Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PHTY2220 > L28: Elderly and Adolescents > Flashcards

L28: Elderly and Adolescents Flashcards

1
Q

Prevalence rates of severe and persistent LBP increase with ____ age.

A

older

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the 4 things that older adults are more likely to have?

A

More at risk of having red flags

  1. Fractures- Very common (even after mild trauma eg. coughing)
  2. Tumors or Infection
  3. Spinal Stenosis
  4. Degenerative Spondylolisthesis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

_____ degeneration is more prevalent; however, it is ____(more/less) likely to be a pain source as compared to young adults

A

Disc; less

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

_________ is common among women aged 60 years or older and is usually associated with facet hypertrophy

A

Lumbar degenerative spondylolisthesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

For almost 40 years, the mechanistic model of geriatric LBP has been _____ degeneration. But, _____ degeneration is highly prevalent with age and weakly associated with pain prevalence and pain intensity

A

pathoanatomical; spinal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

In older adults, Diagnostic imaging for spinal degeneration ____(increases/decreases) the likelihood of invasive interventions and yield _____ (no better/better/worse) outcomes for many conditions

A

increases; no better

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are 5 other biological factors in older adults?

A
  1. Older adults have altered pain processing both peripherally and centrally (More pain)
  2. The elderly pain neuroprocessing system also demonstrates maladaptive responses to prolonged pain over time.
  3. Reduced grey matter density is considered to contribute
  4. Affects how older adults perceive, process and inhibit (Poor pain inhibition = more pain) pain and may predispose older adults to pain persistence.
  5. Hip OA and Hip pain are increased risks for LBP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are 3 social and historical factors in older adults?

A
  1. History of employment involving whole-body vibrations, lifting, bending, twisting, stooping are related to LBP in older adults
  2. Lower education levels, lower income, and smoking are also related
  3. Those with poor economic status may have difficulty in accessing healthcare and those with limited resources may delay seeking healthcare until their symptoms are intolerable, which in turn increases the chronicity and severity of LBP

Usually don’t seek help/treatment until very late (when seeing patient for the first time –> condition must be severe)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

LBP in older adults is often _____-treated or left ____

A

under; untreated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are 7 results of not treating or undertreating older adults with LBP?

A
  1. Sleep disturbances
  2. Withdrawal from social and recreational activities
  3. Psychological distress
  4. Impeded cognition
  5. Malnutrition
  6. Rapid deterioration of functional ability
  7. Falls
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Older adults are already at risk for_____ behavior; therefore, further physical activity avoidance during geriatric LBP increases the likelihood for _____ consequences—mainly physical function decline

A

sedentary; long-term

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are 7 characteristics of osteoporotic vertebral fractures?

A

Not a massive concern = manage conservatively

  1. Post-menopausal women are more susceptible to osteoporotic fractures
  2. Approximately 25% of all postmenopausal women suffer from a vertebral compression fracture
  3. As high as 40% in women 80 years or above
  4. Those with vertebral fractures experience higher levels of disability
  5. Only one third of cases are correctly diagnosed
  6. Older age, corticosteroid use, and significant trauma are the main risk factors
  7. Most commonly thoracolumbar region
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

In osteoporotic vertebral fractures, most commonly a ____ trauma that causes a _____ (anterior/posterior) wedge fracture

A

flexion; anterior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Since the posterior vertebral body remains intact and the collapsed anterior vertebra heals without regaining height, it may result in a _____ deformity without compromising the spinal cord

A

kyphotic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

A less common fracture involves the axial compression of the entire vertebral body or the _____ (anterior/posterior) portions of the vertebra, often results in neurological deficits

A

posterior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the 2 types of osteoporotic vertebral fractures? EXAM QUESTION

A
  1. Anterior vertebral fractures
    • Most common
    • Safe
      • Spinal cord is not impacted
    • Cause kyphotic deformities (eg. if multiple fractures)
  2. Posterior vertebral fracture
    • Increase risk of spinal cord compromise
    • More dangerous
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are 3 characteristics of tumour?

A
  1. Exponentially increase with age
  2. Still only less than 1% of the causes of LBP
  3. The majority of tumors are related to metastases
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are 5 symptoms of tumour for LBP?

A
  1. Progressive, unremitting
  2. Localised, often with a radiating pain
  3. Aggravated by movement
    • Ease with movement (eg. change in position) = not as likely a red flag
  4. Worse at night
  5. Cannot be eased by rest. In addition, patients may experience weakness and feel the presence of a lump
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is an infection for LBP?

A

Vertebral osteomyelitis is a life-threatening infectious disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are 5 presentations for infection for LBP?

A
  1. Fever
  2. Elevated c-reactive protein
  3. Unremitting pain
  4. Localised pain and
  5. Neurological symptoms

Suspicion where older patients demonstrate unidentified fever with LBP. Clinical findings, laboratory results, bone scintigraphy, and/or spinal biopsy are used

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the 6 considerations in assessment for LBP?

