons
- Decreased NVC and myelin
- Defects in neuronal transport mechanisms, protein synthesis
- Cumulative trauma, oxidative stress, & vascular changes
18
Q
Common sensory changes with aging
A
- Vision: muscle weakness resulting in poor convergence, cornea thickens resulting in astigmatism, impaired visual acuity
- Hearing, vestibular system: loss of hair cells
- Somatosensory: touch, temperature
- Taste
- Smell
19
Q
Common motor changes with aging
A
- Fewer & larger motor units
- Less stable NMJs
- Lower & more variable motor unit action potential discharge rates
20
Q
What is the most common MOI and leading cause of death from injury in >65 y/o
A
- Falls
21
Q
Prevalence of falls in older adults
A
- Occur in 1/3 of elderly >65 and in 1/2 of elderly >90
- 1 in 5 falls result in serious injury such as fracture or head injury
22
Q
Define fall
A
- Failure to maintain an appropriate lying, sitting, or standing position, resulting in an individual’s abrupt, undesired relocation to a lower level
23
Q
Age related intrinsic causes of falls
A
- Somatosensory
- Visual
- Vestibular
- Neuromuscular
- Cardiovascular
- Psychosocial
24
Q
Health conditions related intrinsic causes of falls
A
- Macular degeneration
- Vestibular hypofunction
- BPPV
- Diabetic neuropathy
- Parkinson’s Disease
- Stroke
- Impaired posture
- Orthostatic hypotension
- Incontinenece
- Dementia
- Depression
- Alcohol abuse
25
Extrinsic causes of falls
- Medications
- Polypharmacy: commonly considered to be the use of ≥5 medications
- Environmental hazards
26
If suspected of poly pharmacy refer for _________
- Brown bags medicine review
27
What medications are associated with increased confusion, sedation, cognitive decline, oH, dizziness, & visual disturbances
- Anticoonvulsants
- Antihypertensives
- Antidepressants
- Anxiolytics
- Sedatives
- Tranquilizers
- Diuretics
- Opioids
28
List some common indoor and outdoor environmental hazards
- Indoor: loose unsecured rugs, clutter, poor lighting, pets, extension cords, & unstable furniture
- Outdoor: uneven terrain, cracked sidewalks, sloping driveways, slippery surfaces (wet or icy), & variable curb/step heights
29
Fall risk assessment and prevention programs
- STEADI (Stopping Elderly Accidents, Deaths, and Injuries)
- AGPT outcome measure Toolkit for fall/balance assessment
- AGPT CPG for fall management
30
Tests for fear of falling
- Fall efficacy scale (FES)
- Activities-specific balance confidence scale (ABCs)
31
Tests and measures for balance/fall risk
- Single leg stance test
- Functional reach test
- MDRT
- 4 Square step test
- BBS
- Posturography
- SOT
- Romberg
- 6 MWT
- TUG Test
- The Short Physical Performance Battery
- DGI
- FGA
- Gait Speed
- 5x sit<>stand and 30 sec sit<>stand tests
32
Interventions for older adults with balance/fall risk problems
- Balance training exercises: training ankle/hip strategies, Dynamic balance/gait exercises, Tai Chi, Yoga
- Exercises to increase strength, endurance, ROM, posture, motor control/coordination
- Vestibular training/treatment
- Assistive devices: footwear, walking devices
- Pt/caregiver education
- Referral as needed
33
Effects of aging on mental function (the 3 D's)
- Depression
- Dementia
- Delirium
34
Define depression
- Feeling of sadness, hopelessness, loss of interest/pleasure in previously pleasurable activities
35
Characteristics of clinical depression
- Cognitive problems: difficulty concentrating, indecisiveness, memory problems
- Somatic symptoms: problems with appetite, sleep, increased pain
- Social problems: withdrawal from family friends
36
What are the 2 clinical diagnoses of depression
- Major depressive disorder
- Adjustment disorder with depressed mood
37
Self report tools for depression
- Beck depression inventory (BDI)
- Center for epidemiological studies Depression scale (CES-D)
- Best psychometrics for geriatric population: Geriatric Depression scale (GDS) = higher scores mean more severe Sx, and PHQ-9
38
2 most common approaches for depression management
- Pharmacotherapy: SSRI, SNRI, TCA; older adults tend to prefer this
- Psychotherapy: CBT
39
What are the beneficial effects of exercise/physical activity in depression management
- Increase in endorphin after exercises reduce depression (Physiological)
- Increased feelings of self-efficacy (Psychological)
40
Describe clinical diagnosis of MCI (Mild Cognitive Impairment)
- Consistent memory deficits
- Normal ADLs
- Abnormal age and education adjusted cognitive measures
41
Describe clinical diagnosis of dementia
- Objective evidence of memory and language impairments
- Impairment oof ADLs/IADLs/social participation
42
Cognitive screens for dementia
- Most have poor accuracy in detecting MCI
- MMSE
- Mini-cog
- SLUMS
- Short Blessed test
- Clock Drawing test
- Time and Change test
- Sniff test
- Naming
- CDR: interview based
43
Neuroimaging assessment of dementia
- CT
- MRI
- PET
- Severity of Sx does not always correlate
44
Role of PT in dementia management
- Assist pt, family, caregiver to improve/maintain functional abilities
- Home/environment modification
- Caregiver education for providing regular activities while maintaining safety
- Not much success with motor learning type exercises/activities with advanced dementia
45
Increasing evidence of the role of exercise/physical activity on cognitive improvement specifically
- Aerobic endurance exercise and dual tasking training on early dementia
46
Pharmacotherapy management of dementia
- Cholinesterase inhibitors
- Antidepressants
- Antipsychotics
- Mood stabilizers
- Anxiolytics
47
Define delirium
- Sudden episodic decline in mental function (not slow)
48
What is the most common complication after medical illness, during recovery from surgery, hospital admission, poly pharmacy
- Delirium
49
What are the 2 types of delirium
- Agitated (hyperactive)
- Quiet (hypoactive)
- Sometimes can have mixed Sx
50
Describe the treatment of delirium
- Identify & remediate the cause
- Possible causes: medications, infections, dehydration, nutrition/electrolyte imbalance, prolonged lying in bed
- PT recommendations to prevent delirium includes early mobilization & walking
51
Risk factors for delirium Slide 2nd to last slide
