The Geriatric Patient- Chap 14

Question 1

objective

To understand the relevance of the practice of the PTA when treating the elderly patient

Answer 1

fyi

Question 2

Overview

Answer 2

• Geriatrics: generally covers problems associated with individuals over age 65
  
  • Cost of providing healthcare: 3-5 times greater than those under age 65
  • 35% of deaths in US for older Americans: associated with smoking, poor nutrition, lack of physical activity

Question 3

Socioeconomic Status

Answer 3

• Older Americans: many live at or below poverty level
• Healthcare: rehabilitation services
• Medicare and the future?

Question 4

Case study

Answer 4

• 2 patients
• 90 years old
• Pt #1 retired teacher with severe arthritis in her left hip, dislocation of R THR, limited family availabilty
• Pt #2: widower, hunts birds with friends, hurts his back while moving a table

Question 5

Pathophysiology of 
Aging

Answer 5

• Correlation between neurological function and age
• Mm and nerve cells do not regenerate
• Several factors may limit longetivity
• Preprogrammed life expectancy
• Loss of production of hormones
• Reduction in some immune cells (T cells)
• Lack of restorative sleep
• Poor GI absorption of nutrients

Question 6

Aging

Answer 6

• Cells ability to produce energy
• Heart and blood vessels:
• Lungs:
• Skeletal muscle and connective tissue:
• Fat vs muscle
• Bone mass
• Change in neurological tissue

Question 7

Effects of Aging on the Skin

Answer 7

Skin ages due to several factors

• ^{Nutrition, hydration}
• ^{Decreased elasticity and flexibility}
• ^Bruising
• ^{Decreased circulation}
• ^{Thinning of tissue}
• ^{Thinning of subdermal fat}
• ^{Alteration of connective tissue}
• ^{Decreased ability of nerve endings in skin to detect heat/cold, touch, pressure}
• ^{Decreased proprioceptive sensation}
• ^{Wrinkling of skin}
• ^{Dryness, scaling, itching}
• ^{Loss of body hair}
• ^{More likely to break down}
• ^{Weight loss and decreased body fat}
• ^{Dehydration and loss of flexibility}
• ^{Dermis and epidermis thin}

Question 8

False assumptions

Answer 8

• Immobility
• Sex and desire
• Senility
• innactivity

Question 9

• Reduction in ability to travel in public
  
  • Loss of driving status
• Loss of cognitive abilities
• Socially unacceptable behaviors
• Loss of friends: how to enlarge the circle
• Ageism: form of discrimination
  
  • PT: positive attitude
  • Depression and grieving

Answer 9

Psychological Effects of Aging

Question 10

Diseases Associated with Aging

Answer 10

• Heart disease
• CHF
• Pulmonary Disease
• COPD, pneumonia, obstructive airway disease
• Osteoarthritis
• Osteoporosis
• RA
• CVA, Parkinson’s, ALS, Alzheimers
• Diabetes

Question 11

50% of people over age 80

• Reduced clarity of vision
• Increased glare, halo around lights
• Break up lens and remove it and replace

Answer 11

Cataracts

Question 12

eye

• Sudden or due to trauma
• Medical emergency
• Onset: floaters or curtain
• Treat? immediately

Answer 12

Detached retina

Question 13

Eye

• Closed angle vs open angle
  
  • Family history
  • Diabetes
• Symptoms
  
  • Acute
  • chronic

Answer 13

Glaucoma

Question 14

• Acquired, progressive, irreversible
• Wet vs Dry
• Central or peripheral loss

Answer 14

Macular Degeneration

Question 15

Low vision in physical therapy

Answer 15

• Home exercise program
• Appearing uncooperative
• Clutter and rugs
• Steps and curbs
• Grumpy?
• Hearing loss (add problem to low vision)

Question 16

• Benign
• Difficult to diagnose
• Reduced hearing and tinnitus, balance issues
• Diagnose with MRI, treat: monitor, surgery

