Test1 Flashcards

Question

6MWT | 200-299 m

Answer 1

Permits more WB shift (50% or more) than a cane Less stable than walker Requires good balance and upper body strength Inappropriate use can lead to brachial plexus injuries Loftstrand crutches permit hand use and reaching

Answer 2

2” loss over lifetime Decreased ability to withstand compression, tension and shear Thus more load bearing on neural arch- osteoarthritis and osteophyte formation Thinning trabeculae of bone- increased risk for spinal deformities and fractures

Answer 3

OA Disc degeneration Spinal ligament hypertrophy

Answer 4

0.21-0.88 m/s | Average 0.49 m/s to meet traffic light timing

Answer 5

Speed (TUG; gait speed) Endurance (6MWT; 2MWT) Balance (Berg, Tinetti, 4 square step) Postural stability (Dual Task: TUGognitive; TUGmanual) (Multiple Task: DGI; FGA)

Answer 6

Large toe clearance OR Tripping OR both Forefoot or foot-flat contact during IC Excess PF or DF

Answer 7

Strength: MMT, 5x sit>stand, 30 sec chair stand ROM and flexibility: Ankle, knee, hip, trunk, c-spine

Answer 8

Assessment drives intervention Body structure and function Activity Participation Maximize independence and functioning Prevent falls Reduce risk

Answer 9

1- mild, barely noticeable 2- moderate, bothersome 3- moderately severe, very uncomfortable 4- most severe or intense pain ever experienced

Answer 10

Decline in bone mineral Increased osteoclast activity, Decreased osteoblast activity Osteopenia- leads to increased risk of osteoporosis Load absorption decreases Decreased load dispersion to other parts of the joint Results in increased bone loading, results in increased risk for fracture

Answer 11

Ability to detect smell and identify odors decreases with age Has been linked to 3 types of dementia High prevalence of hyposmia (decreased smell) and anosmia (loss of smell) Can create safety risk Impaired ability to taste food Thirst sensation declines

Answer 12

Maximize function Prevent or slow decline (muscle strength, ROM, balance, mobility, etc) Environmental recommendations Exercise: Aerobic- improved cognition Task specific - dancing, walking, stationary bike, etc Resistance

Answer 13

Neuron loss - decreased gray matter Myelin loss - decreased white matter Results in decreased brain weight Nerve cell shrinking Delayed impulse conduction and conduction velocity Reduction and altered balance of neurotransmitters Decreased size of cerebellar hemispheres Vestibular changes- decreased hair cells and receptor ganglion cells Decreased cerebral blood flow Decreased glucose metabolism

Answer 14

Ave 1-4 inches

Answer 15

Use stimulus for teaching and performing (sound, scent) - Use lots of cues (tactile, sense based, non-verbal) ``` Simple, one step commands Minimize distractions Use positive reinforcement Repeat, repeat, repeat Provide feedback after task Minimize variation - Consistency is key Functional, meaningful, pleasant ``` Go slow, be patient, avoid debate/conflict

Answer 16

1. Arthritis/MSK issues 2. Heart/Circulation issues 3. Vision/Hearing issues 4. Fractures/Joint issues 5. Diabetes 6. Mental illness

Answer 17

Generally begins -6th decade “Immunosenescence” Can begin prematurely in conditions such as RA and chronic organ diseases (COPD, CKD..) Combo of declining protective immunity and increasing incidence of inflammatory disease

Answer 18

Decreased: Blood flow to oxygenate tissue Cardiac output Venous return ``` Increased: Risk of clots in venous circulation Risk of myocardial ischemia/infarction CVA, PVD and renal failure Resting BP ```

Answer 19

Significant decrease in free velocity (<0.85 m/s) | With loss of ability to voluntarily increase speed from self-selected

Answer 20

Community program 2 hour week, 8 weeks Coping strategies to reduce fear of falling, prevention strategies, and exercise

Answer 21

Impaired gas exchange Air trapping Decreased inspiratory and expiratory reserve volumes Increased resistance to airflow in small airways Decreased pulmonary artery pressure Decreased pulmonary capillary network Decreased mucous clearance

Answer 22

No action if asymptomatic Refer to physician if symptomatic

Answer 23

6MWT 2MWT 2 min step test

Answer 24

Increased: Pro inflammatory cytokines C-reactive protein (CRF) Tumor necrosis factor May occur bc of: Shift in fat mass from periphery-> abdomen Along w/ overall increase in intra-abdominal fat w/ age Abdominal fat is metabolically active and serves as inflammatory organ Increase inflammatory cytokines assoc w/ metabolic syndrome and decrease organ system function

Answer 25

Psychological health - increased depression and anxiety common ``` Discuss realistic goals Teach ADL strategies Teach behavioral modification strategies Encourage self-care Community support groups Respite care ```

Answer 26

Dependent in ADLs and IADLs More likely to be hospitalized

Answer 27

Restrict use of this term only with long-term overall functional decline ``` Reflects the sum of interactions between: Health condition Environment Personal factors Impairments Activity limitations Participation restrictions ``` Activity limitations and participation restrictions in older adults change over time... and these are subject to change with intervention

