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103 Cards in this Set
- Front
- Back
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Ageism
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younger people overestimate how many of aged are impaired.
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Successful aging
Vs. Optimal aging |
successful: "absence of disease and disability. High cognitive and physical functioning. Active engagement with life" - Wroe and Khan
compression of overall morbidity and delay the onset of disability process. Intrinsic factors (heredity/genes) and extricsic factors (stress, diet, exercise) optimal: quality of life. more based on the individual. "the capacity to function across: physical, functional, cognitive, emotional, social, spiritual" - brummel-smith. more the current definition.. incorporates emotional, social, and spiritual. to encompass not only societal but also individual views as well. |
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Gerentology
Vs. Geriatrics |
the study of the social, psychological and biological aspects of aging. It is distinguished from geriatrics, which is the branch of medicine that studies the diseases of older adults. multidisciplinary nature of gerontology. Gerontologists view aging in terms of four distinct processes: chronological aging, biological aging, psychological aging, and social aging. the comprehensive study of aging and the problems of the aged
a branch of medicine that deals with the problems and diseases of old age and aging people |
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Life expectancy in the US:
inc/dec women/men AA/whites social |
Increasing
Women live longer. AA life longer than whites Social gradient exists |
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Income of older adults
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24,000 – 14,000
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Primary aging
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the gradual - and presently inevitable - process of bodily deterioration that takes place throughout life: the accumulation of biochemical damage that leads to slowed movements, fading vision, impaired hearing, reduced ability to adapt to stress, decreased resistance to infections, and so forth.
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Secondary aging
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Process of aging
PT goals for secondary agers – reduce disabling effects of disease and stop the cycle of disease-siability-new incident of disease result from disease and poor health practices (e.g. no exercise, smoking, excess fat and other forms of self-damage) and are often preventable, whether through lifestyle choice or modern medicine. |
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Genetic, damage, gradual imbalance (biological aging theory)
#6 |
Accumulation of damage: collagen protein with cross liking, free radicals (oxidation changes), glycosylation (modified forms of protein)
Preprogrammed gene regulation: telomere shortening with cell division Master clock (loses function over time) Epigenetics |
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PT goals for Accelerated aging
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maintain current level of function and prevent rapid deterioration
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Acute care/Disease model of aging
FOCUS ON GOAL APPROACH INTERVENTIONS MODIFIERS LIMITATIONS #12 #6 |
Focuses on DX and RX of discrete dz.
Goal: cure acute condition and control chronic conditions Approach: standardized care Interventions: Meds and Sx Modifiers: Cognitive status, culture, family, environment Limitations: Whne there is a chronic illness is it the same disease leading to different impairments OR is it a different disease causing the same impairments. When there are multiple diseases, pathology is not always Dz A + Dz B = Symptoms. There is an interaction between Dz’s. Necessary to challenge Dx, have multiple providers, and difficult for efficacy of the treatment. |
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Multifactorial health model for geriatrics (Tinetti)
#12 #6 |
Health conditions result from interactionof genetic, lifestyle, cognitive, cultural, envt and psychosocial factors.
Goal: ID and address modifiable contributing factors and impairments Approach: Functional, Individual Intervention: Integration of medical, surgical, wellness, and rehabilitative approaches |
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Strengths of Multifactorial health model for geriatrics (name 4)
#12 #6 |
Can reliably ID impairments
Targets Dz if modifiable cause of impairment Useful for geriatric “sydromes” (falls, delirium, dizziness, incontinence, chronic pain) Reduce chance of over- or under-treatment |
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Limitations of multifactorial health model for geriatrics (name 3)
#12 #6 |
Requires interdisciplinary care/ coordination
Change in paradigm for providers and reimbursers Less Evidence to guide practie |
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What is the overall goal in geriatrics? (3)
#5 |
Maintain/improve functional status of older adults by:
- Changing impairments underlying functional limitation with therapeutic interventions - teaching compensatory strategy for unchangeable impairments - Addressing alternative practice paradigms including care coordination and training health care team/practitioners on geriatrics |
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What factors attribute to increase in number of elderly
#5 |
Declining birthrate/fertility
Declining death rate/mortality Immigration Life expectancy (at birth and a time closer to death) |
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What are the top three killers in the US?
