Midterm Flashcards
1
Q
What are some things that can happen from aging to the GI tract
A
- decreased appetite
- reduction in active metabolic mass lowers energy needs
- decreased absorption of nutrients
- constipation
- ulcerative colitis, Crohn’s, Small Bowel Obstruction, Gastro esophageal reflux disease
- slow changes over time
2
Q
What are the most common causes of vision loss among the elderly
A
- age-related macular degeneration (loss of central vision)
- glaucoma
- cataracts
- diabetic retinopathy
3
Q
How can vision impact mobility in the elderly
A
balance and coordination
4
Q
Which of the following is NOT a risk factor for falls
- incontinence or urgency
- prescription medications
- changes in health
- pain
- neuropathy
- visual impairments
- age
A
Age
5
Q
What happens after a fall?
A
- Many individuals who have reported a fall do suffer an injury afterwords
- individuals who fall once are at risk of falling again in the next 6 months
- individuals who fall, even if they don’t get injured, develop a fear of falling again
- individuals who fall can sustain broken bones to various parts of the body as well as head injuries such at TBI’s
5
Q
Fall recovery steps for getting back up as the caregiver/ provider
A
- assess the situation
- get the person ready
- position a chair
- assist to kneel
- help them stand
- sit them down
5
Q
Fall prevention techniques
A
- staying active with activities to boost strength and balance.
- review medications for potential fall risks
- ensure good vision with regular eye check-ups
- Home modifications
- maintain foot health with proper footwear and hydration
- assistive devices
- maintain bone health with calcium, vitamin D, and exercise
- Stay connected and informed about fall prevention strategies through community programs
6
Q
what is the OT role in fall prevention?
A
- mobility
- pre functional mobility: the skills associated with strength, balance, and performance
- caregiver education
- identify appropriate DME
7
Q
What are the components of recommending DME
A
- identify the type of equipment
- educate
- assess and re-assess
- considerations
8
Q
Mobility interventions for fall prevention
A
- therapeutic exercises and activities
- pain management techniques
- functional training and ADL retraining
- home safety and environmental modifications
- education and training
9
Q
What are the components of a mobility evaluation for fall prevention
A
- observe ADL performance, patterns and routines
- ROM/MMT
- Balance (sit to stand, Berg, TUG)
- cognition
- vision
- vestibular
10
Q
What are the most common causes of death in the older adult population (excluding covid)
A
- heart disease
- cancer
- unintentional injuries
- stroke
- chronic lower respiratory diseases
- Alzheimer’s
- diabetes
- influenza and pneumonia
- kidney disease
- suicide
11
Q
How can the effects of social determinants of health be exacerbated for older adults?
A
contributes to:
- risk for frailty
- mental health concerns
- oral health
- vascular disease
- cognitive impairment
12
Q
environmental factors affecting the experience of aging
A
- place of residence
- aging in place
- institutionalization
- domestic migration
- international migration
- homelessness
13
Q
what are the four dimensions of occupation
A
- doing
- being
- becoming
- belonging
14
Q
Theories for supporting meaning
A
MOHO: individual must identify actions that are meaningful
Meaningful Activity and Life Meaning Model (MALM)
15
Q
Assessments to support meaning
A
- occupational profile
- COPM
- life satisfaction instruments
16
Q
intervention to support meaning
A
- encourage expression and management of identity and connect the older adult to the past, present and future
Activities should emphasize:
- wellness
- reminiscing
- self reflection
- connection to nature and broader world
17
Q
three categories of biological theories of aging
A
- programmed theories
- error theories
- genetic theories
18
Q
Programmed theories
A
the body degrades through mechanisms that fail due to programmatic deterioration throughout the life course
- programmed longevity theory
- endocrine theory
- immunological theory
19
Q
Error theories
A
Aging as a result of accumulated “insults” from the environment
- somatic mutation theory
- free radical theory
20
Q
Genetic theories
A
Illustrate aging and age-related morbidities as associated with inherited genetics and acquired genetic mutations
- epigenetic
21
Q
Psychological theories of aging
A
theories seeking to explain changes in individual behavior in the middle and later years of life span
- life-span development theory
- selective optimization with compensation theory
- socioeconomic selectivity theory
- personality and aging theories
- cognition and aging theories
- neuropsychology of aging
22
Q
Environmental theories of aging
A
- ecological model of aging
- ecological systems theory
- aging in the right place
- place integration
- person-environment-occupation
- situational model of care
23
Sociological theories
consider social structure, culture, and context in which aging occurs.
