Week 10

Question 1

Which is the lie

Answer 1

A

Question 2

Which is the lie

Answer 2

C

Question 3

List some evidence based exercise programs

Answer 3

Tai chi

Otago

Stepping on

(SAIL) stay active and independent for life

A matter of balance (for fear of falling)

Individualized PT with progressive gait/balance/strength training

Question 4

Which is the lie

Answer 4

C

Question 5

What is cachexia?

Answer 5

metabolic syndrome related to underlying illness and characterized by muscle mass loss with or without fat mass loss that is often associated with anorexia, an inflammatory process, insulin resistance, and increased protein turnover

Question 6

Can malnutrition, sarcopenia, frailty, and cachexia be present in weight loss

Answer 6

Malnutrition: yes
Sarcopenia: not necessarily
Frailty: yes
Cachexia: yes

Question 7

What is the difference between sarcopenia and cachexia?

Answer 7

Sarcopenia and cachexia are both conditions characterized by muscle loss, but they have different underlying causes, mechanisms, and associated conditions.
1. Sarcopenia:
* Definition: Primarily refers to the loss of skeletal muscle mass and strength due to aging.
* Causes: Often related to aging, physical inactivity, and hormonal changes. It can also be influenced by poor nutrition and chronic diseases but is generally seen as a part of the natural aging process.
* Mechanism: Decline in muscle protein synthesis and an increase in muscle protein breakdown due to aging.
* Population Affected: Mostly affects older adults, especially those who are sedentary.
* Symptoms: Reduced muscle strength, decreased stamina, and increased risk of falls and fractures.
2. Cachexia:
* Definition: A complex syndrome involving severe muscle loss usually seen in people with chronic diseases.
* Causes: Commonly associated with chronic illnesses like cancer, heart failure, chronic kidney disease, or COPD. It results from an inflammatory response to these conditions.
* Mechanism: Involves an increased rate of muscle protein breakdown, often triggered by inflammation and catabolic signaling due to the underlying disease.
* Population Affected: Affects people of various ages who have chronic diseases, regardless of age.
* Symptoms: Rapid weight loss, fatigue, muscle wasting, and weakness, often seen in conjunction with other symptoms of the underlying disease.

Question 8

Can malnutrition, sarcopenia, frailty, and cachexia be present in low BMI

Answer 8

malnutrition: yes
Sarcopenia: not necessarily
Frailty: yes
Cachexia: yes

Question 9

Can malnutrition, sarcopenia, frailty, and cachexia be present in muscle loss/weakness

Answer 9

malnutrition: yes
Sarcopenia: yes
Frailty: yes
Cachexia: yes

Question 10

Can malnutrition, sarcopenia, frailty, and cachexia be present in fat loss

Answer 10

malnutrition: not necessarily
Sarcopenia: not necessarily
Frailty: not necessarily
Cachexia: not necessarily

Question 11

Can malnutrition, sarcopenia, frailty, and cachexia be present in inflammation

Answer 11

malnutrition: yes
Sarcopenia: not necessarily
Frailty: not necessarily
Cachexia: yes

Question 12

Can malnutrition, sarcopenia, frailty, and cachexia be present in loss of appetite/nutrition impact symptoms

Answer 12

malnutrition: yes
Sarcopenia: N.A.
Frailty: not necessarily
Cachexia: yes

Question 13

Can malnutrition, sarcopenia, frailty, and cachexia be present in low food intake

Answer 13

malnutrition: yes
Sarcopenia: N.A.
Frailty: sometimes
Cachexia: yes

Question 14

Which is the lie

Answer 14

B

Question 15

Which is the lie

Answer 15

A

Question 16

Which is the lie

Answer 16

C

Question 17

Which is the lie

Answer 17

A

Question 18

List max HR for ages 60, 70, 80, 90

Answer 18

DO NOT USE (220 - age = HRmax) for geriatric patients because it UNDERESTIMATES capabilities

Use (0.7 x age = HRmax)

60: 166
70: 159
80: 152
90: 145

Question 19

Which is the lie

Answer 19

B

(300-600 meters (~2000 ft) for community access

Question 20

Give an example question to screen for floor transfer ability

Answer 20

How much difficulty in your daily routine do you think you have in getting down and up from the floor? (check the box that best applies to you.)
* I can perform the task by myself without using any support from a person or furniture.
* I can perform the task with some help or support from a person or furniture.
* I am unable to perform the task.

