Exam I Flashcards
1
Q
How can an OT help individuals maintain their independence?
A
Recommending home modifications and strategies to make ADLs easier, treatment of conditions associated with aging
2
Q
Which of the following individuals has the longest life expectancy?
a. A white female in the U.S
b. A black male in Canada
c. An individual in South America regardless of gender/ethnicity
d. A Hispanic female in a large U.S city
A
a. A white female in the U.S
3
Q
Early theories of aging focused on describing it as:
a. A problem
b. A normal, welcomed life stage
c. A rare and unique process
d. Too idiosyncratic for generalized description
A
a. A problem
4
Q
Definition of culture
A
Patterns of behavior from family, all ways of life including arts, beliefs and institutions of a population that are passed down from generation to generation
5
Q
Cultural identity
A
Language, race, ethnicity, religion, occupation
6
Q
What are examples of ways culture affects occupational performance?
A
What they believe in, music they listen to, and hobbies they like can motivate them to approach difficult changes in their life with a different perspective
7
Q
How would you assess the impact of culture during an evaluation?
A
Ask questions such as “where did you grow up?”
Where they grew up can influence traditions or what was taught to them
8
Q
Which of the following reflects a possible cultural identity?
a. Race
b. Religion
c. Occupation
d. Two of the above
e. All of the above
A
e. All of the above
9
Q
Although increasing awareness of positive aging has begun to improve attitudes, this outlook has been criticized for its potential to:
a. Encourage subtle discrimination against those who are not able to age well
b. Raise unrealistic expectations among older adults about what the experience will be like
c. Reduce family support because families assume elders will do fine without them
d. Encourage older adults to do too much and wear themselves out
A
a. Encourage subtle discrimination against those who are not able to age well
10
Q
What are the 3 components of occupational participation?
A
Volition, habituation, and performance capacity
11
Q
What is an example of a theory that can explain the experience of growing older in the context of human performance?
A
MOHO
12
Q
Which of the following are most difficult for older adults?
ADL: 1) walking 2) bathing 3) going outside 4) transferring 5) toileting
IADL: 1) heavy housework 2) shopping 3) meal prep 4) light housework 5) money management 6) phone management
A
Going outside and phone management
- going outside is particularly difficult (changes in weather, terrain) in turn affecting phone management and social participation (less connected with outside world)
13
Q
Do most older adults need help with self-care?
A
No
14
Q
Practical vs. Symbolic side of self care
A
Practical- things we need to do such as washing hands, wiping after using the bathroom
Symbolic- maintaining independence and self-esteem such as washing face or applying makeup
15
Q
What factors should OTRs look at before completing a self care assessment?
A
Vision, hearing, sensory skills, and cognition
- think of the whole individual
16
Q
Definition of leisure
A
Something we choose to do that can increase occupational performance
17
Q
Why is leisure important to older adults?
A
Keeps them going, improves client factors (ROM, cognition) and it is time they have earned to do something they enjoy
- helps them express their identity (valued occupations)
18
Q
What are some questions to ask to evaluate an older adult’s leisure skills
A
What do you love to do? What are you passionate about? What makes you forget about the outside world?
19
Q
How can employers support older adults?
A
Working in shifts
20
Q
In late life, the number of expected roles tend to:
a. Decrease
b. Increase
c. Remain the same
d. Number of roles is not associated with age
A
a. Decrease
21
Q
Occupational value can be thought of as:
a. The individual’s assessment of the importance of the activity
b. The extent to which an occupation can be measured in economic worth
c. Recognition by society of an occupation’s contributions to the community
d. A measure of prestige imparted by participation in particular activities
A
a. The individual’s assessment of the importance of the activity
22
Q
How does one achieve positive social interactions in later life and what are some benefits?
A
Improve cognition, multigenerational can be validating
Older adults may be hesitant to receive help, try to improve connection with others
23
Q
What are some societal trends that affect late life family interactions?
A
Smaller family size, higher divorce rate, geographic mobility
24
Q
What are some common occupations or roles that older adults engage in, and what are their benefits?
A
Grandparents as babysitters, friends, neighbors
Feel important/needed- reciprocity
25
How are the rates of STDs lowered in nursing homes?
"Hotel rooms" are created, safe sex is discussed with patients (decreased inhibition)
26
What is the continuum of care?
