Gerontics Test 2 Flashcards
Use of non pharmacological therapies to manage the dementia process, appropriate use of available medications
Active management
Impairments for diagnosis of dementia
Memory impairment, aphasia (language impairment), apraxia (motor planning impairment), agnosia (inability to recognize people and things), and/or loss of executive function
AD + vascular disease (other dementing disorder)
Mixed dementia
Acute and fluctuating change in cognition and function, must be ruled out to make diagnosis of dementia
delirium
Areas of brain affected in AD?
hippocampus, medial temporal lobe, parietal lobe
__________ can present itself after an acute vascular accident (stroke)
Vascular dementia (VaD)
Dementia with __________ results from the development of accumulations of alpha-synuclein proteins within nerve cells of in the cortex and substantia nigraof midbrain, protein also linked with Parkinson’s disease, shared symptoms of AD and Parkinson’s disease dementia
Lewy Bodies
Represents a complex group of degenerative disorders that primarily affect the frontal and anterior temporal lobes of the brain
Frontotemporal dementia
Affected lobes in frontotemporal dementia responsible for what?
reasoning, personality, movement, speech, social grace, language
What is important in all stages of dementia?
Promoting independence
Normal functioning, absence of cognitive functional disability, relevant info from memory stores can be activated and used to carry out complex activity with accuracy and safety
5.6
Mild functional decline due to deficits in executive control functions (task planning, problem solving, divided attention, new learning), difficulties may manifest in the performance of IADLs. Check- in support and assistance with IADLs may be needed but there is no change in ADLs
5.0
Mild to moderate functional decline due to significant deficit in executive control functions, difficulty with divided attention and problem solving. Complex tasks performed with inconsistency or error. Problem with details in IADLs, decline in ability to self-initiate ADLs. Risk in independent living (managing meals, finances, medications), Driving dangerous due to impaired attention and lack of environmental cues, family crisis point, assisted living is a good fit
4.5
Moderate functional decline from abstract to concrete thought processes, person relies on familiar routines and environments, IADLS done with or by others, quality of ADLs declines, not safe to live alone
4.0
Moderate functional decline concrete thought processes, ADLs require set up and often direction during performance, need 24 hr care, benefit from supportive residential placement
3.5
Severe functional decline, poor use of familiar objects, total assist with ADLs, little speech, may be resistant with cares
2.5
Moderate to severe functional decline, concrete to object centered thought processes, cues needed during task, one on one for ADLs necessary
3.0
Severe functional decline, intermittently responsive
2.0
Late stage dementia, unresponsive to surroundings, comfort and hospice care
1.0
Represents sensory and perceptual info gathered from environment, serves to filter down vast arrays of info and retains only what is deemed as relevant for further processing
Sensory-perceptual memory
Enables us to combine info retrieved from LT memory with info that arrives from the environment, central role= release individual from reliance on fixed repertoires and reactions and to allow mental representations of alternatives, DRIVES ALL OCC. PERFORMANCE
Working memory
Comprises explicit and implicit stores
Explicit= episodic and semantic Implicit= procedural, perceptual priming, conditioning
Long term memory
Long term store most severely affected in AD, inability to recall newly presented info= one of the earliest signs of the disease
Episodic (LT) memory
More stable memory with less decline in AD, retaining conceptual knowledge of the world
Have this until later in disease
Semantic memory
remembering names of objects
Semantic recall
Getting lost in familiar places
spatial disorientation
Constellation of motor, perceptual, and skills associated with movement or skill based info
Most durable form of memory, deteriorates slower
Procedural memory
Is recall or recognition more demanding?
Recall
What does CMS stand for?
Center for Medicare Services
Patient with a documented fall 2+ times in last year or any any fall with injury in past year, should be reported on physician quality reporting initiative (PQRI), and a care plan should be developed to reduce further risk of falling
CMS
What fraction of adults 65+ fall each year?
1/3
What percentage of fractures in elderly are result of falls?
87%
What % return home after a fall?
60%
Why does fear of falling increase risk for falls?
