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Geriatric PT > COMPS: PT Exam & Intervention of Psychosocial Issues > Flashcards

COMPS: PT Exam & Intervention of Psychosocial Issues Flashcards

1
Q

It’s getting better all the time:

Happiness, Well-Being INC after 50yo

A

see pics

Stress

Worry

Anger

Sadness

Happiness

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2
Q

The Reality for Many

Story of Mr. Smith, an 83yo retired salesman in NYC…

Why should we care?

A
  • What are the psychosocial issues experiencing?
  • suggestions to help cope?
  • How does PT fit into this HC schema??
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3
Q

Depression is NOT Normal Aging

What is it?

A

Primarily the result of loss of health, as well as cognitive impair, incontinence, chronic cond’s, and personal/emotional loss

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4
Q

Depression is NOT normal aging

Contributing Factors:

A
  • social iso
  • substance misuse
  • financial insecurity
  • depression
  • elder abuse
  • caregiver burden
  • self-neglect
  • housing issues
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5
Q

Depression is NOT Normal Aging

W/ contributing factors, and depression:

what happens?

A
  • Pts LESS likely to take meds, obtain necessary tests and proc’s, and access routine and preventative med care
  • The course of acute and chronic illnesses can be negatively effected
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6
Q

Depression

aka….

A

“The common cold of the elderly”

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7
Q

MOST common psychological problem in the elderly is_______

A

Depression

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8
Q

NIH stats on depression

A

Of the 35mil Am’s age >65yo→ about 2mil suffer from full blown depression→ nearly 20% of Am’s 65+

*another 5mil suffer from LESS severe forms of depression

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9
Q

Major Depressive Disorder (MDD)

5 or more sx’s present for @ least 2wks:

A
  • At least ONE of the following:
    • Depressed or irritable mood OR loss of interest or pleasure
  • AND the rest from the following:
    • Sig wt loss or Dec in appetite
    • Insomnia or hypERsomnia
    • Psychomotor agitation or retardation
    • Fatigue or lack of energy
    • Feelings of worthlessness or guilt
    • Dec concentration or indecisiveness
    • Recurrent thoughts of death or suicide
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10
Q

S/S Depression in Older Adults:

Older adults who deny feeling sad or depressed may still have major depression

Clues:

A
  • Unexplained or aggravated aches and pains
  • Hopelessness
  • Helplessness
  • Anxiety+worries
  • Memory probs
  • Loss of feelings of pleasure
  • Slowed mvmt
  • Irritability
  • Lack of interest in personal care
    • skip meals
    • forget meds
    • neglect personal hygiene
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11
Q

Depression and Physical Illness:

Factors INC’ing risk of depression in pts w/ phys illness

Biological:

A
  • hormonal, nutritional, endocrine
  • meds effects
  • phys consequences of systemic or cerebral dis’s
    • CVAs
    • PD
    • DM
    • CA
    • AD
    • MI
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12
Q

Depression and Physical Illness:

Factors INC’ing risk of depression in pts w/ phys illness

Psychological

A
  • Sense of loss assoc’d w/ serious illness
  • Effects of body img, self-esteem
  • Impaired capacity to work and maint relationships
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13
Q

Depression and Phys Illness

Somatic concerns found in 60% of men and women 60+

What does this entail?

A
  • Exaggerated focus on self and sx magnification replace social interactions
  • Can lead to w/draw+social iso.
  • Loss of autonomy→ results in phys sx’s in an effort to get attn, signal for help, control others
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14
Q

Pain-Anxiety-Depression Connection

Explain…

A

People suffering from depression tend to experience more severe and long-lasting pain than other people

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15
Q

The Pain-Anxiety-Depression Connection is particularly evident in pain syndromes such as:

A
  • fibromyalgia
  • IBS
  • LBP
  • HAs
  • Nerve pain
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16
Q

Pain-Anxiety-Depression Connection

*Researchers once thought the relationship bw pain, anxiety, and depression resulted mainly from psychological rather than biological factors:

A
  • Chronic pain is depressing, and likewise major depression may feel phys painful
  • BUT researchers have learned more about how brain works, how NS interacts w/ other parts of body→ discovered that pain shares bio. mech’s w/ anxiety and depression
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17
Q

Tx When Depression Overlaps Pain

5:

A
  1. Relaxation
  2. Exercise***
  3. Psychotherapy
  4. Hypnosis
  5. Pharmacologic
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18
Q

