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Gerontology > Exam 1 Review > Flashcards

Exam 1 Review Flashcards

1
Q

Essential features of dementia [5]:

A
  • cognitive impairment
  • aphasia
  • agnosia
  • apraxia
  • disturbance of executive functioning
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2
Q

Most common cause of dementia:

A
  • Alzheimer’s Disease
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3
Q

Patient Presentation:

  • Sadness, anhedonia, crying
  • fatigue, insomnia, anorexia, guilt, self blame, hopelessness, helplessness
  • Normal Speech
  • Episodic Subacute onset
  • No memory Loss
  • Usually worse in the morning
A

MAJOR DEPRESSION

  • Disturbance in mood, low vital sense, low

self attitude

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4
Q

Patient Presentation:

  • Initially alert, attentive. Gradual development of amnesia, aphasia, apraxia, agnosia, disturbed executive functioning. No signs of illness.
  • Depression, delusions, , irritability
  • hallucinations uncommon
  • Normal Speech in early stages
  • Slow onset over months or years
  • Memory Loss
  • No clear pattern
A

DEMENTIA

  • Global decline in cognitive capacity in clear consciousness
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5
Q

Patient Presentation:

  • Inattention, distractibility, drowsiness, befuddlement; signs of illness
  • Cognitive impairment, Hallucinations common, mood lability
  • Slurred Speech
  • Sudden onset over hours or days
  • Memory Loss
  • Usually worse in night/evening
A

DELIRIUM

  • Reduced level of consciousness
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6
Q

[Rowe and Kahn] The specific elements they present as the signs of an individual who is aging successfully are [3]:

A
  • (1) absence of disease and disability,
  • (2) high cognitive and physical functioning, and
  • (3) active engagement with life.
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7
Q

Physical therapists can assist the promotion of successful aging by:

A
  • Encouraging modification of some extrinsic factors, particularly in teenagers and young adults, which lead to less disease and disability in the later years.
  • (per class notes) Lifestyle modification:
    • eating habits
    • exercise
    • smoking cessation
    • stress factors
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8
Q

Optimal Aging:

A
  • Allows an individual to achieve life satisfaction in multiple domains—physical, psychological, and social— despite the presence of disabling medical conditions.
  • Is a concept to be used for those with disease and disability.
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9
Q

Physical therapists can promote optimal aging by:

A
  • Reducing the disabling effects of disease and stopping a vicious cycle of “disease–disability–new incident disease” to maintain quality of life.
  • [Per class notes]:
    • improved life satisfaction
      • maintence of lifestyle
    • reduce the effects of disease
    • interruption of the disease-disability-new incident cycle
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10
Q

Four distinctive functional levels that are descriptively labeled in the slope of aging [Schwartz]:

A
  1. Fun
  2. Function
  3. Frailty
  4. Failure
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11
Q

Slope of Aging: Fun

A
  • The highest level
  • Represents a physiological state that allows unrestricted participation in work, home, and leisure activities.
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12
Q

Slope of Aging: Function

A
  • Individual continues to accomplish most work and home activities but may need to modify performance and will substantially self-restrict leisure activities (fun) because of declining physiological capacity
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13
Q

Slope of Aging: Frailty

A
  • Moving from function into frailty occurs when managing basic activities of daily living (BADLs; walking, bathing, toileting, eating, etc.) con- sumes a substantial portion of physiological capacity, with substantial limitations in ability to participate in community activities and requiring outside assistance to accomplish many home or work activities.
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14
Q

Slope of aging: Failure

A
  • The final threshold into failure is reached when an individual requires assistance with BADLs as well as IADL’s and may be completely bedridden.
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15
Q

Approximately half of the decline with age has a (1) _______ _____.The remainder of age-related change is the consequence of (2) _________, primarily (3) ________ ________ that can account for the other half of the decline with age.

