geriatrics (1 + 2) Flashcards
what percent of people over 65 are in nursing homes
4%
____ is associated with earlier death (7.5 years), poorer physical and mental health, and poor health behaviors
ageism
what is ageism
stereotyping, prejudice and discrimination based on age
in 2020, people 65 and over comprised of ___% of the population in the US
20%
for every 100 women between the ages of 65-74, there are ___ men
86
___% of people over 85 live in long term care facilities
15%
primary aging
inevitable
affects all systems
secondary aging
caused by lifestyle, environment, and disease
____% to ____% muscle loss per decade after 50
12-15%
neuromuscular red flags in aging
confusion, seizures, sudden incontinence, gait abnormalities, loss of conciousness
what is the #1 cause of death in the US in older populations
heart disease
VO2 max declines __% per decade after 20
10%
cataracts
clouding of lens due to protein buildup
cataracts occur in ___% of 75 year olds
70%
glaucoma
loss of peripheral vision
macular degeneration
loss of clarity at center of visual field
retinopathy
damaged blood vessels in eyes
integumentary system makes up __% of our body weight
15%
what is the largest organ in the body
skin
a pressure sore can develop within how many hours
2 hours
how is long term memory and procedural memory affected by age
it isn’t! these are relatively stable
mild cognitive impairment (MCI) affects ___% of people age 65-74, and __% of people age 85+
19%
38%
mild cognitive impairment increases risk for
alzheimer’s
what is the most common form of dementia
alzheimer’s
delirium vs dementia
delirium is SUDDEN change of mental function whereas dementia happens over time
what are some symptoms of delirium
UTI
dehydration
hospitalization
drug interactions
what is the most common mental health condition in people over 65
depression
__% to __% of the older population has depression
11-16%
PHQ-2
2 question screening tool to identify depression
what are the 2 questions on the PHQ-2
- have you ever felt down, depressed, or hopeless
- have you felt little interest or pleasure in doing things?
a score of 3 or higher on the PHQ-2 indicates…
likelihood of major depressive disorder
cancer incidence has increased by __% in older adults in the last 30 years
26%
__x more likelihood of developing cancer as an older adult than younger
11x
African-Americans, American Indians, and Pacific Islanders are more susceptible to…
type 2 diabetes
what are the 4 degrees of frailty
- fit
- mild frailty (prefrail)
- moderate frailty
- severe frailty (end stage)
what are the 3 main risks of developing a stroke
- age
- high blood pressure
- diabetes
__% of women 65+ have had a UTI within 12 months
10%
4 things to look for in potential stroke patients
face
arms
speech
time
what type of infection can mimic dementia symptoms
UTIs
how many times more likely are primary older adults to have pneumonia
4x
how many times more likely are primary older adults to be hospitalized from pneumonia
5x
what is the second leading cause of hospital acquired infection
pneumonia
pneumonia occurs in __% to __% of all hospital admissions
8-10%
pneumonia leads to__% of all diagnosis of sepsis
50%
what % of people die from pneumonia
33%
bone density score of osteoporosis
< -2.5 s.d. below 0
bone density score of osteopenia
<-1 s.d. below 0
what age is peak bone density
30
t/f: MCI interferes with ADLs
false
it reduces the person’s capabilities compared to others in their age group/education level, but ADLs remain
4 atypical changes due to aging
mood changes
visuospatial changes
memory changes
communication difficulties
what type of condition has an inverse relationship with education
mild cognitive impairment (MCI)
PHQ-2
screening tool to identify depression in patients
what score on the PHQ-2 indicates a likelihood of major depressive disorder
3 or higher (out of 6 points total)
what is the highest cause of geriatric mortality
heart disease
polypharmacy
excesive or inappropriate use of medications
adults over 65 purchase over __% of all prescription medications
30%
___% of older people take at least 1 unnecessary drug
50%
average older adult takes ___ medications.
