2.1 Functional Capacity Assessment and the older adult Flashcards
What is in the SPPB subscale?
Walking speed
5x sit-to-stand
Balance progression - lowest reliability
The SPPB assess LE physical performance and predict:
Future hospitalization, disability, and mortality
The SPPB will likely have a ceiling effect in:
75 year old female living alone
Gait speed alone and the SPPB have predictive value for the overall health of older adults. In which of the following scenarios does the SPB offer a better predictive value?
Incident disability over a 1-year period
What is the most important factor that we can help/impact in cardiopulmonary patients?
Physical activity
Cardiorespiratory fitness
Impact the overall health of our patients!
Decrease risk/onset/severity of future events!
What can aerobic fitness help decrease?
All cause of mortality
Incidence of CAD or CVD events
At what MET level significantly decreased rates of mortality and/or CAD/CVD events?
> 7.9 METS
How much a reduction in mortality per 1-MET increase in exercise? %
10-25% decrease in mortality
Can see 30% decrease in poorly fit patients!!
Aortic stenosis causes what symptoms he may have during physical activity?
SOB, dyspnea during exercises!!
When would you not do an open heart for CAD?
If there’s still blood flow in heart… unless there’s S&S of angina…
Coumadin would NOT be used in what types of patients?
Fall risks!
What might impact balance/strength falls?
Think musculoskeletal as well for increase of falls.
How does paroxysmal afib impact us?
He’s post-op so this is a complication… Think about and get ready for this!
After post-op what should we look for in the indirect chart?
Why is the patient in the hospital? Surgical procedures MD note on dat of PT eval/Rx Post comp complications? Diagnostic imaging? CMC, chemistry panel, troponin, BNP Vital signs/ECG trends
TALK TO THE NURSE:
Anything I need to know that isn’t in the chart
Falls, syncopal events, adverse symptoms, ECG changes
Has he been functional?
TAVR procedure
Goes from femoral a. then goes up to the heart valves and does the repair…
What does additional time to wean from the ventilator tell you?
Social history?
Medical history?
What does decrease CBC tells us?
Decreased aerobic capacity!
Sill work with them!!
BUN tells you?
Kidney issues
What type of lower lung volumes issue we might see with patients post-op?
Atelectasis
What are some key subjective exam questions?
Home environment
PLOF
DME
Home support
If a pt has decreased walking time and distance over past 3-months we can hypothesize:
Already decreases functional/aerobic capacity impairment prior
Decreases strength
Decreased independence
What is the scale for fall risk stratification for older adults?
Fall history (8 points) Living alone (3 points) Taking 4 or more medications (3) Female gender (3)
Low fall risk: 0-4 points
Moderate: 5-10 points
High fall risk: 11-16 points
What does the Life space mobility assessment tell us?
How far they travel? Daily routine, weekly activities? How mobile are our patient? Can they access diff areas of the home? Are they going into the community? How much are they limited?
Helps us find motivation to give your patient to focus on and improve QOL and life participation.
The life space mobility measures how many days prior?
Last 30 days
What resources do we need to get our patients to enter life space 5?
Safety & balance Strength & power to sustain functional demands Aerobic capacity Cognitive function Financial Mobility assistance
What does the Duke Activity Status Index (DASI) tell you?
Gives us an idea based on a patient’s functional capacity on what activities they have been doing
What components are on the DASI?
0.43 timesEstimates VO2peak up to 34 ml/kg/min or 9.8 METS
Helps us initiate intervention and set goals
How is VO2peak calculated with a DASI?
0.43 x DASI + 9.6
What is the minimal aerobic capacity to remain functional independent?
Males: 18 ml/kg/min (5.14 METS)
Females: 15 ml//kg/min (4.3 METS)
Each L of oxygen increases by how much percent?
3-4%
Why would a patient be max A for bed mobility while mod A for sit-to-stand?
Trunk/Proximal muscles atrophied from surgery and bedridden
To stand you need:
Power
Leg strength, larger muscle groups…
No gross weakness means…
Document better! Can’t measure this…
What will contractures of PF and subtler pronation restriction impact?
Sit to stand
Walking
Transfers
Objective exam:
Vitals Telemetry Pulmonary sounds Heart sounds Chest wall excursion IS
What can be missing or not helping our patient with our documentation?
Gait analysis!
Things affected ambulation!
Gait speed??
Quality of gait.
Hypothesis of Key Impairments
Compromised function and aerobic capacity Decreased gait speed Decreased muscular power Frailty Fall risk
What test can we use in older adults to give us measurable documentation on a patient’s function?
SPPB
Static standing balance
gait speed in 4m
5x sit to stand
If balance is impaired, is an SPPB enough? What else can we use?
NO! BERG.
Which part of the SPPB independently can be used to show fall risk?
5x sit-to-stand
What are the normative for 5x sit-to-stand?
Age 60-69 = 11.4s
Age 70-79 = 12.6s
Age 80-89 = 14.8s
>15s 2x the incidence of falls
0-4 = 5 fold increase risk
5-7 = 2.6 fold increase risk
1 point increase in SPPB = 14% reduction in risk
One point increase in the SPPB reduces how much risk?
14%
Justifies a its needs for PT
What speed do you need to get across the red light?
0.8 m/s
FITT principle
How can we progress OP PT program to address functional capacity limitation.
Start to write of exercise programs!
What was significant associated w/ MCID in SPPB and gait speed?
Muscular power!!
What training approaches to improve aerobic capacity?
Aerobic & Resistance combined!!
Increase CV O2 delivery, oxidative capacity, muscle weakness
Want to impact all!!!
With d/c planing think about?
PLOF
Physical performance - future disability