#5 |
Heart dz – CHD
Cancer Stroke |
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Black-White Crossover
#5 |
black high infant mortality rate and higher young death compared to their white counterparts. however, after 70-80 years old, aferican americans liver longer.
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Mortality disparities
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#5
Median income – rising for all groups Residential segregation High school dropout - diminished |
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African American men:
income mortalitiy coverage |
INCOME: Income inequality in men vs. women (blacks make less money compared to their white counterparts)
MORTALITY: Spike in gun related homicides (Higher death). Mortality rate related to HIV (higher deaths) COVERAGE: Lack of medicare and Medicaid coverage for low income adult men (people qualify but they don’t get it – don’t know about it) |
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Morbidity trends
Active life expectancy, Prevalence of chronic Dz. #5 |
Disparity/inequality is being reduced
Active life expectancy: active life decreases as you age but differs between income levels Prevalence of chronic dz’s: over 80 y/o, greater than 2 chronic conditions (50-70%) |
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Glaucoma:
Due to ___ Symptoms ____ Treatment/prevention |
DUE TO pathologically high intraocular pressure. Damages the nerve, sclerotic, hardened.
SYMPTOMS: Tear flow: a 40% reduction (Medications are available). Visual field disturbances occur with blind spots TREATMENT/ PREVENTION: No cure. Most claucoma is preventable through early detection. Annual exams are very helpful esp w/people with DM – pressure causes damage |
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Macular degeneration:
cause, treatment vision affected #1, #8 |
CAUSE: Deterioration of macula (small area of the retina responsible for fine, acute vision)
TREATMENT: No treatment if severely progressed VISION AFFECTED: causes impairment in central vision |
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Cataracts:
Cause Symptoms Worse with vision affected treatment #1, #8 |
CAUSE: Degenerative opacity of lens causing obstruction of light to the retina
SYMPTOMS: gradual darkening of vision and acuity – loss of clear lense like having dirty windows. WORSE WITH: glare, or in direct sun VISION AFFECTED: Central vision is affected first with gradual involvement of the peripheral field TREATMENT: Sx of removal OR replacement is highly successful. Glasses often cause magnification of images – don’t help |
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Visual changes with Aging (6)
#1, #8 |
- visual acuity declines
- visual field declines - depth perception declines - color vision changes (ability to perceive, differentiate and distinguish colors as a result of change in retinal cones) - adaptation to light changes decreases - tear flow decreases - glaucoma, cataracts, age-related macular degeneration, presbyopia |
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Presbyopia:
Symptoms Due to Vision affected Treatment/prevention #1, #8 |
SYMPTOMS: “old sight” = loss of accommodation, Loss of depth perception, inability to focus clearly over a range of distances, and Usually occurs btwn 4th and 5th decades
DUE TO: Lens looses its elastic nature and becomes rigid VISION AFFECTED: affects near vision first TREATMENT/PREVENTION: Reading glasses are usually indicated. Stress annual eye exams |
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Color vision changes
#1, #8 |
Cool colors, esp blues, greens and violets are particularly affected
Warm colors (reds, oranges, and yellows) are easier to differentiate Should be used as focal points against sharply contrasting backgrounds Retina – rods and cones – are effected. The lower side of the spectrum |
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Depth perception changes
#1, #8 |
Ability to estimate the relative distances
Lack of color contrast results in flat visual effect, or decreased depth perception and inability to judge distances Avoid checker patterns – skew depth perception |
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Accommodation strategies for visual changes (7)
#1, #8 |
Avoid startling an older adult – approach slowly with verbal greetings and touch
Avoid positioning the person in glaring light Adjust levels of light to accommodate the persons vision Behaviora changes (annual eye exams, diets with antioxidants, smoking) Use tactile stimulation for cuing Wait for the person to adapt to changes in light Reduce glare on surfaces (floors, tables, sinks) |
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Accommodation strategies for Handouts
#1, #8 |
Use color contrast
Use 14-18 point font size or larger Give frequent verbal cues |
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Conductive hearing loss
internal/external dysfunction in ______ factors responsible treatment |
EXTERNAL
