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hdal - post midterm > Introduction to Geriatrics 2 > Flashcards

Introduction to Geriatrics 2 Flashcards

1
Q

True or false aging itself is not pathological?

A

True, aging influences predisposition to disease, but aging itself is not pathological

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2
Q

What are the six disease independent changes in the aging heart associated with reduced function?

A

1) Reduced number of myocytes and cells within conduction tissue

2) Development of cardiac fibrosis

3) Reduced calcium transport across membranes

4) Lower capillary density

5) Decreased intracellular response to β-adrenergic stimulation

6) Impaired autonomic reflex control of heart rate

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3
Q

What is the most notable and clinically important cardiovascular change in the aging population?

A

Decline in max heart rate

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4
Q

Why is the entire vascular system stiffer and less compliant and the elderly?

A

Due to fundamental changes in connective tissues, increased cross-linking of collagen, altered matrix composition, & loss of elastin,

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5
Q

What Major Age-Related Changes in Cardiovascular Tissues & Associated Clinical Consequences and their clinical consequences?

A
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6
Q

What is Arteriosclerosis

A

any form of vascular degeneration associated with arterial wall thickening and loss of resilience in the arterial wall4

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7
Q

What is Atherosclerosis

A

: a specific type of degeneration associated with accumulation of fat in the intimal lining of blood vessels and an increase in connective tissue in the subintima4

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8
Q

What are the cardiovascular pathologies associated with aging?

A

Ischemic Heart Disease

Cardiomyopathy / Congestive Heart Failure

Conduction System Disease

Valvular Disease

Hypertension

Myocardial Degeneration

Peripheral Vascular Disease

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9
Q

When do cardiovascular pathologies associated with aging have an effect?

A

Overall, none of these changes have clinical relevance at rest, but they can have significant consequences during activities that produce cardiovascular stress, including:
Increased flow demand (exercise)
Demand for acute autonomic reflex control (postural changes)
Severe disease (uncontrolled HTN, MI)

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10
Q

True or false, resting cardiac function shows minimal age-related changes?

A

True

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11
Q

What are some examples of the formulas for maximum heart rate?

A

220 – age
208 – (age x 0.70)
205 – ½ age (males)
225 – age (females

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12
Q

What are some of the physical therapy the implications for cardiovascular decline in the elderly?

A

Warm-ups and cool-downs
Vital signs
HR and BP
Rate of perceived exertion (RPE)
Borg (6-20)
Modified Borg (0-10)
Medication review
Some medications blunt HR response, e.g., beta-blockers

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13
Q

What is the effect of aging on the pulmonary reserve capacity?

A

Aging decreases the reserve capacity of all pulmonary functions regardless of lifestyle; however, a sedentary lifestyle accelerates the decline
The effects of age are not as influential as the effects of smoking regarding a premature decline in lung function, and subsequently, the ability to exercise

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14
Q

What are some of the structural changes that occur in the respiratory system with aging?

A

1) Structural changes result in functional impairment of gas exchange

2) Changes in rib joints/spine & collagen result decreased chest wall compliance

3) Increased stiffness affects volume of air moved and the work of breathing

4) Intermolecular collagen cross-links decrease elastic recoil

5) Capacity for gas exchange is reduced by flattening of alveolar walls (reduced surface area, air trapped in collapsed airways)

6) Reduced ciliary action

7) Reduced respiratory muscle strength and endurance

8) Increase in work of breathing requiring greater muscle oxygen consumption

9) Reduced calcium transport within respiratory musculature

10) Decreased production of myosin chains

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15
Q

What are some common pulmonary pathology associated with aging?

A

Pneumonia

Chronic Obstructive Pulmonary Disease (COPD)

Resistive Airway Diseases

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16
Q

What kind of breathing can be helpful for patients with decreased aerobic capacity?

A

Pursed lip breathing

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17
Q

True or false endurance training cannot reverse the decline in physical disk conditioning associated with aging

A

False, it can

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18
Q

What are some of the renal domestic manifestations of aging?

A

Decreased blood flow to kidneys
Decreased amount of blood the kidneys can filter
Decreased mass & weight of kidneys
Decreased number & size of nephrons & glomeruli
Decreased ability of kidneys to reabsorb water & solutes
Greater renal vasoconstriction
Reduced bladder capacity
Transition of day-time urine production to night-time urine production

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19
Q

What are some common we encountered problems for the older adult that altered renal function contributes to?

A

1) Too much or too little water
2) too much water to little sodium
3) too much potassium
4) drug intoxication
5) acute and chronic renal failure

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20
Q

What can UTIs cause in the older adult?

A

Confusion involves

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21
Q

What lab values can occur in older patients because of renal decline?

A

Potassium: arrythmias
Sodium: mental status changes

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22
Q

Were the effects of drug intoxication on older patients with renal decline?