Hospital-rehab: Acute rehab (IRF- inpatient rehab facility)
Skilled nursing facility (SNF- short term rehab)
Long term acute care (LTAC)
Home (with or without home care)
27
What is the difference between a formal and informal care network?
Formal- professional services
Informal- friends and family
28
Home Health Care
To provide support services to elders with daily living needs so they can remain at home
- administered by the EOEA (Executive Office of Elder Affairs)
- eligibility based on age (60+), financial status, and ability to do daily tasks
-rigid medicare guidelines
29
Older Americans Act
Provides funding for community-based services
30
Community-based services are used by:
a. A majority of older adults
b. About half of all older adults
c. A small proportion of older adults
d. Use varies depending on geographic location
c. A small proportion of older adults
31
Older adults typically prefer services provided by:
a. Visting nurses
b. Home health aides
c. Neighbors or church groups
d. Nuclear or extended family
d. Nuclear or extended family
32
History of Medicare
Became a law in 1965, health insurance for those 65 and over
- largest payer of healthcare services in the U.S
33
Medicare components
Part A- hospital stays, short stay at SNF, home health, hospice
Part B- supplemental insurance that covers 80% of outpatient services, office visits, and DME
- not all older adults have Part B
34
Of UK, US, and Sweden which country does not have universal healthcare?
U.S
35
Medicaid
Law that addresses health care needs of low income and older individuals
36
CMS (Centers for Medicare Services)
Change how reimbursement works and can drive how you are documenting
37
Medicare coverage for OT
- Services must be prescribed by a physician
- Services are reasonable and necessary
- Have goals that make sense for their independence at home or getting home
-Services cannot be a duplication of another discipline (PT)
38
What are the 3 factors of the Rowe and Kahn Model of Successful Aging (1998) ?
Absence of disease and disability, positive cognitive and physical function, engagement with life
39
Definition of health
A state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity (WHO)
40
Definition of health promotion
Engaging in activities that promote health, engage all populations with differing abilities
41
Definition of wellness
A multidimensional state of being, describing the existence of positive health in an individual as exemplified by quality of life and a sense of well-being
42
Definition of a preventative occupation
Promotes physical activities, lecture series about preventing falls
43
Person factors
Genetics, spirituality, and personality characteristics
44
Environment factors
Home- may present barriers such as many flights of stairs or support positive aging
Community- environmental factors support or inhibit well-being (transportation access)
45
Occupation factors
Physical activity- helps older adults maintain function and decrease risk for disease...does not have to be intense exercise
46
What are the 8 domains that determine an age-friendly city?
Outdoor spaces and building
Transportation
Housing
Social participation
Respect and social inclusion
Civic participation and employment
Communication and information
Community support and services
47
What is the definition of social determinants of health?
Conditions in which people live, including access to health care
48
Why is staying active important for older adults' participation in occupations?
Supports cognition, social connectedness, and productivity as well as physical health
-prevents cognitive decline
49
What are some health behavior change strategies for older adults?
Discussion about nutrition, exercise, managing medical conditions, and lifestyle redesign for adults moving into retirement
- health promotion programming, specific interventions such as LiFE to promote wellness
50
Focus of rehabilitation interventions
Restoration, remediation, compensation, and adaptation
51
Health education
Provides evidence to support establishment of good health practices
52
Health coaching
A client-centered approach that is based on behavior change models and uses motivational interviewing to help individuals develop and implement a plan of action to achieve goals
53
Health promotion
Emphasizes the importance of motivating people to establish health and wellness goals as a means to engage in their life passions
54
Lifestyle redesign
Focuses on educating older adults about the importance of occupation to enhance physical, mental, emotional, and spiritual health and on preparing them to be reflective about their occupational choices
55
By 2050, what percent of the population in the U.S will be 65+?
88.5 million (roughly 20% of the population)
56
Spirituality vs. religion
Spirituality- a human characteristic of being sensitive to or seeking the presence of spirit (a relationship to a higher power or meaning/purpose in life)
Religion- organized, institutionalized expression of belief and system of worship (may be a subset of spirituality)
57
Why does spirituality matter to OT?