Decline in mobility, activity, and confidence, fear of toileting- drink less, drinking less causes electrolyte imbalance which leads to impaired cognition, leading to another fall
Detects motion, spatial orientation for postural alignment and adjustment to environment
Visual aging effects on balance
Labyrinth system hair cells reduce in number and information is less reliable
Vestibular aging effects on balance
Threshold increases of joint, muscle and cutaneous receptors leading to slower reaction time
Proprioceptive aging effects on balance
Ability to remain upright when one’s posture has been disturbed
Balance
Most falls occur during __________ movements? Or when __________?
Transitional, multi-tasking
Response to vestibular and proprioceptive processing from stimuli
Righting reactions
4 righting reaction strategies
Ankle strategy, knee strategy, hip strategy, stepping strategy
A risk assessment is comprised of what?
Balance/gait and 1 of the following: postural, blood pressure, vision, home fall hazards, documentation on meds as contributing factor within last 12 months
1st and 2nd purposes of walker?
1st- proprioceptive input, 2nd- stability
4 Balance tests
Tinetti, Berg Balance Scale, Get up and Go, Functional reach
Gold standard balance test, smaller assessment, 16 tasks rate 0 or 1 or 2 (only a few items have 2s)
Tinetti
Bigger balance assessment, 4= perfect score, ex: sit to stand, stand unsupported 2 mins, *only looking at personal factor of one’s balance
Berg Balance Scale
What balance assessment should be used if specifically looking at ADL balance?
Berg Balance Scale
Used 1-10 scale for client to rate confidence in regards to falls in ex: shower, reaching into cabinets, getting in and out of bed
Falls Efficacy Scale
Since hip/leg abductors are likely to be weak in elderly, what does righting reaction look like?
Side step
Interventions for falls should __________ balance strategies
Automize
How should balance strategy intervention progress?
Balance w/ no outside factors, balance w/ environmental strategies (music, people, lighting, furniture), add cognitive factors (“b” words, name animals)
Symptoms of depression not severe enough to meet criteria for MDD
Subsyndromal depression
What % of elderly are depressed?
15%
What % of elders with depression are able to recover and resume daily life patterns
80%
Symptoms of depression that are only presented physically
Atypical depression
Depression w/ cognitive symptoms that look like dementia, acute onset w/ rapid progression, history of loss or stressful life event, highlights failure and emphasizes disability, social withdrawl
Pseudodementia
When awareness and cognitive ability declines as effect of depression likely that increased functional disability will also occur
Double disability/ excess disability
What cue is used at cog. levels 2-3? (perseveration level 2)
hand over hand
What cues used in cog. level 3.5?
Visual and short verbal
What level is goal oriented? Use short, simple sentences
3.5
Cog level- drive past sign and not notice?
5
Cog level- goal= engagement, inactivity, striking out against other residents, understands some words, not goal oriented
3
Cog level- can’t speak/understand well, perseverates
2
Cog level- Students
6
Goal- oriented, not sleeping, dethreaded hospital gown, 3-4 step tasks only
4
Type of dementia with most personality changes?
Frontotemporal
What precedes memory?