A
  1. Must assess psychosocial factors – depression and anxiety are common – consider measures for these
  2. Use functional outcome measures
  3. Set goals – particularly aimed at function and physical activity
  4. Assess risk of falls- Have you had any falls? When was your most recent fal?
  5. Seeking appropriate medication use is critical
  6. Early communication and involvement with interprofessional team – especially GP and Pharmacist- Often have polypharmacy Usually have a close relationship
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are 5 assessment levels of physical activity?

A
  1. Are they sitting at home and never go out? OR Go out? –> don’t assume Older adults are already at risk for sedentary behavior
  2. LBP may indirectly pose health risks above and beyond the pain experience
  3. Outcome measures should therefore encompass movement, physical activity (duration and intensity), and physical function
  4. Include assessment of proposed and preferred physical activity – what the patient will likely do, is interested in and has access to in order to start planning
  5. Consider getting the patient to use a diary to monitor physical activity levels
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are 7 yellow flags in the older adult?

A
  1. Psychological distress (especially anxiety or depression) is a risk factor for persistent or debilitating LBP in older adults
  2. Fear-avoidance beliefs are closely related to chronic LBP in older people
  3. Assess social conditions and stressors – access to social networks and care- Family?
  4. If something goes wrong, who do you call?
  5. Loneliness is a predictor for developing persistent LBP
  6. Assess coping strategies
  7. Assess barriers (barriers to care seeking, barriers to physical activity).
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are 4 ways we manage LBP in older adults differently?

A
  1. Broad management guidelines are the same for all adults
  2. However the mobility, cognition and access the person has must be taken into account
  3. For persistent pain – management is at the cognitive-psychological level as well as physical
  4. Older adults likely have more barriers to management – so barriers should be considered and managed.- Eg. can you drive? Can you get to exercise class?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is the approach to management for LBP in older adults?

A

Positive patient-clinician interaction has been associated with improved outcomes for persistent LBP Positive patient-clinician interactions in combination with non-pharmacologic treatment is associated with improved LBP outcomes. Older adults often face obstacles such as age stereotypes and poor clinical understanding that negatively affect care. It is common for clinicians to attribute geriatric LBP to the inevitability of old age and/or to prescribe activity avoidance, which adversely affects patient outcomes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Positive _____ interaction has been associated with improved outcomes for persistent LBP

A

patient-clinician

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Positive patient-clinician interactions in combination with non-pharmacologic treatment is associated with _____ LBP outcomes.

A

improved

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Older adults often face obstacles such as age _____ and _____- understanding that negatively affect care.

A

stereotypes; poor clinical

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

It is common for clinicians to attribute geriatric LBP to the inevitability of old age and/or to prescribe______, which adversely affects patient outcome

A

activity avoidance

30
Q

_____ is an individual’s confidence to perform tasks or exercises.

A

Self-efficacy

31
Q

In older adults with persistent pain, _____ is positively associated with physical activity, and negatively associated with pain-related disability and depression

A

self-efficacy

32
Q

What is self-efficacy?

A

an individual’s confidence to perform tasks or exercises

33
Q

What are 5 aims to boost self-efficacy in management of LBP for older adults?

A
  1. Start with activities and exercises (lower back and general) that the patient has confidence to achieve and gradually build up
  2. Working in groups and modeling from others can boost self-efficacy (even using examples of others experiences)- Eg. tai chi
  3. Provide positive feedback and positive reinforcement
  4. Let others know the goals (family, GP)
  5. Address other factors causing low self-efficacy (anxiety and depression)
34
Q

What are 8 characteristics of addressing pain processing with activity in older adults with LBP?

A
  1. Older adults with altered pain neuroprocessing require graded exercises or modification to exercise interventions that they perceive to exacerbate symptoms (same as persistent pain management in adults)
  2. Graded activity programs are feasible and effective
  3. Performing graded tasks with others, patients can observe successful task completion and successfully complete tasks themselves, while receiving verbal encouragement
  4. Consider other treatments (massage, manual therapy etc) if used in conjunction with exercise.
  5. Cognitive-behavioral therapy can impact psychological and cognitive aspects
  6. Both CBT and mindfulness-based stress reduction are effective in improving long-term pain, functional limitations, pain catastrophizing and self-efficacy
  7. Mindfulness-based stress reduction can be integrated into exercises like tai chi
  8. Although the direct influence of tai chi on pain is still unclear, there is some indication for its use in patients with arthritis and LBP (in addition to improving balance, depression, strength and socialization)
35
Q

What are 8 services should be encouraged to the patient depending on preference and access to service?

