Introduction to Geriatrics 2 Flashcards

Question

What are some G.I. related pathologies in the older adult?

Answer 1

Constipation, incontinence, diverticulitis Dysphagia Colitis Gastroesophageal Reflux Disease (GERD) Malnutrition

Answer 2

Dysphagia & aspiration Increased incidence in older adults Recognize and refer to Speech Therapy Positioning Decreased nutrient intake, decreased energy reserves Colitis Fluid & electrolyte imbalance “I don’t want to eat anything because then I might have diarrhea.”

Answer 3

Loss in muscle mass and strength Reduced bone health Increased stiffness Decreased flexibility Joint proprioception declines with age, mostly in knee and ankle Lean mass decreases, fat mass increases2 Women are affected earlier than men for declines in muscle mass and bone health due to hormonal changes of menopause At all ages, woman are more vulnerable than men to loss of lean body mass

Answer 4

Decreased muscle fiber size Reduced number of Type II fibers Increased intermuscular adipose tissue Reduced number of mitochondria/mitochondrial DNA Age-related low-grade chronic inflammation contributes to reduced muscle function Changes in excitation-contraction coupling, calcium release & reduced muscle protein synthesis reduce muscle performance

Answer 5

Increased collagen concentration & increased collagen cross-links Decreased elastin fibers Less fibrinogen & fewer macrophages result in micro-adhesions Loss of water content in articular cartilage & extracellular matrix Articular cartilage thins/degenerates Decrease in tensile strength Decreased secretion of hyaluronic acid (for joint lubrication)

Answer 6

Calcium-related loss of mass & density Decreased circulating levels of Vitamin D Decreased bone strength Alterations in maturation & function of the osteoblast and the osteoclast, resulting in greater removal compared to replacement Decreased estrogen Decreased muscle mass

Answer 7

Osteoarthritis Osteoporosis Sarcopenia Fracture

Answer 8

Strength training helps offset loss in muscle mass and strength that is associated with normal aging, in addition to improvement in bone health, postural stability, flexibility, and ROM Significant strength gains are possible for older adults when they are exposed to adequately dosed training methods We will discuss dosing in the next lecture Physical activity of all types can be scary for older adults It is your job as a Physical Therapist to make it less scary and ease their apprehension

Answer 9

The speed of central processing is reduced with advanced age Cognition, balance, reflexes, reaction times, energy expenditure, and muscle function are all effected by changes in the neurological system Neurochemical changes occur Decreased hormonal balance Decreased sensitivity to pain and changes in temperature Sensorimotor changes contribute to balance difficulty and slower movements seen in older adults Denervation and reinnervation of muscle fibers results in fewer, but larger surviving motor units This impacts motor unit recruitment and decreases performance of fine motor control

Answer 10

Decreased brain mass Decreased cerebral blood flow Decreased conduction velocity Decreased impulse conduction & cerebral synaptic transmission Decline of neurotransmitters Hypothalamus less sensitive to physiological feedback, resulting in difficulty with thermoregulation Decreased reactivity of autonomic nervous system Increased amyloid plaques, lipofuscin, neurofibrillary tau tangles

Answer 11

Decreased nerve cells Decreased blood flow to nerves Changes to layers of nerve Perineurium & epineurium thicken Endoneurium can become fibrosed with collagen Decreased conduction velocity

Answer 12

Confusion and delirium cerebrovascular disease Parkinson's disease dementias peripheral neuropathy is vestibular problems essential tremor

Answer 13

Geriatric patients will present with decreased speed, coordination, reaction times, and overall movement time Keep instructions simple and direct if possible Ex: Asking an older adult to get out of bed Incorporate visual feedback and demonstrations if able Take advantage of procedural memory and functional movements Incorporate warm-ups and cool-down periods to allow for increased catch-up of thermoregulation system Remember that the neurological system is heavily intertwined with the other body systems

Answer 14

Decreased visual acuity, decreased field view, decreased contrast sensitivity (sharpness) Visual impairment is correlated with depression, reduced quality of life, cognitive decline, and mortality Pupil reacts more slowly to light Ability to focus from far to near declines (presbyopia) Due to decline in ciliary muscle efficiency and increased stiffness of ocular lens Decreased ability to adapt to changes between light & dark Increased intraocular pressure Loss of color discrimination, especially between blues & greens

Answer 15

Loss of central vision Peripheral remains intact Leading cause of new cases of blindness in 65+ years old

Answer 16

Opacity of the lens of the eye Reduces visual acuity Early sign is c/o glare from lights at night Painless, progressive loss of vision

Answer 17

Increased intraocular pressure that damages the optic nerve Slow loss of visual field, effecting both eyes

Answer 18

Vascular complication of individuals with diabetes Retinal ischemia due to microvascular occlusion

Answer 19

Hearing loss occurs more frequently in later years Sensorineural hearing loss Sound well-conducted through the external and middle ear Age-related impairment of the inner ear or auditory nerve prevent sound transmission to the brain Sclerotic changes in the tympanic membrane, cochlear otosclerosis, and degeneration of the auditory nerve may contribute Presbycusis: decreased ability to hear & discriminate speech Hearing loss is associated with slower gait speed, poor cognition, and mortality

Answer 20

Thinning of the epidermis & atrophy of the dermis Decreased effectiveness as a barrier to infection & environmental/physical stressors Decreased collagen & elastin Loss of elasticity Wrinkles Specialized appendage atrophy Sweat/sebum glands (temperature regulation) Pacinian corpuscles (vibration, deep pressure, proprioception) Meissner corpuscles (fine touch, discriminative touch, vibration) Hair follicles (hair loss) Decreased density of Langerhans cells Decreased immune response Decreased epidermal proliferation & diminished vascularity Delayed wound healing Skin grows & heals more slowly Decreased inflammatory response

