geriatrics midterm

Question 1

what age is an older adult?

Answer 1

55

Question 2

what age is geriatric?

Answer 2

65

Question 3

why to women have lower mortality rates than men?

Answer 3

“men are dumber”
men are more likely to take risks
men are less likely to go to the dr
estrogen is cardio protective
women support each other better than men
men are more likely to have comorbidities

Question 4

what are the modifiable mortality risks of older adults?

Answer 4

heart disease
T2D

Question 5

what fraction of older adults have some type of disabilty?

Answer 5

~1/3

Question 6

what are the physical function activites?

Answer 6

mobility
ADLs
IADLs
work
recreation

Question 7

what is aging?

Answer 7

a persistent decline in age-specific fitness components of an organism due to internal physiological deterioration

Question 8

define extrinsic theory.

Answer 8

aging is result of cumulative damage

free radicals
radiation exposure

Question 9

define intrinsic theory.

Answer 9

aging is pre-programmed

genetically programmed cellular death
telemere shortening

Question 10

what are some accommodations for visual field decline?

Answer 10

for the decrease in peripheral and upper fields, pts need to be aware and improve lateral awareness

for relaxation of upper eyelid and loss of vision above head height, signs should be placed at eye level

Question 11

what are some accommodations for visual acuity?

Answer 11

for pts that cannot see fine details, they can use glasses, magnifiers, large print, zoomed in electronics

Question 12

what are some accommodations for visual glare?

Answer 12

glare is caused by light scattering on the retina.

pts can use lamp shades to soften light, non-glare flooring and flat paint

Question 13

what are some accommodations for illumination and dark adaptation?

Answer 13

due to having smaller pupils, they have a harder time adapting to darker environments.

they can use a night light, flashlight, light timers.

Question 14

what are some accommodations for depth perception?

Answer 14

colored tape or paint to differentiate changed in height or flooring types.

Question 15

what are some accommodations for color?

Answer 15

pts who cannot differentiate color have thicker lenses and are now less sensitive to colors with shorter wavelengths.

use bright, warm colors. do not use pastels or monotones.

Question 16

describe what cataracts look like.

Answer 16

blurry

Question 17

describe what diabetic retinopathy looks like.

Answer 17

spotty vision

Question 18

describe what glaucoma looks like.

Answer 18

loss of the outer rim of vison

Question 19

describe what macular degeneration looks like.

Answer 19

loss of a spot in the middle of vision

Question 20

what is conductive hearing loss?

Answer 20

sound transmission to inner ear is lost

could be from ear wax, perforation of tympanic membrane, otosclerosis

Question 21

what is sensorineural hearing loss?

Answer 21

dysfunction of sound waves to electrical signals by inner ear or dysfunction of nerve impulses to brain.

try to decrease background noise

Question 22

what are some recommendations for tactile sensitivity?

Answer 22

AD’s for dressing because harder to feel through finger tips

Question 23

what are considerations for thermal sensitivity?

Answer 23

room temps and pt comfort

Question 24

between taste and smell, which has a more significant change?

Answer 24

smell

results in OAs not eating because the food does not taste good.
use spices, be extra careful that food is not spoiled

Question 25

how much bone is lost per year, and what age does this start at?

Answer 25

.5-1% loss per year starting at age 30 2% for women in menopause

Question 26

why is osteoporosis more common in women?

Answer 26

3x more common women have a lower peak bone mass and have large hormonal changes at menopause

Question 27

what are the 3 major age-related changes in collagenous tissues?

Answer 27

loss of water from matrix - loss of height incr in # of collagen crosslinks - stiffer loss of elastic fibers - sagging skin

Question 28

what changes happen in the fibroblasts?

Answer 28

decr cell proliferation poor homeostasis altered ability for repair decr response to growth factors less response to loading

Question 29

what are glycoconjugates and how do they change?

Answer 29

molecules of carbos bonded to other compounds with aging, there is an incr in degradation and decr in synthesis

Question 30

what changes occur in collagen?

Answer 30

increase in cross links causes incr stiffness and decr energy absorption

Question 31

describe the healing prognosis of articular cartilage.

Answer 31

once it is damaged, the capacity to heal is limited and injury may even progress to development of cartilage lesions

Question 32

what are the 3 types of calcification and how do they occur?

Answer 32

metastatic calcification: calcium-phosphorous levels are elevated dystrophic calcification: in presence of damaged or necrotic tissue calcinosis: hypo-vascularity or hypoxia

Question 33

describe the changes in discs.

Answer 33

nucleus becomes more fibrous and gel-like. it looses shock absorption.

Question 34

describe the changes in tendons.

Answer 34

not able to disperse forces as well not as taught CSA and tensile strength decr

Question 35

in upper cross syndrome, which muscles are tight and which are weak?

