Exam 1 (wks 1-4) Flashcards
What is ageism
Prejudice or discrimination against a particular age-group and especially the elderly
What is the difference between optimal aging and successful aging?
Successful aging = avoiding disease and disability, maintaining high physical and cognitive function, and sustained engagement in social and productive activities.
Optimal aging = the capacity to function across many domains in spite of medical conditions.
What are the 5 most common causes of death among older adults?
Heart disease
Cancer
Covid
Cerebrovascular diseases
chronic lower respiratory diseases
Alzheimer disease
What are the 6 most common chronic health conditions among older adults?
Hypertension
High cholesterol
Arthritis
Heart disease
Diabetes
Kidney disease
What is the life expectancy for men and women?
In 2021
73.2 for males
79.1 for females
What percentage of work is needed to provide an overload when prescribing exercise?
60%
How would you describe the 4 different stages of the Slippery Slope of Aging?
- Fun: What you want, when you want, for as long as you want
- Function: Choices made based on decreased physical capacity, Have mobility disability or at risk for
- Frailty: Require help with ADLs and IADLs
- Failure: Completely dependent
What are the 5 criteria for measuring frailty?
- Unintentional weight loss of >/ 10 lbs in past year
- Self-reported exhaustion 3 or more days/week
- Muscle weakness
- Grip strength < 23 women, < 32 men
- Walking speed < 0.8 m/sec
- Low level of activity
- Sitting quietly or lying down majority of the day
What is the difference between a fall and a near fall?
Fall = inadvertently coming to rest on the ground (excludes change in position, resting on furniture wall or other objects)
Near fall = slip, trip, stumble or loss of balance with recovery and remaining upright
How does fear affect fall risk?
Fear of falling leads to restricted activities which leads to reduced physical capabilities more restricted activity/ ability and greater fear of falling.
Can you describe and differentiate the intrinsic and extrinsic risk factors for falls?
Intrinsic ex.: medical conditions, impaired vision/hearing, age related changes in neuromuscular function, gait, and postural reflexes
Extrinsic ex.: medications, improper prescription, use of assistive devices, environmental hazards
How can PTs screen for fall risk?
Stay independent brochure
OR
3 key questions:
- Have you fallen in the past 12 months?
- Do you feel unsteady when standing or walking?
- Do you worry about falling?
*If pt scores >4 on the stay independent or if they answer yes to any of the 3 questions
Name the four key components of a focused exam for fall assessment.
Focused history
Physical exam
-sensory
-neuromuscular
-aerobic endurance
Functional assessment
Environmental assessment
What outcome tool can PTs use to best assess sensory integration?
What are the 3 outcome measures that best predict falls?
Activities-specific Balance Confidence (ABC) Scale
Fear of Falling Avoidance Behavior Questionnaire
Timed Up and Go
What type of motor learning is important to enhance an individuals feed-forward mechanisms to reduce their risk of falls?
Practice
Mistakes
What is the intensity required to change a pts balance?
2-3 hrs/wk for a minimum of 12 wks
Is an assistive device enough to reduce falls?
No. not as a single intervention
Name some community intervention programs to decrease fall risk.
Otago Exercise Program
Master of Balance
Stay Active and Independent for Life
Moving for Better Balance
The three health conditions which should be identified as part of every fall assessment.
Osteoporosis
Depression
Polypharmacy
What interventions have Grade A & B evidence supporting their use in addressing fall-related risk factors?
Strength training
Balance training
Gait training
Correction of environmental hazards
Correction of footwear
What are the 4 distinct phases of falling?
Pre-fall
Near-fall
Fall-landing
Completed fall
What is one of the best outcome assessment tools to assess reactive postural control?
MiniBest test
3 primary intervention strategies to address righting and stepping during near fall phase
Power training
Perturbation training
Step training
Two primary intervention strategies to prepare older adults for safe landing strategies.
Knee and elbow flexion
More points of contact
Highest risk meds for falls
Benzodiazepines
Cardiac meds
Anti-depressants
Antipsychotics
Antiepileptics
Antihypertensives
What does the Barthel index assess?
Bed mobility, transfers, use of assistive devices and adaptive equipment
Name 3 tests you could use to assess aerobic endurance
6-min walk test
2-min walk test
2-min step test
Perceived functional ability and fear of falling assessment tools
Falls efficacy scale
Activity specific balance scale
Fear of falling avoidance behavior questionnaire
Identify and name the psychological factors contributing to gait alterations
Depression
Self efficacy
Appearance
Perception of mobility
Anxiety and fear
Perceived risks
Fear of harm from others
Worries about access/barriers
What is dual-tasking and how could a PT incorporate these principles into their treatment
plan?
Assess using the TUG cognitive or TUG manual
What are normal age related changes to gait?
Decreased walking speed with ability to increase speed voluntarily
Smaller steps/stride length but symmetrical
Step width avg. 1-4 inches
Smaller toe clearance
What performance measures and markers indicate the functional category of aging?
Gait speed = .9-1.4
6 min walk = 300-500
30 sec sit to stand = 8-14
10 stairs = 9-30 sec
Floor to stand = 11-30 sec no assistance
What are the six determinants of gait?
Pelvis rot.
Pelvic tilt
Knee flexion in stance phase
Foot mechanism
Knee mechanism
Lateral displacement of the pelvis
What are the contextual factors that impact patient outcomes after primary TJA for OA?
Behavioral/ psychosocial
Support and attitudes
Biological/ intrinsic
Provider and systems factors
Compare and contrast the effectiveness of Pre-op PT and Pre-op educational classes.
Pre op PT - training with walking devices, managaing expectations, planning for recovory (debatable)
Pre op edu = good evidence, more benefit
When should physical therapy start for those s/p TJA and what are the benefits?
Immediately
Describe the differences between an anatomic TSA and a reverse TSA.
Anotomic - must have intact rotator cuff
Reverse - no rotator cuff but need deltoid
What are typical impairments or activity limitations that a physical therapist can address
right after a TSA?
Bed mobility
Single Arm ADLs
Core strengthening
Functional reach
What are the key components of the history when interviewing a patient after a total hip
arthroplasty?
What early post-operative complications are important to be aware of and screen for
within the history and tests/measures?
Describe the most common hip precautions based on the surgical approach (Anterior or
Posterior)
Consider how a physical therapist may construct a post-operative treatment plan keeping
weightbearing status and hip precautions in mind.
Describe the strong to moderate recommendations for those undergoing TKA. How are
these the same and how are they different from what you learned in the asynchronous
lecture?
What are the best practice recommendations for outcome measures to use with those who
have undergone a TKA?
What physical agents are recommended for use after TKA and why?
What are the impacts of a hip fracture on mortality?
Describe the types of hip fractures and the associated repairs typically completed.
What type of hip surgical procedures typically have hip precautions?
Which outcome measures have the strongest recommendation based on evidence for use
with patients s/p hip fracture?
What types of exercise are highly recommended for patients s/p hip fracture?
Which interventions have strong to moderate support for people s/p hip fracture in the
inpatient setting?