Answer 21

1)Cellulitis 2)Herpes Zoster (Shingles) 3)Diabetic Neuropathic Wounds 4)Pressure Wounds (Decubitus) 5)Arterial & Venous Insufficiency Wounds 6)Malignant Skin Cancer

Answer 22

Use caution with modalities/equipment, including but not limited to heat, ice, E-stim (adhesive pads), kinesiotape, bandages Positioning in bed, wheelchairs Wheelchair cushion selection Minimizing shear forces and off-loading bony prominences Dependent limbs, patients with inattention/neglect due to brain injury Ex: A patient with hemiparesis due to stroke has no control of his left arm When assisting the patient with mobility during therapy, you as the PT need to prevent harm to the dependent limb Wheelchair parts Watch your grip!

Answer 23

Use of 5 or more medications (prescription or OTC) according to 50% of the studies included in a systematic review by Masnoon et al in 2017 More drugs being prescribed or taken than are clinically appropriate in the context of a patient’s comorbidities11 Rational polypharmacy (follows best practice guidelines & clinical indications) vs. irrational polypharmacy (inappropriate prescription, more than 1 drug from same class, prescription of drugs with similar pharmacological action to treat different conditions, multiple providers, self-medication)1

Answer 24

Polypharmacy associated with increased number of Adverse Drug Reactions (ADRs), medication administration errors, non-adherence, and higher mortality rates1,11

Answer 25

how the body handles and disposes of drugs Absorption Distribution Metabolism Excretion – parameter most affected by age

Answer 26

what the drug does to the body Number of drugs prescribed to older adults is higher than that prescribed to younger individuals Increased prevalence of disease with increase in age Clinical practice guidelines recommend combination drug therapy Advertising by pharmaceutical companies Inappropriate prescribing practices Unmonitored self-medication

Answer 27

Rate at which a drug leaves the administration site & extent to which this occurs Stomach & small intestine

Answer 28

Time until peak affect absorption rate Gastric acid secretion Gastric acidity GI surface area Gastric emptying Splanchnic blood flow Intestinal motility Active transport mechanism

Answer 29

Extent of drug dispersion in the systemic circulation to the site of action Bloodstream

Answer 30

Volume of distribution for fat-soluble drugs-higher Volume of distribution for water-soluble drugs-lower LOWER Cardiac output Body water content Lean body mass Serum albumin HIGHER Peripheral vascular resistance Fat mass Serum alpha-1 glycoprotein

Answer 31

Biological transformation of the drug into an inactive molecule, a more soluble compound, or a more potent metabolite Liver

Answer 32

Half-life-higher drug clearance for hepatically cleared drugs-lower hepatic blood flow and liver size - lower

Answer 33

Elimination of the drug from the body Kidneys* & large intestine

Answer 34

Half-life-higher Drug clearance rate for renal excreted drugs-lower Renal blood flow, glomerular filtration rate, tubular subscription-lower

Answer 35

Declines in homeostatic mechanisms: BP & volemic maintenance Thermoregulation Respiratory function Postural & gait stability Cognitive reserve Clotting cascade Bowel & bladder function Insulin regulation Bone & skeletal muscle homeostasis Receptor alterations: → make target tissue more or less responsive to drug binding Reduced number of receptors Receptor competency Drug-receptor affinity

Answer 36

Presence of multiple disease states Lack of proper drug testing & regulation Problems with patient education and non-adherence to drug therapy Use of inappropriate medications Poor diet Excessive use of OTC drugs Smoking Caffeine, alcohol consumption

Answer 37

GI symptoms Sedation Confusion Depression Orthostatic hypotension Fatigue & weakness Dizziness Falls Anticholinergic effects: delirium, drowsiness, blurred vision, tachycardia, urinary retention, impaired diaphoretic response Extrapyramidal symptoms: tardive dyskinesia, parkinsonism

Answer 38

In general, you should be familiar with medications your patients may be taking so that you can optimize the time you have with them and be aware of potential adverse drug reactions Patient adherence to medications Example: BP medications Oral opioids should be taken 30-90 minutes prior to therapy1, but they can also make patients dizzy NSAIDs should be taken 60-90 minutes prior to therapy1 Schedule therapy within 2-3 hours of Levodopa morning dose1 Be aware that beta-blockers will lower heart rate Insulin is absorbed much quicker in an active extremity; insulin dose may need to be adjusted for someone who is initiating an exercise program1

Answer 39

Age-related loss of skeletal muscle2 Decreased muscle mass, strength, power, and endurance Decreased functional quality

Answer 40

sarcopenia

Answer 41

sarcopenia

Answer 42

1)Unintentional weight loss (10+ pounds in the past year) 2) Fatigue, self-reported exhaustion 3) Muscle weakness (grip strength lowest 20% for gender/BMI) 4) Slow walking speed (slowest 20% for gender & height) 5) Low levels of physical activity (lowest 20% for gender; <383 kcal/week for men; <270 kcal/week for women)

Answer 43

Strength Power (high velocity) Balance Endurance (muscular & aerobic) Gait Flexibility

Answer 44

3 sets of 8 reps at 80% 1RM – better improvement than 20-40% 1 RM19 Supplementation of nutrition, hormonal imbalances

Answer 45

Regular exercise over a long duration 2-3 times per week 3 months – most common tested according to systematic review by Theou et al., 201119 ≥ 5 months – superior outcomes19