A
  1. Multidisciplinary pain clinics (through the GP)
  2. Tai Chi (local parks – see council website)
  3. Exercise Physiology classes (most centres, “active over-50’s”)
  4. Aqua Classes (most local pools)
  5. Curves
  6. Men’s Sheds
  7. Walking groups
  8. 60 and better programs
36
Q

What are the 4 characteristics of Prevalence of LBP in Adolescence and Its Impact?

A

At age 14, LBP in the last month: 30% of adolescent girls 26% of adolescent boys 11% of both sexes report persistent LBP For most, LBP has little impact on function and they do not seek medical attention

37
Q

What are the 4 things that a significant number with persistent LBP associated with adolescence?

A
  1. taking medication
  2. health care seeking
  3. modifying physical and daily life activities
  4. taking time off school and/or work
38
Q

MRI findings such as disc degeneration are prevalent (30%) as young as 13 years, however pathology associated with LBP is ____(common/rare)

A

rare

39
Q

Disc herniation with radiculopathy is extremely ____ (high/low) in adolescents (0.2%–0.6%).

A

low

40
Q

What are 2 causes of LBP from adolescence?

A
  1. Traumatic fracture
  2. Spondylolysis or spondylolisthesis
41
Q

What is the traumatic fracture of LBP from adolescence?

A

Consider where LBP is acute, disabling, and associated with a clear history of a trauma.

42
Q

What is the spondylolysis or spondylolisthesis of LBP from adolescence?

A
  • Where LBP is associated with repetitive loading
  • Conservative management of spondylolysis/ spondylolisthesis results in successful outcomes for the vast majority
  • Only high-grade spondylolisthesis associated with neurological/cauda equina symptoms indicates surgical consideration
43
Q

What are contributing factors but are not shown to cause LBP?

A
44
Q

What are 3 characteristics of joint hypermobility in LBP for adolescents?

A
  1. There is debate within the research literature
  2. Generalized joint hypermobility is prevalent in adolescents, especially in girls.
  3. No relationship between joint hypermobility and LBP
45
Q

What are 3 characteristics of scoliosis in LBP for adolescents?

A
  1. Scoliosis has a prevalence ranging from 0.5% to 5% (Cobb angle >10 degrees)
  2. Systematic reviews reveal that the prevalence of LBP in those adolescents with scoliosis is similar to those without
  3. Magnitude of curvature does not correlate well with pain
46
Q

What is spinal posture in LBP of adolescents?

A

There is a common belief that postural problems, such as slump sitting, are a cause of LBP

47
Q

What are 6 associations of slump sitting?

A
  1. Males
  2. Non-neutral standing postures
  3. Lower perceived self-efficacy
  4. Lower back muscle endurance
  5. Greater TV use
  6. Higher body mass index (BMI)
48
Q

_____ at 14 years of age is only weakly predictive of LBP associated with impact at 17 years of age

A

Slump sitting

While can be a factor –> not a major cause

49
Q

Generic postural advice for LBP, may not be ______, as postural presentations in adolescents are heterogeneous and postural patterns are only weakly predictive of future LBP.

A

warranted

Only assess sitting if its relevant to patient (eg. aggravated in sitting)

50
Q

The individual’s LBP ____ and unique ______ should be evaluated when providing postural advice.

A

experience; postural presentation

51
Q

What are 3 characteristics of movement patterns of LBP in adolescents?

A
  1. There has been little research into the role of movement patterns in adolescents with LBP
  2. Boys with LBP provoked by rowing demonstrated a greater tendency to position their spine closer to end-range flexion during the drive phase compared to a pain-free comparison group
  3. Like in adults, motor control should be assessed in those with predicted impairments from the interview and those undertaking repetitive tasks that aggravate symptoms
52
Q

Boys with LBP provoked by rowing demonstrated a greater tendency to position their spine closer to ______ during the drive phase compared to a pain-free comparison group

A

end-range flexion

Repeated end range loading = need to observe/assess

53
Q

Like in adults, motor control should be assessed in those with predicted ______ from the interview and those undertaking ______ that aggravate symptoms in adolescents.

A

impairments; repetitive tasks

54
Q

What are 4 other factors that must be considered in LBP in adolescents?

A
  1. Sleep
  2. Back pain belief
  3. Mental health
  4. Social
55
Q

What are 2 characteristics of sleep that must be considered in LBP in adolescents?

A
  1. Sleep deficits are independent predictors of LBP in adolescents.
  2. Changes in pain thresholds and inflammatory processes via the neuro-immune-endocrine system. Adolescents need more sleep than adults and older people
56
Q

What are back pain beliefs that must be considered in LBP in adolescents?

A

Adolescents with more negative LBP beliefs (ie, the back should be rested when in pain, back pain will stop you working, back pain gets progressively worse with age) were associated with greater levels of activity modification and care seeking Ask patient and parents about what their understanding is? What are their concerns?

