Exam 1: Aging Part 1 Flashcards
6 Guiding Principles from APTA for caring for the geriatric population
- Utilize person centered care
- Anti-ageist
- Holistic assessment and evaluation to inform treatment plan and relate to patient’s goals
- Evidence based interventions
- Promote health, well-being, chronic disease management, mobility
- Collaboration
What are musculoskeletal considerations with aging?
Sarcopenia, decreased muscle contraction velocity, decreased strength, decreased muscle fiber cross-section area, bone, loss, collagen stiffness
What are cardio/pulmonary considerations with aging?
Calcification of valves, decreased arterial elasticity, muscle strength, forces expiratory volume, increased residual volume
What are neuro considerations with aging?
Decreased brain weight and size, increased ventricular size, decreased nerve speed and conduction, decreased reaction time
What are integumentary considerations with aging?
Decreased sensory perception, increased risk of hypo or hyperthermia, decreased temperature regulation, thick dermis
What are metabolic and endocrine considerations with aging?
Decreased sensitivity to insulin, decreased metabolism
What are GI considerations with aging?
Decreased energy requirements, decreased drug metabolism, increased risk of side effects, constipation, decreased gastric acid
What are genitourinary considerations with aging?
Increased prostate size, incontinence, decreased kidney function and filtration rate, decreased bladder capacity
What type of memory is most affected with aging?
Short term memory
What is semantic memory?
Knowledge of specific information
What is procedural memory?
Knowledge of performance of a specific task or skill
What is working memory, and how is it affected by aging?
Use of relevant information during a task
Decreased with age, but not as much decline as STM
What is episodic memory, and how is it affected by aging?
Lived personal experiences
More affected than semantic and procedural memory
What is sustained attention?
Maintaining attention over a long period of time
What is selective attention?
Selective disregard of items that are irrelevant
What is divided attention?
The ability to process two or more sources of information at the same time
Decreased ability to switch attention between dual tasks
How does aging affect divided attention?
Older adults have more difficulty that can lead to increased fall risk
Will prioritize motor tasks
What is general intelligence?
Broad mental capacity and performance on cognitive ability measures
When does general intelligence begin to decline?
50-70 years old
What is crystalized intelligence, and what affect does aging have?
Accumulation of knowledge and skills
Is maintained or improved with age
What is fluid intelligence, and what affect does aging have?
The speed and ability to problem solve
Declines with age
What is presbycusis?
Progressive hearing loss
What is tinnitus?
Ringing in ears
When does hearing decline begin?
Around 40 and will accelerate overtime
How can hearing deficits be managed in treatment?
Reduce background noise, speak loudly and slowly, be careful with pronunciation, lower frequency of voice
What affect does aging have on pupils?
Smaller in size, less responsive
Leads to increased difficulty seeing in the dark
What are techniques to assist with decreased ability to see in the dark?
Use contrasting colors to highlight barriers or steps, remove throw rugs or uneven surfaces, night lights, motion sensors, allow for extra time transitioning between light and dark areas
What are common conditions that cause visual impairment?
Cataracts, glaucoma, macular degeneration, diabetic retinopathy
What affect does aging have on taste and smell?
Decreased taste sensitivity due to decreased size and number of taste buds
Decreased saliva production
Decreased ability to smell
What are the relevant consequences of decreased ability to taste and smell?
Decreased desire to eat that can cause poor nutrition and increased salt consumption, leading to poor health outcomes
What affect does aging have on touch sensation?
Decreased sensation to touch, pain, vibration, pressure, proprioception, temperature
What clinically relevant effects does decreased touch perception have?
Increased risk of injury from burns and pressure ulcers, balance impairments, increased fall risk
What is optimal aging?
Absence of disease and disability, quality cognitive and physical function, socially engaged
What is the definition of polypharmacy?
Taking multiple medications, often defined as five or more
What is rational polypharmacy?
Multiple medications to treat multiple medical issues or to treat single medical issue where each drug works together to control symptoms
What is irrational polypharmacy?
Excessive, duplicate, contraindicated medications are prescribed to treat the same condition
What is pharmokinetics?
Study of what happens to the drug once it is in the human body
What is absorption, and what affect does aging have?
Movement of drug into the blood stream
Decreased stomach acidity, decreased motility
What is distribution, and what affect does aging have?
Transport of the drug to various tissues
Decreased total body water, increased adipose tissue, decreased muscle mass
What is metabolism, and what affect does aging have?
Drug clearance primarily from the liver
Liver mass, enzyme levels, blood flow
What is excretion, and what affect does aging have?
Elimination of drug by the renal system
Decreased kidney size, renal blood flow, and filtration rates
Why are older adults more susceptible to adverse drug effects?
Decreased GI absorption, decreased total body water, decreased body mass, plasma protein concentrations, increased fat can affect lipid and water-soluble medications, reduced kidney excretion
What are some adverse drug effects?
GI symptoms, sedation, confusion, depression, orthostatic hypotension, fatigue
What are drug considerations for PT treatment?
- Distinguish drug effects from symptoms
- Schedule sessions around dose
- Educate drug compliance
Why are older adults vulnerable to malnutrition?
Decreased energy requirements, decreased lean body mass, decreased metabolic rate, increased need for specific nutrients
What are some things that can cause malnutrition in older adults?
Changes to taste and smell, medication that reduce appetite, decreased sense of thirst, GI distress, chewing difficulties, financial concerns
What is the definition of frailty?
Clinically recognized state of increased vulnerability resulting from age-associated decline in reserve and function across multiple physiologic systems
What are the 5 characteristics of frailty?
- low grip strength
- low energy
- slowed walking speed
- low physical activity
- unintentional weight loss
What are complications associated with frailty?
