Complex Older Adult Flashcards
Pt’s __________ will drive direction of communication and POC
cognitive status
What is the leading cause of morbidity and mortality of older adults?
coronary heart disease (CHD)
NY Heart Association Classification
Class 1 - no limitations
Class 2 - slight limitations - ordinary PA results in fatigue, dyspnea
Class 3 - marked limitations - less than ordinary activity causes fatigue, comfortable only at rest
Class 4 - symptoms of fatigue at rest
What happens when Coronary artery disease progresses to cause ischemia?
causes acute coronary syndrome - severe imbalance of O2 demand and supply
- STEMI and NSTEMI
treatment for STEMI and NSTEMI
- STEMI – require CABG
- NSTEMI – treated medically
With acute coronary system, there is a concomitant increased risk for __________, _________, and ________.
respiratory failure, syncope, and stroke associated w/ MI
What is the gold standard for diagnostic heart disease? What is most commonly seen?
- gold standard - graded exercise testing
- most commonly seen - cardiac catheterization
Normal troponin levels. What does it mean when it is elevated?
normal - < 0.1-0.3 ng/mL
elevated troponin means demand ischemia (excessive workload on the heart)
normal creatine kinase level
0-3 ng/mL
normal BNP. What does it mean if it is elevated?
< 100 pg/mL
elevated means heart disease
CHF is a _____ dysfunction. What are signs and symptoms of heart failure?
pump dysfunction - heart cant pump enough blood to meet needs
- fatigue, SOB, decreased activity tolerance
What is the leading cause of heart disease? What is the second leading cause?
leading cause - ischemic lef ventricular dysfunction due to CAD
second leading cause - HTN
Pitting edema scale
0+ - no pitting edema
1+ - mild pitting edema (2 mm that disappears quickly)
2+ - moderate pitting edema (4 mm that disappears in 10-15 sec)
3+ - moderately severe pitting edema (6 mm that lasts 1+ min)
4+ - severe pitting edema (8 mm that lasts 2+ min)
Signs and symptoms of HF are often related to what?
back up of fluid caused by the pump dysfunction
- fatigue, SOB, decreased activity tolerance, edema
What do most medications for HF due?
try to reduce fluid or reduce workload on the heart
What is normal pulse pressure? At what point is medical attention necessary?
normal - 10-60 mmHg
medical attention - > 60 mmHg
What drop in BP is considered orthostatic hypotension?
20 mmHg drop in systolic OR 10 mmHg drop w/ increased HR
What is a reflexive HR increase after exercise indicator of?
venous pooling or othostasis
What is the average respiratory rate? Bradypnea rate? Tachypnea rate?
average - 12-18 breaths/min
brady - < 10
tachy - > 24
What is the normal inspiratory/expiratory ratio? What does a low ratio mean? High ratio?
normal - 1:2 w/ expiration lasting twice as long as inspiration
1: 1 suggest hyperventilation
1: 3 suggests hypoventilation (hypoxia) - common in COPD
How many syllables per breath are normal?
12-15
______ and _______have decreased work of breathing compared to supine
sitting and standing
At how many breaths per min should you hold activity? How about using caution?
hold activity w/ > 50 breaths/min
cautious at ~45 breaths/min
CHF adventitious breath sound
crackles
Asthma adventitious breath sound
wheezing
What is the primary cause of UTI? What causes this in females and males?
urinary stasis
- females - decreased pelvic floor strength, decreased estrogen levels
- males - decreased bladder emptying due to BPH
What is a major sign of a UTI?
acute delirium
What is the leading cause of hospitalization and most expensive inpatient condition?
sepsis
What differentiates sepsis from a regular infection?
dysregulated host response that results in organ dysfunction
- loss of adaptive homeostasis
signs and symptoms of sepsis
- lactase > 18 mg/dl
- hypotension
- fever > 103
- HR > 90
- RR > 20
- often confirmed infection
septic shock criteria. Mortality is _____ times greater when these criteria are met.
- low mean arterial pressure (MAP) < 65
- elevated blood lactate level > 2 mmol/L
mortality is 4x greater
Sepsis is a __________ shock to the body
hypotensive
- decreased blood volume so increased HR and RR
T/F: Patients on vasopressors can participate in PT
false - pt must be off of vasopressors
What CNS impairment is a sign of sepsis?
altered mental status - can lead to encephalopathy and/or polyneuropathy (can lead to muscle wasting)
What is the most common manifestation of sepsis?
leukocytosis
- can also cause other coagulation abnormalities
What is the most common symptom in dizziness?
syncope
What medications may cause dizziness?
- antihypertensives
- diuretics
- sedatives
Why are older adults more susceptible to dehydration?