DYSFUNCTION IN: the external ear, the middle ear, or both FACOTRS RESPONSIBLE: : impacted cerumen, performation of the tympanic membrane, serum or pus in the middle ear, otosclerosis (bone hardening in the middle ear), infection in middle ear TREATMENT: people you want to yell at. Benefit from hearing aids. Talk clearly, slowly, loud. Speak into the older adults ear. Shorter sentences |
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Sensorineural loss
Internal/external Casue of Dysfunction in ______ affecting ______ loss of ______ |
INTERNAL
CAUSE OF: nerve fibers in the ear (hair cells) die off as you age. the cumulative effect of a number of disorders or insults, all contributing to the degeneration of the auditory system. Includes TBI, falls, industry with lots of noise in envt (bus drivers, mechanics) DYSFUNCTION IN: conversion of sound waves to electrical signals by the inner ear or dysfunction in transmission of nerve to the brain AFFECTING: transmission, reception and perception of sounds LOSS OF: high frequency sounds and in spespeech discrimination – sounds such as S, T, F, and G. Background noise can enhance distortion |
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Hearing aids
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Amplify all sounds – not just speech and discrimination
Requires batteries – may need to make sure it is in correctly. May become occluded with ear wax Squeal is related to loose or improperly fitting earmold, to a high volume setting, or crack in the tubing. Don’t like moisture |
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Accomodations for sensorineural hearing loss (4)
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Eliminate background noise
Lower pitch Hearing aids will have only limited benefit. Implants to amplify the noise – looks like a little wire to the ear, impulse driving mechanism to accommodate |
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Behavioral changes (5)
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Inattentiveness
Inappropriate responses Difficulty following directions Speech that is unusually loud Habitually turing one ear to the speaker Frequent requests for repeating statements Irrelevant comments Tendency to withdraw from acitivities that require verbal communication or understanding of verbal communication such as family or other social gatherings. |
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Starting in the third or fourth decade, normal aging without disease is associated with what percent loss in strength? Type, which mms, other things decrease (2)
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1% loss in strength per year
loss of type II –fast twitch fibers. Loss of balance, don’t have fast twitch to recover. Can prevent or minimize it. loss of strength in larger bigger muscles. Loss of grip strenth. Decrease in ROM, Decrease in proteoglycans, less water in discs. Loss of power and strength |
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What does CABG stand for
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Cardiac bypass
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What is the PAR-Q
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Short questionairre. Screening tool to ID adults who physical activity may be inappropriate
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to improve strength/power you have to increase _____. To improve cardiovascular fitness you have to increase ______.
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Intensity
Duration |
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Resistance
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= >1x/body weight
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Strength gais vs. risk of injury
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Related to % of 1RM
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Importance of stretching
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stretching before or after exercise does not confer protection from muscle soreness and stretching before exercise does not seem to confer a practically useful reduction in the risk of injury
however, flexibility is important, is a benefit for function |
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Recommendations specific for strength training (8)
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Intensity = 80% of 1 RM
10 reps concerted effort self determined quality of movement Volume – 1 set 2-3x per week all major muscle groups |
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Recommendations general for strength training (5)
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Lower functioning/lower tech okay (therabands, soup cans)
Higher functioning is better Body weight Supervise Progress Record parameters Consent Class/group based (social interaction) Assume fraility or over confidence |
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ACSM guidelines
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Do mod intense aerobic exercise 30 mins a day, 5x per week, or total of 150 min/wk