- life course
- social exchange
- social constructionist
- political economy of aging
- critical perspective of aging
24
population health
a concept of health characterized by both objective and subjective determinants and health outcomes of a population
25
What is OT role in end of life care
- advocate for clients
- utilize holistic treatment methods tailored to client values and beliefs
- address symptoms within scope of practice
- educating other providers
26
Common health issues that lead to special concerns in the aging population
Overarching diagnosis of failure to thrive
- frailty
- medication use
- oral health
- malnutrition
- dehydration
- urinary issues
- fall risk
27
What is there an increased vulnerability to due to frailty?
- developing increased dependency
- disability
- falls
- institutionalization
- hospitalization
- dying
28
What does OT intervention focus on in medication management?
- addressing barriers to adherence
- improving understanding of medication regimens
- promoting independence in medication-related task
29
OT intervention for medication management
- education and training
- functional skills training
- environment modification
- cognitive strategies
- adaptive equipment
- caregiver training
- follow-up and monitoring
30
Classifications of nutritional status
- undernutrition
- micronutrient-related malnutrition
- overweight, obesity, diet-related noncommunicable disease
31
What is the purpose of the MoCA
to assess how cognitive deficits may be impacting a person's ability to perform everyday activities
32
What are the domains assessed in the MoCA
- executive functions (primary)
- attention and concentration
- visuospatial and visuoconstructional skills
- conceptual thinking
- memory
- calculations
- language
- delayed recall
- orientation
33
What are the ranges for scoring of the MoCA
normal: 26 +
mild cognitive impairment: 19-25
moderate cognitive impairment: 10-18
severe cognitive impairment: <10
34
clinical implications for the MoCA
- home discharge recommendations
- safety awareness
- treatment interventions
- IADLS, bill management, shopping, home care, HEP, medications
-evidence based practitioner
35
typical age-related changes in the neuromotor system
- proprioception (impaired integration of proprioception input)
- balance (decreased stability)
- decreased reaction time
- coordination
- upper extremity movement
36
Techniques to test proprioception
- joint position sense (JPS) test
- passive movement sense test
- Romberg test
- finger-to-nose test
- heel-to-shin
- functional tests (walking in a straight line, standing on one leg)
- vibration sense test
- proprioception devices
37
techniques to test coordination
- finger to nose
- rapid alternating movements (RAMs)
- finger opposition test
- heel to shin
- nine hole peg test
- box and block test
- Purdue pegboard test
- Jebson hand function test
- Minnesota manual dexterity test
- grooved pegboard test
- tandem walking test
- functional reach test
38
common neuromotor health conditions in older adults
- Amyotrophic lateral sclerosis (ALS)
- Motor neuron disease (MND)
- Myasthenia gravis
- multiple sclerosis (MS)
- stroke
- cerebral palsy
- spinal cord injury
- Guillain-Barre syndrome (GBS)
- polymyositis
39
ALS
progressive neurodegenerative disease that affects neurons in brain and spinal cord that control voluntary movements
typical course 3-5 years (can be 10+)
40
Motor neuron disease (MND)
group of progressive neurological disorders that destroy motor neurons (cells that control skeletal muscle activity such as walking, breathing, speaking and swallowing)
life expectancy and pattern of weakness depends on type
41
Myasthenia gravis
chronic autoimmune, neuromotor disease that causes weakness in the skeletal muscles, worsening after periods of activity and improves after periods of rest.
