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Geriatrics > Final > Flashcards

Final Flashcards

1
Q

Pain Classifications by clinical management

A

Transient
Acute
Chronic pain due to cancer
Chronic pain due to nonmalignant diseases

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2
Q

Pain Classifications by presumed source

A

Nociceptive
Neuropathic
Mixed/unspecified
Psychiatric

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3
Q

Why does medication efficacy decrease with age?

A

Reduction in renal and hepatic clearance with age
Increased time needed for elimination of pharmaceutical agents
Elderly: increased fat mass, lower muscle mass, lower water
Start low, go slow, and follow-up

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4
Q

Psychological Support

A

Psychophysiological (biofeedback)
Behavioral approaches
Acceptance-based approaches

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5
Q

Behavioral Approaches

A

Relaxation Training
Operant conditioning
Cognitive-behavioral therapy
Acceptance-based

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6
Q

When is TENS best utilized?

A

When used during functional movements

When used at acupoint sites

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7
Q

When are thermal agents best used?

A

adding exercise to heat treatment = improved function

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8
Q

Patient Specific Functional Scale

A

Up to 3 patient selected activities

MCID: varies by diagnosis, 2-3 is reasonable

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9
Q

Brief Pain Inventory

A

Regular: 32 items
Short form: 9 items
Copyrighted, need permission to use

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10
Q

FABQ predictor for SI manipulation:

A

less than 19, increase success

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11
Q

FABQ predictor for stabilization:

A

less than 9 decrease success

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12
Q

Oswestry Low Back Disability Questionnaire

A

Self-report measure scored 0-100, higher number = greater disability
Scores 80 and over = bed-bound or exaggerating
MCID = 10

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13
Q

Hospice

A

has specific requirements, including the fact that a patient is no longer seeking curative treatments

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14
Q

Qualifications for Medicare Hospice Benefit:

A

Physician must provide certification of a terminal condition with a prognosis of less than 6 months
Patients must certify that they are no longer seeking curative measures for their condition
Patients must be entitled to Medicare Part A services (inpatient)
Begin with 2 initial 90-day periods, which can then be followed by unlimited 60-day periods as long as documentation supports continued need
A patient may revoke their hospice benefit if they decide to pursue curative measures

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15
Q

When doe hospice IDT team meetings occur?

A

These must occur at least every 2 weeks to determine any changes to the current plan of care

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16
Q

Who is founder of modern hospice movement and why?

A

Dame Cicely Saunders, MD Once a physician, she researched and took more training in pharmacology to find a way to provide continual analgesia

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17
Q

PT in hospice and palliative care:

A 
rehab light
rehab in reverse
case management
skilled maintenance
supportive care
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18
Q

Rehab light

A

Patient has multiple co-morbid items, maybe a recent treatment and long course of disease. Patient may be experiencing adverse effects of treatment interventions like chemo, surgery, or radiation.
PT might start at once weekly or every other week.
Home exercise program is important.
Progress toward goals might be very slow, but should be measurable over weeks or months.

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19
Q

Rehab in reverse

A

Utilizing skilled patient and family instruction as a person moves through the transitions from an independently mobile level to a more dependent one as the disease progresses and as strength and balance wane.
May necessitate need for use of equipment, including wheelchair, bedside commode, shower bench.
As time goes on, may need to educate family or caregiver on proper positions for comfort and skin care management
PRN visits
Problem solving functional decline

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20
Q

Case Management

A

Providing long-term, ongoing care for challenging and changing conditions.
This model is useful in palliative and hospice care, with patients that are relatively stable, but gradually declining over weeks or months

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21
Q

Skilled Maintenance

A

Under hospice rules, when activities provide for significant quality of life, they are considered skilled care.
Consultation with the IDT is important to establish a care plan that provides for the frequency needed, as well as patient and family support through the process of letting go of activities during the course of care

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22
Q

Composition

A

number of generations that make up the family and various roles that the individuals play inside and outside the family system

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23
Q

Governance process

A

the rules” inside the family; including communication, relationships, behaviors, and power

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24
Q

Organization

A

refers to interdependent subsystems or “connections” of members as well as their position within the life span

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25
Q

Resilience

A

the term used to describe the outcome and effectiveness of coping

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26
Q

What is the most important component of driving?

