C - Immobility and rehabilitation

Question 1

What is the commonest cause of immobility in the elderly?

Answer 1

A musculoskeletal condition

Question 2

What is age related loss of muscle mass and function known as?

Answer 2

This is known as sarcopenia

Question 3

What is the european working group definition for diagnosing sarcopenia?

Answer 3

Criterion 1 - low muscle mass + Criterion 2 - Low muscle strength or Criterion 3 - Low physical perfomance

Question 4

Define sarcopenia and the criteria to diagnose it? How does it cause difficulty in performing ADL?

Answer 4

Sarcopenia is the gradual age related loss of muscle mass and function Need to have a low muscle mass + low muscle strength or low physical performacne The loss of muscle mass makes normal activites such as gait and balance difficult

Question 5

At what age does muscle mass begin to decline and when does the decline accelerate?

Answer 5

Mass begins to decline at age 30 and accelerate at 60 years of age

Question 6

The muscle mass eventually becomes infiltrated by fat What is this known as?

Answer 6

Sarcopenic obesity

Question 7

Define sarcopenic obesity? What risks does this cause?

Answer 7

Loss of muscle mass with increased fat Greater risk of cardiometabolic disorders – insulin resistance, metabolic syndrome, cardiovascular disease

Question 8

How does sarcopenia lead to increased insulin resistance and obesity?

Answer 8

Due to the muscle wasting, this will decrease exercise capability causing a decrease in energy use and increase in fat deposition This in turn leads to increased insulin resistance and obesity

Question 9

How can sarcopenia increase the chances of depression?

Answer 9

Due to the muscle loss, this can cause immobility and therefore isolation leading to depression

Question 10

What is one of the best proven methods for treating sarcopenia?

Answer 10

Progressives resistance training - increases strength and endurance Helps improve mood also

Question 11

What is the recommended physical activity levels for older people >65?

Answer 11

Recommend 150 minutes moderate intensity exercise throughout the week or a 75 minute vigorous intensity exercise period

Question 12

What do strength and balance training help combat in the elderly?

Answer 12

Strength helps fight against sarcopenia and the balance training helps reduce the risk of falls in the elderly

Question 13

Physical activity monitors have made objective measurement of physical activity possible.. Why is it important to reduce sedentary time?

Answer 13

This can lead to increased muscle loss - movement strengthens the musccle

Question 14

Which drug that should not be used in bilateral renal artery stenosis has a tested effect in helping with muscle strength? Which drug used in the treatment of gout also has studies in its effects on muscle strength?

Answer 14

ACEinhibitors are shown to have cause increase walking distance over time in elderyl Allopurinol is believed to increase muscle strength

Question 15

Allopurinol may exert what beneficial effects on skeletal muscle function?

Answer 15

* Can reduce muscle oxidative damage * Improves vascular function * Increases the availability of high energy ATP for skeletal muscle contraction

Question 16

Rehabilitation can take place at any time across a life course or in a continuum and may include habilitation, reablement and recovery. (rehabilitation is the action of restoring someone to health or normal life through training and therapy after imprisonment, addiction, or illness.) What does habilitation and reablement mean?

Answer 16

Reablement is the active process of an individual regaining the skills, confidence and independence to enable them to do the things for themselves, rather than having things done for them. Habilitation is the process of assisting an individual with achieving developmental skills when impairments have caused a delay or blocking of initial acquisition of these skills.

Question 17

Would habilitation or reablement be used for stroke or fall?

Answer 17

Reablementn may occur after a person has fallen to help the person regain the confidence to walk unaided again Habilitation may occur after an event such as a stroke where a person must learn to use their muscles again

Question 18

How can sarcopenia lead to a person having a greater dependency on others? (ie falls)

Answer 18

Loss of muscle mass can cause muscle weakness increasing the risk of falling This can lead to fractures and then immobility where a person will depend on others to perform basic ADL

Question 19

What are the 4 principles of rehabilitation?

Answer 19

It should be : Person centred Goal - directed Co-ordinated Improved outcomes

Question 20

Why is it important for the goals to be adaptable and realistic for the patient?

Answer 20

This encourages the patient to engage in the rehabilitation process

Question 21

What is the framework used by the MDT to help a patient recover after having eg a fall or CVA? helps the MDT identify problems with the patient and set realistic goals

Answer 21

The international classification of functional disability and health (ICF)