Answer 35

tight: upper traps, levator scapula, pec major and minor weak: deep neck flexors, low/mid traps, and serratus anterior

Question 36

in lower cross syndrome, which muscles are tight and which are weak?

Answer 36

tight: errector spinae and hip flexors weak: glute max and abdominals

Question 37

what are the changes in cardiovascular tissues?

Answer 37

decline in max HR!! less compliance stiffer vascular walls

Question 38

what is laminar bloodflow?

Answer 38

normal straight through the vessel

Question 39

what is turbulent blood flow?

Answer 39

blood swirls like in a drain has trouble moving through due to plaque build up

Question 40

describe body comp changes.

Answer 40

decr in lean mass and incr in fat mass most fat is stored in the peritoneum.

Question 41

what type of organ is fat?

Answer 41

highly active, central metabolic organ more adipose = more insulin resistance

Question 42

what is the path to diabetes?

Answer 42

standard american diet - sugar & white flour insulin resistance hyperinsulinemia weight gain high blood sugar

Question 43

what are the changes in the immune system?

Answer 43

incr in inflammation shift in fat mass from periphery to abdomen incr inflammation exercise can reduce inflammation markers

Question 44

compare muscle mass of a young adult to older adults.

Answer 44

young: lean muscle mass is 50% of body weight older: decrease to 25% by 80 vastus lateralis CSA decr by 40% and total muscle fibers decr by 25% - loss of fast twitch

Question 45

describe fat infiltration.

Answer 45

altered muscle fiber orientation adipose secreting pro-inflam cytokines which inhibits muscle force production

Question 46

what is half of muscle mass decline with age due to?

Answer 46

axonal loss (loss of innervation)

Question 47

what causes muscle loss and altered endocrine function?

Answer 47

RMR declines 1-2% per decade after 20 yo decr growth hormone decr IGF-1 incr insulin resistance decr estrogen and testosterone vitamin D deficiency incr PTH

Question 48

what is the number 1 treatment for muscles?

Answer 48

progressive overload

Question 49

describe the hormonal axis.

Answer 49

loss of sex hormones and responsiveness of target tissues loss of sex hormones associated with reduction in muscle strength

Question 50

what is benevolent ageism?

Answer 50

mix of good and bad

Question 51

what is hostile ageism?

Answer 51

OA are drain on economy, health care system and cause issues at work

Question 52

how many OA reported daily ageism?

Answer 52

50-80%

Question 53

3 types of demeaning speech?

Answer 53

speaking loudly when not needed simplistic terms often patronizing tones

Question 54

what are the harmful effects of ageism?

Answer 54

overtreatment undertreatment reduced health outcomes

Question 55

how can we combat ageism?

Answer 55

policy and law educational activities intergenerational interventions

Question 56

transtheoretical model of change (6 stages)

Answer 56

pre-contemplation: no intention of taking action contemplation: intentions and plan for near future preparation: intention and some steps already taken action: behavior has been changed for short period of time maintenance: behavior changed and continues for LT termination: no desire to return to prior neg behaviors for at-risk populations, 40% in pre-contemp

Question 57

what are the steps to engaging-establishing a working relationship?

Answer 57

build trust focus more on process than outcome promote client buy in OARS

Question 58

what are the steps to focusing?

Answer 58

clarify client priorities collaborate on the conversation tool-agenda setting, action plan

Question 59

what are the steps to evoking?

Answer 59

identify barrier to change focus on past successes tool-readiness ruler, responding to change talk

Question 60

what are the steps to planning?

Answer 60

collaborate on goals tool-change plan, coping plan

Question 61

what are the 4 key principles of motivational interviewing?

Answer 61

partnership - express empathy evocation - develop discrepancy compassion - roll with resistance acceptance - support self-efficacy

Question 62

what is OARS?

Answer 62

open questions affirmations reflective listening summarizing

Question 63

DARN CAT

Answer 63

preparatory change: desire ability reasons need mobilizing change: commitment activation taking steps

Question 64

what are some responses to resistance?

Answer 64

shift focus of convo reframe and offer another perspective emphasize client's responsibility in personal choices support clients ability to change use reflective responses to give client ability to clarify

Question 65

importance and confidence ruler

Answer 65

importance scale: how important is it for your right now? on scale of 0-10 what number would you give yourself? confidence scale: if you did decide to change, how confident are you that you would succeed? on scale of 0-10 what number would you give yourself? follow up questions: what puts you at the number what would it take to move up one number when do you see importance rising how will you know when the time has come

Question 66

components of habit formation

Answer 66

repetition - consistency is key situational - popcorn at the movies insensitive to outcome

Question 67

goals for behavior change

Answer 67

make it personal SMART identify and assess obstacles identify the tradeoffs you are willing to make choose goals that do not require perfection

Question 68

goal structure

Answer 68

outcome, behavior, learning broad, specific, specific subgoal