A

vision

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27
Q

Homebound status:

A

Required by Medicare A and B for treatment
Leaving home would be extremely difficult
Occasional excursions outside the house allowed

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28
Q

Who can collect data at start of care in home health?

A

PT, Skilled Nursing, and SLP

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29
Q

Components of OASIS

A 
Consent and emergency plan/advanced directives
Emergency Planning
Medication Reconciliation
Health Risk Screening
Home Safety Assessment
Functional Assessment and Musculoskeletal Assessment
Goal Setting
Physician Verbal Order
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30
Q

Inpatient Rehab Facilities

A

Reasonable and necessary care and significant rehab potential
Require the coordinated care of at least two therapy disciplines (PT, OT, SLP)
Required to participate in minimum of 3+ hours therapy per day, at least 5 days per week

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31
Q

Payment in IRF:

A

PPS
based on FIM scores
60% must have qualifying diagnosis

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32
Q

CMS-13

A

Stoke
Spinal cord injury
Congenital deformity
Amputation
Major multiple trauma
Fracture of femur (hip fx)
Brain injury
Neurological disorders (MS, Parkinson’s, etc)
Burns
Active, polyarticular rheumatoid arthritis, psoriatic arthritis…
Systemic vascularities with joint inflammation, resulting in significant fxnl impairment
Severe or advanced OA (Involving 2+ major weight bearing joints)
Knee or hip jt replacements (bilateral, extremely obese (BMI of 50), 85+ years old)

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33
Q

Skilled Nursing

A

PPS

RUG levels

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34
Q

Ultra High Rehab

A

720 min/ week + 1 discipline 5 days/ week + 1 discipline 3 days/ week

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35
Q

Very High Rehab

A

500 min/week + 1 discipline 5 days/ week

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36
Q

High Rehab

A

325 min/ week + 1 discipline 5 days/ week

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37
Q

Medium Rehab

A

150 min/ week + 5 days any combination of 3 rehab disciplines

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38
Q

Low Rehab

A

45 min/ week + 3 days any combination of rehab disciplines + restorative nursing 6 days/ week

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39
Q

Long Term Care:

A

Once skilled benefit is exhausted (>100 days) or when residents no longer require skilled intervention, they transition to an LTC resident.
Leading causes of LTC admission: decreased cognition, incontinence, increased falls, decreased functional status.

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40
Q

Modified Physical

Performance Test

A

test for frailty

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41
Q

Modified Physical Performance Test not frail

A

32-36

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42
Q

Modified Physical Performance Test mild frailty

A

25-32

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43
Q

Modified Physical Performance Test moderate fraility

A

17-24

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44
Q

Modified Physical Performance Test no longer independent

A

<17

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45
Q

Categories in Modified Physical Performance Test

A 
book lift
put on and off coat
pick up a penny
chair rise
turn 360
50 ft walk
one flight of stairs
four flights of stairs
progressive romberg
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46
Q

Motor Control

A

Ability to regulate or direct movements

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47
Q

Gross motor control

A

Ability to make large, general movements

Requires proper coordination and function of muscle, bones, and nerves

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48
Q

Cerebellum

A

correction of movement and coordination

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49
Q

Basal ganglia

A

selection of desired movements, initiation of movements, and inhibition of competing movements

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50
Q

Brainstem

A

postural control and basic/ gross movements

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51
Q

Motor cortex

A

planning, initiation, and direction of voluntary movements

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52
Q

Primary motor cortex

A

initiates signals that are involved in execution of movement

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53
Q

Secondary motor cortices

A

additional areas involved in motor function

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54
Q

Subconscious pathway

A

allows for subconscious control of muscle tone, balance, eye, hand, and upper limb position

