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Special Clientele > Geriatrics > Flashcards

Geriatrics Flashcards

1
Q

Demographics for geriatrics

A 
65+ accounts for 13% population
85+ accounts for 4% population by 2050
women live longer than men
2% ages 65-74 in nursing home
20% 85+ in nursing home
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2
Q

Why are women prone to poverty in old age

A

low wages
fringe benefits
interrupted careers
reduction in benefits when they become widowed

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3
Q

3 most common causes of death in elderly

A

heart disease
cancer
stroke

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4
Q

Chronic disease statistics

A

more than 50% males and 70% females over 80 have 2+ chronic conditions

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5
Q

Most common self reported chronic diseases

A 
arthritis
HTN
diabetes
hearing impairments
heart disease
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6
Q

Common causes of disability

A 
cardiovascular disease
diabetes
obesity
stroke
hip fractures
osteoarthritis
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7
Q

Recovery statistics after hip fracture

A

more recovery of walking/ADL occurred within 6 months.

Poor recovery associated with old age, pre-fracture dependency, longer hospital stay, dementia, etc.

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8
Q

Intense rehab program for stroke pt statistics

A

improvement in weight shifting, balance, and ADL ability 1 year post stroke.

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9
Q

Psychosocial factors that can modify disability

A 
income
smoking
social isolation
depression
education
alcohol use
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10
Q

Decline in physical fx caused by

A

reduced physical activity.

can possibly reversed by exercise

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11
Q

Cardiovascular aging changes

A

ADL ability to depends on cardio system
physiological capacity and reserve are reduced
Older=closer to maximum limit

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12
Q

Structural changes in myocardium, conduction system, and endocardium

A

Result in reduction of heart’s pumping capacity

1 degree in L ventricle

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13
Q

Arterial vessels lose elasticity resulting in:

A

chronic increase in vessel diameter and vessel wall rigidity.
Increased resistance to blood leaving L ventricle=increase afterload
(doesn’t pump as much blood out)

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14
Q

Accumulation of lipids in arteries results in:

A

impedance of blood flow

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15
Q

Walls of veins become thicker resulting in:

A

valves become stiff and incompetent

increased risk of phlebitis and thrombus (blood clot) formation

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16
Q

Stroke volume and CO at rest is

A

unchanged

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17
Q

Maximum heart rate raises or lowers with age?

A

lowers

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18
Q

Aging on systolic and diastolic BP

A

Systolic BP tends to increase with age

Diastolic BP increases until ~60 and then stabilizes or falls

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19
Q

Structural changes in skeletal muscle with aging

A 
Muscle mass is reduced
mm fiber and size are reduced
Type 2 mm fibers reduced (fast twitch)
less precise grading/control of mm force (decrease in motor units)
Diameter of motor axons reduced
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20
Q

How much reduction in maximal isometric strength by 7th and 8th decade?

A

20-40%

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21
Q

Loss of extremity strength is greatest in:

A

LE mm strength loss is greater than loss of arm mm strength

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22
Q

Power

A

Reduced by 20%

Ability to respond quickly decreases

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23
Q

Two types of immobility

A

acute/accidental:accident/illness

chronic: long standing problem

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24
Q

Deconditioning

A

multiple changes in organ system physiology that are induced by inactivity and reversed by activity

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25
Q

Degree of deconditioning depends on

A

degree of inactivity

prior level of fitness

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26
Q

Acute changes associated with immobility

A 
distortion of time perception
decrements in intellectual tests
mood changes
balance
increase resting HR
greater increase in HR and BP at submaximal activity levels
lower maximal O2 uptake
loss of lean body mass
accelerated bone erosion
decrease in joint ROM
constipation
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27
Q

Chronic changes associated with immobility

A 
poor sense of well being
balance
prolonged reaction time
increase resting HR
greater increase in HR and BP at submaximal activity (moreso than acute)
lower maximal O2 uptake (more than acute does)
loss of lean body mass
accelerated bone erosion
decrease in joint ROM
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28
Q

Why are PROM and AAROM important?

A

exercise reverses physiological changes of inactivity

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29
Q

Causes for falls

A

hip weakness
poor balance
postural sway
exercise training is important to prevent falls!

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30
Q

Effects of aerobic exercise

A

extent of change depends on baseline fitness level
changes occur in both skeletal and cardiac mm
Glucose tolerance improves

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31
Q

Exercise interventions for geriatrics

A

should contain aerobic and resistance training

Resistance can cause elevated BP, but if proper technique is used it should be minimal

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32
Q

Risk of sudden death

A

Occurring either during activity or 1 hour after is most serious but least commong.

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33
Q

Risk of Injury

A

Due to 1 degree of overuse
ankle most likely to be injured
lower rates are associated with low impact exercise

34
Q

Risk of stimulating arthritis

A

OA affects 85% of population
inactivity may promote OA
weight bearing may prevent OA by improving mm strength and increasing bone density and reducing obesity

35
Q

Dietary risks

A

May need to increase dietary protein than when younger

36
Q

Changes in periarticular tissue (PCT with age

A

(Ligaments, joint capsule, aponeurosis, tendon, muscle, and skin)
Increased stiffness of PCT
mobility is severely compromised in tissue

37
Q

Changes in elastin with age

A

elastin is designed for mobility
returns to shape after deformation
reduces with age

38
Q

Predominance of collage with old age

A

designed for immobility
excellent tolerance to tensile forces
no tolerance to compression forces
INCREASES with age

39
Q

What is hyaluronic acid

A

naturally occurs in humans for joint and eye lubrication

decreases with age

40
Q

What is fibrin?

