Intro to PT Chapter 14 Flashcards
1
Q
Life expectancy (2017)
A
Male at birth - 76.1
Male at 65 - 83.1
Female at birth - 81.1
Female at 65 - 85.6
Both at birth 78.6
Both at 65 - 84.5
2
Q
2018 U.S. # of people over 65
A
51 million - 15.6 %
3
Q
By 2060 U.S. over 65
A
94.7 million
4
Q
groups have at least 1 disability:
65-74:
A
26.4%
5
Q
groups have at least 1 disability:
75-84:
A
45%
6
Q
groups have at least 1 disability:
85 and older:
A
72.5%
7
Q
41.5% of people over 85 have
A
3 or more
disabilities
8
Q
ADL examples
A
- Eating
- Dressing and undressing
- Bathing and grooming
- Bed and bathroom
- Transfer and ambulatory activities
- Other activities such as propel wheelchair, manage elevator, dial a telephone
9
Q
IADL - instrumental activities of daily living - examples
A
- Shopping
- Laundry
- Housekeeping
- using public transportation
- managing finances
10
Q
Primary goal of PT for old old independent population:
A
achieve optimal physical function and prevent conditions that might limit ability to continue at independent level.
11
Q
Older persons that impair daily function primary goal of PT:
A
may need PT to regain mobility skills
12
Q
Settings Patients are seen
Hospital
A
acute conditions
13
Q
Settings Patients are seen
Rehabilitation Center-
A
after medically stable and
need intensive rehabilitation
14
Q
Settings Patients are seen
Long-Term Care
A
if require nursing care or
assistance with activities of daily living (ADLs)
Skilled Nursing Facility (SNF)
Assisted Living Facility (ALF)
15
Q
Two types of services offered to pts in long term care
A
- rehabilitation to return to prior level of functioning (PLOF)
- functional maintenance programs to maintiain current skills and prevention of further disability.
16
Q
Healthy Older People who want to maintain, regain or improve physical status
A
may attend aquatic exercise programs, tai chi, or yoga conducted or supervised by PTs
17
Q
PTs provide…. To pts before limitations
A
Education, prevention, health, wellness, fitness to pts before they have limitations.
18
Q
Consulting with an individual, PTs provide the knowledge necessary to acquire
A
appropriate Adaptive Equipment or Assistive Devices.
19
Q
Example of Adaptive Equipment
A
Grab bars - transfer pole -
20
Q
Assistive Devices
A
Provides assistance during periods of mobility.
21
Q
Older patients
PT Other roles: administrator
A
Researcher, administrator manager of rehabilitation services, or supervisors of PTAs.
22
Q
hypokinesis
A
decreased activity or movement
23
Q
Physcical changes in bones, muscles and joints and decreased strength
A
often related to hypokinesis, or sarcopenia
24
Q
Musculoskeletal deficiencies
A
Decreased strength from hypokinesis (decreased
movement) and sarcopenia (decreased muscle mass)
Decreased flexibility
Decline in bone mass
Weight bearing joint deteriorate
25
connective tissue changes with age
Becomes less hydrated and stiffer.
26
Without activity muscles
have fewer oportunities to lengthen and shorten.
27
CNS changes with age
Lower conduction velocity to make movements slower.
28
Sensory systems changes with age
Vision (cataracts, macular degeneration)
Hearing losses (presbycusis)
Affect balance, mobility, ability to detect environmental hazards
29
# Vision (cataracts, macular degeneration)
effective lighting and use of contrasting colors
importent for offerning the older person cues about objects or surfaces that might interfere with safe mobility.
30
Macular degeneration
affects the retina and loss of central vision.
31
Presbycusis
1/3 of adults over 65. 1/2 of adults over 75. - Loss of hearing high pitched sounds.
32
Vestibular aging
senses of head movement and degree and acceleration for coordination of posture and balance. - may become less sensitive.
33
Hypertension and aging
65.75% - age 65-74
73% of age 75 over
34
Tactile loss
Age causes tactile loss which reduces touch, pressure, and pain recieved from the environmnet.