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55
Q

Motor System Impairments

A 
Paresis
Abnormal tone
Fractionated movement deficits
Ataxia
hypokinesia
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56
Q

Sensory System Impairments

A

Somatosensory loss

Perceptual deficits

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57
Q

Motricity Index

A

Uses standard MMT of 3 specific UE and 3 specific LE segments
Used to assess paresis impairment
Provides a standard MMT score that is objective

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58
Q

UE segments

A

shoulder abduction, elbow flexion, pinch grip

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59
Q

LE segments

A

hip flexion, knee extension, ankle dorsiflexion

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60
Q

Age-Related Changes Muscle Changes:

A

Decline of body protein reserves
Diminished capacity to meet protein synthesis demands
Loss of muscle mass with gains in fat mass
Preferential atrophy of fast-twitch (type II) fibers

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61
Q

Protein Requirements in Elderly

A

0.8 g/kg/day protein recommended for adults
1.0 to 1.3 g/kg/day recommended for elderly
20g to 30 g per meal

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62
Q

Frail Elderly Exercise Prescription

A

3x/week
3 sets of 8-12 reps
Start 20% 1RM, progress to 80% of 1RM
No adverse events/injuries reported

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63
Q

Program 1 Consideration

A

1 RM = 50 pounds leg press
3 sets of 8, 3x/week, 10 pounds (20% 1 RM)
Total volume = 720

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64
Q

Program 2 Consideration

A

1 RM = 50 pounds leg press
3 sets of 8, 1x/week, 30 pounds (60% 1RM)
Total volume = 720

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65
Q

Chondroid:

A

cartilaginous, articular cartilage, labrum, meniscus

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66
Q

Fibrous

A

tendons and ligaments

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67
Q

Fibrous Structure Changes

A

Information on normal aging of fibrous structures limited
Fibrous structures thought to demonstrate increased stiffness and decreased elasticity with age
Animal models suggest decreased tensile strength with age

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68
Q

Bone Changes

A

Thickness and density of subchondral bone tends to decrease with age
Increased osteoclast activity and decreased osteoblast activity -> risk of osteopenia/osteoporosis
Bone’s ability to absorb load compromised with osteopenia and osteoporosis

69
Q

Stage I OA

A

doubtful
minimum disruption
10% cartilage loss

70
Q

Stage II OA

A

mild
joint space narrowing
occurrence of osteophytes
Cartilage breakdown

71
Q

Stage III OA

A

moderate
moderate joint space reduction
gaps in cartilage can expand until they reach the bone

72
Q

Stage IV OA

A

severe
joint space greatly reduced
60% of cartilage already lost
large ostephytes

73
Q

Interventions for Joint Mobility

A

Stretching
Strengthening
Manual Therapy
Therapeutic Exercise

74
Q

Age related changes in the heart

A

Increase adipose tissue
Increase collagen content
Decrease muscle cells (myocytes)
Decrease innervation/nerve conduction tissue
Decrease sympathetic modulation of HR
Results in decrease excitability, decrease cardiac output, venous return and an INCREASE in dysrhythmias.

75
Q

With the walls of the heart becoming less compliant results in:

A

Declines in Left ventricle expansion and contractility (i.e. reduced end diastole volume)
Results in decreased ejection fraction (Frank-Starling law

76
Q

Increased atrial size correlates to:

A

Left ventricular compliance
increased workload on the atria
hypertrophy of the aorta

77
Q

What is stroke volume dependent upon:

A

contractility
preload
afterload

78
Q

Factors Affecting Aerobic Activity

A

Age
Gender
Training
Physiological Make Up

79
Q

What is needed for optimum aerobic performance:

A

slow twitch muscle fibers
mitochondria
myoglobin stores

80
Q

Factors Influencing Aerobic Capacity in the Older Adult

A

deconditioning
age related physiological changes
specific pathology

81
Q

Angina Scale

A
  1. Mild, barely noticeable
  2. Moderate, bothersome
  3. Moderately severe, very uncomfortable
  4. Most severe or intense pain ever experienced
82
Q

