Geri final Flashcards
Acute care
Temple, Einstein
Stay is short
Sub acute care
Magee, SNF (Tender touch, Pheobe)
Can be residential or short term
Outpatient
Medicare PB can do at home sessions
Nova Care,
More specialized to residual effects: uq rehab, driver rehan, vision, work hardening & conditioning
Main goal of rehab in geri
Maintain independent mobility & ADLs
frailty
Age related loss of physiological reserve (how cells function)
COVID 19
Geri pop most likely to pass
-venous thrombolation: CVA
- GBS
- Fraility & multi morbidity: more likely to be effected by COVID 19
Sarcopenia
age related loss of skeletal muscle mass & strength
Acute Care
Purpose: Medically stabilize & manage
LOS: 5 1/2 days
- unnecessary days: health care infection & falls risk increased
- OT Consulted after medically stabilized
- OT/PT discharge after: independence, diagnosis, home setup & caregiver support
- OT Eval: Vital signs, cognition & vision, ROM, BADLs noting positioning of pts & attach tubes and drains
- Family present: Address & assess them, PLOF of pt
- Common conditions: CVA,TBI, CVA, pulmonary conditions requiring mechanical vent, cardiac disorders with telemetry machine, post surgical complication with resp/cardiac, systemic infections causing cardiopulmonary compromise
Transitional Care
- LOS: 45 Days
- Geri pop that needs time & treatment to recover from illness instead of making new hospital beds (low ratio of nurses)
- Must have rehab need & receive daily rehab services but no specific time required
Inpatient Rehab (IRF) aka Acute Rehab
- Pts scheduled as early as 7am for ADLs
- Pts must be recommended for services
- Might have to be transferred to diff facility
- 60% must have these dx for reimbursement: Congenital deformity, CVA, SCI, TBI, Amputations, Major multiple trauma, hip fx, burns, neuro conditions: PD & MS, arthritis, hip/knee replacement in pts with BMI > 50 or over 85 y.o
- tolerate 3 hrs of therapy for 5 days a week
- Must keep progressing or will be d/c
Acute Care/ SNF
- Searching for medically stable pts to see everyday
- More intense than other OT services
Adult Day Care
- Alt to LTC for those with physical/cog impairments
- For those who can’t be alone during day but also don’t need 24/7
Home Health
- Medicare Pt A &B
- Requirements: Under MD and POC established, need doctor certif that you need intermittent skilled nursing care, rehab therapy & home bound status
- Who can open case?: OT, PT, SL
- Who can remain in place after end of services: SW, dietician, CM, CNA
OT can complete initial eval & assessment if SLP/PT even without nursing - PCA’s and housekeeping not covered
Maintenance Care
Jimmo: Medicare beneficiaries shouldn’t be declined maintenance nursing/therapy when skilled nursing personnel must provide it
SNF Payment
PPS (perspective payment system) for SNFs (set pay per day for everything or can pay out of pocket)
OASIS (Home Health Outcome and Assessment Information Set)
- At start of care (within 48 hrs or when pt d/c home)
- At 30 days for re-eval
- For resuming care
- For d/c
PDGM (Patient Driven Grouping Models)
- OT assessment of level of assist is crucial
- Assessment results = payments of home health agency
- every 30 days for LOA via OASIS for:
UBD + LBD Dressing
Txf
Toilet Txf
Ambulation & Locomotion
Grooming
Risk for hospitalization
Acute pain
Activation of nociceptors causing inflammtory response & hyperalgesia
COPM can address pain
Hyperalgesia
Heightened sensitivity to pain
Depression is…
Common & treatable which affects mood, thoughts, bx
Symptoms range from mild to severe
Cognitive changes such as age, brain structure & chemistry can cause depression
CVD can be risk factor
True or false can age be a factor for depression
True
% of adults over 65 to meet diagnostic criteria
8.19% but most adults meet the symptoms of depression but fail to meet diagnostic criteria
High incidence of depression?
Nursing home
Depression is not a part of aging
Depression rates decrease over lifespan
True or false: cognitive declines can occur with depression
True can have decreased memory, attention, executive functioning problems
Suicide
Rate 3x higher in geri pop
highest suicide rate in men
Passive: refuse medication, tx, food
Pain OT assessment
COPM
Depression OT assessment
COPM
ACS
OT Depression Ix
CBT
cCBT: Computerized (internet based approach ie mood gym)
Depression Ix
Light Therapy (white- serotonin& blue): increases energy levels & alertness
- don’t use if bipolar disorder or agitated
Psychotherapy
Support Therapy
Eden Alternative: Aims to reduce depression with home like environments. has plants & animals
ECT: esp if hallucinations/delusions LAST RESORT IS ECT
Anti depressants- FALLS RISK
- older adults have lower dosages than young
PDGM
Patient driven grouping models
Theories for leisure
MOHO, OA, Rehab & Biomechanical
Leisure Assessments
- KELS
-KTA
-AMPS
-Barthel ADL index - RTI
- FIM
- Katz Index of ADL
- CPT
3 elements of positive leisure experience
- Motivation
- Control over one’s life
- Freedom from constraints
Retirement
Both process & life stage
Phase retirement
Gradually reducing effort & work time
Bridge employment
Changing jobs & moving to part time employment for maybe supplemental income
Increase in crashes in geri pop
70-74 increase, highest among 85+ and usually not related to alcohol but occurs at intersections
PENNDOT
20% lose driving privileges, 21% get driving restrictions
-50% of this are in geri pop
PENN DOT Hearing Requirements
For bus drivers ONLY
Certified Driver Rehab Specialist
Only one to make changes to your car
Vision requirements to drive
20/40 and less = no need for glasses
20/70 and more= glasses
Cognitive Assessments for driving
- MOCA
- MMSE
- SLUMS
- ACL
- Mini Bless Test
- Trail Making A & B
Visual Perceptual Assessments for Driving
- MVPT
- Clock drawing
- UFO
ROM, Balance, Endurance, Strength Assessment for Driving
- 6 minute walk test
- Functional reach
- 9 hole peg test
- ROM & MMT
- TUG
- BERG
- 30 sec chair test
- Arm curl test
- Rapid pace walktest
Most common type of dementia is?