Answer 28

Gait speed: 0.9-1.4 m/sec 6MWT : 300-500 m Chair rise (30 sec no hands): 8-14 reps Climb 10 stairs: 9-30 sec (with or without rails) Floor-stand: 11-30 sec (with or without assistance)

Answer 29

Axonal degeneration Greater internodal length Slower conduction velocity Decreased ability to adapt to environmental or visceral changes Decreased neurons per muscle fiber (fiber grouping) Decrease in Ruffini’s, Pacinian, and Golgi tendon-like receptors Increased sympathetic activity Decreased cerebral blood flow

Answer 30

PFM exercises: Quick contractions Sustained contractions Contractions during functional activity Biofeedback: Surface EMG (internal) Palpation Electrical stimulation (lacks evidence)

Answer 31

Begins to decrease in 3rd decade Neuron loss in visual cortex Presbyopia : Decreased flexibility of lens to accommodate far to near ``` Decreased elasticity of lens Decreased recovery from glare Decreased tear production Decreased acuity Decreased visual fields ```

Answer 32

Anticholinergics | Beta blockers

Answer 33

Medical and neuropsychiatric conditions Impaired hearing and vision Age-related changes in NM function, gait and postural reflexes

Answer 34

``` Age-related loss of strength and changes in tissue elasticity decrease anal resting tone (esp women) Loss of anal sensation Fecal impaction Psychological/Behavioral problems Neoplasms (rare) Loss of normal continence mechanisms: Local neuronal damage (ex pudendal nerve) Impaired neurologic control Anorectal trauma/sphincter disruption ```

Answer 35

Assess static balance 4 standing positions that get progressively harder to maintain Should NOT use AD and should keep eyes open. Describe and demo position Stand next to patient, hold their arm and help assume the position When patient steady, let go and time how long can hold (but remain ready to assist if they lose balance) If patient can hold for 10 sec without moving feet or needing support, move to next position If not, STOP test Feet together side-by-side-> instep of 1 foot touches big toe of other-> tandem -> 1 foot

Answer 36

More than just... making sure patient has a clear path through the home Rearranging obstacles and removing barriers Looking at flooring surfaces Is environment functional at current level of mobility? What recommendations would make it functional or help pt achieve function required to live in home? Understanding big picture- Mobility, needs, medical issues, social support, safety

Answer 37

``` Polypharmacy Basic ADL assistance Physical activity Falls/Fear of falling and imbalance AD use Home environment Vision CV Continence Pain Depression Skin ```

Answer 38

> 4 inches OR <1 inch Or too much/too little step width variability

Answer 39

5* forward rotation during WA 5* backward rotation at TSt/PSw Iliac crest on reference limb >= iliac crest on opposite during MSt

Answer 40

Limited or excessive flexion, wobbling, extension thrust Weight bearing increases valgus or varus moments

Answer 41

Decreased number and density of myelinated peripheral nerve fibers Decreased thickness of remaining fibers Decreased nerve conduction velocity and AP Increased H-reflex latency

Answer 42

Timeline may need to be longer to accomplish goals May need to focus on ADL training as these tasks require more energy and may be more difficult for the patient Matter of fact approach is better than overly cheery approach Discourage negative self-perception and emphasize achievement Demonstrate a genuine and respectful regard for the patient Realize these pt aren’t “fun” at times bc they appear unmotivated, but they aren’t lazy. It just takes s lot of energy to accomplish simple tasks.

Answer 43

Flexion and ER | Thoracic kyphosis May also impact

Answer 44

60 seconds needed for those 65 years and older to achieve long term muscle lengthening 4 reps 5-7 days a week Muscles to consider in aging adults: Suboccipital, pec minor, downward rotators, protractors, lumbar extensors, hip flexors and external rotators, ankle PFs

Answer 45

Many other CVP changes COMMON in aging adults due to MODIFIABLE factors, not necessarily aging

Answer 46

Ankle pumps/marching/hand clenching prior to standing Counting to 5 before walking away from chair Slow positional change Pressure stockings

Answer 47

Weakened antimicrobial immunity Susceptibility to respiratory infections Deactivation of chronic viral infections (shingles) Impaired anti-vaccine responses Insufficient protection against malignancies Predisposition for unopposed tissue inflammation (ie atherosclerotic disease, OA, neurodegenerative disease) Failing wound repair mechanisms

Answer 48

1. Slow tentative pace 2. Loss of balance 3. Short strides 4. Little or no arm swing 5. Steadying self on walls 6. Shuffling 7. En bloc turning 8. Not using AD properly

Answer 49

Systemic skeletal disease characterized by low bone mass and micro architectural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fracture Anterior vertebral body (can be asymptomatic) Caution: ADLs in trunk flexed position

