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Second Developmental Exam > Geriatrics pt.2 > Flashcards

Geriatrics pt.2 Flashcards

(61 cards)

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1
Q

What is polypharmacy?

A

The excessive or inappropriate use of medications

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2
Q

Adults over 65 purchase over __% of all prescription meds

A

30%

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3
Q

Older adults are more likely to experience adverse drug reactions (ADRs) and ___ of older people take at least 1 unnecessary drug

A

1/2
Avg. older adult takes 5 meds
Avg. nursing home resident takes 7 meds

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4
Q

What are the causes of polypharmacy?

A

● Physicians may prescribe medications to relieve symptoms that could be relieved through nonpharmacologic methods
- Ex- a patient who naps during the day cannot sleep at night and is prescribed a sleeping pill
● Patients may obtain prescriptions from multiple providers
● Patients may take over the counter medications that interact with
other medications
- Interactions may be seen as new symptoms, resulting in new medications prescribed

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5
Q

What are 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 medications
● Use of inappropriate dosage
● Use of drug therapy to treat adverse drug reactions

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6
Q

How does aging affect drug absorption?

A

● Decreased gastric acid
● Decreased stomach emptying
● Decreased gastric motility

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7
Q

How does aging affect drug distribution?

A

● Decreased body H2O
● Increased body fat
● Decreased plasma proteins
● Decreased lean body mass

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8
Q

How does aging affect drug metabolism?

A

● Decreased liver mass
● Decreased blood flow to liver
● Decreased enzyme activit

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9
Q

How does aging affect drug secretion?

A

● Decreased kidney mass
● Decreased blood flow to kidneys
● Decreased nephron function

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10
Q

What medications are most commonly overprescribed?

A

● Laxatives
● BP meds
● Diuretics
● DM meds
Likely due to side effects of other meds and because quick fix

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11
Q

What drug commonly causes gastrointestinal side effects?

A

NSAIDs

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12
Q

What drug has a common side effect of sedation?

A

Opioids

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13
Q

What drugs commonly cause confusion as a side effect

A

Antidepressants
Analgesics
Lithium

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14
Q

What drugs commonly cause depression as a side effect?

A

Barbiturates
Antihypertensives

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15
Q

What drug typically causes orthostatic hypotension as a common side effect?

A

Antihypertensives

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16
Q

What drugs cause fatigue/weakness as a common side effect?

A

Diuretics
Glucocorticoids

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17
Q

What can we, as PTs, do to help prevent polypharmacy?

A

Carefully review patient’s medication list
● Look for any possible adverse drug reactions
● Does their medication list make sense with their comorbidities? (Ex. taking antibiotics from an infection years ago?)
● Think about how medications will affect physical therapy (Dosing schedules, RPE)
● PATIENT EDUCATION

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18
Q

___ % of people over ages 65 reported at least one fall in a year

A

29%

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19
Q

Wha is the leading cause of death/hospitalization from injury in older adults?

A

Falls
- Medical treatment costs >$50 billion/yr
- Can occur with or without injury
- Associated with pain, loss of confidence, functional decline, and institutionalization

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20
Q

What are some environmental risk factors for falls?

A

● Slippery or uneven surfaces
● Rugs
● Poor lighting
● Obstacles in path (Cords, clutter)
● Lack of grab bars or handrails
● Poorly arranged furniture

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21
Q

What are some risk factors for falling?

A
  • CVA/neuro diagnosis
  • prior falls/ fear of falling
  • recent hospitalization
  • poor sensation/ pain/ LE weakness/ frailty
  • difficulty with ADLs
  • age 65+
  • use of assistive device
  • orthostatic hypotension
  • polypharmacy
  • incontinence
  • depression or anxiety
  • foot problems
  • cog impairment
  • meds like benzodiazepines, diuretics, sedatives
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22
Q

What is the 6th vital sign*?

A

Gait speed but not really
good for indication of fall risk

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23
Q

Gait speed is correlated with what outcomes?

A

● Re-hospitalization
● ADL performance
● Number of medications
● Depressive symptoms
● Discharge location from hospital
● History of multiple falls

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24
Q

What is the cut-off for community ambulation?