onset may be sudden and not immediately recognized
female onset: 20-30 years
male onset: 50 years
42
what is a common cause of SCI in older adults
falls
43
Guillain-Barre Syndrome (GBS)
rare neurological disorder where body attacks part of the peripheral nervous system
sudden and rapid onset, 70% of people recover fully
44
Polymyositis
group if muscle diseases known as the inflammatory myopathies
chronic muscle inflammation and weakness in the skeletal muscles starting at proximal muscles. Most people respond to therapy
45
most common impairments following a stroke
- postural instability
- apraxia
- hemiparesis
- ataxia
- dysarthria
- changes in muscle tone
- shoulder subluxation
46
common motor feature of Parkinson's
rigidity
bradykinesia (slowness of movement)
resting tremor
47
How is Parkinson's best managed
combination of medications and rehabilitation
48
Motor control frame of Neurodevelopmental theory
- based on belief that reflexes drive motor movement as a response to sensory input
-therapy focuses on building foundational skills to then transfer to functional activities of daily living
49
Assessments of body structures and functions for neuromotor conditions
muscle tone, ROM, strength, balance, coordination, upper limb function assessment
50
When positioning a stroke patient on their affected side what should you always remember to do?
protect the shoulder
51
interventions for neuromotor and neuromotor conditions
- prevention of postural and limb deformities (muscle tone, ROM, strength)
- facilitate proper positioning for affected limbs (muscle tone, ROM, strength)
- fall prevention education (balance)
- environmental modifications (balance)
- adaptive equipment (balance)
- preventing learned non-use (coordination)
- task-oriented mental practice (coordination)
52
Attention
foundational to problem solving and decision making
- sustained
- selective
- alternating
- divided
53
memory
memory deficits often mistaken for sensory changes
- sensory
- short-term
- working
54
executive functioning implications in older adults
underlies ability to engage in daily activities
55
intellectual abilities implications in older adults
decline in fluid and intelligence with aging. adaptations to compensate due to processing and memory changes
56
wisdom implications in older adults
knowledge gained through experience, increases with age
57
implicit and explicit processing implications for older adults
common to experience changes in explicit learning
explicit: common knowledge
implicit: takes more effort
58
functional cognition implications for older adults
- compensation for differences in memory and attention during decision-making tasks
- changes in work performance
- driving
59
Cognitive theories of aging
- speed of processing
- sensory deficit theory
- memory deficit and dual-process
- structural changes in aging
60
factors impacting functioning for persons living with dementia
- cognition
- communication
- ADL
- behavioral and psychological symptoms
61
OT interventions for people with dementia
- emphasis on promoting QOL and participation
- minimize behavioral symptoms and enhance functional status
- consider needs of caregiver
- education and resources for symptom management and coping
62
mental health conditions in older adults
- depression
- anxiety disorders
- schizophrenia
- bipolar disorder
- substance abuse disorders
63
OT intervention for mental health
- occupation-based interventions
- psychoeducation
- skills training
- cognition-based interventions
- technology-supported interventions
64
Uses of mirror box therapy
- phantom limb pain
- stroke rehab
- chronic regional pain syndrome
- rehabilitation of spatial neglect
65
At what age does decline in metabolic system begin?
40 years old
66
what are modifiable risk factors that lead to the most common causes of death
- smoking
- physical inactivity
- obesity
- nutrition
- high blood pressure
- dietary fat/ blood lipids
- elevated glucose levels
- alcohol
67
what is the general degeneration of cardiac structures with aging?