Answer 50

``` Thin, less elastic skin Thinner dermis Decreased dermal vascularity Flattening of rete pegs Decreased fibroblasts Loss of subcutaneous fat ``` Decreased: Langerhans- 50% by age 80 (altered immunity) Melanocytes- 8-20% every 10 years after age 30 Blood vessels become thinner/fragile Decreased oil/sweat gland activity

Answer 51

1. Unstable angina 2. Uncontrolled cardiac dysrhythmias causing symptoms of hemodynamic compromise 3. Uncontrolled symptomatic HF 4. Acute or suspected major CV event (severe aortic stenosis, pulmonary embolus or infarction, myocarditis, pericarditis, or dissecting aneurysm) 5. Acute systemic infection, accompanied by fever, body aches, or swollen lymph glands

Answer 52

Decrease in autonomic regulation of BP Combined with physiological issues contributing to hypovolemia such as GI bleed, diarrhea and dehydration Combined with common meds like antihypertensives, antipsychotics, antiparkinsonian Increased inactivity Contributes to high fall risk

Answer 53

``` Ask what works. Eat for patient Use a lower tone Face the person when possible Slow rate of speech appropriately Keep background noise to minimum ``` Avoid “elderspeak” Avoid jumping from one idea/topic to another quickly

Answer 54

Increases in proportion to workload >250 is indication to stop exercise

Answer 55

``` Memory impairment Lapse in judgement Personality changes Depression possible Language problems Difficulty with ADLs Visual spatial problems Short tempered, hostile Loss of motor function (swallowing, bowel/bladder) ```

Answer 56

Forward, backward or sideways lean

Answer 57

1. Heart disease 2. Malignant neoplasms 3. Cerebrovascular disease 4. Chronic lower respiratory diseases 5. Pneumonia/Influenza

Answer 58

DF decreases

Answer 59

“Underutilized and undermanaged” Proper form Watch for breath holding

Answer 60

Community program 17 strength and balance exercises 30 min day, 3x week Walking program 30 min day, 3x week Great for preparing to enter a community program or as a starter community program

Answer 61

1. Known significant cardiac disease (L main coronary stenosis, moderate stenosis valvular disease, hypertrophic cardiomyopathy, high-degree AV block, ventricular aneurysm) 2. Severe arterial HTN (systolic >200 or diastolic >110) at rest 3. Tachycardia or Bradycardia 4. Electrolyte abnormalities 5. Chronic infections disease 6. Mental or physical impairment leading to inability to exercise safety

Answer 62

3 out of 5 = frail 1 or 2 = pre-frail 1. Unintentional weight loss >10 lbs in past year 2. Self-reported exhaustion 3 or more days per week 3. Muscle weakness: grip strength <23 women, <32 men 4. Walking speed <0.8 m/sec 5. Low level of activity: sitting quietly or lying down majority of day

Answer 63

Errors in proprioception have a bigger effect on balance than errors in vision in older adults With vision available, oldest older adults need accurate proprioception to maintain balance Impairment associated with increased fall risk and functional decline PTs need to provide older adults with sensory strategies to increase sensory information

Answer 64

Calcification of bronchial and costal cartilages Increased stiffness of costovertebral joints Increased A-P diameter Increased wasting of respiratory muscles Structural changes in thoracic cage and spine

Answer 65

Commonly feared environmental obstacle Successful negotiation requires greater ROM and muscle strength than level ground Older Adult self-efficacy relates to speed And safety precautions May serve as significant barrier to home mobility and safety Don’t forget about curbs and ramps

Answer 66

Loss of synaptic connections Creates memory impairment (slowed but intact) Evidence of mild decline in executive function

Answer 67

General whole body inflammatory response Genetics Consequences of lifestyle- primarily decline in physical activity

Answer 68

Fun: what you want, when you want, for as long as you want Function: choices made based on decreased physical capacity Have mobility disability or at risk for Frailty: require help for ADLs and IADLs Failure: completely dependent

Answer 69

Remains similar to resting or may drop slightly Increase >115 is indication to stop exercise

Answer 70

Consider adding or increasing supplemental oxygen Refer to physician if previously undiagnosed

Answer 71

Contraindication to initiating activity/exercise Refer to physician immediately

Answer 72

Anti-inflammatory drugs Antioxidants Caloric restriction Exercise

Answer 73

Contraindication to initiating activity/exercise Refer to physician

Answer 74

300k+ hospitalized each year for hip fractures Greater than 80% caused by falling- usually sideways Chances breaking hip increase w/ age

Answer 75

Decreased self-selected speed and fast speed Ability remains to voluntarily increase speed from self-selected to fast speed Increased gait variability

Answer 76

Common; 1 in 4 each year Cost $50 billion annually Preventable- clinicians can use STEADI to prevent falls and reduce cost

Answer 77

Fear of falling-> Restricts activity-> Physical capabilities reduced (moves slower; avoids movement) -> Restricts more activities-> More impaired physical capabilities (becomes deconditioned; decreased strength and endurance) -> Fear of falling

Answer 78

Often overlooked Key for safety and prevention of falls at home Consider all areas of living environment: Physical environment, level of assistance, support, adaptations using and needed Include other family members living in home and caregivers/caretakers present in home.

Answer 79

No action if asymptomatic and normal ECG Refer to physician if symptomatic, or of no ECG available and no history of dysrhythmia or chronotropic medication use

Answer 80

Failure of articular cartilage ``` Load bearing joints UE: hands LE: hips, knees, feet Spine: cervical and lumbar (Can compromise diameter of canal...spinal stenosis) ``` Joint destruction May lead to need for total joint arthroplasty

Answer 81

Change what you can, adapt/compensate what you can’t Address obvious structural limitations caused by pathology or surgical procedures

Answer 82

Increased recruitment of motor units- more work to do a task Increased co-contraction at the ankle Altered motor control and postural stability Decreased LE proprioception, vibration, discriminative touch, and balance Increased risk of falls Resting BP rises with age Delayed response to pain

Answer 83

Extension decreases | Decreased walking speed

Answer 84

Too much stress >100% max Injury or tissue death Sufficient overload 60-100% max Strengthening Usual stress 40-60% max No change in tissues Too little or no stress 0-40% maximum Atrophy and loss of ability to adapt

Answer 85

Gait speed: 0.3-0.8 m/sec 6MWT : 200-299 m Chair rise (30 sec no hands): <8 reps Climb 10 stairs: 31-50 sec (with rails) Floor-stand: >30 sec (with assistance)

Answer 86

Decreased testosterone->delayed and less firm erection, more stimulation required to attain erection/orgasm Shorter ejaculation time Rapid loss of erection Increased refractory period between ejaculations (12-48 hours) NOT synonymous with ED

Answer 87

Gait speed: >1.5 m/sec 6MWT: >500 m Chair rise (30 sec no hands): >15 reps Climb 10 stairs: under 10 sec, no rails Floor-stand: under 10 sec, no assistance

Answer 88

2nd most common type of dementia ``` Risk factors: HTN Smoking Hypercholesteremia Diabetes CV disease Cerebrovascular disease ``` Deterioration may be select with other functions left completely intact

Answer 89

Increased time OOB Walking Managing hydration, hypoxia, and nutrition

Answer 90

Osteoporosis (fractures) Osteoarthritis (joint arthroplasty) Spinal stenosis Frailty

Answer 91

1. Drop in systolic >10 from baseline despite increased workload in absence of other evidence of ischemia 2. Increasing chest pain 3. Hypertensive response (systolic >250 or diastolic >115) 4. Fatigue, SOB, wheezing, leg cramps, claudication 5. ST or QRS changes such as excessive ST depression (>2 mm) 6. Arrhythmias other than sustained ventricular tachycardia 7. Development of bundle-block or intraventricular conduction delay that cannot be distinguished from ventricular tachycardia

Answer 92

Decreased total body water = Decreased blood volume Decreased speed of RBC production = Decreased response to blood loss and anemia Decreased neutrophils = Decreased immune response/infection resistance

Answer 93

Surface: Concrete, wood, tile, carpet, gravel, grass, dirt, throw rugs, rugs, runners... Lighting: Adequate, dim, bright, glare... Steps/Stairs (handrails, number, height, condition) Door widths and direction of open/close Thresholds Objects: clutter, cords, furniture... Phone- accessible

Answer 94

Besides habitual posture, age related changes in bone, disc, cartilage, muscle etc... Decreased IV and bone height Decreased elastin in ligaments of spine

Answer 95

Must purchase Mini mental state exam 11 questions to assess: Orientation, registration, attention, calculation, recall, language, and visual construct Scoring: 0-17 = severe impairment 18-24 = mild impairment 24-30 = no impairment

Answer 96