A

Potassium: arrythmias
Sodium: mental status changes

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23
Q

What can dehydration be causeed by and cause in the older adult?

A

Decline in renal function, confusion or low blood pressure

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24
Q

What is the manifestations of aging and the G.I. tract in the older population?

A

Decreased gastric acid production
Decreased gastric emptying
Decreased GI blood flow
Decreased intestinal & esophageal motility
Diminished area of absorptive surface
Decreased saliva production
Decreased taste buds and olfactory bulb cells
Proteins, fats, minerals, vitamins, and carbohydrates are absorbed more slowly

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25
Q

What are some G.I. related pathologies in the older adult?

A

Constipation, incontinence, diverticulitis
Dysphagia
Colitis
Gastroesophageal Reflux Disease (GERD)
Malnutrition

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26
Q

What are some physical therapy implications of GI related issues in the older population?

A

Dysphagia & aspiration
Increased incidence in older adults
Recognize and refer to Speech Therapy
Positioning
Decreased nutrient intake, decreased energy reserves
Colitis
Fluid & electrolyte imbalance
“I don’t want to eat anything because then I might have diarrhea.”

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27
Q

What are some musculoskeletal manifestations of aging?

A

Loss in muscle mass and strength
Reduced bone health
Increased stiffness
Decreased flexibility
Joint proprioception declines with age, mostly in knee and ankle
Lean mass decreases, fat mass increases2
Women are affected earlier than men for declines in muscle mass and bone health due to hormonal changes of menopause
At all ages, woman are more vulnerable than men to loss of lean body mass

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28
Q

What are the muscular changes in older population?

A

Decreased muscle fiber size
Reduced number of Type II fibers
Increased intermuscular adipose tissue
Reduced number of mitochondria/mitochondrial DNA
Age-related low-grade chronic inflammation contributes to reduced muscle function
Changes in excitation-contraction coupling, calcium release & reduced muscle protein synthesis reduce muscle performance

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29
Q

What are the connective tissue changes in the older population?

A

Increased collagen concentration & increased collagen cross-links
Decreased elastin fibers
Less fibrinogen & fewer macrophages result in micro-adhesions
Loss of water content in articular cartilage & extracellular matrix
Articular cartilage thins/degenerates
Decrease in tensile strength
Decreased secretion of hyaluronic acid (for joint lubrication)

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30
Q

What are the bone changes in the older population?

A

Calcium-related loss of mass & density
Decreased circulating levels of Vitamin D
Decreased bone strength
Alterations in maturation & function of the osteoblast and the osteoclast, resulting in greater removal compared to replacement
Decreased estrogen
Decreased muscle mass

31
Q

What are the 4 main musculoskeletal pathologies that are related to aging?

A

Osteoarthritis
Osteoporosis
Sarcopenia
Fracture

32
Q

What are the physical therapy implications regarding muscular skeletal changes in the older population?

A

Strength training helps offset loss in muscle mass and strength that is associated with normal aging, in addition to improvement in bone health, postural stability, flexibility, and ROM
Significant strength gains are possible for older adults when they are exposed to adequately dosed training methods
We will discuss dosing in the next lecture
Physical activity of all types can be scary for older adults
It is your job as a Physical Therapist to make it less scary and ease their apprehension

33
Q

What are the neurological manifestations of aging?

A

The speed of central processing is reduced with advanced age
Cognition, balance, reflexes, reaction times, energy expenditure, and muscle function are all effected by changes in the neurological system
Neurochemical changes occur
Decreased hormonal balance
Decreased sensitivity to pain and changes in temperature
Sensorimotor changes contribute to balance difficulty and slower movements seen in older adults
Denervation and reinnervation of muscle fibers results in fewer, but larger surviving motor units
This impacts motor unit recruitment and decreases performance of fine motor control

34
Q

What are the central nervous system changes in aging?

A

Decreased brain mass
Decreased cerebral blood flow
Decreased conduction velocity
Decreased impulse conduction & cerebral synaptic transmission
Decline of neurotransmitters
Hypothalamus less sensitive to physiological feedback, resulting in difficulty with thermoregulation
Decreased reactivity of autonomic nervous system
Increased amyloid plaques, lipofuscin, neurofibrillary tau tangles

35
Q

Where the peripheral nervous system changes in aging?

A

Decreased nerve cells
Decreased blood flow to nerves
Changes to layers of nerve
Perineurium & epineurium thicken
Endoneurium can become fibrosed with collagen
Decreased conduction velocity

36
Q

What are some neurological pathologies related to aging?

