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Second Developmental Exam > Geriatrics pt.2 > Flashcards

Geriatrics pt.2 Flashcards

1
Q

What is polypharmacy?

A

The excessive or inappropriate use of medications

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2
Q

Adults over 65 purchase over __% of all prescription meds

A

30%

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3
Q

Older adults are more likely to experience adverse drug reactions (ADRs) and ___ of older people take at least 1 unnecessary drug

A

1/2
Avg. older adult takes 5 meds
Avg. nursing home resident takes 7 meds

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4
Q

What are the causes of polypharmacy?

A

● Physicians may prescribe medications to relieve symptoms that could be relieved through nonpharmacologic methods
- Ex- a patient who naps during the day cannot sleep at night and is prescribed a sleeping pill
● Patients may obtain prescriptions from multiple providers
● Patients may take over the counter medications that interact with
other medications
- Interactions may be seen as new symptoms, resulting in new medications prescribed

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5
Q

What are characteristics of polypharmacy in older adults?

A

● Use of medications for no apparent reason
● Use of duplicate medications
● Concurrent use of interacting medications
● Use of contraindicated medications
● Use of inappropriate dosage
● Use of drug therapy to treat adverse drug reactions

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6
Q

How does aging affect drug absorption?

A

● Decreased gastric acid
● Decreased stomach emptying
● Decreased gastric motility

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7
Q

How does aging affect drug distribution?

A

● Decreased body H2O
● Increased body fat
● Decreased plasma proteins
● Decreased lean body mass

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8
Q

How does aging affect drug metabolism?

A

● Decreased liver mass
● Decreased blood flow to liver
● Decreased enzyme activit

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9
Q

How does aging affect drug secretion?

A

● Decreased kidney mass
● Decreased blood flow to kidneys
● Decreased nephron function

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10
Q

What medications are most commonly overprescribed?

A

● Laxatives
● BP meds
● Diuretics
● DM meds
Likely due to side effects of other meds and because quick fix

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11
Q

What drug commonly causes gastrointestinal side effects?

A

NSAIDs

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12
Q

What drug has a common side effect of sedation?

A

Opioids

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13
Q

What drugs commonly cause confusion as a side effect

A

Antidepressants
Analgesics
Lithium

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14
Q

What drugs commonly cause depression as a side effect?

A

Barbiturates
Antihypertensives

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15
Q

What drug typically causes orthostatic hypotension as a common side effect?

A

Antihypertensives

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16
Q

What drugs cause fatigue/weakness as a common side effect?

A

Diuretics
Glucocorticoids

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17
Q

What can we, as PTs, do to help prevent polypharmacy?

A

Carefully review patient’s medication list
● Look for any possible adverse drug reactions
● Does their medication list make sense with their comorbidities? (Ex. taking antibiotics from an infection years ago?)
● Think about how medications will affect physical therapy (Dosing schedules, RPE)
● PATIENT EDUCATION

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18
Q

___ % of people over ages 65 reported at least one fall in a year

A

29%

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19
Q

Wha is the leading cause of death/hospitalization from injury in older adults?

A

Falls
- Medical treatment costs >$50 billion/yr
- Can occur with or without injury
- Associated with pain, loss of confidence, functional decline, and institutionalization

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20
Q

What are some environmental risk factors for falls?

A

● Slippery or uneven surfaces
● Rugs
● Poor lighting
● Obstacles in path (Cords, clutter)
● Lack of grab bars or handrails
● Poorly arranged furniture

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21
Q

What are some risk factors for falling?

A
  • CVA/neuro diagnosis
  • prior falls/ fear of falling
  • recent hospitalization
  • poor sensation/ pain/ LE weakness/ frailty
  • difficulty with ADLs
  • age 65+
  • use of assistive device
  • orthostatic hypotension
  • polypharmacy
  • incontinence
  • depression or anxiety
  • foot problems
  • cog impairment
  • meds like benzodiazepines, diuretics, sedatives
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22
Q

What is the 6th vital sign*?

A

Gait speed but not really
good for indication of fall risk

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23
Q

Gait speed is correlated with what outcomes?

A

● Re-hospitalization
● ADL performance
● Number of medications
● Depressive symptoms
● Discharge location from hospital
● History of multiple falls

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24
Q

What is the cut-off for community ambulation?

A

0.8 m/s

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25
Q

What are some interventions for fall prevention?

A

Balance Training- Somatosensory, Vestibular, and Visual
● Dynamic and static balance training
● Lower extremity strengthening and endurance training
● Coordination
● Flexibility and ROM

Cardiovascular endurance training Assistive Device Training
Home environment modification

26
Q

What are some Balance outcome measures for Geriatrics?

A

● Berg Balance Scale
● Sharpened Romberg
● 4 Square Step Test
● Functional Reach Test
● MiniBEST

27
Q

What are some Self-Report outcome measures for Geriatrics?

A

● MFES- Modified Falls Efficacy Scale
● Fear of Falling Avoidance Behaviors Questionnaire

28
Q

What are some Functional Outcome measures for Geriatrics?

A

● 5xSTS
● 30s STS
● TUG
● 10mWT

29
Q

What are Endurance Outcome measures for Geriatrics?

A

● 6MWT
● 2min step test

30
Q

What is the Sharpened Romberg?

A
  • screening tool for balance
  • patient stands with feet together, semi-tandem, and tandem with eyes open for 10 sec then closed for 10 sec
31
Q

What are cutoffs for fall risk in TUG, 5xSTS, BERG?