``` System changes: MSK changes Higher level neural processing Sensory and perceptual changes Individual sensory systems ``` Others: Specific and individual pathologies Adaptive and anticipatory mechanisms Intricately related to balance responses

Answer 97

Memory and at least one other: Aphasia Apraxia Disturbance of executive function

Answer 98

1. Screen for falls and risk factors for other conditions (DM, osteoporosis, etc) and make appropriate referrals 2. Identify characteristics of frailty, depression, abuse/neglect, geriatric syndromes and make proper referrals 3. Plan for sustainable outcomes and increase in safe physical activity/participation through education and exercise prescription 4. Ascertain the role of social support in their condition or limitation 5. Consider their health literacy and education contribution to condition or limitation

Answer 99

``` Static -> Dynamic Incorporate head, arm, leg movements Change/advance environment Single task -> Dual Task Surface changes Add resistance Change speed ```

Answer 100

Changes are not inevitable- but are common Habitual postures often lead to... FHP- forward head posture Thoracic kyphosis Increases >40 y/o; women>men Associated with osteoporosis and vertebral fractures ``` Lumbar flattening (reduction of lordosis) Decreased IV space = decreased diameter of IV foramen : impact nerve root integrity ```

Answer 101

``` Identify a line 3 m (10 feet) away. Instruct: When I say “Go” I want you to: 1. Stand up from chair 2. Walk to line at your normal pace. 3. Turn 4. Walk back to chair at normal pace. 5. Sit down again. ``` >=12 seconds to complete = at risk for fall (Stay by patient for safety)

Answer 102

Increased double limb support, but generally equal stance time B LE

Answer 103

1. Drop in systolic >10 from baseline despite increased workload when accompanied by other evidence of ischemia 2. Moderately severe angina (>2/4 on scale) 3. Increasing nervous system symptoms 4. Signs of poor perfusion 5. Subject’s desire to stop 6. Technical difficulty with monitoring equipment 7. Sustained ventricular tachycardia 8. ST elevation (+1.0) in leads without diagnostic Q waves