Tx When Depression Overlaps Pain

Relaxation Training

A
  • Muscle relaxation
  • yoga
  • mindfulness
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19
Q

Tx When Depression Overlaps Pain

Exercise

A
  • Strong evidence that exercise boosts mood and alleviates anxiety
  • Less evidence on impact about pain
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20
Q

Tx When Depression Overlaps Pain

Psychotherapy

A
  • Cognitive Behavior Therapy (CBT)
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21
Q

Tx When Depression Overlaps Pain

Hypnosis

A

******

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22
Q

Tx When Depression Overlaps Pain

Pharmacologic:

A
  • Dr may prescribe anti-depressants or mood stabs to address BOTH depress and pain
    • SNRI’s
    • Tricyclic Antidepressants
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23
Q

Depression or Dementia?

A

see pics

24
Q

Depression or Dementia?

Sx’s of Depression

*NOTE the key words highlighted

A
  • Mental decline is relatively rapid
  • Knows correct time, date, and where he/she is
  • Diff concentrating
  • Lang and motor skills are slow, but normal
  • Notices or worries about memory probs
25
Q

Depression or Dementia?

Sx’s of Dementia

NOTE key words highlighted

A
  • Mental decline happens slowly
  • Confused and disoriented; becomes lost in familiar loc’s
  • Diff w/ STM
  • Writing, speaking, motor skills are impaired
  • Does NOT notice memory probs or seem to care
26
Q

Depression Scales

Several used to examine depression:

GO TO LINKS PROVIDED!!!

A
  • Geriatric Depression Scale short form:
    • extensively used for older adult pop
    • geriatrictoolkit.missouri.edu/cog/GDS_SHORT_FORM.PDF
  • Beck Depression Scale
    • BDI used for 35yrs to ID and assess depressive sx’s→ highly reliable regardless of pop.
    • southlakepsych.org/index.htm/Patient_Forms_files/BeckDepressInv.jpg
27
Q

Whooley Questions for Depression Screening

A
  • A positive test (~95% Sn) IDs pts who may benefit from further eval
  • A negative test essentially rules OUT depression
    • SnNOUT
    • Sn→ great Screening test
  • The Whooley Questions (~65% Sp) cannot be used to dx or measure severity of depression
28
Q

Mgmt of Depression

Create a _________ and provide the pt w/ a sense of _______

A

Trusting therapeutic relationship; autonomy

  • Lessens feelings of despair and helplessness
  • Be an active listener, unbiased listener→ allowing for pts to reveal concerns/issues that may affect tx
29
Q

Mgmt of Depression

INVOLVE THE Pt**

A

in the exam process, setting goals, creating POC

30
Q

Mgmt of Depression

Clear and concise explanations of…

A

Explanations of interventions, proc’s and expected outcomes

31
Q

Mgmt of Depression

Depressed pts often become ______ in their communication abilities and req assist w/ ______

A

immobilized; motivation

  • Diffs making decisions
  • Become overwhelmed
  • Extra time given to help them make decisions about their care
32
Q

Mgmt of Depression

W/ LOW motivation, how can PTs assist?

A

Assist by providing encouragement, emphasizing pts strengths, offering positive feedback and promoting perceptions of self-worth

33
Q

Mgmt of Depression

Info about the good prognosis of depression w/ pharmaco. intervention

A

VERY VALUABLE****

*depends on person

34
Q

Mgmt of Depression

*Drug tx remains most common approach

5 Categories:

A
  1. Selective Serotonin Reuptake Inhibitors (SSRIs)
  2. Hetercyclic Antidepress’s
  3. Tricyclic Antidepress’s
  4. Serotonin/NE Reuptake Inhibitors
  5. Monoamine Oxidase Inhibitors (MAO inhibitors)
35
Q

Mgmt of Depression

Drug Tx SE’s:

A
  • balance dysf
  • OH
  • blurred vision
  • constipation***
  • Urinary retention
  • mild tremor***
36
Q

Mgmt of Depression

This is NOT used as freq’ly as pharmacotherapy and older adults are LESS LIKELY to access it….

A

Psychotherapy***

37
Q

Mgmt of Depression

*Pyschotherapy (less accessed by older adults)

What is it?

A
  • Involves counseling that helps people cope w/ depression and reinforces + outlook
38
Q

3 Professions that can provide psychotherapy

A
  1. Psychologist
  2. Psychiatrist
  3. Social Worker
39
Q

Mgmt of Depression

EXERCISE***

A
  • Effective tx for depression
  • Bastone and Filho (2004)→ report that ex program produces bennies w/ regard to reduction of deprssive sx’s and prevention of decline in mental status in institutionalized elderly
  • Research shows clear relationship bw phys act and Dec lvls of depression******* USE IT!!!!
40
Q

Ways to assist in prevention of depression:

ALL GIVE PURPOSE***

A
  • Getting out into world
  • Connecting to others
  • Participating in acts.
  • Volunteering
  • Caring for a pet
  • Learning a new skill
  • Enjoying jokes and stories
  • Maintaining healthy diet
  • Exercising/phys activity****
41
Q

Bipolar Older Adults

Dx of Mania req’s…..

A
  • Dx of mania req’s a distinct pd of persistently elevated mood lasting for 1 or more weeks
    • Three add. sx’s may include:
      • inflated self-esteem or grandiosity
      • hyper-sexuality
      • incd act.
      • dec’d need for sleep
      • pressured speech
      • racing thoughts or flight of ideas
      • distractibility
    • Grandiose or paranoid delusions may be present
42
Q

Bipolar Older Adults

Criteria for Dx’ing

A
  • Identical to those for younger adults**
    • pds of unusual elevation or irritability in mood that are coupled with inc’s in energy, sleeplessness, fast thinking or speech
43
Q

Bipolar in Older Adults may also be a __________

A

Reoccurence or undx’d from younger days

44
Q

Bipolar in Older Adults may be ______ that presents as ______

A

Depression that may present as irritability

45
Q

Stress and the Older Adult

What is Stress?

A
  • Stress response is like an airplane readying for take-off
  • All systems are primed all the time
    • Heart and blood vessels
    • Immune system
    • Lungs
    • GI
    • Sensory organs
    • Brain
  • ALL modified to meet perceived danger (stuck in fight or flight)
  • Systems effected by stressful situations
    • Dec’s efficiency
      • Acute (over time) + Long term (chronic)
46
Q

Ability to achieve a _________ after a stressful event becomes more difficult

A

Relaxation response

*can’t let it go even just “for now”

*talk to them about things but stay productive

47
Q

What reduces the efficiency of the brains response to stress?

A

Aging

48
Q

Older adults are often exposed to major stressors such as:

A
  • med probs
  • loss of spouse or friends
  • change in living situation
  • retirement or financial worries
49
Q

Determining these in an older adult patient’s life during Hx taking can provide you w/ info that can help you with your _____, ______, ______

A

Stressors;

Dx, Prognosis, creating POC

50
Q

Stress and Older Adult

Ex’s of Stressors

A
  • Caregiving
  • Loss and grief
  • Changing roles as we age
    • Ex. move in w/ son/daughter
  • Change in social status
51
Q

Stress and Older Adult

Caregiver Issues:

A
  • Health of caregivers overlooked
  • Research has demo’d that over 23% of family caregivers met the req’s for home health services for themselves and that 50% report their own health to be fair or poor
  • Most common self-reported health problem of caregivers:
    • depression- 66%
    • HTN- 34%
    • arthritis- 30%
52
Q

Stress and Older Adult

Caregiver Issues Stats

A
  • ¼ Am households provide some degree of caregiving
  • 7.3mil older adults (65+) need care
  • 61% of “intense” family caregivers (providing @least 21hrs care/week) suffer from depression
    • some studies say caregiver stress inhibits healing
53
Q

Stress Scale

A
  • Holmes and Rahe Life Events Scale → widely used tool for eval’ing stress
  • purported as an indicator to determine chance of serious illness if high score is rendered
  • en.wikipedia.org/wiki/Holmes_and_Rahe_stress_scale
54
Q

Coping Strategies for Stress and Older Adult

A
  • thinking confidently and optimistically in the face of bad news
  • more time doing a few selected activities→ get the most out of them
  • participating in family and community activities→ personal satisfaction
  • social networks→ emo/phys support
  • spiritual or religious involve.
  • Positive healthy behaviors
55
Q

Add. Tx Strategies for Stress and Older Adult

A
  • Relaxation
    • meditate
    • progress. relaxation
    • guided imager, hypno.
    • biofeedback
    • breathing tech’s
  • Phys act/exercise
    • aerobic
    • dancing
  • Prioritize stressors

Geriatric PT (7 decks)

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