A
  1. genetic basis
  2. lifestyle
  3. physical inactivity
  • Coupling sedentary lifestyle with inadequate nutrient intake, excess body weight (which puts stresses on tissues, increases inflammation, predisposes toward disease), and variables such as smoking and excessive alcohol intake, the biological decline is more precipitous and greater in magnitude.
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16
Q

Four approaches to the management of total-body inflammation have been considered:

A
  1. Anti-inflammatory drugs
  2. Use of antioxidants
  3. Caloric restriction
  4. Exercise.
  • Exercise is far superior to the minimal impact noted from anti-inflammatory drugs and antioxidants.
    • Single session bout results in a significant reduction in markers of inflammation such as IL-1 and TNF-􏰊
    • Cumulative exercise sessions further reduce inflammation, which should enable chronic exercisers to resist fatal infections and aggressive pathogens.
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17
Q
  • Severe decline in muscle and body wasting that cannot be improved through nutrition
  • Response to one or more pathologically ovrwhelming diseases (CA, HIV/AIDS, TB)
    • Recovery is rare in older adults
    • Does not respond to exercise
    • Typically precedes death
    • Thought to be caused by increases in inflammatory cytokines
A
  • Cachexia
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18
Q
  • Muscle wasting of old age
  • Hallmark of frailty
  • Can be improved through exercise and nutrition
  • Can be identified through tests (absorptometry)
    • diagnosis present if muscle mass as determined by dual-energy x-ray absorptiometry is two or more standard deviations below values obtained for young adults.
  • Affects men > women (testosterone)
  • Muscle susceptible to change
    • Responds to exercise
A
  • Sarcopenia
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19
Q

Non-modifiable factors for bone loss:

A
  • age
  • genetics
  • caucasian or hispanic
  • premature birth
  • seizure disorders (dilantin)
  • family hx of osteoporosis
  • childhood malabsorption disease
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20
Q

Modifiable factors for bone loss:

A
  • increase calcium
  • decrease alcohol
  • decrease cigarretes
  • increase in body mass more than 18.5
  • increase low estrogen
  • improve activity
  • increase milk vs. soda
  • increase protein
  • increase vitamin D
  • decrease prednisone/cortisone
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21
Q

Notable changes that occur in all collagenous tissues as a result of aging (3):

A
  1. Loss of water from matrix
  2. Increase in crosslinks
  3. Loss of elastic fibers.
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22
Q

[2] Observable clinical changes as a result of increased collagen crosslinking in the aging process:

A
  1. Decreased ROM
    • Even though end range is diminished with advancing years, range should still be sufficient to accomplish all activities of daily living
  2. Increased stiffness
    • lack of “give” that translates, for example, to a greater likelihood of tendon avulsion rather than rupture.
    • Stiffness also means that the passive tension within tissues is increased
      • Coupled with decreased amount of force generation, stiffness is a factor contributing to less muscle endur- ance with age.
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23
Q

The most notable and clinically important change in cardiac tissue is:

A
  • The decline in maximum heart rate
    • Involved factors include
      • increased stiffness of the heart with slower filling of the left ventricle
      • age-related decrease in the number of cells in the sinoatrial (SA) node
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24
Q

Slowing of gastric motility, possible issues with bladder control, hypertension and hypotension, and deficits in control of blood flow to and from the periphery and the failure of the sympathetic nervous system to adequately respond to heat and cold are likely related to:

A
  • Age related alterations in the balance of the parasympathetic and sympathetic nervous system output.*
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25
Q

{True/False]

  • Exercise has a modest effect on speed of reaction and this increase in speed is likely to attain sufficient magnitude to make a significant impact on function.
A
  • FALSE
  • Exercise has a modest effect on speed of reaction but the increase in speed is not likely to attain sufficient magnitude to make an impact on function.
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26
Q

When processing or learning of cognitive materials becomes a problem, _________ ________ of motor programs will become the only avenue to regain functional control over movement.