- blunted thirst mechanism
- reduced total body fluid (decreased muscle mass and increased fat)
- decreased renal function
- physical/mental decline
What is an early sign of dehydration in older adults?
increased confusion
Hypertonic vs hypotonic dehydration. Which is more common in older adults
hypertonic - water > Na+ loss
hypotonic - water < Na+ loss
- more common in older adults, may be caused by diuretics
signs and symtpoms of dehydration
- confusion
- lethargy
- rapid weight loss
- functional decline
What is metabolic syndrome?
3 or more cardiovascular risk factors in combination - increases risk for heart disease, stroke, and diabetes
- obesity
- high triglycerides
- decreased HDLs
- increased BP
- high fasting glucose
What is considered the most effective single therapy of metabolic syndrome for severe obesity?
bariatric surgery
5 clincal attributes of frailty
- unintentional weight loss
- self-reported exhaustion
- muscle weakness
- slow walking speed
- low physical activity
0 characteristics = not frail
1-2 characteristics = prefrail
3+ characteristics = frail
What is considered unintentional weight loss?
> 10 lbs lost unintentionally
general slow walking speed to be considered frail?
< 0.8 m/s
What grip strength is considered frail for men and women?
men - < 30 kg
women - < 20 kg
How many sit to stands is considered frail in 30 seconds?
< 8 in 30 sec
What 3 things are the criteria for frailty assessment?
gait speed
grip strength
chair stands
Mobility disability versus frailty
Frail patients have mobility disabilities but if you have a mobility disability that does not mean that you are frail
What is the most comprehensive method to assess frailty?
comprehensive geriatric assessment
TUG and gait speed scores to be considered frail
TUG > 10 sec
gait speed < 0.8 m/s
What type of exercise is recommended for a frail patient vs pre-frail?
pre-frail – more resistance than aerobic 2:1
Frail – more aerobic than resistance 2:1 - lower RPE and shorter time
Exercise parameters for frail patients
40-80% 1RM - high intensity effort
- 8 reps for 1 set, working up to 3 sets - high intensity effort
LE priority over UE
power and agility
What hormones are used to treat sarcopenia? Which one has less negative effects?
SARMS and testosterone
SARMS can help improve muscles mass w/o negative effects of testosterone
What are the negative effects of testosterone?
CV issues and osteoporosis
What are negative effects of statins?
myalgia/rhabdo
What are negative effects of glucocorticoids?
osteoporosis and muscle wasting
What are negative effects of anticholinergics?
decrease cognitive functions
What are negative effects of benzodiazepines?
can cause drowsiness that can lead to fall risk
Primary, secondary, and tertiary prevention of frailty?
Primary (healthy behaviors to prevent disease)- exercise, healthy diet, ideal sleep, metabolic control
Secondary (screening)- multimodal approach - medication management, falls prevention, nutritional support, exercise, social/psych support
Tertiary (prevent further deterioration of disease state)- resistance training and medication management
risk factors for osteoporosis
- post-menopausal/other hormonal factors
- sedentary lifestyle
- Vitamin D deficiency
- cirgarette smoking
- Asian, caucasian
- excessive caffeine
__________ is a precursor to osteoporosis
osteopenia - low bone density but not as low as osteoporosis
What are T-scores? What population is it used for?
WHO diagnostic classification in postmenopausal women and men over 50
- cannot be applied to healthy and young population
What are Z-scores? What population is it used for? What are ranges?
- reporting bone mineral density in healthy people (premenopausal women, men under 50, and children?
- 2 or less is below healthy range and above -2 is expected range
Which bone mineral density score can be used in young healthy adults and children?
z-scores
What is a normal bone density T-score range? What is considered osteopenia and osteoporosis?
normal - -1 - +1
osteopenia - negative 1 - negative 2.5
osteoporosis - below -2.5
What type of exercises should be done with osteoporosis patients to build bone strength? What exercises should be avoided
closed chain exercises
Avoid trunk flexion or excessive rotation, high impact, joint mobs/manual percussion
Physically active, no restrictions. Few chronic conditions, if any.
What is their degree of frailty?
fit (not frail)
Adaptations to mobility, life space mobility restrictions start. Impaired recovery from illness/injury.
What is their degree of frailty?
mild frailty (pre frail)
Dependent ADLs/mobility, inactive, dying. Life expectancy 6-12 months.
What is their degree of frailty?
severe frailty (end stage)
Loss of independence evident, needs assistance. Life space restrictions.
What is their degree of frailty?
moderate frailty
Gait speed 0.5-0.8 m/s
30s CRT <8 reps
Assistance for floor transfer
What is their degree of frailty?
moderate frailty
Gait speed > 1.0-1.2 m/s
30s CRT 15 reps or more
Independent floor transfer
What is their degree of frailty?
fit (not frail)
Gait speed < 0.5 m/s
30s CRT unable
Floor transfer Unable
What is their degree of frailty?
severe frailty (end stage)
Gait speed 0.8-1.2 m/s
30s CRT 8-15 reps
Modified floor transfer
What is their degree of frailty?
mild frailty (pre-frail)