average nursing home resident takes ___ medications
5 meds
7 meds
how does aging affect absorption of drugs
decreased gastric acid
decreased stomach emptying
decreased gastric motility
how does aging affect distribution of drugs
decreased body water
increased body fat
decreased plasma proteins
decreased lean body mass
how does aging affect metabolism of drugs
decreased liver mass
decreased blood flow to liver
decreased enzyme activity
how does aging affect excretion of drugs
decreased kidney mass
decreased blood flow to kidneys
decreased nephron function
what 4 medications are most commonly overprescribed
laxatives
Blood pressure meds
Diuretics
Diabetes meds
what drugs could cause CONFUSION symptoms in older adults
antidepressants
analgesics
lithium
what drugs could cause DEPRESSIVE symptoms in older adults
barbiturates
antihypertensives
what drugs could cause FATIGUE/WEAKNESS symptoms in older adults
diuretics
glucocorticoids
what drugs could cause GI symptoms in older adults
NSAIDS
what is the key way of preventing polypharmacy
patient education
___% of people over the age of 65 reported at least ___ fall(s) in a year
29%
1 fall/year
medical treatment for falls cost more than ______ each year
$50 billion
what is the leading cause of death or hospitalization form injury in older adults
falls
3 medications that increase risk of falls
benzodiazepine
diuretics
sedatives
what is the cut-off speed for community ambulation
0.8m/s
what is the walking speed for independent ADLs
1-1.5 m/s
household walker speed
0-0.4 m/s
what sensory systems are involved with balance training
somatosensory
vestibular
visual
2 endurance tests to measure fall risk
6 min walk test
2 min step test
5 balance tests to measure fall risk
berg balance scale
sharpened romberg
4 square step test
functional reach test
miniBEST
4 functional tests to measure fall risk
5x sit to stands
30s sit to stands
TUG test
10m walk test
cut off time for fall risk TUG test? what about for community dwelling adults?
13.5s
8.5s for community dwelling adults
cut off time for fall risk on 5x sit to stand
11.4s
cut off score for fall risk on BERG
45/56
5 types of disabilities
ambulation
cognitive
visual
hearing
medical
define disability
mental or physical impairment that limits major activities in life in one or more ways
what % of people over 65 have a disability
34%
what is the most prevalent disability amongst the geriatric population?
What % of people 65 and older have this disability?
ambulatory
21%
ADL’s vs IADL’s
basic day to day activities (bathing, dressing, eating, etc)
vs
help you stay living INDEPENDENTLY FUNCTIONAL (shopping, cooking, cleaning, etc)
medicare
for 65+ or people disabilities
(AID the poor vs CARE for the elderly)
medicaid
low income
pregnant/responsible for minor
people with disabilities
(AID the poor vs CARE for the elderly)
required ambulation distance for discharging an older patient for INDEPENDENT living
400m
required gait speed for discharging an older patient for INDEPENDENT living
1.2 m/s
what is the required weight of being able to carry an object (like a gallon of milk) for discharging an older patient for INDEPENDENT living
8 lbs
what 3 terrains are patients required to walk on comfortably for discharging an older patient for INDEPENDENT living
carpet
grass
uneven surfaces
patient in an IPR facility will have ___ hours of therapy per day
3 hours
what is an SNF
skilled nursing facility
what is the functional capacity of an individual discharged to home health
limited ambulation for community but is safe to be at home and is functional
what does a typical patient present as in LTAC
high complexity of medical needs
poorer prognosis
less need for skilled therapy
what does palliative care address
psychological
social
spiritual
what does hospice care address
end of life care for terminal illnesses
aims to manage pain and symptoms
what is the life expectancy for people in hospice care
6 months or less
what type of illnesses do patients have in palliative care
chronic and serious illness
(not quite terminal illness or it would be hospice care)
what facility would a patient be put in if they are unable to participate in 3 hours of PT a day and are moderately functional
skilled nursing facility
advanced care directives
allows individuals to identify their preferences for care when they are unable to do so themselves
MOLST/POLST
Medical/Physician orders for life sustaining treatment
power of attorney
appoints an individual to make decisions on one’s behalf
adults lose as much as __% of their strength between ages 60-90
40%
what is a good exercise option for aerobic and strength training for patients who cannot tolerate weight bearing well
aquatic exercise
Aerobic FITT recommendations for geriatric populations
F: 5-7 days/week
I: moderate tp vigorous
T: 20-30 min/day for 150+ min/week
T: prolonged, rhythmic activity
strengthening FITT recommendations for geriatric populations
F: 2-3 days/week
I: moderate to vigorous (60-80% 1RM)
T: n/a
T: 2-4 sets of 8-12 reps (major muscle groups)
flexibility FITT recommendations for geriatric populations
Frequency: 2-3+ days/week
Intensity: to feeling of tightness or slight discomfort
Time: hold 60 seconds 2-4 reps
Type: major muscle groups
frequency + time geriatric population should work on balance exercises
3+ days/week
2hr/week
5 neurological diseases that increase with age
stroke
dementia
epilepsy
ALS
parkinson’s
t/f: difficulty learning new things is part of typical aging
true!
however, long term memory stays STABLE
