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Gen Med: Geriatrics > Elderly, Mobility, and Frailty > Flashcards

Elderly, Mobility, and Frailty Flashcards

1
Q

What is ageism?

A
  1. Systemic stereotyping and discrimination against older persons
  2. Any prejudice or discrimination against or in favor of an age group
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2
Q

True/false: older ppl are all the same

A

False. older ppl become more different from each other with age

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3
Q

What are the consequences of ageism?

A
  1. may not receive the full range of choices of health care
    A. less likely to receive preventative care , screening, etc.
  2. May be misdiagnosed based on age
  3. Not being taken seriously
  4. May be reluctant to complain about pain or other sxs for fear of labelling
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4
Q

What can you do to not be ageist?

A 
1. Neutral terms
A. elder
B. Older persons
C. Older adult
D. Senior?
2. Address elders as Mr/Mrs and wait for them to invite you to call them something else
3. Become aware and questions sterotypes
4. Have high expectations for aging process
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5
Q

What are the mobility expectations for older adults?

A
  1. Errands are an average of 1000 ft in duration
    A. 2-3 trips are made at the same time
  2. Carry packages averaging 6.7 lbs at time
  3. Frequently encounter stairs, curbs, slopes
  4. Engage in frequent postural transitions
    A change directions, reach up, look up, move backwards, etc.
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6
Q

What is the definition of frailty?

A
  1. A physiological syndrome characterized by decreased reserve and resistance to stressors, resulting from cumulative decline across multiple physiologic systems and causing vulnerability to adverse outcomes
  2. Frailty is an attribute of aged ppl who are at increased risk of adverse health outcomes
    A. diminished ability to respond to stress
    B. An accumulation of deficits
    C. Diminished reserve
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7
Q

What are stressors?

A
  1. MSK: osteoporosis and sarcopenia
  2. Immunological: more prone to illness
  3. Cardiopulmonary
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8
Q

What are the implications of frailty?

A
  1. Interplay between frailty, dependence, and disability
  2. Sequelae include:
    A. osteoporosis
    B. Sarcopenia
    C. Decreased immunity
    D. Fatigue/exhaustion secondary to lack of physical activity
    E. Failure to thrive
    F. Falls (hip fx)
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9
Q

What are the consequences of frailty?

A
  1. Decreasing mobility
  2. Dependence with IADL
  3. dependence with ADL
  4. Higher rate of hospitalization
  5. Higher mortality: increases with increasing frailty characteristics
  6. Frailty is an important precursor of disability and functional decline
    A. responsible for nursing home placement, increased hospitalizations, falls, disability, and mortality
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10
Q

What are the frailty criteria?

A
  1. Any 3 of the following 5 criteria
    A. Wt loss of >4.5kg (10lbs) unintentional
    B. Exhaustion: self report of any of: low usual energy level, felt unusually tired in the past month, felt unusually weak in the past month
    C. Low energy expenditure (sedentary)
    -women: energy
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11
Q

What does decreased physical activity lead to?

A
  1. muscle weakness and bone fragility
  2. decreased oxygen throughput
  3. decreased arterial size
  4. Altered blood lipid levels
  5. metabolic inefficiency
  6. decreased glucose transporters
  7. obesity
  8. T2DM
  9. Immunologic decay
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12
Q

What are the physical activity goals?

A
  1. 30 mins everyday

2. 10,000 steps

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13
Q

How is physical activity measured?

A
  1. “Do you get any physical activity for the sake of exercising?”
  2. “How often do you leave your house?”
    A. If help is needed to leave home OR if less than 3x/wk, assume frailty
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14
Q

What are the goals of physical activity?

A

capture sedentary activity:

these folks are at risk

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15
Q

What is the 6th vital sign?

A
  1. Gait speed

2. Strong prognostic abilities at

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16
Q

When are you in the frailty stage?

A

Loss of > 65% of strength

17
Q

How is strength measured on the frailty criteria?

A
  1. Chair stands

A. Inability to stand without arms more than 8 times

18
Q

What is the rate of loss of strength as we age?

A

1-3% per year, accelerates after age 70

19
Q

What is the pre-frail stage?