OR do vigorously intense aerobic exercise 20 mins a day, 3x per week, or total of 75 min/week OR a combination of mod and vigorous intensity exercise, total energy expenditure of 500-1000 MET/min/week Do 8-10 strength training exercises, 10-15 reps of each exercise 2 – 3x per week. – on each of the major muscle groups Flexibility exercises for each of the major mm groups – 60 sec per exercise, 2days/wk If you are at risk of falling, perform balance exercises |
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High velocity training
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Have much higher gains in power with higher velocity resistance training program
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Assessing responses to exercises (3)
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Cardiovascular responses (SV, HR, BP)
MM responses (soreness, hypertrophy) Bone, fat, neuromuscular, mental health, endocrine) |
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Delirium
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State of acute confusion
Disturbance of consciousness Change in cognition that develops over a short period of time Concurrent disorder of attention, perception, memory, psychomotor behavior, and sleep wake cycles. Decreased clarity in thought |
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Development of delirium
Onset/ duration/ alertness/ orientation/ affect |
Onset/ abrupt
duration/ hours to days/weeks alertness/ fluctuates orientation/ variable/fluctuates affect/ variable |
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Causes of Delirium (5)
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Drugs
Alcohol withdrawal Cardiac disorders Cancer Trauma Infections Metabolic disorders Cerebral vascular disorders |
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Predisposing factors for delirium (5)
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Increasing age
Baseline brain damage Drug/ETOH addiction Fatigue Psychosocial stress Sleep deprivation |
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Types of dementia (3)
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Senile dementia/ Alzheimers type
Multi-infarct demential Artheriosclerotic |
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Senile demential/ Alzheimers type (SDAT)
Prevalence cause DX symptoms |
PREVALENCE: 60-70% of dementias. Affects 3 times as many women than men.
CAUSE: Neurofibrillary tangles DX: Dx confirmed with an autopsy SX: Progressive decline (early forgetfulness → language and intellectual decline → mute, inattentive, inability to self care |
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Multi-infarct dementia/ artheriosclerotic
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Multiple mini stroke/Cerebrovascualr dz
Artheriosclertic plaques in blood vessels, diabetic deterioration of blood vessels Stepwise progressive decline/abrupt onset It affects twice as many men as women |
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Other causes of dementia (4)
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Pseudodemential – from major depressive episode
PD – irreversible dementia with dopamine insufficiency Huntingtons dz Vitamin B1 deficiencies usually due to alcoholism 10-30% can be treated |
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MMSE
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Dementia assessment tool
Tests for: orientation, registration, attention, calculation, language recall, and spatial construction Further eval needed if <24/30. > or = 24 is normal Median score for >80y/o’s was 25 0-4 years of HS edu, median was 22 Remember: Age appropriate and education appropriate median score Higher edu – neuropsychological tests have more sensitivity – Get a referral |
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St. Louis Exam
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Dementia assessment tool
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SLUMS
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Norms: w/ a HS edu = 27-30. <20= dementia. Wo HS edu = 25-30. <19 = dementia
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FAST
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Staging of Alzheimers
1. normal adult (24-30 MMSE) w/ no functional decline 2. normal older adult (20-30 on MMSE) some functional decline of personal awareness 3. early Alzheimers dz (10-20 MMSE) w/ noticeable deficits in demanding job situations 4. Mild Alzheimers (10-20 MMSE) Requires assistance in complicated tasks (finances, planning parties) 5. Mod Alzheimers (<10 MMSE) Requires assistance in choosing proper attire 6. Mod-Severe Alz (<10 MMSE) Requires assistance dressing, bathing, and toileting. Urinary and fecal incontinence. 7. severe Alz (<10 MMSE) Speech ability declines to about 6 intelligible words. Progressive loss of abilities to walk, sit up, smile and hold head up |
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Remember…. Normal aging….
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Normal aging does not change memory, personality, or intelligence
That would interefere with daily relationships and functions in the elderly. |
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Use it or lose it
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Participation in activity 1 day per week = 7% reduction in risk of dementia.