Dyspnea Scale

A
  1. Light, barely noticeable
  2. Moderate, bothersome
  3. Moderately severe, very uncomfortable
  4. Most severe or intense dyspnea ever experienced
83
Q

Claudication Scale

A
  1. Definite discomfort or pain, but only at initial or modest levels (established, but minimal)
  2. Moderate discomfort or pain from which the patient’s attention can be diverted (e.g., by conversation)
  3. Intense pain (short of grade 4) from which the patient’s attention cannot be diverted
  4. Excruciating and unbearable pain
84
Q

Forward Head Posture

A

Tight suboccipitals
Weak cervical flexors
Head is in front of line of gravity

85
Q

When do height changed start to occur?

A

around age 45

86
Q

Height changes per year

A

Decrease of ~0.1% per year in women and ~0.02% in men&raquo_space; 2” lost over a lifetime

87
Q

Therapeutic Exercise to correct postural faults

A

Core strengthening
Extremity postural exercise
Specific stretches for trunk and extremities
Conditioning and endurance exercise

88
Q

Major Depressive Episode (at least 5+ sx present during 2 wk period

A

Depressed (sad) mood
Markedly diminished interest or pleasure in all, or most, 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 plan

89
Q

Two Very Effective Questions to screen for depression in clinical setting

A

Over the past two weeks, have you ever felt down, depressed or hopeless?”
“Have you felt little interest or pleasure in doing things?”

90
Q

Models of Depression

A

Cognitive model
Learned-Helpless Model
Interpersonal Model
Neurobiological Model

91
Q

Cognitive Model

A

Based on empirical observation
Correlation between negative feelings of self and depression
Set goals

92
Q

Learned-Helplessness Model

A

Tends to be seen in patients who are pessimists

Neglect healthful behaviors

93
Q

Interpersonal Model

A

Overdependence on others + loss or negative life event

Caring for spouse who was previously/ currently abusive

94
Q

Neurobiological Model

A

Changes in speech, motility, and cognition
Disturbance of neurotransmitters, especially serotonin
A lot of the medications for depression are based on this model

95
Q

Clues to Identifying Depression in the Older Adult

A 
Unexplained or aggravated aches and pains
Hopelessness
Helplessness
Anxiety and worries
Memory problems
Weight loss
Loss of feeling of pleasure
Slowed movement
Irritability
Lack of interest in personal care
Tiredness, listlessness
96
Q

Common Mistakes in Working with a Patient with Dementia

A

Don’t assume that everything that you see is the result of their dementia
Don’t discount the person’s opinion
Don’t rely just on verbal communication
Don’t provide too much information – small steps

97
Q

Polypharmacy

A

Excessive or inappropriate use of medication
5+ medications
Vicious cycle

98
Q

Altered gastrointestinal function (absorption) due to:

A

Decreased gastric acid
decreased stomach emptying
decreased absorbing area
decreased motility

99
Q

Distribution altered due to

A

Decreased body water
decreased lean body mass
decreased plasma protein
increased body fat

100
Q

Hepatic metabolism altered due to

A

decreased liver mass
decreased liver blood flow
decrease enzyme activity

101
Q

Renal excretion altered due to

A

decrease kidney mass
decrease kidney blood flow
decrease tubular function in nephron

102
Q

Pharmacodynamics

A

Study of how the drug affects the body

103
Q

Absolute exercise contraindication

A

unstable angina
uncontrolled cardiac dyrhythmias causing symptoms of hemodynamic compromise
uncontrolled symptomatic heart failure
acute or suspected major cardiovascular event
acute infection
Change in ECG suggestive of MI

104
Q

Relative exercise contraindication

A 
known cardiac disease
severe arterial hypertension
tachydysrhythmia or bradydysrhythmia
electrolyte abnormalities
uncontrolled metabolic disease
chronic infectious disease
mental or physical impairment
105
Q

