CH 21: Mobility Flashcards
degenerative joint disease in which there is progressive deterioration and abrasion of joint cartilage, with the formation of new bone at the joint surfaces
osteoarthritis
bone condition characterized by low bone density and porous bones
osteoporosis
a decline in walking speed or grip strength associated with an age-related decrease in muscle mass and function
sarcopenia
Effects of Aging on Musculoskeletal Function**
Decline in number and size of muscle fibers and muscle mass _ decreased body strength
Grip strength endurance declines
Connective tissue changes reduce flexibility of joints/muscles
Sarcopenia can be caused by disease, immobility, decreased blood flow to muscle, and decreased caloric intake
Activity impacted by psychosocial factors (grief, retirement, relocation)
decline in __ leads to decrease body strength
number and size of muscle fibers and muscle mass
reduce flexibility of joints/muscles
connective tissue changes
can be caused by disease, immobility, decreased blood flow to muscle, and decreased caloric intake
sarcopenia - decline in muscles mass
psychosocial factors that impact activity
grief
retirement
relocation
musculoskeletal health promotion**
Maintain a physically active state
Exercise programs should address cardiovascular endurance, flexibility, and strength training
Exercise improves body tone, circulation, appetite, digestion, elimination, respiration, immunity, sleep, and self-concept
Enhance physical activity during daily routines
Exercise 30 min x 5 days/week
Pace exercise throughout the day
Adjust exercise as indicated
Prepare for longer rest periods
Seek advice from PCP about type of exercise best suited for their capacities and limitations
If unable to do aggressive exercise, promote activities that include ROM, joint mobility, and circulation
Well balanced diet with 1500 mg calcium
Weight reduction if obese
Guidelines for Exercise Programs for Older Adults
Physical examination FIRST
Assess current activity level, ROM, muscle strength and tone, and response to physical activity
Emphasize exercises that focus on good speed and rhythm
To determine age-adjusted training HR, subtract age from 220 and multiply by 70%; assesses maximum rate to provide vascular benefits and prevent complications, max range for safety
Monitor pulse during exercise and reduce activity if above 10 bpm of target HR
Consult PCP if resting HR > 100
Wear proper-fitting, shock absorbing shoes with traction
Encourage warm-up and cooling down
Begin with conservative exercise program and gradually increase activity
Stop for adverse s/s
4Ms Framework
-What matters
-Medication
-Mentation
-Mobility
mind body connection
Exercise can influence mood and behavior, and vice versa
Physical activity aids respiratory, circulatory, digestive, excretory, and musculoskeletal function
Used to engage in social activity
Find activities appropriate for their capabilities and needs
Use 4M model for age-friendly care
Use therapeutic recreation
prevention of inactivity
-Effects of inactivity(Decreased muscle strength, GI motility, metabolism, ventilation/chest expansion, and aerobic capacity)
-Don’t encourage dependence!!!!
-Activity can lower BP, maintain muscle strength, improve lymphatic circulation, sharpen mental
acuity, elevate mood, improve digestion and
elimination
-Enhance motivation by showing interest
-Local resources (senior centers, exercise classes, volunteer opportunities, recreational programs, clubs)
-Keep older adults active in the community
common causes of fractures in older adults
trauma (FALLS)
cancer
osteoporosis (brittle bones)
other skeletal diseases
when to suspect fx with older adults
with any fall or bone trauma
what does it mean for absence of typical symptoms
does not r/o fracture; can appear days after initial injury
s/s of fx
change in shape/length of limb
restriction of limb
edema
discoloration
bone protrusion
spasms
fx healing in older adults
Fractures heal slowly in older adults with higher risk of complications
interventions to prevent fx
Advise to avoid risky behaviors
Rise from a kneeling or sitting position
Safe, properly fitting shoes
Watch your step!
