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Neuro Dev/Control II > Geriatrics II > Flashcards

Geriatrics II Flashcards

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)
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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
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3
Q

Changes in fibrous structures due to aging

A
  • Increased stiffness
  • Reduced elasticity
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4
Q

Changes in bones due to aging

A
  • Decreased bone density (osteopenia = increased osteoclast activity & decreased osteoblast activity)
  • Increased risk of fractures
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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
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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
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7
Q

What multi-joint muscles shorten with age

A
  • Ankle PF
  • Hamstrings
  • Hip flexors
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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
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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
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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
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11
Q

Postural impairments are an inevitable part of aging (True/False)

A
  • False
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12
Q

Common postural changes with aging with habitual postures

A
  • Forward head pasture (FHP)
  • thoracic kyphosis
  • Decreased lumbar lordosis
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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
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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
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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)
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16
Q

Trunk flexion exercises are relatively contraindicated in presence of osteoporosis (True/False)

A
  • True
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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
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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
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19
Q

Common motor changes with aging

A
  • Fewer & larger motor units
  • Less stable NMJs
  • Lower & more variable motor unit action potential discharge rates
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20
Q

What is the most common MOI and leading cause of death from injury in >65 y/o

A
  • Falls
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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
Q

Extrinsic causes of falls

A
  • Medications
  • Polypharmacy: commonly considered to be the use of ≥5 medications
  • Environmental hazards
26
Q

If suspected of poly pharmacy refer for _________

A
  • Brown bags medicine review
27
Q

What medications are associated with increased confusion, sedation, cognitive decline, oH, dizziness, & visual disturbances

A
  • Anticoonvulsants
  • Antihypertensives
  • Antidepressants
  • Anxiolytics
  • Sedatives
  • Tranquilizers
  • Diuretics
  • Opioids
28
Q

List some common indoor and outdoor environmental hazards

A
  • 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
Q

Fall risk assessment and prevention programs

A
  • STEADI (Stopping Elderly Accidents, Deaths, and Injuries)
  • AGPT outcome measure Toolkit for fall/balance assessment
  • AGPT CPG for fall management
30
Q

Tests for fear of falling

A
  • Fall efficacy scale (FES)
  • Activities-specific balance confidence scale (ABCs)
31
Q

Tests and measures for balance/fall risk

A
  • 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
Q

Interventions for older adults with balance/fall risk problems

A
  • 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
Q

Effects of aging on mental function (the 3 D’s)

A
  • Depression
  • Dementia
  • Delirium
34
Q

Define depression

A
  • Feeling of sadness, hopelessness, loss of interest/pleasure in previously pleasurable activities
35
Q

Characteristics of clinical depression

A
  • Cognitive problems: difficulty concentrating, indecisiveness, memory problems
  • Somatic symptoms: problems with appetite, sleep, increased pain
  • Social problems: withdrawal from family friends
36
Q

What are the 2 clinical diagnoses of depression

A
  • Major depressive disorder
  • Adjustment disorder with depressed mood
37
Q

Self report tools for depression

A
  • 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
Q

2 most common approaches for depression management

A
  • Pharmacotherapy: SSRI, SNRI, TCA; older adults tend to prefer this
  • Psychotherapy: CBT
39
Q

What are the beneficial effects of exercise/physical activity in depression management

A
  • Increase in endorphin after exercises reduce depression (Physiological)
  • Increased feelings of self-efficacy (Psychological)
40
Q

Describe clinical diagnosis of MCI (Mild Cognitive Impairment)

A
  • Consistent memory deficits
  • Normal ADLs
  • Abnormal age and education adjusted cognitive measures
41
Q

Describe clinical diagnosis of dementia

A
  • Objective evidence of memory and language impairments
  • Impairment oof ADLs/IADLs/social participation
42
Q

Cognitive screens for dementia

A
  • 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
Q

Neuroimaging assessment of dementia

A
  • CT
  • MRI
  • PET
  • Severity of Sx does not always correlate
44
Q

Role of PT in dementia management

A
  • 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
Q

Increasing evidence of the role of exercise/physical activity on cognitive improvement specifically

A
  • Aerobic endurance exercise and dual tasking training on early dementia
46
Q

Pharmacotherapy management of dementia

A
  • Cholinesterase inhibitors
  • Antidepressants
  • Antipsychotics
  • Mood stabilizers
  • Anxiolytics
47
Q

Define delirium

A
  • Sudden episodic decline in mental function (not slow)
48
Q

What is the most common complication after medical illness, during recovery from surgery, hospital admission, poly pharmacy

A
  • Delirium
49
Q

What are the 2 types of delirium

A
  • Agitated (hyperactive)
  • Quiet (hypoactive)
  • Sometimes can have mixed Sx
50
Q

Describe the treatment of delirium

A
  • 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
Q

Risk factors for delirium Slide 2nd to last slide

A

Neuro Dev/Control II (19 decks)

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