Absolute indications for terminating exercise

A 
drop in systolic BO of 10mmHg
moderately severe agina
increasing nervous symptoms 
signs of poor perfusion
subject's desire to stop
monitor equipment
ST elevation
sustained ventricular tachycardia
106
Q

Mini Mental State Exam

A

MDC – 5 point change over 5-10 year period

107
Q

Mini Mental State Exam no impairment

A

< 24

108
Q

Mini Mental State Exam mild impairment

A

18-23

109
Q

Mini Mental State Exam severe impairment

A

<17

110
Q

Geriatric Depression Scale normal

A

0-4

111
Q

Geriatric Depression Scale mild depression

A

5-8

112
Q

Geriatric Depression Scale moderate depression

A

9-11

113
Q

Geriatric Depression Scale severe depression

A

12-15

114
Q

Clock Drawing Test

A

can score as incorrect vs. correct or on a scale from 1-10

< 3-5: cut-off score

115
Q

TUG cutoff risk for falls for community

A

> 13.5 seconds

116
Q

10 meter walk test cut off for community ambulators

A

0.8 m/sec

117
Q

5 time sit to stand fall risk cut off

A

15 seconds or greater

118
Q

Activities Balance Confidence Scale

A

80% or above no risk of fall, 50-80% greater risk for falls

119
Q

6 minute walk test MCID

A

50 meters

120
Q

Mobility disability:

A

Defined as the inability to walk a ¼ mile or climb a flight of stairs

121
Q

Slippery Slope

A

Fun
Function
Frailty
Failure

122
Q

Most important predictor of subsequent institutionalization :

A

leg strength

123
Q

Overload

A

If too much stress is placed on a tissue, then it is susceptible to injury or even death

124
Q

Underload

A

If too little stress is placed on a tissue, then the tissue loses its ability to adapt to stresses; it atrophies

125
Q

ACSM Guidelines Strength

A

60-70% of 1 RM for novice
80-100% of 1RM for advanced
1-3 sets 8-12 reps for novice
2-6 sets 1-8 reps for advanced

126
Q

ACSM Guidelines Power

A

Light load preferred, 0-60% of 1RM

1-3 sets of 3-6 reps

127
Q

ACSM Guidelines Frequency

A

Novice: 2-3 days/week
Advanced: 4-6 days/week

128
Q

Exercise older adults need:

A

2 hours and 30 minutes (150 minutes) of moderate-intensity aerobic activity (i.e., brisk walking) every week AND weight training: muscle-strengthening activities on 2 or more days a week that work all major muscle groups (legs, hips, back, abdomen, chest, shoulders, and arms)…
OR
1 hour and 15 minutes (75 minutes) of vigorous-intensity aerobic activity (i.e., jogging or running) every week AND weight training: muscle-strengthening activities on 2 or more days a week that work all major muscle groups …
OR
An equivalent mix of moderate- and vigorous-intensity aerobic activity AND weight training: muscle-strengthening activities on 2 or more days a week that work all major muscle groups

129
Q

Adult learners require

A

Choice – provide options
Voice – listen to their needs
Relevance – connect learning to valued interests
Ownership – work collaboratively on goal setting

130
Q

Age Changes in Motivation

A

Self regulation
positive emphasis
stronger adherence to behavior changes
positive self concept

131
Q

Self regulation

A

greater ability to control thoughts, emotions, behaviors with age

132
Q

Positive emphasis:

A

elderly respond better to emphasizing positive and short-term outcomes

133
Q

Stronger adherence to behavior change

A

elderly slower to initiate change but more likely to adhere to changes

134
Q

Positive self-concept

A

elderly less likely to conceptualize selves as personally deficient

135
Q

Transtheoretical Model of Change

A 
Precontemplation
Contemplation
Preparation
Action
Maintenance
Termination
136
Q

Precontemplation

A

Individual has no intention to take action within next 6 months

137
Q

Contemplation

A

Individuals intends to take action within the next 6 months but has not made a commitment to action

138
Q

Preparation

A

Individual intends to take action within the next 30 days and has taken behavioral steps in this direction

139
Q

Action

A

Individual changes overt behavior for less than 6 months

140
Q

Maintenance

A

Individual has changed behavior for more than 6 months and prevents relapse

141
Q

Termination

A

Individual has no temptation to relapse

142
Q

Who is the senior athlete?