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Major depression
Most at risk population onset diagnositc qualities |
MOST AT RISK: Oldest old individuals
ONSET: Episode lasts for at least 2 weeks DIAGNOSTIC QUALITIES: Persistence of a depressed mood or loss of interest or pleasure in nearly all activities. Individual must experience at least 5 symptoms. Accompanied by clinically significant distress or social, occupational impairment |
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Depression (define, symptoms (6))
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An alteration or disturbance of mood
Clinical depression = altered mood, somatic symptoms (low motivation, loss of appetite, sleep disturbance), cognitive impairments (concentration, memory, decision making). Feeling of guilt, self derogation, and suicidal impulses are less common (excptions noted) Differentiation of depression and pseudodementia is difficult. |
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Development of Dementia
Onset/ duration/ alertness/ orientation/ affect |
Onset/ insidious
duration/ months to years (7 years) alertness/ usually normal orientation/ near miss answers affect/ labile |
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Development of Depression
Onset/ duration/ alertness/ orientation/ affect |
Onset/ recent
duration/ variable alertness/ diminished talk orientation/ don’t know answers affect/ flat |
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Risk factors for depression and depressive mood (3)
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Grief and bereavement
Changes in network of support Changes in physical function (chronic pain) Low income |
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Medical disorders predisposing for depression and depressive mood (4)
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Malignancy
Infectious process Hypothyroidism PD CHF COPD ESRD |
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Medications associated with depression and depressive mood (3)
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Antihypertensives (resperpine, methyldopa, beta blockers, hydralazine)
CNS depressants (barbiturates, neuroleptics, opiates, alcohol) Other drugs (digoxin, oral hypoglycemic, steroids, cytotoxic agents) |
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Types of depressive disorders (2)
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Major depressive episode
Adjustment disorder with depressive mood |
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Adjustment disorder with depressive mood
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Significant emotional or behavioral sx in respose to an identifiable psychosocial stressor (the reaction is either.. in excess of what is normally expected)
Tearfulness, feeling of hoplessness, depressed mood Sx occurring within 3 months of stressor |
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Assessment tools for depression (3)
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5-item geriatric depression scale – specific for older population
beck depression inventory – severity of depression zung self rating depression scale- screen for depression |
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Intervention strategies for patients with depression (5)
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Be aware of time requirements (apathy)
Emphasize pt’s feelings of mastery rather than feelings of pleasure Focus on small incremental goals/adl training Avoid excessive cheerfulness Be aware of effects of pharmaco-, psycho-, therapies and exrcise |
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Define learning
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A relatively permanent change in the capability for responding that results from practice or experience. Learning is based on performance.
Poor performance → insufficient learning has occurred. Performance doesn’t accurately reflect the extent of learning achieved |
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Factors affecting performance on learning tasks (6)
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Learning style
Sensory acuity Health status Anxiety Motivation Meaningfulness Learning pace Practice Feedback Past experience |
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Flexibility in learning styles with age
Older adults learns ________ than young adults if _____. |
Flexibility in learning styles with age. Older adults learns just as well or better than young adults if TIME is not a factor.
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Sensory acuity and learning (if senses are intact ____), and Recommendations for improvement (5)
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If senses are intact, learning is enhanced when matching auditory and visual inputs are combined.
- wash lenses of glasses - check hearing aid battery - use large print handouts - models and equipment - eliminate background noise |
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Health status/anxiety/motivation and learning: learning is affected by ______.
And Recommendations for improvement |
Learning is affected by: Pain, decreased strength or endurance, dulled senses.
- find the optimum time for therapy – barriers predict adherence (not motivators) PTs need to emphasize barriers. Address current/potential changes in health status. |
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Barriers for exercise – ranked (5)
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Not interested in exercise
Health status Bad weather Not strong enough Feel Depressed Fear of falling Short of breath Doesn’t change how I feel |
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Components of patient education materials/HEP (7)
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Purpose statement
50% white space Large print (14-18 font) Layman’s language Illustrations or dramatic titles Color contrast Contact information |
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Drugs: inappropriate use
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Polypharmacy
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Polypharmacy
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No apparent reason
Duplicate drugs Contraindicated drugs Interacting drugs Inappropriate dose Drugs used to treat ADR’s (adverse drug reactions) Improvement when drug stopped |
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Consequences of polypharmy (4)
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Adverse drug reactions
Drug interactions Financial, compliance issues (medicare part D) Vicious cycle of prescribing cascade |
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Describe the prescribing cascade
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Diagnosis → treatment 1 → new symptom → sub treatment 2
Depression → anti D → ^ constipation → laxative use |
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Factors responsible for inappropriate medication use (4)
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Multiple pathologies
Inaccurate dx Non specific presentation of illness Atypical presentation of illness Multiple providers Patient expectations |
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DTCA – what does it stand for, beliefs (medical, industry, pt advocates), edu diffs.