Answer 104

Limited flexion or extension “Past retract” (visible forward then backward movement of thigh during TSw) Excessive ABD or ADD Excessive or limited IR or ER

Answer 105

More than typically quoted goal of 150 ft

Answer 106

Determine if low, moderate or high fall risk ``` “Stay independent” brochure OR 3 key questions: 1. Have you fallen in past 12 months? 2. Do you feel unsteady when standing or walking? 3. Do you worry about falling? ``` >4 on “Stay independent” OR if “yes” to any of the 3 questions above = should receive full assessment

Answer 107

During middle age, prostate enlarges (BPH: benign prostatic hypertrophy) -> Growth of prostatic tissue encroaches on prostatic urethra

Answer 108

Multidirectional Balancing (dynamic weight shifts, perturbations) External cueing (speed, stride length, timing) Carrying/picking up/teaching for objects

Answer 109

Smaller steps and stride length, but symmetrical

Answer 110

Falls efficacy scale, Activity specific balance scale, Fear of falling, Avoidance behavior questionnaire

Answer 111

Stage 1: alternate placement of feet onto step/bar at 6 inch., rate = 1/sec Stage 2: 12 inches Stage 3: 18 inches Stage 4: 18 inch step and add alternating arms HR, BP monitored; at 2 min below 75% HRmax continue for 5 minutes After 5 minutes, if <75% the progress to next stage

Answer 112

Focus on: Reduce deviations Improve gait efficiency and safety Increasing endurance Incorporate: Specificity, Task-oriented, Dual-tasking, Task and environmental constraints Rehab ALL components

Answer 113

Significant decrease in step and stride length and/or non-symmetric steps

Answer 114

``` Shouting and resisting Refusal to cooperate with medical care Potential to be injured falling Combative Pulling of lines and tubes ```

Answer 115

``` 0= nothing 1 = very light 2 = fairly light 3 = moderate 4 = somewhat hard 5 = hard 7= very hard 10 = very, very hard ```

Answer 116

``` Impairments May include: Memory Abstract thinking Judgement Impulse control Personality changes ``` Characterized by more abrupt onset, step by step deterioration, fluctuating course, and emotional lability

Answer 117

Rural : 0.5 m/s | Urban: 1.375 m/s

Answer 118

<= 0.1 m/sec

Answer 119

Do you leak urine with laughing, coughing, sneezing, lifting or exercise? Do you leak urine on the way to the bathroom? Do you have to strain to empty your bladder? Do you feel that your bladder is still not empty after you void? A “yes” to any = refer to PCP or specialist

Answer 120

50 hours of training over 3-6 months

Answer 121

Converts into cartilaginous tissue for scarring | Become thickened- spinal stenosis

Answer 122

``` Dosing: 60-90% Measured using: Target HR (220-age) X 60% to 90% Karvonen Method RPE: 12-16 = 60-90% on 6-20 scale; 5-8 = on 10 point scale (good for those w/ blunted HR response) Talk test ``` Joint pain, muscle weakness- May limit May need strengthening exercise first; Aquatics may also be option

