Subgroups of geriatrics and Ages
65-75: Young-old
75-85: Older-old
85+: Old-old
Most common form of arthritis
Osteoarthritis
Hands, feet, knees, hips
Leading cause of LE disability in older adults
Osteoarthritis
Osteoarthritis presents with joint stiffness at what periods?
After periods of inactivity:
Just after waking up
Just after sitting
Progression of osteoarthritis
Initial: pain in one joint
Progress to multiple joints
Night pain, interference with sleep
What finding is classic on XR of osteoarthritis
Osteophytes
Narrowed joint spaces
Medical treatment of osteoarthritis
Pain relief
Weight management, exercise
Walkingaids, braces, orthoses
Topical, oral analgesics
OMM/PT
Orthopedic intervention
Fastest growing source of disability due to neurologic disorders
Parkinson’s disease
Most common infectious cause of death in the elderly
Pneumonia
Leading cause of injury among older adults in the US
Falls
Fall Risk Assessment: Get up and Go test
Observe older person move from seated to standing without using arms for support
Walk 3 meters, turn, and return to chair
Sit back in chair w/o support
>12 seconds indicates fall risk
Goals in geriatric management
Optimize function - ability to walk, daily activities
Avoid institutionalization - 80% prefer to die at home
Maintain sense of community
Common gait changes in elderly:
Waddling gait indicates _______
Pelvis weakness (deconditioning)
Common gait changes in elderly:
Antalgic gait indicates _____
Avoiding pain (mechanical change in low back/pelvis, LE)
Common gait changes in elderly:
Hemiparetic gait indicates ______
Post stroke (neurologic compromise)
Common gait changes in elderly:
Steppage gait indicates ______
Foot drop (neurologic compromise)
Common gait changes in elderly:
Shuffling gait indicates ____
Parkinsons (neurologicl compromise)
How do you want to modify OMT for geriatric patients? (3)
Caution with direct techniques
Avoid position changes (do seated, most cannot lay flat or pron)
Limited “doses” of treatment (poor reserve for compensation)
The MOPSE trial showed what effect of OMT on pneumonia in the elderly?
OMT added to standard abx reduced length of hospital stay compared to light/no touch therapy
The international Journal of Osteopathic Medicine showed what effect of OMT on chronic constipation?
Statistically significant improvement over:
- Severity of constipation
- Colonic transit time
- Pt assessment of constipation sx, quality of life
In the Journal of the American Osteopathic Association’s study on the effect of OMT on women with clinical depression, what was the outcome on the Zung Depression Scale?
All pts in OMT group reverted to normal range by 8 weeks
70% of pts in controlg roup still had signs of moderate depression