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Direct to consumer advertising
Marketing to consumers Medical = negative Industry = positive Pt advocates = mixed Social and edu influences acceptance of DTCA and depends on which sector |
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What is SPIT
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Small positive industry sponsored trials
- be skeptical |
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Ghost writers
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Write research reports and submit evidence to help the drug companies
Doctors sponsored by the drug companies professional writers are paid by pharmaceuticals to produce manuscripts. physicians and other scientists are frequently permitted or paid to attach their names to these manuscripts. These scientists or physicians may have little involvement in the research or the writing process |
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Altered responses to drugs in the elderly (2)
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Pharmacokinetic changes = 1. Absorption, 2. Distribution, 3. Elimination (metabolism decreases, excretion decreases – drugs hang out loner, longer lasting side effects. Also don’t drink as much to avoid bathroom trips, dehydration makes elimination harder)
Pharmacodynamic changes = body’s response to a drug (older frail women, small stature have a harder time with medications) |
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Pharmacokinetics and exercise
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High intensity exercise reduces portal blood circulation by 50-80% (may alter the transformation of the medication) Altered biotransformation
Oral drugs with high first-pass effect should be held until after exercise (so that the portal system is not shut down) |
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Pharmacodynamic changes
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Altered sensitivity to drugs at normal doses
Altered response due to : changes in receptor types/number, changes in organ mass/composition, changes in neurotransmitter production. |
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Risk factors for ADRs in elderly (6)
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ADR (adverse drug reaction)
➢ 75 years old ➢ small stature ➢ multiple drug use ➢ high risk drug use ➢ organ dysfunction ➢ previous ADRs |
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Define ADR
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Any unwanted harmful side effects occurring at recommended dosage
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Statin
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Cholesterol medication
Main side effect is risk for myopathy (muscle soreness, stiffness. |
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Meds frequently causing ADRs (5/10)
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NSAIDs
Diuretics Beta blockers Kigoxin Benzodiazepines Antidiabetic agents Anticonvulsants Antihypertensives Anticholinergics antipsychotics |
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Article author, year, title
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Author: white et al
Year: 2013 Title: Facilitating the Use of Implicit Memory and Learning in the Physical Therapy Management of Individuals With Alzheimer Disease Study design: case series |
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Article purpose
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–Apply implicit learning strategies (high-rep practice, errorless learning, and spaced retrieval) to PT management of moderate AD
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Define explicit memory
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recollection of fact, ideas, events, learning and error detection (lack of explicit makes it hard to learn or relearn mobility activitiy
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Define implicit memory
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intact until late stages of AD. Is formed by recurrent practice and does not require development of conscious rules to guide performance. Implicit memories are stable with out conscious awareness of what was learned – or how it was learned.
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Define spaced retrieval
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high rep practice to promote accurate recall over progressively longer intervals. Example: “what should you do before you get out of bed” - “sit for a little bit”
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Define errorless learning
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high rep, low variability, designed to prevent or minimize inaccurate performance during the learning process. Used with AD patients lack explicit memories – may be unable to correct themselves. Example: minimize verbal instruction and feedback, number of tasks is limited, blocked practice, limited variability (modeling, concurrent tactile cues, hand over hand guidance to promote correct performance and implicit learning of the tasks)
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Article subjects
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3 women, aged 89-95, with Moderate AD
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Article Intervention
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Patient specific functional tasks – incorporating Errorless Learning and Spaced Retrieval
12-10 treatment sessions over the course of 4 weeks |
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Article outcomes
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All patients improved performance on: balance, minimal detectable change for the BBS or POMA, but no significant clinical change for TUG and SSWS.
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Article clinical implications (7)
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–Longer treatment time
–Larger sample size in future studies –Good for novice clinicians –Discrete tasks/sequential tasks with discrete steps are best for EL –Cant apply errorless learning on tasks practiced without clinician –Unable to transfer learning from one task/environment to another –Typically used by OT and SLT, new for PT |