Answer 123

``` Decreased: Excitability Max cardiac output (25-30%) Venous return Max HR ``` Increased: Cardiac dysrhythmias No change in RHR

Answer 124

Be sensitive to descriptions of unusual changes and observant of subtle changes with older adult patients in every setting- especially OP setting Be prepared to treat older patients in hospital with medical dx of infectious disease for the effects of deconditioning Realize may not be able to challenge them- but return to basic function and prevent functional decline remain high priority Prepare for functional setbacks with acute illness Prepare for exacerbation of previously compensated system deficits after acute illness

Answer 125

No action if asymptomatic Refer to physician if symptomatic

Answer 126

Depressed mood or loss of pleasure in all activities AND At least 5 associated symptoms for at least 2 weeks that impact function, social or occupational endeavors Associated symptoms: weight loss, insomnia, hypersomnia, decreased or hyperactive motor activity, fatigue, loss of energy, feelings of worthlessness, excessive inappropriate guilt, diminished ability to think/concentrate, recurrent thoughts of death, suicide ideation or attempt

Answer 127

Should remain =>90% 86-89% relative indication to stop exercise =<85% absolute indication to stop exercise

Answer 128

Gait speed: <0.3 m/sec 6MWT : <200 m Chair rise (30 sec no hands): unable Climb 10 stairs: unable Floor-stand: unable

Answer 129

Anti anxiety: Change libido, erection problems, delayed orgasms Antidepressants: Changes in libido, delayed orgasm Antihypertensives: ED, Decreased libido Ulcer medications: Decreased libido, ED

Answer 130

Decreased HR max -> Decreased CO -> Decreased tissue oxygenation Resulting in Progressive decrease in VO2max beginning between ages 20-30, decreases 10%/decade

Answer 131

Decreased-> | increasing incidence of HTN

Answer 132

Decreased resting metabolic rate Less lean muscle mass ``` Insulin resistance (common in older adults) Increased body fat further contributes Regulator of protein metabolism and important for protein gain and muscle growth ``` Decreased growth hormones Decreased estrogen and testosterone Vitamin D deficiency

Answer 133

Nutrition and hydration Environment: ~40% humidity Control of comorbidities: Glycemic control, etc Skin care: Moisturize

Answer 134

Reactive postural control: Ankle, hip, knee, stepping strategies Weight shifts; Perturbations Anticipatory postural control: Expected changes and learned experience Functional and Dynamic activities Stability limits: Reaching and Functional activities Sensory orientation: Surface changes, Functional activities, Eyes open/closed

Answer 135

1. Avoid bar soaps Use gentle, moisturizing liquid soaps 2. Soft cloths, cooler water temps 3. Moisturize after bathing Within 3 minutes to trap moisture No fragrance (eucerin, Vaseline, etc) 4. Don’t over bathe. 10 min daily or 2x week

Answer 136

Not biologically uniform

Answer 137

Normal aging-> Mild impairment-> Dementia Not everyone follows the continuum Mild impairment and dementia are pathological

Answer 138

15-20* flexion during WA and 15-20* apparent hyperextension at TSt

Answer 139

0.8-1.2 m/sec

Answer 140

Involuntary leakage of urine Continence requires: neural coordination between bladder, urethra, and pelvic floor muscle muscles (PFMs) ``` Types: Stress UI Urge UI Overflow UI Functional UI Mixed UI ```

Answer 141

Practice conditions: Massed, constant, Blocked (No variety, No random) Whole vs Part - Depends (Opposite from normal cognition:) Specificity- Unable to transfer Mental practice- NO Discovery vs Guidance- Guidance Feedback: Simple, lacking intrinsic, skillfully given

Answer 142

Strong desire to pass urine which is difficult to defer without involuntary leakage (can’t get to toilet in time) Low bladder compliance Detrusor over-activity- involuntary bladder contractions: assoc with neuro conditions; pelvic organ prolapse with urethral obstruction in Femalee. Prostatic enlargement in males Smoking, hysterectomy, arthritis, impaired mobility

Answer 143

Limited or excessive rotation forward or backward Pelvic drop or hiking

Answer 144

Just 1 exercise bout results in significant decrease in inflammatory markers Cumulative exercise sessions further decrease inflammation- enables regular exercisers to resist fatal infections and aggressive pathogens Results in wider window of homeostasis Enhances systemic “reserve” Decreases risk for disease Delays functional decline

Answer 145

``` Confusion Agitation Anorexia Insomnia Fatigue ```

Answer 146

Community program 2 hour class, 1x week, 12 weeks Slow, therapeutic Tai Chi movements

Answer 147

Prejudice or discrimination against a particular age-group and especially the elderly

Answer 148

Bacterial pneumonia | UTI

Answer 149

Acute confusion | Minimal or absent abdominal pain and tenderness

Answer 150

To test leg strength and endurance Straight back chair, without arm rests, seat 17” high 1. Sit in middle of chair 2. Place hands on opposite shoulder crossed, at wrists 3. Keep feet flat on the floor 4. Keep back straight and arms against chest 5. On “Go” rise to full standing, then sit back down 6. Repeat for 30 seconds Below average scores = fall Risk Age 60-64 M: <14 W: <12 ... Age 90-94 M: <7 W: <4

Answer 151

Modified version of “successful aging” Not all can avoid the effects of disease and disability Capacity to function across several domains to one’s satisfaction and in spite of medical conditions

Answer 152

Age related loss of skeletal muscle mass and strength Not completely age related Decreased physical activity Co-morbidities Results in decreased protein reserves Challenge to meet protein synthesis demands with injury or disease This even worse sarcopenia

Answer 153

``` Decreased joint space Increased laxity Altered load dispersion Altered joint forces Decreased joint ROM (not uniformly) ```

Answer 154

In absence of pathology, knee ROM remains fairly stable

Answer 155

Provides greater WB shift (50% or more) than a cane but with more stability than crutches Difficult to maneuver on stairs Standard offers greater stability but can be difficult for older adults to maneuver Requires more attentional demand and has greater destabilizing effect compared to RW RW less stable than std but easier to propel w/upper body weakness; decreased energy cost over std walker (5%) Rollators have brakes Platform walkers are heavy- increased energy but permit WB

Answer 156