Mind-body-spirit, experience of illness or disability raises questions of a spiritual nature, spirituality takes on a special meaning later in life
58
Religion and how it affects medical care
Some patients will state they cannot utilize medication/treatments based on their religion
- emergency situations rules can be waived, however it is always up to the individual
59
How common is depression in late life?
8.19% of older adults vs. 12.9% age 18-29
-environment plays a role...nursing homes prevalence is 35% for depression
60
(T/F) Older adult males have the highest suicide completion rate
True
61
Depression risk factors for older adults
Losing spouse/friends
Losing independence
Loss of roles
Financial burdens
Substance abuse
Terminal diagnoses
Previous suicide attempts
62
SIGECAPS symptoms
Sleep, Interest, Guilt, Energy, Concentration, Appetite, Psychomotor slowing, Suicidality
63
Prevalence of major depression in older adults
1-5%
64
Prevalence of minor depression in older adults
10%
65
Symptoms of atypical/somatic depression
Pain in stomach, headache
Sleep problems, decreased appetite
66
Difference between major depression and somatic depression
Somatic depression shows physical symptoms
67
What types of anxiety are more common in older adults?
Excessive worry, phobias, and social fears
68
Anxiety etiology
Gender, chronic medical conditions, marital status, stressful events, physical limitations, adverse childhood events
69
Somatic symptoms of anxiety
Restlessness, fatigue, body aches, insomnia, increased cardiovascular and respiratory response (symptoms can be from comorbidity disorders)
70
Bipolar disorder
65+ prevalence is low, genetic and environmental factors, greater incidence for men in 80s/90s
Treatment- antipsychotics, lithium, and aripiprazole
71
Substance abuse
Prevalent with veterans (18-29%), genetic vulnerability and environmental factors, metabolization of substances is slower in older adulthood- substance abuse occurs more easily
72
Side effects of antidepressants
Confusion, disorientation, dry mouth, urinary retention and constipation, blurred vision, sleep disturbances, nightmares, agitation, cardiovascular changes (increase in BP, HR changes)
73
Why is it important for OTs to be aware of medication side effects?
Find ways to optimize treatment for the patient when they are alert, educate them on side effects
74
Other treatment for depression that works with some patients
Electroconvulsive therapy
75
What are some examples of cardiovascular disease?
Coronary artery disease (CAD), heart rhythm (arrhythmias), congenital defects
76
What is the leading cause of death for men and women in the U.S?
Heart disease
77
What happens to the heart's pumping cycle during arrhythmia?
Atria and ventricles are not working together and become out of sync
78
Diastole
Relaxed phase of cardiac cycle when the chambers of the heart are re-filling with blood
79
Systole
Heart chambers are contracting
80
Atrial diastole
Relaxing of the atria
81
Ventricular diastole
Relaxing of the ventricles
82
Fast vs. slow heart rate
Fast- up to 300bpm, inadequate filling during diastole which reduces cardiac output
Slow- also reduces cardiac output including to the brain and heart
83
Irregular heart rate
Inefficient, can result from a heart attack, fevers, stenosis, infection, and drug toxicity
84
Myocardial infarction (MI)
Heart attack
85
Hypertension (high blood pressure)
Common, resting systolic BP >140mmHg and/or diastolic >90mmHG on repeated examination
86
High force of blood through vessels creates significant stress on the heart, increasing risk for...
CAD, MI, CVA
87
Risk factors for hypertension
family history, stress, high sodium intake, obesity, excessive alcohol intake
88
Treatment for hypertension
Medication to lower BP
Lifestyle changes
89
How does hypertension affect the kidneys?
Narrowing lumen decreases blood supply and will increase vasoconstriction
90
What is the most common cardiac related disorder?
Coronary artery disease (CAD) aka ischemic heart disease (IHD)
91
What is coronary heart disease?
Buildup of fatty, fibrous plaque in arteries that can narrow vessels over time
- occludes blood supply to heart muscle
92
CAD increases risk for...
-Angina pectoris (arteries narrow in aging, heart muscle constricts with activity causing pain in chest, left shoulder, neck, back, jaw)
-MI
-Heart failure
93
Modifiable risk factors for CAD
High cholesterol
Smoking
Inactivity
High BP
Diabetes
Weight
Stress
94
Arteriosclerosis vs. Atherosclerosis
Arterio: hardening/stiffening of vessels
Arthero: plaque that occurs
95
Complications of CAD
Ischemia, infarction, LDL, HDL
96
Disease continuum of CAD
Stenosis (narrowing), thrombosis (clot), embolus (circulating clot), aneurysm
97
What are the permanent changes in heart rate after an MI?
