Exam 1: Aging Part 2 Flashcards
What are the six essential competencies for geriatric PT according to the APTA?
- Health promotion and safety
- Evaluation and assessment
- Care planning and coordination across the care spectrum
- Interdisciplinary and team care
- Caregiver support
- Healthcare systems and benefits
Briefly describe the patients in the acute care setting
Complex cases that require a higher intensity of daily therapy
What is the main goal of the physical therapist in the acute care setting?
Assess the patient’s mobility and provide recommendations for continued care settings
What are some responsibilities of the PT in the acute care setting?
Monitor vitals and tolerance to activity, create goals, make discharge recommendations, coordination with other team members, perform treatment sessions and assess bed mobility, transfers, ambulations, stair negotiation
What does DME stand for?
Durable medical equipment – supplies ordered by a provider for everyday patient use
What are examples of DME?
Walkers, canes, wheelchairs, hospital beds, transfer boards, crutches, lift devices
How long does a patient typically stay in the acute care setting?
2-3 days
What does FIM stand for?
Functional Independence Measure
What is the FIM?
1-7 rating scale used at admission and discharge from the acute care setting that evaluates the patient’s presentation
What are the requirements for acute care admission?
- Active ongoing therapy from multiple disciplines
- Intensive rehab of at least three hours per day, five days per week
- Reasonable expectation of significant benefit and measurable improvement
- Physician supervision
- Intensive, coordinated interdisciplinary approach
What are some common conditions seen in acute care?
Stroke, spinal cord injury, amputation, major multiple traumas, brain injury, neurologic disorders, arthritis
What conditions would result in a post-op hip or knee replacement patient being admitted to acute care?
Bilateral, BMI > 50, age > 85
Briefly describe the sub-acute setting
Short-term program of care which typically includes 1-3 hours per day of therapy
What are the general requirements for admission to sub-acute care?
Requires definitive rehab goals, identified skilled need, possible close monitoring
What are the Medicare eligibility requirement for home health care?
- Under physician care
- Require at least one service
- Homebound
What is the definition of being homebound?
It is challenging and taxing to leave the home, may require assistance or assistive devices
What is the goal of home health care PT?
Improve independence and mobility, decrease fall risk and re-hospitalization, decrease burden of caretakers
What are the benefits of home health PT?
Reassessments done every 30 days, full set of vitals taken at each visit, medication assessment, DME ordering
What does OASIS stand for?
Outcome and Assessment Information Set
What is OASIS?
Standardized documentation in the home health setting that measures quality and outcomes
What information does OASIS provide?
Clinical condition, comorbidities, physical and mental state, functional status, living situation, health care needs
What is independent living?
Handicap accessible but does not require 24/7 supervision
What is assisted living?
Meals included, medication management, 24/7 supervision, possible vision or hearing deficits, ADL assistance, independent transfers, not a danger to themselves or others
What is long-term care?
Assistance needed 24/7, do not meet the criteria for rehabilitation
What is hospice?
Palliative care for terminally ill patients who have a limited life expectancy that focuses on their pain management and death acceptance
What is the goal of hospice?
Allow patients to remain in their home as they near death
What are advanced directives?
Documents that are completed by a patient prior to the onset of an illness that dictates how the patient wants their end-of-life care to be
What is a living will?
Legal document in which the patient dictates their preferences for health care treatment. Becomes important if the patient becomes terminally ill and can no longer express their wishes
What is a DNR?
Medical order written by a doctor that documents the patient’s wishes to not be resuscitated with CPR if they stop breathing or their heart stops
What is palliative care?
Approach to patient’s care that aims to relieve their pain and suffering as well as address any psychological, social, or spiritual problems
What is the goal of palliative care?
Improve quality of life
What are important considerations for continuity of care?
Improve quality of life, quality of care and outcomes, prevent medical errors, prevent unnecessary hospitalizations and readmissions, support patient choice and preferences, efficient use of resources
What are the seven essential interventions for continuity of care?
- Manage medications
- Transition planning with a care coordinator
- Patient and family engagement and education
- Information transfer
- Follow-up care appointments made prior to discharge
- Health provided engagement
- Shared accountability
What are the requirements to be eligible for Medicare?
- Age > 65 and either qualifies for social security or have been a US citizen living in the US for at least the past 5 years
- Age < 65 and has either a disability or end stage renal disease
What is the definition of a fall?
An event whereby an individual unexpectedly comes to rest on the ground or another lower level without known loss of consciousness
What types of injuries are associated with falls either forward or backward?
Wrist fractures
What types of injuries are associated with falls to the side?
Hip fractures
What are risk factors for falls?
History of falls, age, living alone, medications, medical conditions, muscle weakness, gait and balance problems, fear of falling, nutritional deficiencies, impaired cognition, visual impairments, environmental hazards, footwear, inappropriate walking aids or assistive devices
What is included in the multifactorial fall risk assessment?
Focused patient history, physical examination, functional assessment, standardized outcome measures, environmental assessment
How many minutes of moderate intensity aerobic activity are recommended every week?
150 minutes
How many days per week is it recommended to do muscle strengthening activities?
2x per week
What are the characteristics of exercise frequency?
Times per day, times per week, should gradually increase over time
How is the intensity of exercise measured?
HR and RPE
What is the most important factor of exercise prescription?
Intensity
What are the four characteristics of exercise prescription?
Frequency, intensity, time, and type
What are the recommendations for vigorous exercise per week?
20-60 minutes, at least 3 days for at least 10 minutes each
How many weeks does it take to develop a habit?
3-4 weeks
What are the ACMS guidelines for balance training?
2-3x per week, progressively difficult postures that reduce the base of support, dynamic movements that perturb the center of gravity, stress postural muscle groups, reduce sensory input, multimodal programs with two or more components of strength, balance, endurance, or flexibility
How many sit-to-stand transfers does the average person 40 and older perform every day?
64
Describe the pre-extension phase of a sit-to-stand
Requires proximal control, need trunk to stay neutral, slight thoracic extension and neutral pelvis progressing to anterior tilt and hip flexion, ankle dorsiflexion essential.
Weight shifts forward and tibia translates anterior
Describe the extension phase of a sit-to-stand
Symmetrical firing, requires strength and power in bilateral LE
If the patient does not have symmetrical alignment or strength, what side will they lean toward when performing a sit-to-stand?
Their strong side