A

Confusion and delirium

cerebrovascular disease

Parkinson’s disease

dementias

peripheral neuropathy is

vestibular problems

essential tremor

37
Q

What are some of the physical therapy implications regarding neurological changes in the older adult

A

Geriatric patients will present with decreased speed, coordination, reaction times, and overall movement time
Keep instructions simple and direct if possible
Ex: Asking an older adult to get out of bed
Incorporate visual feedback and demonstrations if able
Take advantage of procedural memory and functional movements
Incorporate warm-ups and cool-down periods to allow for increased catch-up of thermoregulation system
Remember that the neurological system is heavily intertwined with the other body systems

38
Q

What are some of the visual changes associated with aging?

A

Decreased visual acuity, decreased field view, decreased contrast sensitivity (sharpness)
Visual impairment is correlated with depression, reduced quality of life, cognitive decline, and mortality
Pupil reacts more slowly to light
Ability to focus from far to near declines (presbyopia)
Due to decline in ciliary muscle efficiency and increased stiffness of ocular lens
Decreased ability to adapt to changes between light & dark
Increased intraocular pressure
Loss of color discrimination, especially between blues & greens

39
Q

What is macular degeneration?

A

Loss of central vision
Peripheral remains intact
Leading cause of new cases of blindness in 65+ years old

40
Q

What are cataracts?

A

Opacity of the lens of the eye
Reduces visual acuity
Early sign is c/o glare from lights at night
Painless, progressive loss of vision

41
Q

What is glaucoma?

A

Increased intraocular pressure that damages the optic nerve
Slow loss of visual field, effecting both eyes

42
Q

What is a diabetic retinopathy?

A

Vascular complication of individuals with diabetes
Retinal ischemia due to microvascular occlusion

43
Q

What are some of the hearing changes associate with aging?

A

Hearing loss occurs more frequently in later years
Sensorineural hearing loss
Sound well-conducted through the external and middle ear
Age-related impairment of the inner ear or auditory nerve prevent sound transmission to the brain
Sclerotic changes in the tympanic membrane, cochlear otosclerosis, and degeneration of the auditory nerve may contribute
Presbycusis: decreased ability to hear & discriminate speech
Hearing loss is associated with slower gait speed, poor cognition, and mortality

44
Q

What are some of the integumentary changes associated with aging?

A

Thinning of the epidermis & atrophy of the dermis
Decreased effectiveness as a barrier to infection & environmental/physical stressors
Decreased collagen & elastin
Loss of elasticity
Wrinkles
Specialized appendage atrophy
Sweat/sebum glands (temperature regulation)
Pacinian corpuscles (vibration, deep pressure, proprioception)
Meissner corpuscles (fine touch, discriminative touch, vibration)
Hair follicles (hair loss)
Decreased density of Langerhans cells
Decreased immune response
Decreased epidermal proliferation & diminished vascularity
Delayed wound healing
Skin grows & heals more slowly
Decreased inflammatory response

45
Q

What are some of the integumentary related pathology older adults?

A

1)Cellulitis
2)Herpes Zoster (Shingles)
3)Diabetic Neuropathic Wounds
4)Pressure Wounds (Decubitus)
5)Arterial & Venous Insufficiency Wounds
6)Malignant Skin Cancer

46
Q

What are some of the physical therapy implications associated with integumentary related changes in the elderly population?

A

Use caution with modalities/equipment, including but not limited to heat, ice, E-stim (adhesive pads), kinesiotape, bandages
Positioning in bed, wheelchairs
Wheelchair cushion selection
Minimizing shear forces and off-loading bony prominences
Dependent limbs, patients with inattention/neglect due to brain injury
Ex: A patient with hemiparesis due to stroke has no control of his left arm
When assisting the patient with mobility during therapy, you as the PT need to prevent harm to the dependent limb
Wheelchair parts
Watch your grip!

47
Q

What is polypharmacy?

A

Use of 5 or more medications (prescription or OTC) according to 50% of the studies included in a systematic review by Masnoon et al in 2017
More drugs being prescribed or taken than are clinically appropriate in the context of a patient’s comorbidities11
Rational polypharmacy (follows best practice guidelines & clinical indications) vs. irrational polypharmacy (inappropriate prescription, more than 1 drug from same class, prescription of drugs with similar pharmacological action to treat different conditions, multiple providers, self-medication)1

48
Q

What is polypharmacy related to?

A

Polypharmacy associated with increased number of Adverse Drug Reactions (ADRs), medication administration errors, non-adherence, and higher mortality rates1,11

49
Q

What is pharmacokinetics?

A

how the body handles and disposes of drugs
Absorption
Distribution
Metabolism
Excretion – parameter most affected by age

50
Q

What is pharmacodynamics?

A

what the drug does to the body
Number of drugs prescribed to older adults is higher than that prescribed to younger individuals
Increased prevalence of disease with increase in age
Clinical practice guidelines recommend combination drug therapy
Advertising by pharmaceutical companies
Inappropriate prescribing practices
Unmonitored self-medication

51
Q

What is absorption?

A

Rate at which a drug leaves the administration site & extent to which this occurs

Stomach & small intestine

52
Q

What are some factors that affect absorption?