Increased risk of infections and disease, longer healing time, surgery is more risky, hospital stays are longer and more expensive
Recommendations for older adults with frailty or failure to thrive?
Drink more liquids, portion control, plan healthy meals, consume soft foods, use herbs and spices, eat socially, eat safely, read labels, communicate with MD about supplements and vitamins
What are a few reason why older people are more likely to develop dehydration?
Decreased thirst, dilute urine due to changes in renal flow, medications, caffeine
What are symptoms of dehydration?
Confusion, lethargy, rapid weight loss, functional decline, decreased skin turgor, decreased BP, orthostatic hypotension, tachycardia
What are risk factors of dehydration for older adults?
Diminished thirst, loss of mentation, water metabolism changes, loss of physical function, visual changes, medications, vomiting and diarrhea, acute illness, decreased food intake, fear of incontinence
What are symptoms of a UTI?
Pain with urination, frequency, persistent urge to urinate, hematuria, odor, cloudy urine
What is stress incontinence?
Leakage while jumping, coughing, laughing, straining
What is overactive bladder incontinence?
Strong urge to urinate even without a full bladder
What is mixed incontinence?
Symptoms of both stress and overactive incontinence
What is overflow incontinence?
Bladder does not completely empty, urine leakage, with or without the urge to go
What is functional incontinence?
Urinary tract is functioning properly, but other illness or disabilities prevent bladder control
What is osteoporosis?
Metabolic condition caused by a decrease in osteoblast function with decreased calcium and phosphate salts that caused bones to lose mass and become brittle, which increases the risk of fracture
What are the signs and symptoms of osteoporosis?
Compression and other bone fractures, low back pain, thoracic pain, decreased lumbar lordosis, kyphosis, decreased height
What is the treatment for osteoporosis?
Vitamins and medications, nutrition, assistive device use, education, surgery if stabilization is required
What is osteopenia?
Low bone mass, but not low enough to classify as osteoporosis
What type of bone is affected by osteoporosis in postmenopausal women?
Trabecular bone
What type of bone is affected by osteoporosis in the geriatric population
Trabecular and cortical bone
What bones are at highest risk of fracture with osteoporosis?
Vertebrae, distal radius and ulna, femoral neck
What can cause secondary osteoporosis?
Prolonged drug therapy, specifically heparin and corticosteroids
What are primary goals of rehab for a patient with osteoporsis?
Decrease fall risk and exercise
What should be avoided in patients with osteoporosis?
Excessive forward bending, exercising with the trunk flexed, trunk flexion paired with rotation, prolonged immobilization
What are the effects of trunk orthoses in patients with osteoporosis?
Short term pain relief, long term weakness and deconditioning
What is the definition of mild cognitive impairment (MCI)?
Lower than expected cognitive performance in comparison to age group
Does not affect the ability to function
Is MCI associated with increased risk of dementia?
No
What is the definition of dementia?
Slow gradual onset of diminished ability to reason and make sound judgements, loss of social skills, develop or regressed antisocial behaviors
What are the two most common forms of dementia?
Alzheimer’s and multi-infarct dementia
What are symptoms of dementia?
Difficulty with comprehension of language, decreased problem solving, behavioral disturbances, memory deficits
Symptoms will increase with age
What is delirium?
Transient mental disorder with relatively rapid onset that fluctuates. Duration can be a couple of hours up to four weeks
What are the typical characteristics of delirium?
Reduced ability to pay attention to external stimuli, shift attention to new stimuli, disorganized thinking, irrelevant and incoherent speech
What are possible causes of delirium?
Hospitalization, surgery, side effect of a new medication
What are the risk factors of delirium?
Age > 70, decreased cognitive status, depression, alcohol abuse
What is the pathophysiology of Alzheimer’s?
Progressive deterioration and irreversible damage to the cerebral cortex and subcortical areas associated with the development of amyloid plaques and neurofibrillary tangles
What are the signs and symptoms of Alzheimer’s?
Difficulty with new learning, memory and concentration changes, loss of orientation and time, difficulty finding words, depression, poor judgement, rigidity, bradykinesia, shuffling gait, decreased ability to perform ADL’s, incontinence, functional dependence, inability to speak
What are possible treatments for Alzheimer’s?
Medication to alleviate cognitive symptoms and control behavior
What is required for an official Alzheimer’s diagnosis?
Must have at least two deficits in memory and cognitive function found via physical exam, neurologic exam, and neurophysiological testing
What motor changes are found in patients with Alzheimer’s?
Slow movement, halting gait, generalized weakness, increased fall risk due to decreased postural reflexed, decreased awareness of self and environment, and decreased ability to navigate obstacles
What are the PT treatment goals for patients with Alzheimer’s?
Improve quality of life, functional performance, safety, decrease fall risk, caregiver training
What are the symptoms of Geriatric Syndrome?
Decreased bladder control, sleep problems, delirium, dementia, falls, osteoporosis, weight loss, polypharmacy
What are signs of caregiver stress?
Lacking energy, fatigue, sleep problems, changes in eating, withdrawing, overwhelmed, anxiety, depression, mood swings, impatient, anxiety about the future, difficulty coping with daily tasks, lowered resistance to illness
What are strategies to help with caregiver stress?
Support, self-care, share the load, family leave, support groups, respite
How can you combat ageism?
Recognizing inherent beliefs and prejudices to allow practitioners to provide unbiased care and meet the needs of the patients
What people are at highest risk of elder abuse?
Women, people that are dependent, frail
What are the different types of elder abuse?
Physical, emotional, neglect, abandonment, sexual, financial
What are warning signs of elder abuse?
Unexplained injuries, annoyance, malnutrition, dehydration, soiled or inappropriate clothing, weight loss, trouble sleeping, bed sores, depression, confusion, withdrawn