- loss of elasticity
- fibrotic changes in valves
- infiltration of amyloid
- buildup of plaques in heart muscle
68
Age related changes to the cardiovascular system
- slower heart rate
- blood changes
- stiffening and thickening of heart valves, aorta, and capillaries
- decreased cardiac function (subcellular changes)
69
risk factors for cancer
- genetic and physiological
- Metabolic syndrome
- obesity
70
age related pulmonary changes
- decreased volume of thoracic cavity
- reduced lung volume
- changes in respiration muscles
71
Which chronic lower respiratory disease are problematic in older adults
COPD
Asthma
Emphysema
Chronic bronchitis
72
Which type of diabetes is the most common and has a higher prevalence in adults 65+
Type II
73
Aging-related factors that influence risk of developing diabetes
- inflammatory markers
- body composition changes (increase in fat mass, decrease in muscle mass)
- insulin secretion and sensitivity
74
aging changes in the oral cavity that can lead to gastrointestinal disorders
- poor fitting prosthesis
- medication side effects
- dry mouth taste disturbances
75
aging changes in the esophagus that can lead to gastrointestinal disorders
- dysphagia: difficulty swallowing
- painful swallowing
- GERD
76
aging changes in the stomach that can lead to gastrointestinal disorders
- decreased blood flow
- decreased mucus
- problems with repair mechanisms (increase risk for ulcers)
77
aging changes in the intestines that can lead to gastrointestinal disorders
hormone secretion
absorption of small intestine
78
non-occupation-based theories and frameworks for working with older adults with metabolic conditions
transtheoretical model of change (helping them get ready for change)
health belief model (education)
79
occupation-based theories and frameworks for working with older adults with metabolic conditions
MOHO : looking at habitualization, performance, and environment to promote healthy lifestyle
PEOP : look at factors effecting environment and occupations
80
Non pharmacological interventions for older adults with metabolic conditions
Healthy lifestyle behaviors
- nutritious diet
- regular physical activity
- managing med routines
- healthy sleep routines
- mental health
81
Age related visual system conditions
- low vision
- cataracts
- age-related macular degeneration (AMD)
- glaucoma
- diabetic retinopathy
- Parkinson's and Alzheimer's
82
Cataracts
leading cause of vision loss in older adults and can lead to AMD
83
Age-related macular degeneration (AMD)
loss of central vision, pattern of loss is from center-> out
84
glaucoma
damage to the optic nerve causing peripheral vision loss
85
diabetic retinopathy
affects retina's blood vessels, leads to complete blindness
86
What are the two types of AMD
Dry AMD
wet AMD (rapid progression)
87
What are the two most common types of glaucoma in older adults
Primary open angle glaucoma (POAG)
angle- closure glaucoma (ACG)
88
what are the stages of diabetic retinopathy
non-proliferative
proliferative
neovascularization
89
visual impairments caused by Parkinson's
dry eyes
diminished blink rate
impaired saccades
90
visual impairments caused by Alzheimer's
difficulties reading
problems discriminating color and form
inability to perceive contrast
difficulties in spatial orientation and motion detection
agnosia
difficulty developing visual strategies
91
Assessments for visual changes
- Snellen chart
- MNREAD
- Mars Constrast sensitivity test
- confrontation testing
- brain injury visual assessment battery for adults (biVABA)
*consider that many cognitive tests rely on intact vision*
92
environmental modifications to address visual changes in older adults
- increase lighting
- increase contrast
- maintain organization
- low-vision interventions
- education of client, family and caregivers
- assist in developing adaptive techniques
- refer to community resources
93
presbycusis
age-related hearing loss
94
types of hearing loss
conductive
sensorineural
mixed loss
95
auditory implications for older adults with hearing loss
- affects hearing sensitivity
- decreased speech perception
- social consequences
96
three types of hearing aids
-behind the ear
- in the ear
- in the canal
97
age-related taste and olfactory changes
- higher smell detection thresholds
- decreased thickness and dryness of oral mucosa
- decline in replacement of acini
- decreased density of taste buds
- decreased ability to detect and discriminate types of tastes
98
implications for treatment of the chemosensory system
- flavor amplification
- providing various flavors, textures, and temperatures
- ensuring good oral care before meals
- counseling
99
Age-related changes of the somesthesis and integumentary system
- epidermis becomes thinner, drier, stiffer
- increased dermis thickness
- reduction in number and size of sweat glands
- decreased production of collagen and elastin
- less fat stored in hypodermis
100
somesthesis and integumentary system implications for adults in treatment
- precautions with transfers, bathing, and dressing
- assess skin integrity
- changes in tactile sensitivity
- temp discrimination
101
pain implications for older adults in treatment
- impacted engagement in functional performance