Without oxygen for 20 mins necrosis begins and can become scarred over, heart function compromised, will cause arrhythmias
98
How is CAD diagnosed?
Medical history, physical exam, diagnostic tests
99
Treatment for CAD
Coronary artery bypass graft (surgery to detour around blocked vessels) or percutaneous coronary intervention (coronary angioplasty with or without stent to open artery)
100
Acute coronary syndrome
Unstable angina and acute MI- irreversible damage to the heart muscles, result of coronary artery obstruction or prolonged lack of oxygen
101
How often does a heart attack occur in the U.S?
Every 43 seconds
102
Half of Americans have at least 1 of what 3 risk factors for heart disease and possibility for MI?
HTN (hypertension), high cholesterol, smoking
103
What are the 3 types of acute coronary syndrome?
-Unstable angina
-Non-ST segment elevation MI and ST segment, Elevation MI (STEMI)...determined by presence or absence of ST-segment elevation or Q waves on EKG
104
Treatment focus for MI
Minimizing complications, restoring normal function, exploration of lifestyle modifications
105
Post discharge after an MI
Cardioprotective medications, cardiac rehabilitation, ongoing dietary/lifestyle education
-Lifestyle modifications include low-fat and sodium diet, smoking cessation, and increased physical activity
106
Congestive heart failure
Heart muscle becomes stretched beyond its ability to contract resulting in fluid in lungs or extremities
107
What percent of individuals with CHF have a history of hypertension?
75%
108
(T/F) Many cases of CHF are asymptomatic, but some being with acute onset and progress to chronic
True
109
(T/F) Left-sided heart failure will lead to right-sided dysfunction
True
110
Most common symptoms of CHF
Shortness of breath, fatigue, and muscle weakness
111
What happens during CHF?
Loop/pump fails to bring blood back to heart and out of heart, decreased efficiency, causes ventricular enlargement (compensates for failed pump)
112
Left CHF symptoms
Dyspnea (difficult breathing), anxiety, paroxysmal nocturnal dyspnea, pulmonary congestion
113
Risk factors for heart failure
High BP, high blood sugar, obesity, blood clots, stroke, virus, family history, toxic meds
114
Common symptoms of heart failure
Having trouble thinking or being sleep, dizziness, weakness, unable to walk/do activities as normal, short of breath, cough, inability to lay flat, chest pain/tightness, fast heart beat, weight gain, abdomen or ankle swelling
115
Zone tool- everyday checklist
- weigh yourself in the morning before breakfast
-eat low sodium foods
-balance activity and rest
-check for swelling in ankles/stomach
-take meds
Warning Zone- gain 3 lbs in 1 day or 5 lbs in 1 week. increased swelling, difficulty breathing. dizziness
116
Peripheral vascular diseases (PVD)
Any abnormality in blood vessels outside the heart
117
Atheroma
degeneration of the walls of the arteries caused by accumulated fatty deposits and scar tissue, leading to restriction of circulation and risk of thrombosis
Most common sites: abdominal aorta and memorial/iliac arteries
118
Symptoms of PVD in the lower extremities
Pain, weakness, sensory impairment, bluish tinge
119
Complications of PVD
Amputation or gangrene
120
Age-related changes to the heart
-Collagen becomes stiffer
-Fattier muscle tissue
-Coronary artery is less elastic
-Conduction system changes, controls heart rhythm
-Vessels fill with plaque (leads to hypertension)...occlusion completely closes off the vessel
-Afib (premature ventricular contractions)
-Decreased max heart rate, myocardial contractibility, stroke rate
121
Consequences on CV function
-Reduced capacity for oxygen transport
- Activities associated with low RPE are perceived as physically demanding (more rest breaks)
122
Sternal precautions
After heart surgery there is no lifting, no pushing, no pulling
-Mostly leg muscles are used to stand rather than pushing up with arms
123
Pacemaker precautions
No lifting or pulling, no putting arms above head
-Activity on the side of the pacemaker limited for 4-6 weeks (lifting arm on that side or any activities involving large arm movements)
-Avoid devices that have electromagnetic fields (metal detectors in airport), cell phones held at least 6 inches away or on opposite side
124
Cardiac education to reduce functional impairment
Energy conservation and work simplification
-Decline in function can lead to anxiety or depression
-Increased work load can cause shortness of breath or fatigue
125
OT considerations for cardiac disease
-Maximize occupational performance
-Endurance
-ADLs and exercise
-Safety
126
What are common parameters measures during activity for individuals with heart disease?
