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7 Geriatrics > L6/7 Falls & Exercise > Flashcards

L6/7 Falls & Exercise Flashcards

1
Q

Screening tools

A
  • CPG recommend all adults 65+ be screened
  • commonly used at community health events or if pt is being seen for something else
  • screening tests need HIGH SENSITIVITY so that they don’t miss individuals at risk
  • tests should be brief
  • examples for falls include “fallen in the past year”, MAHC-10, feel unsteady
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2
Q

Assessment for Falls

A
  • CPG recommend only if indicated based on screening results
  • often occur after a fall has already happened
  • need tests with high SPECIFICITY
  • tests often more time consuming than screening tests
  • commonly used performance based functional measures are Berg, mini-best, 4SQ, TUG
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3
Q

SPINS

A

4 SQ Spin = 100%
Berg Spin = 90%
TUG = 85%
3 Key Qs = 75%
Mini-Best = 75%
Gait Speed = 70%
STEADI = 63%
Mahc-10 = 13%

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4
Q

SNOUTS

A

Mahc-10 = 97%
3 Questions = 94%
Gait Speed = 89%
4SQ = 85%
Mini Best = 85%
Berg = 73%
STEADI = 70%
TUG = 31%

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5
Q

Stopping elderly accidents, deaths, and injuries (STEADI)

A

Developed in 2012 by the CDC
* based on CPG, geared towards PCP and pts
* recommends that all adults age 65 yo + be screened for falls annually

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6
Q

Three parts of STEADI

A
  • SCREEN = pts to identify their fall risk with stay indpendent and STEADI
  • ASSESS = pts modifiable fall risk factors
  • INTERVENE = to reduce fall risk by using effective clinical and community based strategies
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7
Q

Questions asked on STEADI

A
  • falls
  • ADs
  • unsteadiness
  • concern for falls
  • B/B function
  • neuropathy
  • medicine
  • mood

12 Q total, scoring 4 or more indicates increased risk

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8
Q

Three key questions for patients falling on STEADI

A
  1. Feels unsteady when standing or walking
  2. Worries about falling
  3. Has fallen in past year –> how many times, were you injured
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9
Q

Screen all adults ___ for falls risk

A

over 65

should ask if they have fallen the past year, their fear of falling. PT will note balance or mobility impairments or neuro

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10
Q

PTs should do for falls…

A
  • home safety assessment and recommendations
  • assessments or performance outcomes as necessary
  • set goals and provide interventions within PT scope of practice
  • refer to provides outside PT scope of practice
  • give advice about community exercise or ways to prevent falls
  • intervene with evidence based exercise and education
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11
Q

Beers Criteria

A
  • lists potentially inappropriate medications for 65+
  • does not forbid from takin gthese meds
  • meds on the beers criteria are usually becuase they sedate or cause confusion, increasing fall risk
  • PTs have ability and obligation to advise PCP about pt’s fall risk and medication ADRs
  • it is important to do medication review and reconciliation especially after hospitalization
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12
Q

Medication Intervention Strategies

A
  • evaluate polypharmacy
  • drug to drug interactions
  • help recommend med minders
  • eliminate psychotropics (rf for fall injuries) includes antipsychotics, antidepressants, sedatives
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13
Q

Approx ___ of american adults…

A

1/3
in their 60s to 70s use 5+ meds regularly

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14
Q

CDC PA Guidlines for 65 yo+

A
  • at least 150 min a week of moderate intensity or 75 min week of vigorous intensity, at 10 min at least a bout
  • 2 days a week of activities that strengthen muscles
  • activities to improve balance
  • RPE 13-16, somewhat hard
  • large muscle groups
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15
Q

Less than __ of americans aged 65+ achieve CDC guidelines

A

15%

37% of older adults meet aerobic
19% of older adults meet strength

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16
Q

Physical Stress Theory

A

predictable response of tissues, organs, and systems to mechanical and physiological stressors

changes in relative level of physical stress causes a predictable adaptive response in all biological tissues

helps explain overload and underload effects as well as lack of change if usual load is placed

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17
Q

Underload

A

tissues that lose thier ability to absorb and dissipate stress, results in atrophy

<40% of maximum

examples: bed rest, sedentary activity

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18
Q

Overload

A

tissue responds with increased ability to absorb and dissipate stress, causes hypertrophy

60-100% of max, resulting in adaptation

ex: strength training with 1 RM max

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19
Q

Excessive Stress

A

susceptible to injury or death

> 100% of max

ex: weight bearing on osteoporotic bone

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20
Q

Usual Stress

A

40-60% of maximum, causes no change. More of maintenance of muscles

ex: walking 5000-7000 steps a day

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21
Q

No stress

A

0% of max, loss of ability to adapt, resulting in death

ex: prolonged bed rest such as coma

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22
Q

Sarcopenia and Frailty

A
  • sarcopenia is a normal age related loss of skeletal muscle
  • sarcopenia thought to be main driver of frailty
  • sarcopenia 2x common as frailty
  • both increase risk for medical and disabling conditions
  • both are amenable to interventions and are reversible
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23
Q