A

0.8 m/s

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25
What are some interventions for fall prevention?
● Dynamic and static balance training ● LE strengthening and endurance training ● Coordination ● Flexibility and ROM Cardiovascular endurance training Assistive Device Training Home environment modification
26
What are some Balance outcome measures for Geriatrics?
● Berg Balance Scale ● Sharpened Romberg ● 4 Square Step Test ● Functional Reach Test ● MiniBEST
27
What are some Self-Report outcome measures for Geriatrics?
● MFES- Modified Falls Efficacy Scale ● Fear of Falling Avoidance Behaviors Questionnaire
28
What are some Functional Outcome measures for Geriatrics?
● 5xSTS ● 30s STS ● TUG ● 10mWT
29
What are Endurance Outcome measures for Geriatrics?
● 6MWT ● 2min step test
30
What is the Sharpened Romberg?
- screening tool for balance - patient stands with feet together, semi-tandem, and tandem with eyes open for 10 sec then closed for 10 sec
31
What are cutoffs for fall risk in TUG, 5xSTS, BERG?
- TUG: 13.5 sec - 5xSTS: 11.4 sec - BERG: 45/56
32
What is a disability?
A mental or physical impairment that limits major activities in life in one or more ways
33
What are types of disabilities?
● Ambulation ● Cognitive ● Visual ● Hearing ● Medical
34
What percent of persons age 65 and over with any disability are there in the U.S.?
34%
35
What is Medicare? What is Part A vs Part B?
- age 65+ OR people with disabilities - Part A: IP, SNF, HH, Hospice - Part B: OP, DME
36
Who is Medicaid for?
- low income - pregnant or responsible for a minor - people with disabilities
37
What ambulation distance is required for independent living?
400 m
38
What gait speed is a requirement for independent living?
1.2 m/s
39
What weight must patient be able to carry for independent living?
One gallon of milk (~8 lbs)
40
What are some other requirements for independent living?
● Must be able to ambulate on variable terrains (Carpet, grass, uneven surfaces) ● Must be able to encounter obstacles (Stairs, curbs, doors, elevators) ● Additional Demands (Postural transitions, head orientation, stop/start, backing up, side stepping)
41
What does a typical patient look like in inpatient rehab (IPR) for discharge planning?
- 3 hrs of therapy per day (PT,OT, SLP) - high prior level of function - not safe to go home - moderate complexity of medical needs
42
What does a typical patient look like in Skilled Nursing Facility (SNF) for discharge planning?
- unable to participate in 3 hrs of PT per day - moderate functional prognosis - variable prior level of function
43
What does a typical patient look like in Outpatient for discharge planning?
- high prior level of function - stable complexity of medical needs - must be able to travel through community to OP facility
44
What does a typical patient look like in Home health for discharge planning?
- limited ambulation for community - safe to go home - good functional prognosis
45
What does a typical patient look like in Long Term Acute Care (LTAC) for discharge planning?
- high complexity of medical needs - poorer prognosis - less need for skilled therapy
46
What does a typical patient look like in Palliative Care for discharge planning?
● Typically for patients with chronic and serious illnesses ● Aims to treat pain and suffering ● Addresses psychological, social, and spiritual problems
47
What does a typical patient look like in Hospice for discharge planning?
● End of life care- terminal illnesses ● Expectation- 6 months or less to live ● Aims to manage pain and other symptoms ● Can take place at home or a facility
48
What are advanced care directives?
Allows individuals to identify their preferences for care when they are unable to do so themselves
49
What are living wills?
General indication of preferences, recommended for all adults
50
What are some things that are recommended for patients with terminal illness as a part of discharge planning?
○ DNR- Do not resuscitate ○ MOLST/POLST- Medical/Physician orders for life sustaining treatment ○ Power of Attorney- appoints an individual to make decisions on one’s behalf
51
What is the most powerful intervention for maintaining well-being?
EXERCISE! - anything is better than nothing - make it attainable for patient - encourage them to meet their goals - consider family support and what is available in their community - make it something patients can do on their own eventually
52
What are the benefits of Group Exercise?
benefit of socialization, supervision, and peer support
53
Adults lose __% of their strength between the ages of 60-90
40%
54
What is a good option for aerobic and strength training for patients who cannot tolerate weight bearing on land
Aquatic exercise
55
What is a better indicator than strength for functional activities such as stair climbing, sit to stands, and gait
Power training
56
What is the percent of older adults who meet both strengthening and aerobic guidelines?
Apparently less than 15% (according to Google AI)
57
What can you do for patients with less visual acuity?
Use large print books and computer software ○ Color- Use bright, warm colors, avoid pastels, avoid monotones ○ Depth perception- Avoid patterned floor surfaces, use warm colors to highlight handrails and steps ○ Contrast- Use bright details on dark backgrounds
58
What can you do for patients with hearing loss?
minimize background noise ○ Say the person’s name before beginning the conversation ○ Try rephasing if repeating is not effective
59
What can you do for patients with taste/smell lost?
Use additional spices and colors to enhance foods
60
What can you do with the environment to help patients with sensory loss?
Avoid temperature extremes Like A/C or heating
61
What are some environmental considerations at Home?
● Is there outdoor lighting? ● Is there a place to put things down when locking/unlocking the door? ● Are there steps to the door? ● Is the door wide enough for a wheelchair? ● Is there a place to sit to put on shoes? ● Are there rugs or cords on the floor? ● Are heavy pots/pans stored in low cabinets? ● How high does the patient have to reach for dishes, groceries, clothes? ● Do their chairs have armrests to push up on? ● Which side is the handrail for the stairs? ● How low is the toilet? ● Are there any grab bars for the toilet or shower? ● Do they have to step over a bathtub ledge to get in the shower? ● Are the hallways, doors, and bathroom large enough for a wheelchair?

Second Developmental Exam (5 decks)

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