``` Either large toe clearance OR Tripping OR Both ```

Answer 157

Memory and language

Answer 158

Flexibility training Strength, power, and agility Cardiovascular Speed

Answer 159

``` Gait and balance issues Visual spatial issues Poor executive functioning Sensitivity to antipsychotics May be depressed ```

Answer 160

Add or increase supplemental oxygen Contraindication to initiating activity/exercise Refer to physician if remains <90%

Answer 161

Hyperkyphosis: Spine extensors lengthened - weakened (Lifting difficultly) FHP: Challenges swallowing, breathing, supine/prone position Decreased lumbar lordosis: Pain nerve root impingement symptoms, spinal stenosis: standing, walking painful- limits activity

Answer 162

Medications Improper prescription and/or use of AD for ambulation Environmental hazards

Answer 163

If they are reducing to avoid UI, can lead to constipation from dehydration or UTI and further aggravate UI

Answer 164

History of falls- need details Medication review Review of risk factors for falls- current and past medical history Living environment- gather info from patient/family/caregiver

Answer 165

All motions decrease Greatest reduction in extension and lateral flexion

Answer 166

Sudden, rapid change about mental function (often confused with dementia) Associated with: Medical illness; recovery from surgery; hospital admission Usually short-term, temporary

Answer 167

Precaution to initiating activity/exercise Refer to physician

Answer 168

Cardiovascular disease

Answer 169

DIAPPERS D- delirium or other altered mental status I- infection, UTI, symptomatic A- Atrophic urethritis or vaginitis P- Pharmaceuticals P- Psychological disorders (esp depression) E- Endocrine disorders (hyper- calcemia or glycemia) R- Restriction Mobility S- Stool impaction

Answer 170

Achieve mobility with stability prior to emphasizing increased velocity Target PF, DF, quads, abductors, and extensors UE strength in lats and triceps when patient using AD Pre-gait activities can be done to focus on strength and control

Answer 171

``` Enhance lighting Remove rugs or secure them Add hand rails Change room layout, furniture Remove clutter, trip hazards.. Change accessibility of food, utensils, clothing.. Widen doors Obtain elevated toilet, shower chair/bench, non-slip surfaces ```

Answer 172

Decreased bladder sensation Decreased detrusor contraction strength -> Decreased urine flow rate Increased post-void residual volume Circadian rhythm changes Decreased diuretic hormone vasopressin -> nocturia Other renal system changes: Loss of renal mass/functional glomeruli Decreased renal blood flow/glomerular filtration rate Leads to increased sensitivity to fluid and electrolyte imbalance and decreased drug elimination

Answer 173

Increased resistance to chest wall deformity Increased choking/aspiration risk ``` Decreased FEV1 (forced expiratory volume) Decreased FVC (forced vital capacity) Decreased cough force ```

Answer 174

``` Most common form of dementia Early onset (30-60) Late onset (after 60) ``` ``` Risk factors: Advancing age Positive family history Women > Men African-American and Hispanic populations ```

Answer 175

``` Depression Self-efficacy/confidence Appearance Older adults perception of his/her mobility Anxiety/Fear Perceived risks of community mobility Access to or barriers in community ```

Answer 176

Occurs with effort or exertion; cough; sneeze; lifting activity; Valsalva ``` Childbirth Aging changes in muscle/connective tissues Estrogen loss Radical prostatectomy Caucasian Family history Smoking Obesity Chronic cough/respiratory disease Pelvic surgery Chronic constipation Neurologic disorders ```

Answer 177

Extension becomes most limited | No or very little change in rotation

Answer 178

Cohort born in specific time period (18-22 year increments) Each generation develops a collective world view based on prevailing cultural influences in first 18 years of life. ``` 6 current: GIs : 1901-21 Veterans/Greatest generation: 1922-45 Boomers: 1946-60 X: 1961-81 Y (millennials): 82-04 Z: 04... ```

Answer 179

0.4-0.8 m/sec

Answer 180

Cataracts AMD (age-related macular degeneration) Glaucoma DR (diabetic retinopathy) Retinal detachment Dry eyes

Answer 181

Mild decrease in force at push-off and/or | Slight decrease in PF and DF ROM

Answer 182

30 Q Yes = 1 point No = 0 point >10 need referral or follow up ``` 0-9 = normal 10-19 = mild depressive 20-30 = severe depressive ```

Answer 183

Mini-Cog MOCA: Montreal cognitive assessment Mini mental state exam

Answer 184

Bed mobility, transfers, use of AD and adaptive equipment The Barthel index

Answer 185

Presbycusis: hearing declines with age Effects both genders Men especially lose hearing for higher frequencies Difficulty tuning out background music

Answer 186

Increases in proportion to workload Significant drop is indication to stop exercise

Answer 187

Injury and/or death: Hip, wrist, compression fractures Head trauma, TBI Bruises, contusions, lacerations ``` Psychosocial: Fear of falling Anxiety Isolation Depression ```

Answer 188

Short, shuffling steps Unequal stance time Antalgic pattern

Answer 189

Certain growth factors in brain are inhibited Death and loss of neurons Dementia

Answer 190

Montreal cognitive assessment 16 item test 10 minutes Includes tests for executive function, naming, memory, attention, language, abstraction, delayed recall and orientation Score >26 = normal

Answer 191

1/3 of all deaths in 65+ Early detection difficult due to absence of typical s/s : Lack of fever, leukocytosis. In UTI, absent/masked clinical manifestations 1st sign of illness is: Change in mental status or cognitive impairment Decline in function Falls Weight loss/anorexia Slight increase in respiratory rate Vague symptoms: nausea, vomiting, decreased urine output