35
Non-hispanic blacks
More likely to to be hypertensive than any other group.
36
# aging
Cardiovascular reserve
aging causes reduced ability to respond to increased workloads.
37
death rates by falls for older adults
up 30% over 2007-2016
38
Dynamic balance
complex interaction of multiple systems that are subject to age related changes.
39
# Balance questions
Three questions routinely asked older patients about falling
1. Have you fallen in the last year
2. Do you feel unsteady when standing and walking.
3. Do you worry about falling?
40
Myth about cognition and older people
cognitive funnction always significantly decreases with advanced age..
41
# Older adults
Alzheimers
age is a risk factor. 5.8 million americans.
42
cognitive features of normal aging
slower processing speed and declines in certain memory, language, visuospatial and executive functions which are not significant enough to impair function.
43
# agiing
Psychosocial changes
May face discrimination
Adjustment to retirement
Depression from functional deterioration and social isolation
The PT and PTA has a responsibility to bring signs of psychological problems to the attention of other members of the health care team.
44
# Common conditions of elder adults
Osteoarthritis
Most common orthopaedic problem for older adults
Typically occurs in hands, hips and knees
cartilage deteriorates to joint injury or overuse. (calcium deposits)
maintain at least a moderate activity level while protecting the joints.
| 22.7% adults
45
# aging
bariatric programs
therapists spcialize in treating excessively overweight individuals.
46
# aging
Rheumatoid Arthrits
Autoimmune disease
Inflammation of joints
More common in women; peak at 40 to 60 years of age
PT goals:
pain relief - heat modalities.
Maintaining flexibility necessary to function
47
# aging common conditions
Osteoporosis
Not part of normal aging process
Decreased mineralization of bones
More common in women
Primary role of PT is prevention of injury (book says just prevention)
dual energy x-ray absoptiometry.
Need to be active and load bearing.
48
# aging common conditions
Hip Fracture
One of most imp health care issues.
20% mortality rate within 1 year
300,000 hip fractures a year.
95% from fall
Significantly diminishes ability to perform ADLs and IADLs
PT essential after surgery; focuses on early mobility, transfer training, gait training, weight-bearing precautions, use of assistive devices
49
PT plays role in preventing both osteoporosis and hip fracturs
address activity level, weight bearing, flexibility, strengthening and education.
50
# aging
reasons for falls
related to both:
Interinsic factors and extrinsic factors.
51
# Aging
Intrisic factors for falling
Age
Previous history of falls
Cognitive changes
Sensory problems
Multiple medical condiitions
Muscle weakness
Orthostatic hypostension
52
# aging
Extrinsic factors for falling
Poor lighting
Uneven or slippery surfaces
Medications
Improper AD or improper use of device
Improper footwear
Throw rugs
Lack of handrails or grab bars.
53
# aging common conditions
Diabetes mellitus
21.4% over 65
12 million people over 65
Insufficient insulin action (production or absorption) results in excessive glucose in blood
Complications include renal failure, peripheral
neuropathies, poor circulation that causes skin
ulceration, coronary artery disease, and retinopathies
54
# Principles of Examination aging
Examination
musculoskeletal, neurolotic, cardiovascular, pulmonary and integumentary status.
skils and capabilities needed for maximum independence.
55
# Principles of Examination aging
History
Review of medical chart provides information about other services the patient is receiving
May include a family member
Includes social history, and can include screening for cognitive status, depression, urinary incontinence, nutrition
establish raport. Information about evironment.
56
# Principles of Examination aging
Geriatric Self-Efficacy Index for Urinary Incontinace
Judge if further testing need to be done related to incontinance
57
# Principles of Examination aging
Braden Scale
determine if there is a risk for developing pressure sores.