Most common symptoms of frailty

A

muscle weakness
decreased gait speed

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24
Q

Frail Adults and Exercise

A

start with strength and balance training before aerobic to build up reserve

25
Strengthening for Older Adults
* can do 70-80% of 1 RM safely * 8-12 reps is 70-80% of 1 RM * true 1 RM testing is not recommended for adults * should do 8-10 exercises that target major muscle groups * 2-3 days a week that are non-consecutive * significant improvements in muscle strength and functional performance despite advanced age presence of chronic disease, sedentary habits, and functional disabilities
26
The ___ weight that can be lifted ___ with number of repetitions
MAX DECREASES
27
Flexibility Principles for older adults
* higher dose has same effects as younger adults * best to stretch after aerobic or strength b/c tissue is vascularized * at least 30-60s hold with slight resistance and mild discomfort * breathing during the stretch helps to minimize activation of muscle spindles
28
Joint mobs and osteoporosis
* osteoporosis is a precaution for grade 1-4 * no clear evidence of harm * grade 5 is contraindicated with osteoporosis
29
Frid Frailty Phenotype
1. weight loss > 10 lbs in past year 2. Self-reported exhaustion 3. Slow walking speed <.76 m/s 4. Weak grip strength 5. Low physical activity 0/5 = robust 1-2/5 = pre-frail ≥ 3/5 = frail
30
Falls are the leading cause of
injury for adults 65+ visits to ER hospital admissions death
31
Injuries and Falls
* fractures are most common injury, specifically hip, wrist, humerus, pelvis * other serious injuries include hematoma, jt dislocation, laceration * most falls don't cause injuries that are severe enough for medical attention
32
Intrinsic Risk Factors for Falls
* age * previous falls and fear of falling * age related somatosensory and neuro changes * congitive * mental health * behvaior and life choices * medications
33
Extrinsic Factors for Falls
* environment * clothing, shoes, glasses * equipment * social influences * siutational *medications
34
Medical history questions that predict falls
* any previous falls * psychoactive meds * requiring any ADL assistance * self-reported fear of falling * AD device used
35
Berg Balance Cut off
≤ 50
36
Mini best cut off
< 16
37
TUG Cut off
≥ 12 sec
38
Gait Speed Cut off
< 1.0m/s
39
Measurements of Thoracic Kyphosis
Kyphotic Index Occiput to Wall distance
40
Interventions to address fall risk factors
rehab environment medical
41
Interventions to address fall risk need to include
* strength training * balance training * gait training * correction of environmental hazards * correction of footwear
42
Ramps that are ADA approved
1/12 slope for every 1 inch of rise, you need 1 foot of ramp
43
Physical Activity
* not just exercise * voluntary body movement that involves skeletal muscle contraction that results in energy expenditure * encompasses all activities and intensity levels * typically low intensity
44
Exercise definition
higher intensity sub category of PA planned, structured, repetitive involves improvement or maintenance of PF
45
Physical Fitness
state of well-being and overall health can be measured with 5xSTS, TUG, etc
46
Physical Inactivity
* significant rf for developing chronic health condition * can cause sedentary death syndrome * 9.9% of deaths for 40-70 and 7.8% of deaths for 70+ are attributed to not meeting CDC PA guidelines
47
Imediate Benefits of Exercise
* improves sleep * reduces anxiety * reduces BP
48
Other benefits of exercise
* reduces risk of dementia and depression * lowers risk of heart disease, diabetes, stroke * lowers risk of cancers * reduces risk of weight gain * helps people live independently longer * improves bone health * reduces risk of falls * boosts immune function
49
Don't underdose older adults. Instead...
match frequency, intensity, and duration of exercise to abilities and goals
50
Frailty Definition
* decreased reserve across organ systems leading to alterations in function * multidimensional, gives rise to vulnerability
51
Failty Prevalence
* F > M * higher incidence in racial minorities * higher incidence in lower income
52
in high risk adults, interval training
* reduces BP * improves endothelial function * improves lipid profiles * improves VO2 max * improves LV function * improves myocardial function * reverses left ventricular modeling
53
When is lower intensity better for older adults?
* acute conditions * post surgical * extremely frail * RA * other medical conditions that limit intensity
54
Bone Mineral Density
* RET and AET both positively impact BMD * higher intensity, progressive, and novel are best * avoid spinal flexion and rotation, initially supervise other actions
55
Aquatic Exercise
* buoyancy allows deconditioned individuals to exercise by lessening impact * can improve all aspects of fitness * reduces pain, good for those with OA, balance disorder, obesity, post surgical * use RPE not HR for aquatic
56
Home Health Exercise
* similar to healthy individuals * maximize home space for safety * think about how to best use environment for the pt
57
Exercise in Inpatient
* restorative or maintenace programs * may benefit from group exercise for socialization
58
Frail Individuals should perform
Mostly Aerobic exercise, and 45 minutes a session

7 Geriatrics (9 decks)

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