Question 21

Label these gait patterns

Answer 21

1) iNPH gait
2) Normal gait
3) Parkinson’s gait

Question 22

Give abnormal gait examples

Answer 22

1) “conservative” geriatric gait:
Step and stride length affected

Swing phase and double limb stance affected

Gait speed reduced

2) Pathology examples:
Osteoarthritis, CVA, TBI, NPH, Parkinson’s, CFH, COPD

Question 23

Ex: a 75 year old female patient with Parkinson’s, falls, peripheral neuropathy, hypertension, pre diabetes, and obesity. Cancer survivor (endometrial, remission x 10 years). List the effects on activity

Answer 23

1) Abilities:
Moving around within home
Walking short distances
Sitting, rolling over, standing
Making decisions
Sustaining a conversation

2) limitations: (opposite of abilities)
Moving around outside home
Walking long distances
Maintaining standing position
Transferring oneself

Question 24

Ex: a 75 year old female patient with Parkinson’s, falls, peripheral neuropathy, hypertension, pre diabetes, and obesity. Cancer survivor (endometrial, remission x 10 years). List the effects on participation

Answer 24

1) Abilities:
Religion and spirituality
Taking care of pets

2) Restrictions:
Recreation and leisure

Question 25

Ex: a 75 year old female patient with Parkinson’s, falls, peripheral neuropathy, hypertension, pre diabetes, and obesity. Cancer survivor (endometrial, remission x 10 years). List the effects on body structures

Answer 25

mobility of joints Muscle power functions Tremor Pain in back Touch function Proprioceptive function Quality of voice

Question 26

Ex: a 75 year old female patient with Parkinson’s, falls, peripheral neuropathy, hypertension, pre diabetes, and obesity. Cancer survivor (endometrial, remission x 10 years). List the effects on internal environment

Answer 26

(+) Positive coping strategies College education (-) Decreased balance confidence Inconsistent motivation for exercise

Question 27

Ex: a 75 year old female patient with Parkinson’s, falls, peripheral neuropathy, hypertension, pre diabetes, and obesity. Cancer survivor (endometrial, remission x 10 years). List the effects on external environment

Answer 27

(+) Family support Health insurance Elevator available (-) Farm land uneven Elevated home with 16 steps

Question 28

Give examples of aging life roles

Answer 28

Work Caregiver Community member/leader Grandparent

Question 29

Describe the 4 Fs that can gauge an aging adults’ ability

Answer 29

fun: unrestricted participation in work, home, and leisure activities Function: accomplishes activities with modification, adaptation, or self restriction Frailty: basic activities of daily living (BADL). Assistance with IADL and community activities Failure: assistance with IADL + BADL

Question 30

Describe the mental health domain with its wellness dimensions

Answer 30

Mental health domain: Emotional: Sense of well-being and the ability to cope effectively with life's "ups and downs" Spiritual: Aspect of life that provides meaning and direction that connects to something greater than one's self Intellectual: Ability to learn and use information effectively and to reason and use self-efficacy in wellness endeavors

Question 31

Describe the physical health domain with its wellness dimensions

Answer 31

physical health domain: Physical wellness dimension: Physical functioning to the degree that allows one to perform roles in family and society

Question 32

Describe the social health domain with its wellness dimensions

Answer 32

social health domain: Social: Meaningful relationships and presence of a social support structure vocational: Occupational/ Purpose in life, a reason to get up in the morning

Question 33

What are some example questions to gauge the patient’s health domains?

Answer 33

Question 34

Give examples on some exercise screening questions

Answer 34

Question 35

What are some fall screening questions?

Answer 35

1) Do you feel unsteady when standing or walking? 2) Do you worry about falling? 3) Have you experienced a fall in the past year? How many times? Were you injured?

Question 36

What is a fall?

Answer 36

A clinical definition: "An event which results in a person coming to rest inadvertently on the ground or floor or at another lower level." Aging adult perspective: * "It's scary. You are fine and then all of a sudden you are on the ground." * "Oh my. A person loses balance and cannon remain upright. Causes include accidents, poor observation of surroundings, organic dizziness, and intoxication.” * "A fall means fear of breaking something and having difficulty (if not impossible) doing needed life skills."

Question 37

How do you assess gait speed?

Answer 37

1) various distances can be used (3m, 4m, 10m) 2) compare usual vs fast (functional reserve) 3) Normal comfortable (usual) = 1.2 - 1.4 m/s 4) Meaningful changes = 0.1 m/s

Question 38

What is gait speed associated with?

Answer 38

higher risk of bad outcomes like falls, hospitalization, discharge to nursing home, ADL dependence

Question 39

When is intervention for fall risk indicated by gait?

Answer 39

When Gait speed is equal to or less than 1.0 m/s

Question 40

Give some examples of pragmatic interview questions

Answer 40