58
# Principles of Examination aging
Systems Review
Cardiovascular and pulmonary, integumentary,
musculoskeletal, neuromuscular and communication ability
59
# Principles of Examination aging
Tests and measures
Cardiovascular and pulmonary function
Pain assessment
Strength, range of motion, posture
Sensation, coordination, vestibular
Balance and Gait
* Dix-Hallpike Test to rule out Benign Paroxysmal Positional Vertigo
* Static and dynamic sitting and standing including outcome measures
60
sterognosis
perception of form through touch.
61
# examination - aging
static balance in standing
unipedal stance test (UPST) - standing on one foot with eyes open and eyes closed.
62
# examination - aging
Romberg test
Stands with one foot directly in front of the other with their eyes open and closed.
63
# examination aging
Dix-Hallpike Tes
1. pt sit upright with legs extended
1. rotates pts head 45 degree twoard ear being tested
1. pt lie back down with head hanging off the edge of the table
1. holds pt's neck extended for at least 30 seconds
1. Watches the pt's eyes for nystagmus, rapid rhyrthmic eye movement.
1. return pt to upright.
64
# examination aging
Balance tests
30 second chair stand test
4-stage balance stest
STEADI toolkit - fall risk
Berg Balance scale
Balance Evaluation Systems Test (Bestest)
Mini-BESTest
Dynamic Gait Index
Functional Gait Assessment
65
# examination aging
Elderly Mobility Scale (EMS)
The EMS is a seven item, 20 point validated assessment tool for the assessment of frail
elderly subjects (Smith 1994). The EMS is measured on an ordinal scale.
66
# examination aging
Short Physical Performance Battery
an objective measurement instrument of balance, lower extremity strength, and functional capacity in older adults (>65 years of age). The test includes three different domains (walking, sit-to-stand and balance) to assess functional mobility.
67
# examination aging
Functional outcome measures
* Elderly Mobility Scale
* Short Physical Performance Battery
68
# examination aging
Minimal Detectable Change (MDC)
MDC- the smallest amount of change in a measurement that reflects a true change in the pt's condition. For example in Timed Up and Go, MDC helps determine whether a change in performance is statistically significant.
69
# examination aging
Minimal Clinically Important Difference (MCID)
MDIC - smallest change in a measure that a pt or clinician would percieve as meangful. For instance, in 6-minute Walk Test, MCID helps determine whether the observed changes are clinically relevant.
70
# examination aging
Rehhabilitation Measures Database
Searchable database for outcome measures that includes MDC and MCID values if available.
71
# Evaluation, Diagnosis, and Prognosis
PT completes detailed evaluation
Assesses signs, symptoms, or syndromes resulting from the pathologic condition
72
# Evaluation, Diagnosis, and Prognosis
Develop a prognosis estimating maximum level of improvement the patient will experience
Develop functional goals to enhance movement and function
Develop plan of care to achieve goals
73
# Evaluation, Diagnosis, and Prognosis
approach and dischharge
Interprofessional approach
Discharge planning started at initial evaluation
74
# Intervention aging
examples
therapeutic exercise, functional training, physical agents, manual therapies, and pt instruction.
75
# Intervention aging
The American College of Sports Medicine and the American Heart Association Guidelines
Aim for moderate-intensity aerobic activity 30
minutes, 5 days a week or vigorous-intensity for 20 minutes, 3 days a week.
Muscle strengthening recommendations are 8-10 exercises with resistance for 10-15 repetitions performed on 2 or more nonconsecutive days/week
Flexibility exercises performed 2 days a week for at least 10 minutes
Balance exercises
76
# Intervention aging
Go4Life program
National Institute on Aging. individualize interventinos based on older adult's endurance, strength, balance, and flexibility needs
77
# Intervention aging
Education and instruction essential
Include family members and caregivers
78
# Intervention aging
Consider setting
inpatient with lots of equipment or home in the environment the pt must function.
79
# Intervention aging
Other points about interventions
Intervention focuses on improving daily function
Consider medications that could impact rehab program
Include information or instruction in health promotion, wellness, and prevention
80
Ethical Considerations aging
Must consider vulnerability to elder abuse
Could occur in form of neglect, emotional,
psychological or physical, or financial
exploitation