Attention
assessment with purpose of screening to rate level of depression, 5-7 mins, use in all evals
Geriatric depression scale
Assessment screening tool that offers overview of cognitive function to caregivers, uses 7 stages of dementia and determines behavioral characteristics
Global deterioration scale
Multidisciplinary screening tool for any adults who MAY have cognitive impairment, 11 Qs and a drawing
Mini Mental State Exam
Screening tool to determine function status and hours of care for ADLs, not cognitive assessment but assesses ADLs, answers “can do myself, can do with help, or cannot do”
Barthel
Assessment screening tool for cognitive dysfunction, described as a bridge between a screening tool and an evaluation, 30 mins
Brief Kingston Standardized
A _________ is b/t cognitive screens and evals , has 7 items such as word recall, abstract thinking, perseveration, clock drawing
Cognitive assessment
In cog assessment- Immediate short term memory for 10 words
Word recall
In cog assessment- delayed STM for 10 words
Delayed recall
In cog assessment- recognition memory with delay
Word recognition
In cog assessment- ability to from abstractions
Abstract thinking
In cog assessment- spatial orientation- mental manipulation
Spatial reversal
In cog assessment- tests spatial orientation and construction
clock drawing
In cog assessment- ability to follow alternating patterms
Perseveration
Assesses immediate memory, recent memory, spatial orientation, recall of general information, temporal orientation, organization, problem solving, and abstract reasoning, comes in a kit
ROSS (RIPA)- Ross Information Processing Assessment
Assessment that assesses visual task performance, visual spatial, numbering, orientation/memory. Draw a clock following an example drawing
Reality Comprehensive Clock Test (RCCT)
Determines function in 17 areas such as self-care, safety and health, money, transportation, telephone, work, leisure
Kohlman Eval of Living Skills (KELS)
Standardized assessment that assesses visual, sequencing, attention, concentration, and cognitive flexibility, 5 trail making tasks and each gets more complicated with more distraction
Comprehensive Trail-Making Test
Standardized eval to determine cog level based on Allen. Uses occ. taks to assess cognition, does not assess occupations. 7 subtests = toast, shopping, dress, travel, medbox, wash, phone, *uses occupation to assess/evaluate cognition
Cognitive Performance Test (CPT)
Standardized test to quickly screen and eval, used w/ brain injured adults, 17 subtests to assess including attention span, memory orientation, visual neglect, safety and judgement
Cognitive Assessment of MN (CAM)
Screening used to determine cog level, leather lacing with instructions- different stitches
Allen Cognitive Levels (ACL)
Functional measure to record level of cognitive support needed, make pudding or oatmeal, use occupation to assess cognition
Kitchen Task Assessment
Screen for detecting mild cognitive impairment and dementia, more sensitive than mini-mental state exam, answer Qs, name animals, recognize shapes and size, repeating
St. Louis University Mental Status Exam (SLUMS)
Rapid screen for mild cognitive dysfunction, trail making, draw cube, clock, name animals, recall words, fruit similarity
Montreal Cognitive Assessment (MOCA)
Exam of neurobehavioral cognitive status, Qs w/ answers and some functional tasks for consciousness, orientation, attention, language, constructional ability, memory, calculations, reasoning, medications
Cognistat
To diagnose cognitive impairment, tests orientation-memory-concentration
BLESSED
How many stages in AD?
7
AD stage w/ no impairment
1
AD Stage w/ memory lapses, forget some words, misplace some items, use verbal cues and clutter-free environment
2
AD Stage goal oriented still, poor STM, impaired reasoning, difficulty performing complex tasks, difficulty planning, use verbal cues, breaking down tasks, assist w/ important planing
3
AD stage forget recent events, trouble making meals, difficulty managing finances, moody, withdrawn, frustration when confused, delayed responses
Provide supervision much of the time, allow about 5 seconds for responses, use calm and low tone, clutter-free environment
4
AD stage gets lost, confusion w/ time and place, difficulty w/ self care, independent with eating and toileting, remembers details about self and family, fall risk, impaired judgement
Secure environment- locked doors, walker/cane, allow 10 seconds for responses, 100% supervision, only necessary items for task in visual field
5
AD stage loses awareness of environment and experiences, needs help dressing, impaired sleep patterns, difficulty toileting and bowel/bladder control, may be suspicious or delusional, difficulty understanding language, not goal oriented, high fall risk, pressure ulcer risk
Use calm low voice, gentle hand over hand cueing, use demonstration, verbal cues will NOT be understood, allow about 30 seconds for responses, redirect w/ meaningful activities, calming activities, may need skilled nursing, assist with all walking, play calm music
6
AD stage w/ limited interaction with environment, misuses words, total assistance with all cares, impaired swallowing, rigid muscles, can’t smile, high risk of pressure ulcers, at risk for contractures, difficulty standing and turning to sit on another surface
Use calm sounds, reposition every 2 hours, provide total care, may need hand splints, provide gentle ROM to joints 2X per day
7