-Heart rate
-Systolic and diastolic pressure
-Rate pressure product (perceived exertion)
-Breathing frequency
127
What percent of U.S adults have chronic lung disease (asthma or COPD)
15%
128
(T/F) Lung disease is the highest cause of mortality in the U.S
False (3rd- 5% of deaths)
129
Non communicable respiratory diseases
Asthma, restrictive lung disease
130
Factors affecting pulmonary health in elders
-Impaired oxygen transport: physical inactivity, noncommunicable diseases, cardiovascular abnormalities, sarcopenia (muscles get smaller)
-Lifestyle factors
131
COPD
-Emphysema and chronic bronchitis (airflow obstruction impacts gas exchange)
-Lungs are damaged
-Preventable but also progressive
132
COPD risk factors
Smoking, environmental pollutants, history of asthma
133
COPD and CO2 retention
-Either not getting enough oxygen or not being able to exhale enough CO2 (retention)
-CO2 builds up in blood making it difficult to breathe
-Damages alveoli in lungs
-Airways narrow, CO2 gets trapped and takes up space
-Makes COPD more difficult to manage
134
Alveoli damage in COPD
-Alveoli is where oxygen and CO2 is passed between blood and air in the lungs
-COPD there are fewer healthy alveoli and fewer places where this exchange can happen (oxygen can't get into blood, CO2 gets trapped in the lungs)
-Over time patients retain more and more CO2 and an imbalance is created between blood oxygen and CO2 levels (oxygen deprivation)
135
Ventilation-perfusion mismatch
When the body gets confused about which parts of the lungs to prioritize, reduces efficiency of gas exchange
136
Hypercapnia
When your blood CO2 gets too high
- leads to serious breathing problems and low levels of oxygen in the blood
137
Clavicular vs. diaphragmatic breathing
Clavicular- too shallow to be effective
Diaphragmatic- difficult for most patients especially when they are used to clavicular breathing
138
General symptoms of CO2 retention
-Mild headaches
-Drowsiness, fogginess, or sleepiness
-Lack of energy
-Inability to focus
-Dizziness
-Shortness of breath
139
Hypercapnia (CO2 gets too high) symptoms
-Unexplained confusion
-Abnormal muscle twitching
-Abnormal depression/paranoia
-Irregular heart beat
-Bluish tint skin or lips
-Edema in hands/feet
-Hyperventilation
-Seizures or loss of consciousness
140
Causes of CO2 retention
-Supplemental oxygen at a rate that is too high (red blood cells are dropped and CO2 replaces oxygen)...avoid this by following direct prescription...blood saturation at 90%
-Severe emphysema (lungs are enlarged and less stretchy, pushing out air is difficult and air gets trapped)
141
Treatment for COPD/CO2 retention
-Pursed-lips breathing
-Diaphragmatic breathing
-Both help empty lungs more
142
Acute respiratory distress syndrome (ARDS)
-Acute life-threatening inflammatory reaction to illness or trauma
-Around 200,000 annual causes in the U.S
143
ARDS complications
Severe pneumonia, sepsis, major trauma
-severity influenced by age, co-morbidities, and alcohol consumption
-50% of cases are fatal
144
How does inflammation hurt the lungs?
Fluid build up in alveoli, compromising gas exchange, difficulty breathing, and increased risk or respiratory failure
145
Interstitial lung disease (ILD)
Group of disorders that share similar clinical profiles
146
Characteristics of ILD
Scarring of pulmonary interstitial, includes walls of alveoli and spaces around blood vessels
-progressive lung stiffness
147
(T/F) Lung scarring is reversible
False
148
Therapists role in acute care for pulmonary disease
-Early mobilization
-Monitoring vitals with activity
-Education
-Restoration of function
-Individuals with respiratory disorders have a compromised ability to perform ADLs...teach energy conservation