Alzheimer’s disease
Reversible Dementia
Caused by thyroid disorder, UTI, elecrtolyte imbalance, hormonal imbalance, presure hydrocephalus (accumulation of CSF cause ventricles to enlarge
Major Neuro Disorder
SIGNIFICANT COG DECLINE
- Substantial impairment in cog based testing
- IADL decline at min
Mild Neuro Disorder
MODEST COG DECLINE
- Modest impairment in cog based testing
- Cog deficits don’t interfere with occupations
What is a sign of early dementia?
Difficulty completing IADLs
- Can usually complete ADLs (procedural memory) until late stages
Dementia symptoms
Decrease in
-Attention
- Orientation
- Sleep/wake cycle
- Voice production & comprehension
- Visuospatial processing
- Change in activity level
Alzheimer’s Disease
- Most common form of dementia & PROGRESSIVE
- Autopsy diagnosis only
- Plaques & tangles
- Loss of dendritic network
- Decreased production & uptake of ACH
- 5% of early onset: 30 y.o
- 50% FAD
- 4-8 year prognosis after
Alzheimer’s Stages
S1: No deficit
S2: Not notable on tests, object recall & word finding
Mild- S3: Forget appointments & loses things, diff @ work, notable on tests but tries to hide it
Moderate- S4: Forget some life history, need help with community/domestic, ask same q over and over,
S5: Can’t dress self, can’t live alone, forgets personal info like phone number, confusion
S6: 24/7 SUP, BADL help, poor facial recognition, wandering, incontinence
S7: DEP, may not be able to talk/swallow
Vascular Dementia
- 2nd most common type
- Can be progressive
- Symptoms may be similar to Alz or more localized
- Caused by insufficient blood to brain - TIA
- Risk factors: HTN, DM, 1 + strokes, Smoking
Lewey Body Dementia
- Progressive
- Basal ganglia involvement: hallucinations & PD & motor control, planning, procedural learning
- Memories may be intact @ early stages
Korskakoff
- Vit B deficiency & ETOH
- Sx: confabulation & stm problems
Frontotemporal Dementia
Sx: Behavior & personality changes, empathy, foresight, aphasia
Huntington’s Dementia
attention deficits, cognitive slowing, impaired planning and problem solving, visuoperceptual and construction deficits
Capable Model
Collab with nurses, ot to modify the home
Supine Mat Assessment Assess:
- Tilt
- Obliquity
- Rotation
- LE: Hip flexion, knee extension in hip flexion, ankle rom
- Trunk & trunk control: lordosis, kyphosis, scolosis, shoulder rotation & obliquity
- Head & neck: flexion, extension, rotation
Pelvic Obliquity
Side of pelvis is lower than other side
Pelvic rotation
Side of pelvis is more in forward than other side
Tilt
- Anterior (tight hip flexors)
- Posterior
ASIS
Anterior Superior Illiac Spine: Used for mat assessments
W.C Recommendations for Heights
Seat width: measure across and add 2 inches
Depth: measure BLE, measure from buttox to back of knees and subtract 2
Height from floor to seat: 19.5, hemi is 17.5 and super low is 14.5
What degrees of elbow flexion when hands placed at top of rim gives most efficient propulsion
Air wc cushion
Best for pressure management but requires more postural control
Gel wc
Long term w.c users for pressure relief
Honeycomb
More maintenance but good for incontinence
SNF
- Paid by medicare/private
- For rehab and/or medical needs
Custodial care
- Paid by medicaid
- Long term residential care
Rehabilitative
- Goal to transition to lower level of care after weeks- months of Ix
OBRA created MDS (minimum data set)
- MDS is performed at admission, quarterly, after change in resident’s current status and d/c
- MDS screens for problems and abilities
- MDS responses can be Care Area Triggers (CATs): info triggers
CAA (Care Area Assessments)
Further assessment, development of care plan via interdisciplinary team collab & performance of discipline specific assessments
PDPM - Patient Driven Payment Model
Sets limit of 25% of group and concurrent sessions
- Looks at LOA at beginning to d/c for payment
OT Tx
- Seating & positioning: optimizes function
- Modifying w.c.: prevents dysfunction
- Toilet txf: promotes health
Wellspring Program
For memory loss
Eden Alternative
- Has animals, plants, children
What kind of team in LTC?
Interdisciplinary
Hospice
Specialized care for individuals with terminal illness ( SERVICES CANNOT BE INITIATED)
- Pain & management
- Education
- Qualifications: 6 months or less of living & illness should be certified
- Living will
- ALS, alzheimers, ESCD, ESRD, Cancer, HIV, ESLD, ESLD, Stroke, coma
- STOPS IV FLUIDS & CHEMO
Palliative Care
- Services can be initiated at any point
- curative care ix can be used (IV, Chemo)
Physician Assisted Dying
Basically wanting to kill yourself.