A

Former competitive athletes
Lifelong athletes, “sports people”
Nonathletes that start exercising later in life (after 40)

143
Q

Young-old

A

65-74 years

144
Q

Old

A

75-84

145
Q

Old-old

A

85-99

146
Q

Bone/joint changes with age

A

Deterioration of joint surfaces
Breakdown of collagen fibers
Decrease in viscosity of synovial fluid
= loss of flexibility and increase in joint stiffness

147
Q

Muscular system changed with age

A

Decrease in size, number and type of muscle fibers, especially type II.
Change in percentage of type 1 predominant amounts to relative increase in endurance and decrease in force production/power, especially in women, especially in UE

148
Q

Macrotrauma

A

Fewer collision injuries
More likely to avulse muscle/bone than strain muscle or rupture ligament
Time needed for recovery can be devastating to senior athlete

149
Q

Microtrauma

A

Elderly more susceptible due to:
Stiffer collagen
Arthritic changes in WB joints
Lower muscle mass/shock absorption

150
Q

Domains of Wellness

A

Physical
Psychological
Social

151
Q

Exercise benefits

A

Reduce bone density loss (if WB)
Counteract loss of lean muscle mass/strength loss
Improve flexibility
Improve body composition

152
Q

Emotional wellness

A

sense of well-being, ability to cope with ups and downs

153
Q

Spiritual wellness

A

provides meaning and connects oneself to something greater

154
Q

Intellectual wellness

A

ability to learn, self-efficacy

155
Q

Psychological Wellness

A

emotional
spiritual
intellectual

156
Q

Fall Risk Assessment Recommendations

A

Use of structured note template
Recommend home safety evaluations
Increase attention to high risk medications
Use STEADI materials
Increase public health messaging about falls and preventability

157
Q

STEADI recommendation

A 
lower body weakness
difficulties with gait and balance
use of psychoactive meds
postural dizziness
poor vision
problems with feet/shoes
home hazards
158
Q

Typical Gait Changes in Older Adults

A

Decreased gait speed
Decreased step or stride length
Increased stance time and double-limb support time
Increased variability of gait (step or stride time, length, width, frequency, or velocity)
Decreased excursion of movement at hip, knee, and ankle

159
Q

Stance time during gait

A

60%

160
Q

Swing time during gait

A

40%

161
Q

Hip ROM requirements for gait

A

30 degrees flexion to 10 degrees extension

162
Q

Knee ROM requirements for gait

A

0 to 60 degrees flexion

163
Q

Ankle ROM requirements for gait

A

20 degrees plantarflexion to 10 degrees dorsiflexion

164
Q

What percentages of people over the age of 65 fall yearly?

A

1/3

half of these fall multiple times

165
Q

What does self selected gait speed correlate with?

A

with life expectancy in elderly

Slow gait more correlated with future emergence of dementia than subjective cognitive impairment

166
Q

Successful aging

A

Absence of disease
High cognitive and physical functioning
Active engagement with life

167
Q

Usual aging

A

Suboptimal

Chronic health problems

168
Q

Frailty

A

Weight loss: 10 pounds or more over year (unintentional)
Self-reported exhaustion 3 or more days/week
Grip strength lowest 20% (<23 pounds women, <32 pounds men)
Walking speed lowest 20% (<0.8 m/s)
Activity lowest 20% (<270 kcal/wk women, <383 kcal/wk men); sitting/lying most of day
3 of 5 meets clinical criteria for frailty

Geriatrics (17 decks)

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