Answer 16

Acoustic neuroma

Question 17

• Vestibular disorder
• Head injury, inner ear infx, auditory sx, migraines or unknown
• Crystals in wrong canal
• Hall Pike or Epley maneuver

Answer 17

BPPV

bengin postural lssue with balance

Question 18

Inner ear inflammation

• Viral or bacterial infx
• May follow an URI
• Herpes zoster oticus/Ramsey-Hunt syndrome
• Sudden loss hearing with vertigo, N&V
• Treat with bedrest, fluids

Answer 18

Labrynthitis

Question 19

Disease if inner ear

• 0.2% of population
• Block of endolymph duct
• Dizziness, vertigo and loss of balance
• May have sudden attacks
• May use meds: sedatives, antihistamines, anti inflammatories
• PT: work on improving balance, avoidance of injuries

Answer 19

Meniere’s Disease

Question 20

• Middle ear
• Gradual hearing loss
• Which bone is affected?
• Progressive or sudden?
• What is the treatment?

dr c doesn’t expect us to know this

Answer 20

Otosclerosis

Question 21

Hearing Loss in physical therapy

Answer 21

speak clearly

explain slower

Question 22

• CVA, Lung disease, DM
• What does the family tell you?

Answer 22

Arthritis as a co-morbidity

Question 23

Amputation

Answer 23

• Why did it occur
• Slow healing
• What do you need to discuss with pt?

Question 24

• Leading cause of disability >65
• Immobilization
• Loss of independence
• Joint mobility and muscle strength

Question 25

Balance Problems

Answer 25

* Falls: leading cause of injury deaths among older adults * Risk is higher among those over 85 * 4-5X higher than those in 65-74 group * Fear of falling * Muscle weakness

Question 26

* Widen base of support * Increase stability * Slow down * Smaller steps * Decreased depth perception * Hearing and vestibular problems

Answer 26

Increases with osteoporosis

Question 27

Fall Risk

Answer 27

Up at night * Decreased balance * Balance issues * Sit side of bed Foot support

Question 28

Bowel Bladder Dysfunction

Question 29

Dementia

Answer 29

* Not Normal! * Senile dementia, vascular dementia, Lewy Body dementia, alzheimers disease * Progressive, nonreversible May have moments of clarity May have depression B vitamins? Thyroid disease

Question 30

* Avoid trauma or pressure * Watch for polyneuropathy and reduced circulatory function * Self inspection of feet * Podiatrist for foot care * Well fitting shoes * Any wrinkles in those socks???? * the one time insurance will pay for foot dr.

Answer 30

Diabetes

Question 31

* ^{Poor nutrition} * ^{Change in sensory abilities} * ^{Lose the teeth?} * ^{Decreased absorption of minerals and vitamins} * ^{Poor oral function with loss of teeth} * ^{Swallowing disorders} * ^Alcoholism * ^Addiction * ^{Loneliness, depression} * ^{Unable to cook} * ^{Loss of smell and taste} * ^{Difficulty chewing} * ^{Get full rapidly} * ^Poverty * ^{Medication with reduced appetite}

Answer 31

Malnutrition?

Question 32

* ----rigidity * -----tremor * What else? masked face, shuffling gate, poverty movement, hard time talking.

Answer 32

Parkinsons

Question 33

* 20% occur at home * Increase hospital stay by 5 times * Financial cost * Check pt frequently * education

Answer 33

Pressure Ulcers

Question 34

* Be emotionally prepared to deal with death * Maintain objectivity * Assist patient and family * Hospice programs * Stages of dying: **_denial and isolation, anger, bargaining, depression and acceptance_** * PT goal: enhance quality of life * End of life decisions

Answer 34

Terminal Illness

Question 35

Common problem * ^{Home, hospital, nursing home or community} * ^{Physical, sexual or emotional abuse} * ^{Most common within families} * ^{Signs: bruising, repetitive unexplained injuries} * ^{Reluctant to take pt to hospital} * ^{Hunger or dehydration, severe weight loss} 

Answer 35

Elder Abuse

Question 36

* Education programs * Recognize warning signs * Respite care

Answer 36

Elder Abuse Prevention