Answer 192

``` Sensory NM Aerobic endurance Movement analysis Functional balance and gait Perceived functional ability and fear of falling Footwear ```

Answer 193

60-80% of 1RM for strength gains Determine by: Select weight think pt will experience fatigue at ~10 reps Have them perform 1-2 reps and assess RPE 11-15 on 6-20 point scale “Somewhat hard to hard” = 70-80% 8-12 reps should result in momentary muscle fatigue Observe for: concentration, slight tremor, mild increase in respiration. 1 vs 3 sets

Answer 194

Decreased ability to thermo-regulate | Increased pain threshold

Answer 195

Mode of pacing programmed into device affects patient’s CV tolerance to exercise Exercise tolerance dependent on underlying disease, type of pacemaker, and degree to which patient dependent on pacer to maintain CO Fixed rate pacemakers : cannot elevate HR to accommodate higher demand Pacemaker set on dual mode can allow HR to vary according to demand Patient c/o lightheadedness, syncope, Low BP, and decreased activity tolerance should trigger referral back to cardiologist to check pacemaker function

Answer 196

100-140 mmHg

Answer 197

Muscular system Leg strength - most important factor in subsequent institutionalization PT key point- must apply appropriate principles of exercise prescription

Answer 198

1. Need to practice to build experience 2. Error is necessary 3. Intrinsic vs Extrinsic feedback 4. Task analysis- where is the problem 5. Does it require reactive or anticipatory postural response 6. Consider environment

Answer 199

Continue to assess vitals to determine response to training Remember while AD can increase stability, they can also increase energy demands

Answer 200

1- light, barely noticeable 2- moderate, bothersome 3- moderately severe, very uncomfortable 4- must severe or intense dyspnea ever experienced

Answer 201

Center for epidemiological studies depression scale 20 Q Likely scale questions >16 points may need referral Higher score = more likely depression is an issue

Answer 202

CVA TBI Parkinson’s Dementia

Answer 203

Aerobic capacity decreases with age (appx 1% per year) Decreased size and number of mitochondria Decreased capillary/fiber ratio (decreased blood flow) Decreased work capacity 20-30% Decreased O2 uptake and transport Sedentary individuals have a 2-fold decrease in VO2max.

Answer 204

1. Over the past 2 weeks, have you ever felt down, depressed or hopeless? 2. Have you felt little interest or pleasure in doing things? Yes to either of these indicates a need to refer or follow up with MD

Answer 205

Nonspecific mental and physical deterioration | No jaundice or abdominal pain

Answer 206

Often silent, no fever ``` Unilateral costovertebral tenderness Flank pain Ipsilateral shoulder pain Fever and chills Skin hypersensitivity Hematuria (RBC in urine) Pyuria (pus or WBC in urine) Bacteriuria Nocturia ```

Answer 207

Maladaptive reactions to identifiable psychosocial stressors that occur within 3 months of onset of stressors Impairs social or occupational function or marked distress in excess of normal/expected reaction Symptoms: depressed mood, tearfulness, and feelings of hopelessness

Answer 208

Decreased estrogen causes changes in lower urinary tract Decreased arterial flow to vagina -> Thinning of vaginal mucosa and perineal skin breakdown-> Weakened connective tissue structures supporting bladder neck Decreased arterial flow to submucosal vasculature and decreased striated muscle fibers -> Decreased urethral closure pressure (contributes to more frequent UTI)

Answer 209

25% or 1 in 4 fall annually 20% or 1 in 5 falls causes significant injury Falls are most common cause of TBI, and leading cause of fatal injury among older adults.

Answer 210

Increased alveolar duct and alveoli size Increased alveolar compliance Increased mucous glands Decreased mucous clearance Increased stiffness of pulmonary vasculature Decreased bronchial smooth muscle integrity Decreased lung elasticity

Answer 211

ROM from 5* flexion during WA to 60* flexion during swing limb advancement

Answer 212

Listening to music or talk-radio Verbal fluency Answer autobiographical questions Subtraction by 3 Visuospatial task of pattern matching

Answer 213

For Urge UI Gradual increase in time intervals between voids: Distraction Deep breathing to relax PFM contractions to inhibit bladder contractions Goal is to delay voiding to every 3-4 hours

Answer 214

Alzheimer Vascular Lewy body

Answer 215

Decreased: T- and B- cell development Quality and composition of lymphocyte pool Thymic epithelial cells Results in decreased: Efficiency of response to novel or previously encountered antigens (ex: increased vulnerability to flu >70) Responsiveness to vaccines (except shingles vaccine)

Answer 216

Decreased estrogen levels -> Delayed/Decreased vaginal lubrication Decreased extensibility of vaginal tissue Increased refractory period between orgasms and decreased orgasmic contractions Bladder and urethra May become irritated during intercourse

Answer 217

Depression: decreased libido cardinal symptom Dementia: ranges from hyperarousal/inappropriate demands - to withdrawl

Answer 218

<0.4 m/sec

Answer 219

Vision: acuity, contrast, depth, visual field Vestibular Somatosensory: vibration, proprioception, cutaneous Sensory integration: interaction between above 3 (mCTSIB and CTSIB)

Answer 220

At birth: 78.8 Males 76.3 Females 81.2 If live to 65, can expect to live average of 19.1 more years. Between now and 2030, the 65+ Population is expected to make up close to 20%

Answer 221

Progressive cognitive decline with 1. Fluctuations in alertness and attention (may be drowsy or lethargic) 2. Visual hallucinations 3. Parkinsonian motor symptoms

Answer 222

Bladder overly distended causing pressure > urethral pressure From loss of bladder sphincter after surgery or injury