A
  • TUG: 13.5 sec
  • 5xSTS: 11.4 sec
  • BERG: 45/56
32
Q

What is a disability?

A

A mental or physical impairment that limits major activities in life in one or more ways

33
Q

What are types of disabilities?

A

● Ambulation
● Cognitive
● Visual
● Hearing
● Medical

34
Q

What percent of persons age 65 and over with any disability are there in the U.S.?

A

34%

35
Q

What is Medicare? What is Part A vs Part B?

A
  • age 65+ OR people with disabilities
  • Part A: IP, SNF, HH, Hospice
  • Part B: OP, DME
36
Q

Who is Medicaid for?

A
  • low income
  • pregnant or responsible for a minor
  • people with disabilities
37
Q

What ambulation distance is required for independent living?

A

400 m

38
Q

What gait speed is a requirement for independent living?

A

1.2 m/s

39
Q

What weight must patient be able to carry for independent living?

A

One gallon of milk (~8 lbs)

40
Q

What are some other requirements for independent living?

A

● Must be able to ambulate on variable terrains (Carpet, grass, uneven surfaces)
● Must be able to encounter obstacles (Stairs, curbs, doors, elevators)
● Additional Demands (Postural transitions, head orientation, stop/start, backing up, side stepping)

41
Q

What does a typical patient look like in inpatient rehab (IPR) for discharge planning?

A
  • 3 hrs of therapy per day (PT,OT, SLP)
  • high prior level of function
  • not safe to go home
  • moderate complexity of medical needs
42
Q

What does a typical patient look like in Skilled Nursing Facility (SNF) for discharge planning?

A
  • unable to participate in 3 hrs of PT per day
  • moderate functional prognosis
  • variable prior level of function
43
Q

What does a typical patient look like in Outpatient for discharge planning?

A
  • high prior level of function
  • stable complexity of medical needs
  • must be able to travel through community to OP facility
44
Q

What does a typical patient look like in Home health for discharge planning?

A
  • limited ambulation for community
  • safe to go home
  • good functional prognosis
45
Q

What does a typical patient look like in Long Term Acute Care (LTAC) for discharge planning?

A
  • high complexity of medical needs
  • poorer prognosis
  • less need for skilled therapy
46
Q

What does a typical patient look like in Palliative Care for discharge planning?

A

● Typically for patients with chronic and serious illnesses
● Aims to treat pain and suffering
● Addresses psychological, social, and spiritual problems

47
Q

What does a typical patient look like in Hospice for discharge planning?

A

● End of life care- terminal illnesses
● Expectation- 6 months or less to live
● Aims to manage pain and other symptoms
● Can take place at home or a facility

48
Q

What are advanced care directives?

A

Allows individuals to identify their preferences for care when they are unable to do so themselves

49
Q

What are living wills?

A

General indication of preferences, recommended for all adults

50
Q

What are some things that are recommended for patients with terminal illness as a part of discharge planning?

A

○ DNR- Do not resuscitate
○ MOLST/POLST- Medical/Physician orders for life sustaining treatment
○ Power of Attorney- appoints an individual to make decisions on one’s behalf

51
Q

What is the most powerful intervention for maintaining well-being?

A

EXERCISE!
- anything is better than nothing
- make it attainable for patient
- encourage them to meet their goals
- consider family support and what is available in their community
- make it something patients can do on their own eventually

52
Q

What are the benefits of Group Exercise?

A

benefit of socialization, supervision, and peer support

53
Q

Adults lose __% of their strength between the ages of 60-90

A

40%

54
Q

What is a good option for aerobic and strength training for patients who cannot tolerate weight bearing on land

A

Aquatic exercise

55
Q

What is a better indicator than strength for functional activities such as stair climbing, sit to stands, and gait

A

Power training

56
Q

What is the percent of older adults who meet both strengthening and aerobic guidelines?

A

Apparently less than 15% (according to Google AI)

57
Q

What can you do for patients with less visual acuity?

A

Use large print books and computer software
○ Color- Use bright, warm colors, avoid pastels, avoid monotones
○ Depth perception- Avoid patterned floor surfaces, use warm colors to highlight handrails and steps
○ Contrast- Use bright details on dark backgrounds

58
Q

What can you do for patients with hearing loss?

A

minimize background noise
○ Say the person’s name before beginning the conversation
○ Try rephasing if repeating is not effective

59
Q

What can you do for patients with taste/smell lost?

A

Use additional spices and colors to enhance foods

60
Q

What can you do with the environment to help patients with sensory loss?

A

Avoid temperature extremes
Like A/C or heating

61
Q

What are some environmental considerations at Home?

A

● Is there outdoor lighting?
● Is there a place to put things down when locking/unlocking the door?
● Are there steps to the door?
● Is the door wide enough for a wheelchair?
● Is there a place to sit to put on shoes?
● Are there rugs or cords on the floor?
● Are heavy pots/pans stored in low cabinets?
● How high does the patient have to reach for dishes, groceries, clothes?
● Do their chairs have armrests to push up on?
● Which side is the handrail for the stairs?
● How low is the toilet?
● Are there any grab bars for the toilet or shower?
● Do they have to step over a bathtub ledge to get in the shower?
● Are the hallways, doors, and bathroom large enough for a wheelchair?

Second Developmental Exam (5 decks)

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