GETTING OLD NOT FOR WEAK Flashcards
sarcopenia
an age related, involuntary loss of skeletal muscle mass and strength
-loss begins at age 30
-acceleration of loss after age 60
-lower extremity muscle loss is faster than UE muscle loss
What decreases more rapidly with age, muscle strength or muscle mass?
Muscle strength
-2-5x greater
-due to neural connection between muscles and nerves
-ms. atrophy only accounting for 79% of strength loss
Do men or women lose muscle mass faster?
men
The greatest rate of muscle strength loss and atrophy happens in the earliest days of ______
bed rest
35% decrease in protein synth following 7 days bed rest
Concept of threshold of indepedence
want to stay above this level during rehabilitation
-give the patient a buffer so that if they fall behind they are still independent
Majority of patients discharged from hospital are below
pre-hospitalizaiton level of function
What outcome measure is highly correlated with rehospitalization?
the Functional Independence Measure
Does physical activity improve immediately after discharge from a SNF?
It does not improve very much at all
What are the 5 barriers for implementation of optimal practice patterns?
reimbursement based vs evidence based practice
limited incentives for high-quality transitional care
fear of adverse events, penalties, or litigation
current emphasis on returning patients to PLOF (often low)
lack of awareness of more effective clinical care strategies
What settings utilize reimbursement-based practice?
- Acute Care
- Skilled Nursing Facilities – Prior
State (PPS) - Skilled Nursing Facilities –
Current State (PDPM) - Home Health Care-Current State
(PDGM)
What changes have improved transitional care?
-the IMPACT Act (Improving Medicare Post-Acute Care Transformation Act of 2014)
* The Act intends for standardized post-acute care data to improve Medicare beneficiary outcomes through shared-decision making, care coordination, and enhanced discharge planning.
-Accountable Care Organizations
-Bundled Care
What is bundled care?
A payment structure in which different health care providers who are treating you for the same or related conditions are paid an overall sum for taking care of your condition rather than being paid for each individual treatment, test, or procedure.
High intensity of exercise is necessary for medically complex patients, but perceived as _____
unsafe
Message of ‘Choosing Wisely’ program on exercise intensity:
Don’t prescribe under-dosed strength training programs for older adults. Instead, match the frequency, intensity and duration of exercise to the individual’s abilities and goals.
What is the most important to least important forms of exercise for older adults?
BEST: resistance training–>gait, balance and ADL–> aerobic training–> general conditioning WORST
What dosing is appropriate for muscle strengthening?
-want exercise form failure on the 9th repetition
-“more than 8, up the weight”
Characteristics of High Intensity Resistance Training:
-achieve muscle overload
-stronger and different stimulus every time
-objectively assess progression daily
-create conditions for safe and physiological adaptation
what RPE out of 10 do you want HIRT to be at?
7-8
What are safe changes in HR?
HR increases above baseline level <150 bpm
What are safe increases in blood pressure
SBP should stay less than 200
DBP should stay less than 110
What should the pulse ox level stay above?
88%
Outcomes of i-STRONGER program
-safe
-patient participate more readily
-therapist productivity does not decrease
What are 4 primary settings where medically complex older adult care can occur (i-STRONGER program) ?
PACE
HOME HEALTH
TELEREHAB
SNF
Does high intensity training in older adults reduce the risk of re-hospitlization?
yes
Outcomes of study: App of HIFRT in SNF
SPPB: increase by 0.64 points
Walking/Gait speed: increase by 0.13 meters/second
Community discharge rate: increase by 20%
SNF length of stay: decrease 3.5 days, cost decreased 1500 per patient
What was the length of the i-STRONGER study?
3 months therapist training + 12 months intervention + 6 months maintenance
HeRo study: high intensity rehab plus mobility
-a study that used behavioral economics and gamification due to study being performed during COVID
-compared this program to i-STRONGER —> there may be an additional effect on gait speed due to mobility training