A
  • procedural learning
27
Q

In this condition, a sympathetic response to stress may develop initially [normal] sympathetic response, but over time, and sometimes quickly, may switch to parasympathetic response:

A
  • General adaptive syndrome:
    • Implications:
      • decreased blood pressure
      • decreased HR
      • pooling of blood in periphery
      • decreased level of consciousness
28
Q

Pharmacodynamics in aging:

  • Decreased Absorption
A

Altered gastrointestinal function due to:

  • ↓ Gastric acid
  • ↓ Stomach emptying
  • ↓ Absorbing area
  • ↓ Motility
29
Q

Pharmacodynamics in aging:

  • Altered distribution
A

Altered due to:

  • ↓ Body H2O
  • ↑ Body fat
  • ↓ Lean body mass
  • ↓ Plasma proteins
30
Q

Pharmacodynamics in aging:

  • Altered hepatic metabolism
A

Altered due to:

  • ↓ Liver mass
  • ↓ Liver blood flow
  • ↓ Enzyme activity
31
Q

Pharmacodynamics in aging:

  • Altered renal excretion
A

Altered function due to:

  • ↓ Kidney mass
  • ↓ Kidney blood flow
  • ↓ Tubular function in nephron
32
Q

Factors which can disrupt the older individual’s adherence (compliance) to drug therapy:

A
  • A decline in cognitive function
    • may impair the older person’s ability to understand instructions given by the physician, nurse practitioner, or pharmacist.
  • Poor eyesight
    • may limit the older person’s ability to dis- tinguish one pill from another
  • Arthritic changes
    • may make it difficult to open certain “childproof” containers.
  • Patient may feel that their medications are simply not effective
    • they fail to see any obvious benefit from the drugs
  • Side effects:
    • The older adult may also stop taking a medication because of an annoying but unavoidable side effect.
33
Q

Adverse Drug Reactions:

  • GI symptoms
    • nausea
    • vomiting
    • diarrhea
    • constipation
A
  • Common medications
    • opiods
    • NSAIDS’s
34
Q

Adverse Drug Reaction:

  • Sedation
    • Symptoms:
      • drowsiness
      • sleepiness
A
  • Medications:
    • sedative-hypnotic
    • opioid analgesic
    • antipsychotic
35
Q

Adverse Drug Reaction:

  • Confusion
    • Side Effects:
      • mild depression
      • delirium
A
  • Medications:
    • antidepressants
    • narcotic analgesics
    • anticholinergic medication
    • lithium/digoxin (buildup)
36
Q

Adverse Drug Reaction:

  • Depression
    • Symptoms:
      • intense sadness
      • apathy
A
  • Drugs:
    • barbiturates
    • antipsychotics
    • alcohol
    • antihypertensive agents
37
Q

Adverse Drug Reaction:

  • Orthostatic hypotension
    • Symptoms:
      • Systolic BP decrease greater than pr equasl to 20mmHg
      • Diastolic BP decrease greater than or equal to 10mmHg
A
  • Medications
    • antihypertensives
    • antianginal
38
Q

Adverse Drug Reaction:

  • Fatigue and Weakness
    • Symptoms:
      • Strength loss and muscular weakness
A
  • Medications:
    • muscle relaxants
      • skeletal muscle relaxants may directly decrease muscle contraction strength
    • diuretics
      • diuretics may affect muscle strength by altering fluid and electrolyte balance.
39
Q

Adverse Drug Reaction:

  • Dizziness and Falls
    • Symptoms:
      • Dizziness (and subsequent falls)
A
  • Medications:
    • drugs that produce sedation or from agents that directly affect vestibular function.
    • Ex.
      • sedatives
      • antipsychotics
      • opioid analgesics
      • antihistamine drugs
    • Dizziness may also occur secondary to drugs that cause orthostatic hypotension
      • antihypertensives
      • antianginal
40
Q

Adverse Drug Reactions:

  • Anticholinergic Effects
    • Symptoms
      • Central Nervous
        • Confusion
        • Drowsiness
        • Dizziness
        • Nervousness
      • Peripheral Nervous
        • Drymouth
        • Constipation
        • Urinary retention
        • Blurred vision
        • Tachycardia
A
  • Medications:
    • antihistamines
    • antidepressants
    • antipsychotics
41
Q

Adverse Drug Reactions:

  • Extrapyramidal Symptoms
    • Symptoms:
      • Tardive dyskinesia
      • pseudoparkinsonism
      • akathisia: restlessness…
      • dystonia
A
  • Medications:
    • Antipsychotics
42
Q
  • General Strategies for Coordinating Physical Therapy with Drug Treatment in Older Adults
A
  • Distinguishing Drug Effects from Symptoms
    • therapists must try to account for the subjective and objective findings that may be due to ADRs rather than true disease sequelae and the effects of aging.
    • Distinguishing drug-related signs from true patient symptoms may require careful observation and consultation with family members or other healthcare professionals to see whether these signs tend to increase after each dosage
    • medical staff should be alerted to any change in the patient’s response that may indicate an ADR
    • periodic evaluation of patient’s medication list
  • Scheduling Physical Therapy Sessions Around Dosage Schedule
    • Physical therapy should be coordinated with peak drug effects if the patient’s active participation will be enhanced by drug treatment
    • Conversely, physical therapy should be scheduled when drug effects are at a minimum for older patients receiving drugs that produce excessive sedation, dizziness, or other adverse effects that may impair the patient’s cog- nitive or motor abilities.
  • Promoting Synergistic Effects of Physical Therapy Procedures with Drug Therapy
    • In some cases, drug therapy may be reduced through the contribution of physical therapy procedures (e.g., reduction of pain medications through the simultaneous use of TENS, physical agents, and so forth). This synergistic relationship between drug therapy and physical therapy can help achieve better results than if either intervention is used alone
  • Avoiding Potentially Harmful Interactions Between Physical Therapy Procedures and Drug Effects
    • For instance, the use of rehabilitation pro- cedures that cause extensive peripheral vasodilation (e.g., large whirlpool, some exercises) may produce se- vere hypotension in the patient receiving certain antihy- pertensive medications.
  • Improving Education and Compliance with Drug Therapy in Older Adults
    • one area where physical therapists can have a direct impact.
    • Therapists can reinforce the need for adhering to the prescribed regimen, and therapists can help monitor whether drugs have been taken as directed.
    • Therapists can also help educate their geriatric patients and their families as to why specific drugs are indicated and what side effects should be expected and tolerated as opposed to side effects that may indicate drug toxicity.
43
Q

Patient presentation:

  • metallic taste in mouth
  • nausea
  • confusion and slurred speech
  • hand tremors
  • muscle weakness
  • blurred vision
  • When ambulating:
    • incoordination
    • fatigued very easily.
A
  • Lithium Toxicity
    • Mild Symptoms:
      • metallic taste in the mouth, fine hand tremor, nausea, and muscular weakness and fatigue.
    • Moderate:
      • symptoms increase as toxicity reaches moderate levels, and other CNS signs such as blurred vision and incoordination may appear.
    • Severe
      • Severe lithium toxicity may cause irreversible cerebellar damage, and prolonged lithium neurotoxicity can lead to coma and even death
44
Q
  • Characteristics of a major depressive episode:
A
  • Depressed (sad) mood
  • Markedly diminished interest or pleasure in all, or almost all activities
  • Weight loss or weight gain when not dieting or decrease or increase in appetite
  • Insomnia or hypersomnia
  • Psychomotor agitation or retardation
  • Fatigue or loss of energy
  • Feelings of worthlessness or excessive or inappropriate guilt
  • Diminished ability to think or concentrate, or indecisiveness
  • Recurrent thoughts of death, recurrent suicidal ideation, a suicide attempt, or a specific plan for committing suicide
45
Q