A

protein involved in clotting of blood
forms a mesh
increases with age

41
Q

Aging effects on stretch

A

loss of elastin= loss of ability to respond over time to prolonged stretch.
Does not respond well to large force
Oscillations are best way to increase ROM

42
Q

What happens to hyaline cartilage with age?

A

dehydrates and splits into fragments resulting in decreased ability to tolerate compression and tensile forces

43
Q

Arthrokinetics for elderly

A

older joints have subtle decrease in angular velocity and displacement due to structural and sensorimotor changes.

44
Q

Standing normal ROM of hips (line of gravity)

A

line of gravity falls just post. to axis for flex/ext.

Is balanced by natural stiffness in the taut iliofemoral ligament

45
Q

Line of gravity with hip flexion contracture

A

Line of gravity falls just anterior to the axis for flex/ext.
Must be countered by hip extensor mm
Lumbar spine hyperextension and knee flex. occur to help trunk and pelvis

46
Q

Senile kyphosis

A

common in elderly
can cause external gravitational torque on spine with increases intervertebral joint forces
They use increased back extensor mm force to hold head and trunk up

47
Q

Senile kyphosis can result in:

A 
arthritic changes
compression fx
disc injury
loss of height
bony remodeling
48
Q

Sensorimotor changes in brain

A

subtle deterioration of executive order fx

49
Q

Sensory changes in visual acuity

A

Visual acuity (seeing fine details) decreases gradually before the 6th decade
Increases rapidly from 60-80
Affects ability to read

50
Q

Presbyopia

A

Difficulty focusing on near object

Most common vision problem in elderly

51
Q

Color discrimination in elderly

A

Difficulty identifying blues and greens

52
Q

Changes in ocular motor systems

A 
convergence difficulty
ptosis (drooping eyelids)
decreased smooth pursuit
saccades (fast eye movements)
optokinetic nystagmus
53
Q

When is fx impairment to hearing typically seen?

A

70 years old

54
Q

Presbycusis

A

age related decline in auditory fx
gradual loss of bilateral hearing loss
Lose high frequency tones first, then the rest

55
Q

Presbyastasis

A

age related disequilibrium when no other pathological condition is seen.

May result in vertigo, nystagmus, and postural imbalance.

56
Q

Hyposmia

A

diminished sensitivity to smell

57
Q

Hypogeusia

A

diminished sensitivity to tast

58
Q

What is Somatosensory system?

A

Multiple systems for reception and processing

Proprioception declines and LE is more affected than upper

59
Q

Paucity

A

small movements
hesitant and slow movements
delays

60
Q

What happens to control of muscular forces output?

A

less precisely graded

increased cocontraction of paired antagonist muscles

61
Q

Postural changes that occur due to somatosensory changes

A

forward head increases
upper thoracic kyphosis increases
overall height decreases (falling arches, reduced intervertebral disc hydration)

62
Q

Balance

A

rapid movements=loss of balance
Lateral stability is more affected
healthy elderly can maintain bilateral standing balance for 30 seconds w/open or closed eyes

63
Q

Gait changes

A 
step length decline
Time in double support increases
speed decreases
ankle motion decreases
BOS increases
decreased pelvic rotation
increased should. extension
increased toeing out
64
Q

How can gait changes be improved?

A

exercise and physical activity

65
Q

Aging associated cognitive decline (AACD)

A

Gradual cognitive decline for at least 6 months

Has to result in one standard deviation below age and education norms

66
Q

Age-associated memory impairment (AAMI)

A

Memory loss in elderly not sufficient to warrant diagnosis for dementia
One standard deviation below norms

67
Q

Benign senescent (age related causes) forgetfulness (BSF)

A

Term for memory loss associated with normal older person

Not severe enough to interfere with ADLs

68
Q

Fluid Intelligence

A

involves capacity to use unique kinds of thinking to solve unfamiliar problems and is believed to decline wit age

69
Q

Crystal Intelligence

A

acquired through education and acculturation and remains stable through age 70

70
Q

What is executive functioning?

A

Complex behavior comprised of memory, cognitive planning, initiating activity

71
Q

Effects of aerobic exercise on cognition

A

aerobic exercise leads to increased cardiorespiratory fitness–>Increased max 02 uptake

72
Q

Exercise has greatest effects on what?

A

motor function
auditory attention
memory

73
Q

Exercise has moderate effects on what?

A

cognitive speed

visual attention

74
Q

What is dementia?

A

Group of disorders characterized by multiple cognitive defects.
Impairment of short/long term memory, abstract thinking, judgement,
Interferes with daily life and relationships

75
Q

Alzheimer’s type of dementia account for how much?

A

60% of those with dementia
Diagnosis made post mortem (brain tissue autopsy)
Memory impairment, aphasia, apraxia, disturbance in executive function

76
Q

Multi-infarct dementia

A

organic mental disorder

result of infarcts that produce loss of brain tissue

77
Q

Signs/symptoms of multi-infarct dementia

A

Problems with memory, abstract thinking, impulse control, personality, emotional lability

78
Q

Reversible dementia

A

10-30% of those with dementia can be treated to correct a metabolic or structural condition

79
Q

Pseudodementia

A

dementia behavior that is the result of major depressive episode
Psychomotor retardation, disinterest, memory impairment

80
Q

Anxiety

A

Common in elderly
can be present in early stage dementia
can be caused by pulmonary embolus, COPD, alcohol withdrawal

81
Q

Coping behavior

A

depends on personality

no evidence that coping ability declines with age

82
Q

Treatment methods

A 
similar to TBI
simple commands
sensory cues
rest breaks
stay positive
use fx activities rather than exercise programs

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