geriatrics 2 Flashcards
polypharmacy
the excessive and inappropriate use of medications
adults over __ purchase __% of all prescription medications
65yrs, 30%
older adults are ______ to experience adverse drug reactions (ADR’s)
more likely
___ of older people take at least one unnecessary drug
half
average older adults take at least _ medications
5
average nursing home residents take _ medications
7
characteristics of polypharmacy in older adults
- use of medications for no apparent reason
- use of duplicate medications
- concurrent use of interacting medications
- use of contraindicated drugs
- use of inappropriate dosage
- use of drug therapy to treat adverse drug reactions
Pharmacokinetics of aging, absorption
- decreased gastric acid
- decreased stomach emptying
- decreased gastric motility
Pharmacokinetics of aging, distribution
- decreased body H2O
- increased body fat
- decreased plasma proteins
- decreased lean body mass
Pharmacokinetics of aging, metabolism
- decreased liver mass
- decreased blood flow to liver
- decreased enzyme activity
Pharmacokinetics of aging, excretion
- decreased kidney mass
- decreased blood flow to kidneys
- decreased to nephron function
most commonly overprescribed medications (for older adults)
- laxatives
- BP meds
- diuretics
- diabetes drugs
common side effect of NSAIDs
GI symptoms
common side effect of opiods
sedation
common side effect of antidepressants, analgesics, lithium
confusion
common side effect of barbiturates, antihypertensives
depression
common side effect of antihypertensives
orthostatic hypotension
common side effect of diuretics and glucocorticoids
fatigue/weakness
Prevention of polypharmacy
review pts medication lists
- contraindications?
- dosage?
- pt education?
- do they make sense?
__% of people over age __ reported at least 1 fall in the past year
29%, 65yrs
medical treatment for falls costs more than ___ each year
$50 billion
falls can occur ___ or ___ injury
with or without
____ are the leading cause of hospitalization from injury in older adults
falls
falls are associated with:
- pain
- loss of confidence
- functional decline
- institutionalization
fall risk factors
- prior falls
- fear of falling
- recent hospitalization
- poor sensation
- pain
- difficulty with ADLs
- age over 65
- use of an AD
- impaired balance, gait
- LE weakness
- frailty
- orthostatic hypotension
- polypharmacy
- CVA or neuro diagnosis
- incontinence
- depression or anxiety
- foot problems
- cognitive impairment
- benzodiazepine, diuretics, sedatives
environmental fall risk factors
- slippery/uneven surfaces
- rugs
- poor lighting
- obstacles in path (cords, clutter)
- lack of grab bars or handrails
- poorly arranged furniture
gait speed is correlated with multiple outcomes:
- re-hospitalization
- adl performance
- # of meds
- depressive symptoms
- discharge location from hospital
- history of multiple falls
cut off for community ambulation:
0.8-1.2m/s
cut off for fall risk:
1m/s
cut off for independent in ADLs
1m/s
cut off for less likely to be hospitalized:
1m/s
max cut off for more likely to be hospitalized
0.6m/s
limited community ambulator
0.4-0.8m/s
cross street and normal walking speed:
1.2m/s+
d/c to SNF speed
<0.1m/s
household walker speed
0-0.4m/s
interventions for fall prevention
- balance training
- cardiovascular endurance training
- assistive device training
- home environment modification
blance outcome measures
- BERG
- Sharpened Romberg
- 4 square step test
- functional reach test
- miniBEST
self report outcome measures
- MFES: modified falls efficacy scale
- fear of falling avoidance behaviors questionaire
functional outcome measures
- 5x sit to stand
- 30 sec sit to stand
- TUG
- 10m walk test
endurance outcome measures
- 6 meter walk test
- 2 min step test
sharpened Romberg screening
10 sec EO and 10 sec EC in each position:
- feet together
- semi tandem
- tandem
TUG fall risk cut off
- 13.5s
- 8.5s for community dwelling adults
5x STS fall risk cut off
11.4s
BERG fall risk cut off
45/56
disablitiy:
a mental or physical impairment that limits major activities in one or more ways
types of disabilites
- ambulation
- cognitive
- visual
- hearing
- medical
__% of people age __ live with a disability
34%, 65+
requirements for independent living/community:
- ambulation of 400m
- gait speed of 1.2m/s
- carrying objects (1g milk is 8lbs)
- ambulate of variable terrains
- must be able to encounter obstacles
- etc.
IPR:
- 3hr/day of rehab (PT, OT, SLP)
- high prior function
- not safe to go home
- mod complexity
SNF:
- unable to preform 3hr/day of rehab
- mod functional prognosis
- variable prior level of function
___ is the most powerful intervention for maintaining well being
exercise
exercise for geriatrics (PT intervention)
- anything is better than nothing
- make it attainable for the pt
- encourage them to meet their goals (playing with grandkids, cooking)
- consider family support and what is available in the community
- make it something they can eventually do on their own
types of exercise for older adults
- group
- resistance
- aquatic
- balance
- power!!!
adults loose as much as __% of their strength between age __-__
40%, 60-90yrs
__% of women 65-74 meet ACSM guidelines
14%
__% of women 75+ meet ACSM guidelines
7%
__% of women 55-64 meet ACSM guidelines
17%
__% of men 55-64 meet ACSM guidelines
21%
__% of men 65-74 meet ACSM guidelines
18%
__% of men 75+ meet ACSM guidelines
11%
low, moderate, and high intensity loading in power training are ____ for older adults
equally as beneficial
intensity levels for power training
- low: 20% 1RM
- mod: 50% 1RM
- high: 80% 1RM
resistance training recommendations for older adults
Beginners:
- 1-2 d/wk
- low-mod intensity
- 1-2 sets
- 60-120sec rest intervals
trained:
- 3+ d/wk
- mod, mod-high intensity
- 3+ sets
power training recommendations for older adults
Beginners:
- 1-2 d/wk
- low, low-mod, or mod intensity
- 1-2 sets
- 60-120sec rest intervals
trained:
- 3+ d/wk
- low, low-mod, mod, or high intensity
- 3+ sets
osteoporosis intervention
- loading!!!
- under-dosing is a current problem
interventions for pts with decreased visual acuity
- large print books/computer software
- color: bright, warm colors
- depth: avoid patterned floors, use warm colors to highlight handrails and steps
- contrast: bright details on dark backgrounds
interventions for pts with hearing loss
- minimize background noise
- say their name before starting conversation
- try rephrasing if repeating is not effective
interventions for pts with taste/smelling loss
- use additional spices and colors to enhance foods
interventions for pts with sensory loss (envirmonment)
- avoid temperature extremes from AC or heating
IADL stands for:
instrumental activities of daily living
