Frailty, osteoporosis, arthritis, and pain in older adults Flashcards
What is a comorbidity?
an etiologic risk factor for frailty
what is disability
an outcome of frailty
frailty differs from disability and what?
under nutrition dependence prolonged bed rest pressure ulcers gait disorders generalized weakness extreme old age weight loss anorexia fear of falling dementia hip fracture delirium confusion going outdoors infrequently polypharmacy
what’s the definition of frailty according to Fried?
Biologic syndrome of decreased reserve and resistance to stressors, resulting from cumulative declines across multiple systems, causing vulnerability to adverse outcomes
Frailty is a clinical syndrome in which ______ or more of the following criteria are present:
3
(presence of 1-2 criteria = intermediate group = 2x riske of becoming frail as compared to a non-frail subjects)
unintentional weight loss(10lbs/ 5% in the past year)
self reported exhaustion( feeling that everything is an effort or that it’s hard to get going 3/more days per week)
weaknes (grip strength in lowest 20%)[depending on BMI, cutoffs for grip were <270 kcals/activity per week)[less than 1 hour of walking at a moderate pace 2mph- depends on BMI]
frailty phenotype is predictive (over three years of):
incident of falls
worsening mobility or ADL disability
hospitalization
death
Difference between older adults and younger adults?
older adults:
- limited physiological reserve
- recovery time from an injury is usually longer
- loss of adaptive capacity
- illness and threats to homeostasis are tolerated poorly
- rapid de-conditioning with bed rest
- an acute even added to a gradual decline in function may lead to disability
low bone mass is indicated by what score?
T-score between -1.0 and -2.5
-2.5 or below is a diagnosis of osteoporosis
what’s normal bone loss?
decline by age 40
augmented osteoclast activity and diminished osteoblastic activity
estrogen deficiency accelerates rate of bone loss
men 20-30% bone loss
women 40-50% bone loss
declines about 1-1.5%/ year after peak in 25-30 yo range and declines by 3-5%/year in the first 5 years after menopause
uncontrollable factors contributing to osteoporosis:
over age 50 female menopause family history low BW/small and thin broken bones height loss
controllable factors contributing to osteoporosis
inadequate calcium and vitamin D inadequate fruits and vegetables inactive lifestyle smoking too much alcohol losing weight certain medications
primary risk factors for bone fragility
low bone mineral density
flexion-oriented body
additional contributing factors
advanced age
low body height and weight
hx of previous fragility fractures or parent with osteoporosis
current smoking
hx of glucocoricoid use
certain meds (SSRIs, anticoagulants, antiseizure meds)
RA
3 or more glasses of alcohol daily
risk factors for falls
sedentary lifestyle with inadequate bone-stimulating exercise
What is OA/DJD?
Progressive loss of hyaline cartilage of the joint
Underlying bone changes (joint space narrowing, osteophytes, bony sclerosis)
symptoms = pain swelling, stiffness (especially early morning and after prolonged rest)
spine, hips, knees, 1st CMC, 1st MTP
OA Risk Factors
heredity obesity injury joint overuse quadriceps weakness other diseases (RA, excess GH)
OA Sequelae
pain –> decreased activity –> loss of ROM deconditioning –> disability
OA Assessment Tools
- WOMAC: knee and/or hip OA, used extensively in research; self administered; assesses pain, disability and joint stiffness using a batter of 24 questions
- 6MWT
- 5 times sit to stand test (FTSST)
- arthritis self-efficacy scale
Interventions for knee OA
strengthening exercises stretching exercises ROM manual therapy HEP adherence log
types of drugs taken by individuals with arthritis
analgesics
anti-inflammatory agents
antidepressants
nonpharmacologic Tx for OA
moist heat and cold packs ADs joint taping physical therapy exercises tai chi weight loss psychosocial support for depression relaxation techniques biofeedback nutritional counseling addressing barriers to exercise
PT focus with OA
address activity limits and participation restrictions caused by the pain, weakness,and decreased ROM
increase joint stability
educate re: activity modifications to decrease biomechanical loads on joints
provide braces and ADs as needed to improve alignment and protect joints
connect pt to community resources
signs of pain in older adults with dementia
facial expressions (keeping eyes tightly closed, rapid blinking, etc)
sounds (being verbally abusive, etc)
posture (fidgeting, packing)
changes in eating/sleeping habits
increased confusion/irritability/wandering
