Geriatrics

Question 1

3 main goals of geriatrics tx

Answer 1

Optimize function
Avoid institutionalization
Maintaining community involvement

Question 2

SG: Biomechanical model aging

Answer 2

Aging MSK:
-loss of muscle mass leading to increased falls
-loss of bone mineral density leading to osteoporosis and fractures
-osteoarthritis
Aging body composition/conformation:
-Decreased height due to increased kyphosis
-Decreased lean body mass due to change in pharmokinetics
-Thin, fragile, wrinkly skin

Question 3

MSK exam of geriatrics (5)

Answer 3

• Evaluate gait
• Assess posture
• ROM UE and LE
• Evaluate feet for ulcers and nail care
• OSE of muscles and joints for somatic evaluation

Question 4

Common presentation of osteoarthritis

Answer 4

Pain in one joint that progresses to involve multiple joints
Deep ache with use of joints
Joint stiffness after inactivity (waking up or getting up from sitting)
Night pain and interference with sleep
Tenderness over joint line, ROM reduction, swelling

Question 5

What are the methods of tx used in osteoarthritis?

Answer 5

Weight management, walking aids or bracing, topical/oral analgesics, OMM/PT, intra-articular injections, and orthopedic intervention as last resort

Question 6

SG: Osteoarthritis OMT research

Answer 6

Over course of tx, both placebo and tx group showed improvement in ROM and perceived pain, but after tx OMT pt continued to have improvement of ROM and placebo did not

Question 7

Nervous system model aging and effect (7)

Answer 7

• Decrease in brain weight - drug toxicities and delirium
• Alteration in CNS neurotransmitters - cognitive change
• Decrease in memory - benign senile forgetfulness
• Decreased deep sleep and increased wakefulness
• Decreased vibratory sense - altered gait
• Increased postural instability - falls/accidents
• Altered gait - falls/accidents

Question 8

Neurologic exam

Answer 8

reflexes - ankle might be absent
Look for asymmetrical test results
Mini mental status exam to evaluation cognition

Question 9

Signs and symptoms of parkinson’s disease

Answer 9

Pill rolling tremor, bradykinesia, cogwheel rigidity, postural instability, shuffling gait

Question 10

SG: Parkinson’s OMT research

Answer 10

Tx with OMT shows significant increase in stride length, cadence, and maximum velocities of UE and LE

Question 11

Resp/circ model aging changes

Answer 11

CV changes
-Calcification and stenosis - HTN
-Decreased elasticity of arteries
-Decreased baroreceptor reflex - orthostatic hypotension
Respiratory changes
-Decreased costal cartilage - decreased secretion clearance
-Decreased alveolar surface - decreased max breathing capacity
-Decreased respiratory muscle strength

Question 12

SG: Hypertension OMT research

Answer 12

Soft tissue to cervical and thoracic spine decreased BP by at least 3 mmHg

• decreased hemoconcentration
• increased fibrinolytic activity
• Decreased fibrinogen concentration

Question 13

SG: Pneumonia OMT research

Answer 13

Adding OMT to standard antibiotic therapy reduces the length of the hospital stay

Question 14

Metabolic/Energetic/Immune model aging changes (immune)

Answer 14

Immune system

-Decreased T cell fxn leads to predisposition and malignancies

Question 15

Metabolic/Energetic/Immune model aging changes (GI)

Answer 15

• Decreased HCL production - altered digestion and drug absorption
• Diminished colonic motility - constipation
• Decreased calcium absorption - osteoporosis
• Decreased hepatic biotransformation - altered pharmokinetics

Question 16

Metabolic/energetic/immune model aging changes (GU)

Answer 16

-Decreased renal mass . - altered pharmokinetics
Decreased renal blood flow
Decreased bladder capacity - urinary incontinence

Question 17

OMT goals to treat infections

Answer 17

Remove impediments to lymphatic flow and mobilize lymph from congested tissue

Question 18

SG: Research for OMT of LE ulcers

Answer 18

Used thoracic inlet MFR, doming of diaphragm, pelvic diaphragm release, popliteal release, and pedal pump for 10 min, 2x/week
Wound surface area and mean leg volume decreased

Question 19

What alarm symptoms should you look for in constipation of geriatric pt?

Answer 19

hematochezia, FOBT, weight loss, FHx of colon cancer or IBS

Question 20

Which osteopathic findings should you look for in constipated pt?

Answer 20

Viscerosomatic changes on T10-L2
Chapman’s reflex on anterolateral thigh along IT band and transverse process of L2-L4 extending laterally to iliac crests

Question 21

What OMT can be used for constipation?

Answer 21

Sacral rocking and mesenteric release

Question 22

SG: Constipation OMT research

Answer 22

Used OMT directed at thoracolumbar spine and abdomen (ST, MFR, CS, and mesenteric release) and showed improvement in severity of constipation, colonic transit time, and patient assessment of constipation symptoms

Question 23

Behavioral model changes with aging

Answer 23

• Decreased activity and motility leads to increased falls and accidents
• Decreased memory leads to benign senile forgetfulness
• Decrease in brain weight increases risk of drug toxicities and delirium
• Bereavement and disability leads to depression, alchol abuse, and tobacco use
• Loss of independence and impairment of ADLs leads to depression, alcohol abuse, and malnutrition
• Cognitive changes causing dementia and Alzheimer’s disease

Question 24

How do you assess fall risk in elderly patients?

Answer 24

Get up and go
stand from sitting position without using arms for support
Walk several steps and turn and sit in chair without using arms for support

Question 25

What are risk factors for falling?

Answer 25

Vitamin D deficiency, decreased strength and coordination, depression, med side effects, home hazards, SD

Question 26

SG: Depression and OMT research

Answer 26

OMT group treated on individual diagnose for 20 min and by week 8, all OMT group was within normal range. 70% of control group still had signs of moderate depression