Complex Older Adult Flashcards by Connor Michael Davis

Pt’s __________ will drive direction of communication and POC

cognitive status

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What is the leading cause of morbidity and mortality of older adults?

coronary heart disease (CHD)

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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

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What happens when Coronary artery disease progresses to cause ischemia?

causes acute coronary syndrome - severe imbalance of O2 demand and supply
- STEMI and NSTEMI

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treatment for STEMI and NSTEMI

STEMI – require CABG

- NSTEMI – treated medically

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With acute coronary system, there is a concomitant increased risk for __________, _________, and ________.

respiratory failure, syncope, and stroke associated w/ MI

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What is the gold standard for diagnostic heart disease? What is most commonly seen?

gold standard - graded exercise testing

- most commonly seen - cardiac catheterization

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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)

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normal creatine kinase level

0-3 ng/mL

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normal BNP. What does it mean if it is elevated?

< 100 pg/mL

elevated means heart disease

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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

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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

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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)

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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

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What do most medications for HF due?

try to reduce fluid or reduce workload on the heart

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What is normal pulse pressure? At what point is medical attention necessary?

normal - 10-60 mmHg

medical attention - > 60 mmHg

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What drop in BP is considered orthostatic hypotension?

20 mmHg drop in systolic OR 10 mmHg drop w/ increased HR

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What is a reflexive HR increase after exercise indicator of?

venous pooling or othostasis

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What is the average respiratory rate? Bradypnea rate? Tachypnea rate?

average - 12-18 breaths/min

brady - < 10

tachy - > 24

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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

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How many syllables per breath are normal?

12-15

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______ and _______have decreased work of breathing compared to supine

sitting and standing

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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

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CHF adventitious breath sound

crackles

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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)