Depression: Late onset vs. Early onset

A
  • Late onset:
    • More likely to have vascular risk factors, including a history of Cerbrovascular Disease
    • More likely to have concomitant deficits, esp. executive cognitive functioning deficits or dementia
    • White matter hyper intensities, also called leukoencephalopathy
    • Mood regulating pathways are disrupted
      • frontal-striatal
      • frontal-limbic
  • Early Onset:
    • More likely to have a family hx of depression
    • Higher prevalence of personality disorder or elevated socres on personality traits (e.g.neuroticism)
46
Q

DEPRESSION: NEUROLOGICAL SYNDROMES

  • Stroke w/ Right Hemisphere Damage
A
  • Dysphoria
47
Q

DEPRESSION: NEUROLOGICAL SYNDROMES

  • Parkinson’s Disease
A
  • Dysphoria and Anhedonia
48
Q

DEPRESSION: NEUROLOGICAL SYNDROMES

  • Dementia
    • Alzheimer’s Disease and Depression
A
  • Deficits in verbal expression with confounding cognitive symptoms
49
Q

DEPRESSION: NEUROLOGICAL SYNDROMES

  • Vascular Dementia
A
  • Fatigue, muscular weakness, weight loss
50
Q

DEPRESSION: NEUROLOGICAL SYNDROMES

A
51
Q

Basis for normal age related memory impairment:

A
  • Neuroanatomic loss of synaptic connections
52
Q

Basis for dementia:

A
  • Pathologic loss of synaptic conections
53
Q

Plaques vs. Tangles

A
  • Plaques:
    • waste products that buildup between neurons
    • Senile neuritic plaques are considered to have no pathologic significance until the plaque matures and is filled with neurofibrillary tangles and other abnormal proteins.
  • Tangles:
    • waste products that buidup within neurons
    • neurofibrillary tangle frequency and distribution does predict cognitive status.
54
Q

Most common cognitive componenent associated with aging:

A
  • Memory
    • Normal aging
      • slowed, but still intact, memory
      • no interference with social or personal activities
55
Q

MCI was originally characterized by four criteria:

A
  1. memory complaints,
  2. normal ADLs,
  3. normal general cognitive functioning
  4. abnormal cognitive measures using age- and education-adjusted norms.
  • Current criteria include subjective, gradual cognitive decline for at least 6 months and objective criteria as measured by performance at 1 standard deviation below age and education norms by neuropsychological testing.
56
Q
  • Symptoms of dementia most commonly affect:
A
  • memory and language
57
Q
  • Dementia Types:
    • Alzheimer’s
A
  • Memory
  • language
  • visual-spatial disturbances
  • indifference
  • delusions
  • agitation
58
Q

Dementia Types:

  • Frontotemporal (Pick’s Disease)
A
  • Relative preservation of memory and visual-spatial skills
  • personality change
  • executive dysfunction
  • excessive eating and drinking
  • loss of language skills
59
Q
  • Dementia Types:
    • Lewy body dementia
A
  • Visual hallucinations
  • delusions
  • extrapyramidal symptoms
  • fluctuating mental status
  • sensitivity to antipsychotic medications
60
Q

Dementia Types:

  • Vascular dementia
A
  • Abrupt onset
  • stepwise deterioration
  • executive dysfunction
  • gait changes
61
Q
  • Dementia is only diagnosed if:
A
  • Two or more brain functions—such as memory and language skills— are significantly impaired without loss of consciousness.
    • A diagnosis of dementia is applicable only when there is demonstrable evidence of memory impairment and other features to the degree there is interference with social or occupational function.
62
Q

Examination tests for delirium:

A
  • Mini-Mental Status Exam
  • St. Louis University Mental Screen
  • Mini-Cog
  • Short Blessed Test
  • Clock Drawing Test
  • TIme and Change Test
  • Sniff Test
  • Naming (ten items in a category in a minute)
  • Describe similarities between two items such as an apple and an orange
63
Q

Complex motor declines in both MCI and Early AD:

A

Gerontology (4 decks)

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