A
  1. 1-­‐2 of these factors
    are present– with a ↑ risk of becoming frail in 3-­‐4 years
  2. Opportunity for prevention and to build
    reserve…
20
Q

How is frailty treated?

A
  1. Medication review: try to reduce number of meds pt is on
  2. Increase strength, physical activity
    A. Task specific training = resistance training
  3. VItamin D
  4. Protect from acute illness
21
Q

What are the take home points about frailty?

A
  1. Frailty is something to prevent
  2. The MSK system is the pathway to frailty
  3. Prevention and treatment requires multifactorial interventions at inter and intra personal levels, environment and policy levels
  4. Most appropriate interventions for rehab may be at the prefrailty level
22
Q

What is the Timed Up and Go test?

A
  1. Start with back against the chair, and arms on arm rests
  2. Get up from a chair and walk 10 feet (3 meters) at your normal pace
  3. turn around and sit back down
  4. Do 1 practice set and then 2 trials. Average the 2 trials
23
Q

What is the TUG used for?

A
  1. Used to evaluate basic mobility skills in older adults
    A. originally tested on frail community-dwelling older persons
  2. Incorporates functional components of:
    A. sit to stand
    B. Ambulation and gait speed
    C. Turning
    D. Stand to sit
  3. Can be used with or without an assistive device
    A. But should be consistent with particular assistive device being used
24
Q

How is the TUG score interpreted?

A
  1. Mean TUG scores for >60 yrs of age was 9.4 seconds
    A. 8.1s for 60-69
    B. 9.2s for 70-79
    C. 11.3 for 80-99
  2. Every older adult should be able to perform the TUG in 30s indicating dependency
25
Q

What is the chair rise test or sit to stand test?

A
  1. test of LE strength, particularly the quads
  2. instruct person to cross arms over chest if possible and on ‘go’ to rise to standing and sit again as times as possible in 30 seconds
  3. Use standard chair height, place back against the wall
26
Q

What is gait speed a predictor of?

A
  1. Diminished gait speed can be considered a marker of poor health status
  2. Slow gait speed is the single best predictor of functional decline and disability in many different populations
  3. The ability to accelerate/decelerate and from a normal pace characterizes normal healthy waking and indicates the ability to adapt to varying environments
27
Q

What are the falls prevention guidelines?

A
  1. Assessment of all older adults
  2. Ask whether they have fallen in past year
  3. Assessment of anyone with history of falls
  4. Ask about difficulties with walking or balance
  5. If fall is reported, ask for the details
28
Q

What specific classes of medications may increase the risk of falls?

A
  1. Benzos
  2. Antidepressants
  3. Antipsychotics
  4. Cardiac medications
  5. Hypoglycemic agents
29
Q

What other medication guidelines need to be addressed to prevent falls?

A
  1. Recent medication dosage adjustment

2. Total number of medications

30
Q

What drugs could be eliminated or reduced to prevent falls?

A
  1. ETOH
  2. Antibiotics
  3. Anticholinergics
  4. Anticonvulsants
  5. Antidepressants
  6. Antihistamines
  7. Antiparkinsonian agents
  8. Antipsychotics
  9. Barbiturates
  10. Benzodiazepines
  11. Chloral hydrate
  12. H2 blocking agents
  13. Lithium
  14. Opioid analgesics (esp. meperidine)
31
Q

How are falls assessed?

A
  1. Ask all older adults about falls in the past year

2. Refer to therapy if TUG is > 10s, sit to stand is >8, gait speed is

32
Q

How is the fear of falling measured?

A
  1. 3 questions
    A. Are you afraid of falling?
    B. Do you limit any household activities bc you are scared you may fall?
    C. Do you limit any outside activities bc you are scared of falling?
33
Q

What are the ACS Falls prevention guidelines?

A
  1. Multifactorial interventions
  2. minimize meds
  3. initiate individually tailored exercise program
  4. Treat vision impairment
  5. Manage postural hypotension, HR, and rhythm abnormalities
  6. Vitamin D
  7. Manange foot and footwear problems
  8. Modify the home enviroment
  9. Refer to the therapies

Gen Med: Geriatrics (5 decks)

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