- older adults attitudes and barriers generated by health professionals determine decision to seek help for pain
102
pain assessments
self-report (most reliable method)
direct observation of pain behaviors
Wong-Baker FACES pain rating scale
103
interventions for pain
- pharmacologic therapies
- non pharmacologic therapies (NPT)
- physical movement
- application of heat or ice
104
what age-related electrical behavior changes happen in the cardiovascular system
- premature ventricular contractions
- Afib
- heart blocks
105
what age-related mechanical behavior changes happen in the cardiovascular system
amyloidosis: buildup of abnormal amyloid deposits in the body
106
what age-related blood vessel changes happen in the cardiovascular system
- decreased elasticity
- decreased efficiency of contractions
- decreased responsiveness to neurohumoral transmitters
107
what age-related blood changes happen in the cardiovascular system
decreased/ diminished pumping volume
108
the pulmonary system
maintains life through supplying oxygen to organs and tissues while removing carbon dioxide via ventilation and respiration
109
primary care
the first point of contact to the healthcare system and provides care over time
110
primary health care
approach to individuals and communities using a health promotion and health equity lens
111
shared values between OT and primary care
- person and family centered
- continuous care
- comprehensive and equitable
- team based and collaborative
- cordinated and integrated
- accessible
- high value
112
Models of care for primary care
- patient centered medical home (PCMH)
- federally qualified health centers (FQHC)
113
types of service delivery in primary care
outreach services
community based rehab
self management programs
Telehealth
114
Levesque framework
focuses on ability to navigate process of accessing service
115
five dimensions of accessibility of Levesque framework
approachability
acceptability
availability and accommodation
affordability
appropriateness
116
Five approaches to OT in primary care
- client centered approach
- team collaboration
- holistic approach
- inclusion of program outcome and standardized program evaluation measures (using standardized evidence practice and assessments to offer effective delivery of care)
- innovative services delivery
117
The expanded chronic care model (ECCM)
integration of population health promotion with prevention and management of chronic disease
118
ECCM and OT
OTs should consider how their services align with self management support, decision support, delivery system design, and info systems
119
Role of OT in primary care
generalist: implement variety of interventions with a focus ranging from rehab to health prevention and promotion (most likely)
consultant: eval client, identify interventions, make appropriate recs as needed, attend team meetings , plan of care meetings.
120
Important clinical considerations when working with older adults
chronic conditions
multi-morbidity
behavioral health
121
common reimbursement models for primary care
fee-for-sale (private pay)
value-based (insurance)
122
OT role in acute care
- provide support
- prevent further debilitation or disability
- promote return to normal function
- prepare them for the next step in recovery
- evaluate, treat, and prepare for discharge
- facilitate engagement in functional tasks
- problem solve
123
characteristics of acute care level
- brief but severe illness
- conditions resulting from trauma or disease
- recovery from surgery
124
characteristics of ICU care level
- dangerously ill
- kept under constant observation
- specialized staff
- critical care and enhanced constant medical monitoring
- early rehab, preparing them to do more
125
OT eval for acute care setting
OT profile: prior level of function, goals for therapy, considerations for d/c
consider screening for additional impairments: sensation, cognition, hearing, vision
126
Common comorbidities in hospitalized older adults
- geriatrics syndromes (e.g UTI)
- hospital associated deconditioning (HAD)
127
interventions in the acute care setting / ICU
- d/c planning
- early mobilization and activity
- fall prevention
- pain management (positioning, ROM, support)
- skin and joint protection
- address visual and cognitive impairment (small screenings)
- implement AT
- address spirituality
128
acute care documentation
- often with EMR (electronic medical records)
- provide clear and concise info as case evolves
- chart review (accurate, quick, identify red flags, determine hold/ further tx)
129
What is the best approach for older adults to recover from a medical procedure in the presence of decreased activity tolerance?
- education
- get them moving to build endurance
130
An older adult patient presents with confusion or impaired cognition during their occupational therapy eval in the hospital. What factors should be examined as a possible cause to help guide safe discharge planning?
- select assessments that will give info to prepare them for the next level
131
Safe discharge planning begins during the first OT session on eval. What details should be considered when d/c planning for the older adult to leave the acute care hospital setting?