Use of nightlights or sunglasses to prevent glare
interventions for fx
Activity within the limits of provider
Joint exercise and proper positioning to prevent contractures
Correct body alignment
Measures to prevent immobility complications
Gradually mobilize ASAP
osteoarthritis affects what age
> 55 yo
Leading cause of physical disability in older adults
osteoarthritis
causes of osteoarthritis
excessive use of the joint
obesity
trauma
low Vit D and C
genetics
what joints most affected by osteoarthritis
Weight-bearing joints
(knees, hips, vertebrae, and fingers)
sx of osteoarthritis
No systemic symptoms, localized disease
Excessive exercise may cause more pain
tx of osteoarthritis
analgesics (acetaminophen)
rest
heat/ice
aquatherapy
t’ai chi
massage
acupuncture
splints
braces
canes
proper body alignment and mechanics
weight reduction
nutritional intake
PT/OT
avoid stress on the joints
ROM
allow independence
hip and knee replacements
RA in older adults
Most older patients developed it earlier in life
Greater systemic involvement occurs in older adults
Joint pain is present during rest and activity
interventions for RA
rest and support the limb
ROM
PT/OT
heat
massage
analgesics
NSAIDs/immunosuppressants/corticosteroids for inflammation
diet change
gout is characterized by:
exacerbations and remissions
interventions of gout
Encourage fluid intake,
low-purine diet (avoid many kinds of meat)
avoid alcohol
thiazide diuretics can exacerbate
colchicine for acute attack
long-term meds allopurinol
indomethacin
probenecid
when does osteoporosis normally affect
Primarily affects adults in middle to later life
potential causes of osteoporosis
Inactivity/immobility
Disease (Cushing’s, diverticulitis, hyperthyroidism)
Reduction in anabolic sex hormones
Insufficient diet or loss of calcium, Vit D/C, and protein
Meds (antacids, corticosteroids, thyroid supplements)
osteoporosis can cause:
kyphosis
height reduction
fractures
tx of osteoporosis
SERMs
calcium & Vit D supplements
bisphosphonates
diet rich in protein and calcium
braces
regular exercise
avoid heavy lifting, jumping, etc.
ROM, ambulation, PT
caused by friction and irritation on the feet that create layers of thickened skin; usually appears on the heels and soles of feet
calluses
cone-shaped layers of thick, dry skin that forms over a bony prominence
corns
a bony prominence over the first metatarsal head
bunions
hyperextension at the metatarsophalangeal joint with flexion and corn formation at the proximal interphalangeal joint
hammer toe
inflammation of the ligamentous band at its heel attachment in the foot
plantar fasciitis
Podiatric Considerations
Encourage no self-treatment of conditions
Proper foot care
Seek professional podiatric care
Foot massages (but not those with PVD, lesions, or nerve damage)
Shoe shops can modify shoes
Orthotics
Foot exercises, ice
Antimicrobials for infections
how to manage pain
Can interfere with mobility, activity, ADLs, and social life
Avoid injury
Passive stretching to control muscle cramps
Avoid excessive exercise
Correct positioning
Gentle touch and movement
Diversional activities (Guided imagery)
Heat (cautious with neuropathy)
preventing injury
Fall prevention
Do not straighten a contracture
Be careful with turning and transfers
promoting independence
Minimize limitations and strengthen capacities
Appropriate use of mobility aids
PT/OT collaboration
how to facilitate proper positioning
correct body alignment
assisting with range of motion
Promotion of joint motion & muscle strength, stimulation of circulation, maintenance of functional capacity, and prevention of contractures
Active independently by patients
Active assistive with assistance to the patient
Passive with no active involvement of the patient
Most significant concern is degree of ROM to complete ADLs
Put all joints through full ROM daily
steps for assisting with range of motion
Offer support above and below joint
Move joint slowly and smoothly x3
Do not force past resistance
Document
stop ROM if:
resting HR >100 bpm
exercise HR >35% above resting HR
increase/decrease in SBP by 20 mm Hg
angina
dyspnea
pallor
cyanosis
dizziness
poor circulation
diaphoresis
acute confusion
restlessness
Assisting with mobility aids and assistive technology
Enable patients to independently fulfill needs and enhance function
Evaluate for true need
Individually fitted
use of a cane
Provide wider base of support; not for weight bearing; used on unaffected side and advanced when affected limb advances
use of walkers
Offer broad base and used for weight bearing and stability
Advance the walker then step forward
use of wheelchairs
Promote mobility for persons unable to ambulate, disabilities, paralysis, or cardiac disease
use of assistive technology
Promote independent function
Splints, utensil grips, Velcro attachments, computers, voice synthesizers, Braille reading, remote control devices, robotic arms
