Geriatrics

Question 1

what is the primary reason for geriatric hospitalization

Answer 1

falls (usually resulting in fractures)

Question 2

how many Rx medications is considered to be a risk factor for increased falls

Answer 2

4 or more

Question 3

what must be considered with regards to circumstances surrounding a fall

Answer 3

1. onset
2. environment
3. activity
4. dizziness/vertigo/lightheadedness
5. medications
6. direction of the fall

Question 4

if the patient had a fall, what are follow up falls history questions

Answer 4

1. how many falls have you had
2. do you feel unsteady or have a fear of falling
3. have you sustained any injuries from those falls

Question 5

what is the best functional outcome we can use to screen cognition in the older adult

Answer 5

MoCA

Question 6

what is the significant of A&Ox4

Answer 6

name, place, time-date, circumstance

Question 7

what are three techniques you can utilize to enhance success in patients with cognitive impairment

Answer 7

1. use consistent, one-step commands
2. use simple, repetitious activiities
3. get involvement from family and nursing on consistency

Question 8

when should you start to consider hypotension in the older acute care population

Answer 8

after 24 hours of bed rest

Question 9

which pain scales should you consider using for the older acute care population

Answer 9

VAS and NPRS are great, but wong-baker and PAINAD might be needed for the cognitively impaired

Question 10

based on the Snellen chart, what vision rating is associated with noted postural instability

Answer 10

> 20/50

Question 11

at what depth perception discrepancy are we concerned?

Answer 11

> 3 inches

Question 12

what is VOR

Answer 12

vestibulo-occular reflex

gaze at stationary finger and move head R/L and Up/Down

Question 13

what is VSR

Answer 13

vestibulo-spinal reflex

walking with head turning

Question 14

how/where do you test somatosensory vibration in the LE

Answer 14

tuning fork at the first met head

Question 15

why can’t you MMT the older adult in the acute care setting

Answer 15

trick question. there’s no contraindicaiton, but remember that it won’t necessarily provide more information than a functional strength screen

Question 16

how many coordination tests do you need to perform? what are some tests?

Answer 16

1-2 of the following:

finger to nose, RAM, heel to shin

Question 17

what are the functional balance grades

Answer 17

normal, good, fair, and poor

Question 18

how does static balance change along the functional balance grading scale

Answer 18

normal > normal plus sway > handhold or min assist > handhold and mod to max assist

Question 19

how does dynamic balance change along the functional balance grading scale

Answer 19

max challenge > can pick up object off floor > can balance during head/trunk turning > unable to accept any challenge

Question 20

what are six key balances measures for the older adult population

Answer 20

1. romberg
2. SLS
3. FTSTS
4. FSST
5. Tinetti aka POMA
6. TUG

Question 21

what are components of an observational gait analysis

Answer 21

1. BOS
2. step width
3. stride length
4. cadence/speed
5. position of other parts
6. surfaces
7. assistive devices

Question 22

what is a comfortable healthy young adult gait speed

Answer 22

1.2 - 1.4 m/s

Question 23

what is a comfortable healthy older adult gait speed

Answer 23

0.9 - 1.3 m/s

Question 24

what gait speed correlates to strong risk for poor health outcomes

Answer 24

less than 0.6 - 0.7 m/s

Question 25

what is the normal walking speed of hospitalized older adults

Answer 25

0.23 - 0.5 m/s

Question 26

what represents meaningful change in gait speed

Answer 26

change greater than 0.1 m/s

Question 27

what are three functional tasks to be completed by the older adult to be considered independent community-dwelling

Answer 27

1. walk 900-1000 ft
2. carry approx 7 lbs
3. walk 2 flights of stairs, accross grass, and over obstacles

Question 28

what is considered a falls red flag

Answer 28

2+ falls in last 4 weeks

Question 29

what is usually tight/contracted on an older adult

Answer 29

trunk flexors, hip flexors, PFs

Question 30

what are the Rx parameters for strength training the older adult

Answer 30

8-12 reps (with fatigue in the last two reps) or a goal of 15-17 RPE on a 6-20 RPE scale

Question 31

how does specificity of training play into gait training for the older adult

Answer 31

if community ambulation is the goal, practice walking in the community.