A

Time until peak affect
absorption rate

Gastric acid secretion
Gastric acidity
GI surface area
Gastric emptying
Splanchnic blood flow
Intestinal motility
Active transport mechanism

53
Q

What is distribution?

A

Extent of drug dispersion in the systemic circulation to the site of action

Bloodstream

54
Q

What are the factors that affect distribution?

A

Volume of distribution for fat-soluble drugs-higher
Volume of distribution for water-soluble drugs-lower

LOWER

Cardiac output
Body water content
Lean body mass
Serum albumin

HIGHER
Peripheral vascular resistance
Fat mass
Serum alpha-1 glycoprotein

55
Q

What is metabolism?

A

Biological transformation of the drug into an inactive molecule, a more soluble compound, or a more potent metabolite

Liver

56
Q

What are some of the factors that affect metabolism?

A

Half-life-higher

drug clearance for hepatically cleared drugs-lower

hepatic blood flow and liver size - lower

57
Q

What is excretion?

A

Elimination of the drug from the body

Kidneys* & large intestine

58
Q

What are some factors that affect excretion time??

A

Half-life-higher

Drug clearance rate for renal excreted drugs-lower

Renal blood flow, glomerular filtration rate, tubular subscription-lower

59
Q

What is the breakdown of drug administration throughout the body?

A
60
Q

What are altered drug pharmacodynamics in older adults attributed to?

A

Declines in homeostatic mechanisms:

BP & volemic maintenance
Thermoregulation
Respiratory function
Postural & gait stability
Cognitive reserve
Clotting cascade
Bowel & bladder function
Insulin regulation
Bone & skeletal muscle homeostasis

Receptor alterations: → make target tissue more or less responsive to drug binding
Reduced number of receptors
Receptor competency
Drug-receptor affinity

61
Q

What are some factors that increase the risk of adverse drug reactions? (ADRs)

A

Presence of multiple disease states
Lack of proper drug testing & regulation
Problems with patient education and non-adherence to drug therapy
Use of inappropriate medications
Poor diet
Excessive use of OTC drugs
Smoking
Caffeine, alcohol consumption

62
Q

What are some common adverse drug reactions?

A

GI symptoms
Sedation
Confusion
Depression
Orthostatic hypotension
Fatigue & weakness
Dizziness
Falls
Anticholinergic effects: delirium, drowsiness, blurred vision, tachycardia, urinary retention, impaired diaphoretic response
Extrapyramidal symptoms: tardive dyskinesia, parkinsonism

63
Q

The physical therapy implications of drug absorption time in the older population? Or in general

A

In general, you should be familiar with medications your patients may be taking so that you can optimize the time you have with them and be aware of potential adverse drug reactions
Patient adherence to medications
Example: BP medications
Oral opioids should be taken 30-90 minutes prior to therapy1, but they can also make patients dizzy
NSAIDs should be taken 60-90 minutes prior to therapy1
Schedule therapy within 2-3 hours of Levodopa morning dose1
Be aware that beta-blockers will lower heart rate
Insulin is absorbed much quicker in an active extremity; insulin dose may need to be adjusted for someone who is initiating an exercise program1

64
Q

Was associated with the ill-defined geriatric syndrome?

A
65
Q

What is sarcopenia?

A

Age-related loss of skeletal muscle2
Decreased muscle mass, strength, power, and endurance
Decreased functional quality

66
Q

What contributes to deficits in mobility, decline and functional capacity, reduce skeletal muscle oxidative capacity?

A

sarcopenia

67
Q

What is thought to be a precursor of the physical manifestations of frailty?

A

sarcopenia

68
Q

What are the criteria of frailty?

A

1)Unintentional weight loss (10+ pounds in the past year)
2) Fatigue, self-reported exhaustion
3) Muscle weakness (grip strength lowest 20% for gender/BMI)
4) Slow walking speed (slowest 20% for gender & height)
5) Low levels of physical activity (lowest 20% for gender; <383 kcal/week for men; <270 kcal/week for women)

69
Q

How much higher is the mortality risk for frail versus non-frail patients?

A

4 times

70
Q

What are the multicomponent parts of an exercise program to treat frailty?

A

Strength
Power (high velocity)
Balance
Endurance (muscular & aerobic)
Gait
Flexibility

71
Q

What is the intensity needed to treat frailty?

A

3 sets of 8 reps at 80% 1RM – better improvement than 20-40% 1 RM19
Supplementation of nutrition, hormonal imbalances

72
Q

What is the duration of exercise for referral to treatment?

A

Regular exercise over a long duration
2-3 times per week
3 months – most common tested according to systematic review by Theou et al., 201119
≥ 5 months – superior outcomes19

73
Q

What is the overlap between frailty and sarcopenia?

A

hdal - post midterm (4 decks)

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