- do they have a caregiver and are they capable of doing care
- living situation
- medication
- look at any barriers, whats happening with them
132
Age-related changes and the cardiopulmonary system
- airways: decreased elasticity
- lung parenchyma: reduced efficient gas exchange
- alveolar capillary membrane: decreased diffusing capacity
- chest wall: decreased compliance
- respiratory muscles: decreased muscle mass
133
common diagnoses of the cardiovascular system
- coronary artery disease
- MI
- arrhythmias
- heart failure
134
functional impairments associated with cardiovascular conditions
- decreased endurance
- decreased activity tolerance
- decreased independence in ADLs/ IADLs
- decreased participation in work
- decreased participation in leisure
135
major pulmonary conditions
- COPD
- interstitial lung disease
- lung cancer
- acute respiratory distress syndrome
- pulmonary edema
136
issues associated with decreased function of the lungs in pulmonary disease
- airway dysfunction
- disease of lung tissue
- lung circulation disease
137
functional impairments associated with cardiopulmonary conditions
- dyspnea
- chronic cough
- sputum production
- anxiety and depression
138
Assessments and screening instruments for cardiopulmonary and cardiovascular conditions
- Functional Independence Measure (ADLs)
- Barthel Index (ADLs)
- COPM (ADLs/IADLs)
- MMSE (mini mental) (cognition)
- interest checklist/ stress management questionnaire (stress management)
- Borg CR10 Scale (endurance/ activity level)
139
What does the Borg CR10 measure
perceived exertion and breathlessness during functional tasks
140
OT intervention for cardiopulmonary and cardiovascular conditions
- education for health and well-being
- promote positive disease management
- exercise (METs)
- address dyspnea
- ADL/IADL training
- energy conservation/ work simplification
- caregiver education
141
MET levels for common occupations
- grooming/ bathing - seated: 1.0-2.5
- bathing - standing: 2.0-4.0
- dressing: 1.0-4.0
- cooking: 1.0-2.5
- house cleaning: 2.6-4.0
- gardening: 2.6-4.0
- making a bed: 1.0-2.5
- grocery shopping: 2.0-7.0
142
MET levels for common physical activity
- walking (leisurely): 1.0-2.5
- walking (moderate effort): 2.6-4.0
- climbing stairs: 6.0-10.0 (carrying groceries)
- running (moderate effort): 8.8
- various sports: 8.0-12.0 (dependent on task analysis and performance of task)
143
How must OT monitor patient' response to interventions to prevent complications during cardiovascular/ cardiopulmonary rehab?
- monitor BP
- monitor HR
- ensure arterial (oxygen) saturation (on pulse ox) is greater than 90%
- monitor MET levels
- medications
144
what is the continuum that age-related changes in the musculoskeletal system occur on?
- physically elite: sports competition
- physically fit: moderate physical work
- physically independent: very light physical work
- physically frail: light housekeeping/ food prep/ ADL/IADLs
- physically dependent: cannot complete some or all BADLs (basic ADLs)
145
What are typical age-related changes in muscle strength and power
- decrease in maximal muscle strength
- changes in types of strength (isometric, concentric, eccentric, isokinetic): changes begin at age 60 and decreases 6-11% each decade
146
what are typical age-related changes in muscle structure
- sarcopenia (loss of muscle mass)
- disuse atrophy
- overall loss of muscle fibers
- increase in fat and connective tissues
- loss of motor units
- changes in protein metabolism
- decrease in number of capillaries
147
examples of changes in occupational performance due to age-related changes of the musculoskeletal system
- reaching for object
- writing or grasping small objects
- functional mobility
148
typical age-related changes in the skeletal system
- dependent on peak bone mass
- changes in rate and extent of bone remodeling
- changes in quality of bone tissue
- changes to bone health
149
Which activity is best for bone health
weight bearing activities
e.g.: walking, wall push ups, yoga/pilates
150
non modifiable risk factors for OA
age, sex, genetics
151
modifiable risk factors for OA
obesity, high physical workload, high-impact sports
152
management techniques for OA
- joint protection
- reduction or modification of risk factors
- Cognitive behavioral training
- balance training
- modalities
- pharmacological and surgical
153
key risk factors for falls
- abnormal gait
- balance
- muscle strength
- cognition
- environmental hazards
- LE osteoarthritis
154
management of osteoporosis
- consult OT for safe ADL performance
- therapeutic exercise that helps with fall prevention, safe movement, reduced rate of bone loss, and pain control
155
assessments of the musculoskeletal system
ROM/ flexibility: sit and reach, back scratch test
Muscle strength and power: dynamometer, sit to stand
156
management of musculoskeletal impairments in older adults
- strength and resistance exercises
- flexibility (stretching) exercises
