Geriatrics

Question 1

Understand the age-related changes of the musculoskeletal system

Answer 1

Decline in structure/function, impaired maintained system

Bone mineral content decreases, less muscle mass/fibers, less joint cartilage, and more fat

Slow down, lose height, more stiffness, less strength

Aging isn’t everything

Question 2

Understand the implications of falls in the elderly and how to assess fall risk in the clinical setting

Answer 2

Do not have to fall onto floor or result in injury
Falls are very costly and common and preventable
Assess with history and med review

TUG test – walk 3 meters and sit back down

5 times sit to stand, do not allow them to use their arms and do controlled sits

Question 3

Know how to identify frailty in older adults

Answer 3

Frailty – unintentional weight loss, exhausted, slow, low activity, weakness (grip), need 3 of these

Question 4

Determine an individuals need for an assistive device

Answer 4

Weight bearing status – as tolerated, partial, toe-touch, non-weight bearing
Canes, walkers, rollator has seat and brakes, shoe lifts, braces
How many extremities need weight bearing and how frequently is it needed

Question 5

Know screening, diagnosis and treatment of osteoporosis

Answer 5

Reduced bone quality, decreased strength, increased fractures, asymptomatic without fracture

Bone mass decrease

Screen women older than 65, women younger than 65 with increased risk (frax tool)

Screening males is insufficient

Screen with DXA scan (density readings of femur and spine), US or CT less common

Diagnose with T score of -2.5 or lower, -1 to -2.5 is osteopenia

Treat with calcium and vitamin D, non-pharmacological with exercise, can’t be low impact,
* antiresorptive agents (bisphosphonates “dronate” [contraindicate renal impairment and severe GERD, inhibit osteoclast] and monoclonal antibodies)
* anabolic agents (teriparatide [stimulate osteoblast, do not use if have Paget] or raloxifene or estrogen for drugs