57
Q

What is mental health that must be considered in LBP in adolescents?

A

Poorer mental health, defined as higher internalizing behaviors (anxious/depressed and withdrawn) as well as externalizing behaviors (aggressive and rule breaking), is associated with LBP in adolescents

  • Having LBP
  • If have pain = increase risk of persistent pain
58
Q

What are 2 social characteristics that must be considered in LBP in adolescents?

A
  1. Behavioral responses associated with LBP in adolescents (eg, care seeking, taking medication, and avoiding physical activity because of LBP) are aligned to their primary carer’s reported behavioral responses to LBP.
  2. These findings suggest that negative behaviors associated with LBP are learned within the home environment
    • Family’s response = impact pain
    • Keeping child off school = risk of increasing persistent pain (eg. even half a day at school is better than no school)
59
Q

What are 9 adolescent psychosocial questions to consider?

A
  1. Have you had any difficulties at school lately like problems with teachers or other students?
  2. Have you had any difficulties at home in the last year? Do you get along with your family members?
  3. How do your family members respond to your pain?- Can be genetics or nerve effect
  4. Do any of your family members have chronic pain?
  5. Do you feel like you have enough support to feel OK? To do the things you want to do?
  6. Why are you having this pain? What do you think caused this pain?
  7. How does this pain affect you on a daily basis?
  8. What does this pain mean in your life?
  9. What do you do to help the pain? What can we do to help your pain?
60
Q

What are factors associated with adolescent LBP?

A
61
Q

What are 3 key approaches to LBP management in the adolescent?

A
  1. Functional restoration
  2. Education
  3. Healthy lifestyle
62
Q

What are 3 characteristics of functional restoration as key approaches to LBP management in the adolescent?

A
  1. Where LBP is provoked by functional or sports-related activities, graduated conditioning specific to these tasks, while enhancing greater postural variability (Frequent movement) in relation to the individual’s presentation, aims to enhance pain control and confidence during these tasks.
  2. Where LBP is associated with sustained postures or loading – introduce movement variability and consider motor control
  3. Where LBP is associated with avoidance of functional activities, building confidence to gradually engage in these activities in a relaxed and variable manner is stressed.
  4. Keep them active in other ways that load back that don’t hurt = still build confidence
63
Q

What are 5 characteristics of education as key approaches to LBP management in the adolescent?

A
  1. Education via explanation and reflective questioning
  2. Experiential learning to reinforce positive back pain beliefs
  3. Informing the patient (and relevant others) that LBP doesn’t mean the spine is damaged but, rather, reflects sensitization of spinal structures relating to various factors relevant to the individual.
  4. It also reinforces an understanding that postural variability, spinal movement, and loading are safe and important
  5. Collaborative goal setting is important to build confidence to stay engaged in activities of daily living, physical activity, school, and work.
64
Q

What is a characteristic of healthy lifestyle as key approaches to LBP management in the adolescent?

A

Engaging in positive lifestyle behaviors, such as healthy sleep habits, regular physical activity, and balanced diet, is important for general, spine, and bone health and is encouraged.

65
Q

What are 4 examples of unhelpful messages for patients about LBP?

A
  1. Your spine is too mobile – this causes pain
  2. Your posture is the reason for your pain
  3. You should avoid lifting, carrying a school bag, exercises
  4. Condoning activity avoidance or unhelpful rest from activity
66
Q

What are 5 examples of helpful messages for patients about LBP?

A
  1. LBP is rarely associated with serious or long term pathology
  2. LBP is influenced by a number of factors that all contribute
  3. Varying posture is key
  4. Regular physical activity
  5. If carrying loads, activity etc is painful – its about building up the tolerance of the back to do these activities
67
Q

What are 5 other helpful strategies in regards to LBP?

A
  1. Adolescents are strongly influenced by peers – so team sports, exercise and activity is something to encourage
  2. Use technology – apps to monitor physical activity and exercise (general and those prescribed)
  3. For persistent pain – the adolescent should be managed with effective communication with GP and other professionals with shared goals
  4. Psychological factors are commonly present – this should be discussed and encourage input from other professionals
  5. Talk to the adolescent – not just the parent! Offer privacy but include the family.
68
Q

_____ are strongly influenced by peers – so team sports, exercise and activity is something to encourage

A

Adolescents

69
Q

Use _____ – apps to monitor physical activity and exercise (general and those prescribed)

A

technology

70
Q

For persistent pain – the _____ should be managed with effective communication with GP and other professionals with shared goals

A

adolescent

71
Q

_____ factors are commonly present – this should be discussed and encourage input from other professionals in LBP.

A

Psychological

72
Q

Talk to the _____ – not just the parent! Offer privacy but include the family.

A

adolescent

PHTY2220 (31 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions