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Rehabilitation of Functional Movement > Elder Health > Flashcards

Elder Health Flashcards

1
Q

research physiological changes in ageing

A
  • Special senses
  • GI system
  • Body composition and stature • Endocrine/bone
  • Immune system
  • Respiration
  • Liver
  • Kidney
  • Skin
  • Muscle and Joints
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2
Q

home care

A

Home support packages to facilitate in home care for as long as practicable.
Shift in government funding over 2016-7
­ Money in

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3
Q

residential aged care

A

Permanent or respite placement options available.
Shift in government funding over 2016-7
­ Money out

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4
Q

Client characteristics and usage rates

A
  • Limited data available
  • 1/3 people in Home Care were aged over 85 years.
  • Age specific usage rates show that below age 75 years, people receiving services from outlets located in remote and very remote areas had higher usage rates than people in other remoteness areas.
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5
Q

levels of care

A

Level 1: basic care needs
Level 2: low level care needs
Level 3: intermediate care needs
Level 4: high care needs

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6
Q

resident characteristics

A

In Australia during 2014-15:
• Almost $16billion dollars spent on aged care services.
• Over 2/3 of people in permanent RAC were women.
• 1% of people in RAC identified as ATSI compared to 3% of Australians overall.
• 3/5 non indigenous people were aged 85 and over, compared with 1/5 indigenous people in care.
• 31% of people in RAC were born overseas with 18% of those coming from NES countries.
• 1/4 people in RAC were assessed as requiring a HIGH level of care across all three ACFI domains.

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7
Q

funding of aged care placement

A

Accommodation deposits/bonds Aged Care Funding Instrument (ACFI)
­ ADL Domain – nutrition, mobility, personal hygiene, toileting, continence
­ Cognitive and Behaviour Domain – cognitive skills, behaviours (wandering, physical, verbal), depression
­ Complex Health Care Domain – medication, management of complex health issues/problems
Weekly fees

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8
Q

physiotherapy role

A

Assessment
­ Admission assessment
­ Quarterly care plan review assessment
­ Significant change in function assessment (post fall, acute illness/episode, post hospital)

Intervention
­  Falls prevention
­  Pain management
­  Cardiorespiratory function
­  Optimisation and maintenance of mobility (strength, ROM, balance) and function ­  Facilitation of participation
­  Palliative care

Staff education
­ Manual handling, positioning,

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9
Q

have a review of the assessment slides

A

22-24

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10
Q

assessment guidelines

A

Reason for assessment: new admission, acute condition, post falls, recent hospital admission
History of current presenting condition Medical and Surgical History
Current Medications (and past long term meds) Social History
Falls History
Current reported level of function
Cognitive condition/state: ?hx of dementia
Pain: acute, persistent, acute exacerbation on background of persistent pain

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11
Q

Assessment

A

Basic Observations: HR, BP (lying, sitting and standing), Temp, O2 Sats.
Current functional level: physical mobility scale, bed mobility, STS, transfers, sitting balance, standing balance, mobility, UL and hand function,
Basic MSK screening – posture, AROM/PROM, contractures, strength, etc
Basic neurological screening - sensation, coordination, tone, spasticity, clonus, motor planning, visuospatial ability, cognition, response, vestibular, vision, etc
Basic cardiorespiratory screening – AE, auscultation, observation, cough, cyanosis, clubbing, general respiratory function including dyspnoea, WOB, acc mm use., etc

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12
Q

Outcome measures

A

Physical mobility scale
— Falls risk screen: high 28-36/45 total PMS score
— Provides useful information about mobility, balance impairments and safety Barker 2008
TUG
— More an indication of mobility than a grading of falls risk in RAC
— < 15 s some indication of low fall risk Nordin 2008
Abbey Pain Scale
— Non verbal people with dementia
Modified Residents Verbal Pain Inventory – Brief Patient Specific Functional Scale

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13
Q

goals of intervention

A

Resident goals Therapist goals Family goals Organisational Goals

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14
Q

Mobility and transfers

A
  • Mobility
  • Aid prescription and fitting
  • Determination of assistance required, maximum distance, safe environments • Rehabilitation of mobility
  • Advice and instruction on transfers (staff, resident and family) • Stand pivot
  • Stand transfer
  • Sara Steady
  • Stand up hoist • Full sling hoist
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15
Q

intrinsic risk factors + extrinsic risk factors =

A

falls risk

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16
Q

falls, fractures and depression

A

Significant problems in RACFs
­ àdecreased physical activity and quality of life
Rate of falls is 5 times higher in RACFs than in the community for the over 65 yr subgroup
Approximately 22% of all falls related hospital admissions involve people aged over 65 years and living in RAC.
Incidence of depression in RACFs is high
­ Often associated with higher rate of falls due to use of anti- depressants.

17
Q

fracture burden

A

• Loss of mobility
– Walking independently: 95% pre fracture to 32% post fracture
(Maggio, 2001) – “Post-fall” syndrome
• Health care utilisation
– Hip fracture treatment costs AUD$20,000 to $50,000 (McClure, 2005)
• Death
– 35.5% of residents admitted to hospital with a fall-related hip
fracture die within 1 year
• Compared with 20.6% for those who live in the community (Fisher, 2001)

18
Q

post fall syndrome

A
  • Self perpetuating spiral of functional decline
  • Loss of independence
  • Increased carer burden • Increased social isolation
  • Altered self imageà increased perception of frailty and decreased confidence
19
Q

mobility and falls risk in RAC

A

A non-linear relationship between risk of falling and risk of sustaining a fracture
• Highest risk Mild to moderate mobility impairment (PMS total score 28–36) (Barker, 2008)
• Fall rates
ü Highest in those with fair standing balance ü Intermediate in those with the best standing balance ü Lowest in those with the worst standing balance

20
Q

interventions

A

Environment – clear pathways, rooms free from clutter, appropriate levels of light, path of least resistance, bed sheets, etc
Alert systems – out of bed sensors, floor sensor mats, room motion sensors, etc
Equipment – bed rails (covers), transfer aids, mobility aids, beds (style, height, position), crash mats, hip protectors, footwear, eyewear, etc
Medical – pain management, medications, MSK management, etc
Physiotherapy specific interventions – rehabilitation of functional movement

21
Q

ASSESSMENT AND REHABILITATION OF FUNCTIONAL MOVEMENT

A
  • Bed mobility
  • Sitting balance
  • STS
  • Standing balance
  • Mobility – indoors, outdoors and community ambulation • Steps/stairs and obstacles
  • Upper limb function
22
Q

ASSESSMENT OF BED MOBILITY

A 
Bridging
 Up/down bed
 Across the bed (L and R)
 Rolling L and R
 Supine to sitting on edge of bed
23
Q

ASSESSMENT OF SITTING BALANCE

A

Sitting unsupported
Sitting and turning to look over L and R shoulders Sitting and reaching outside BOS
Sitting and retrieving an object from the floor Response to external perturbations

24
Q

ASSESSMENT OF SIT TO STAND

A

Deviations from normal movement sequence – push through, pull up, Weight bearing – symmetry
Control of stand to sit
Repetitions
Completion posture

25
Q

ASSESSMENT OF STANDING BALANCE

A

Stand unsupported
Standing and turning to look over L and R shoulders Standing and reaching outside BOS
Standing and retrieving an object from the floor Response to external perturbations

26
Q

ASSESSMENT OF STEPS, STAIRS AND OBSTACLES

A

Height
Rails
SLS
Mediolateral stability

27
Q

assessment of mobility

A

Indoors/Outdoors/Community – surfaces, incline/decline, rough terrain BOS
Velocity
Dynamic stability
Foot clearance
Swing and stance phase Compensatory strategies Aid used
Distance walked

28
Q

ASSESSMENT OF UPPER LIMB FUNCTION

A

Deviations from normal movement Pincer grip
Cylindrical grip
Range of reach
Trajectory of reach Compensatory strategies

29
Q

pain management

A

Government funding requirements for pain management in RAC
­ ­ ­
Soft tissue work
­ Nil specific style of STW described
Technical equipment – TENs, Laser, Ultrasound etc ­ ?CI/P
Timing of interventions – 20 minutes per day???
Must consider the source, type, intensity of pain, aggs/eases, daily pain patterns/rhythms, use of evidence based pain assessment tools.
What does the evidence tell us?
• STW
• Technical equipment
• Exercise

30
Q

cardiorespiratory function

A

immobility - physiological changes of ageing - meds - pre-existing chronic CR disease - acute CR complications

31
Q

ASSESSMENT AND INTERVENTION

A

Full CR examination including observation and palpation, cough, auscultation, chest expansion, etc.
Intervene prn.
Consider all CI/Ps – esp osteoporosis, pathological fractures, skin
conditions/integrity.
Optimise lung volumes through positioning

32
Q

TYPES OF ULCERS AND RISK FACTORS

A

Vascular ulcers – venous and/or arterial insufficiency Neuropathic ulcers – IDDM, NIDDM, stroke, MS, RA, SLE, alcoholic
neuropathy, metabolic neuropathies, TBI and SCI.
Pressure ulcers – body’s inability to overcome the effect of the pressure load on tissue and thereby maintain circulation to the area
­ Ears, heels of feet and bony prominences.

33
Q

CAUSE AND RECOMMENDED INTERVENTION of ulcers

A

Pressure - bed
Pressure relieving mattress, regular positional change (at least Q2H)
Pressure - chair
Pressure relieving cushions and regular positional change (at least 2H)
Shear stress – bed/chair
Tilt in space chairs, fallout chairs, positioning,
Moisture - sweat
Regular linen changes, climate control using air conditioning units.
Moisture - incontinence
Toileting schedules, aids, regular opportunity for toileting or changing aids, linen changes, regular checks.
Mental confusion
Regular inspection and positional change
Immobility
Regular positional changes, toileting, aids, pressure relieving mattresses/cushions
Behavioural changes
? UTI vs discomfort, regular inspection, regular positional changes, mobilise if able.

34
Q

palliative care

A

• Advice re: manage in bed timing
• Positioning and Pressure Area Care – Q2H day and night, mattress selection, heel
booties,
• Pain Management – light effleurage, observation/liaise with GP re: pain meds,
• Secretions Management – suctioning, positioning, • Family support and care
• Care for yourself

Rehabilitation of Functional Movement (12 decks)

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