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7 Geriatrics > L6/7 Falls & Exercise > Flashcards

L6/7 Falls & Exercise Flashcards

1
Q

Screening tools

A
  • CPG recommend all adults 65+ be screened
  • commonly used at community health events or if pt is being seen for something else
  • screening tests need HIGH SENSITIVITY so that they don’t miss individuals at risk
  • tests should be brief
  • examples for falls include “fallen in the past year”, MAHC-10, feel unsteady
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2
Q

Assessment for Falls

A
  • CPG recommend only if indicated based on screening results
  • often occur after a fall has already happened
  • need tests with high SPECIFICITY
  • tests often more time consuming than screening tests
  • commonly used performance based functional measures are Berg, mini-best, 4SQ, TUG
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3
Q

SPINS

A

4 SQ Spin = 100%
Berg Spin = 90%
TUG = 85%
3 Key Qs = 75%
Mini-Best = 75%
Gait Speed = 70%
STEADI = 63%
Mahc-10 = 13%

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4
Q

SNOUTS

A

Mahc-10 = 97%
3 Questions = 94%
Gait Speed = 89%
4SQ = 85%
Mini Best = 85%
Berg = 73%
STEADI = 70%
TUG = 31%

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5
Q

Stopping elderly accidents, deaths, and injuries (STEADI)

A

Developed in 2012 by the CDC
* based on CPG, geared towards PCP and pts
* recommends that all adults age 65 yo + be screened for falls annually

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6
Q

Three parts of STEADI

A
  • SCREEN = pts to identify their fall risk with stay indpendent and STEADI
  • ASSESS = pts modifiable fall risk factors
  • INTERVENE = to reduce fall risk by using effective clinical and community based strategies
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7
Q

Questions asked on STEADI

A
  • falls
  • ADs
  • unsteadiness
  • concern for falls
  • B/B function
  • neuropathy
  • medicine
  • mood

12 Q total, scoring 4 or more indicates increased risk

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8
Q

Three key questions for patients falling on STEADI

A
  1. Feels unsteady when standing or walking
  2. Worries about falling
  3. Has fallen in past year –> how many times, were you injured
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9
Q

Screen all adults ___ for falls risk

A

over 65

should ask if they have fallen the past year, their fear of falling. PT will note balance or mobility impairments or neuro

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10
Q

PTs should do for falls…

A
  • home safety assessment and recommendations
  • assessments or performance outcomes as necessary
  • set goals and provide interventions within PT scope of practice
  • refer to provides outside PT scope of practice
  • give advice about community exercise or ways to prevent falls
  • intervene with evidence based exercise and education
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11
Q

Beers Criteria

A
  • lists potentially inappropriate medications for 65+
  • does not forbid from takin gthese meds
  • meds on the beers criteria are usually becuase they sedate or cause confusion, increasing fall risk
  • PTs have ability and obligation to advise PCP about pt’s fall risk and medication ADRs
  • it is important to do medication review and reconciliation especially after hospitalization
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12
Q

Medication Intervention Strategies

A
  • evaluate polypharmacy
  • drug to drug interactions
  • help recommend med minders
  • eliminate psychotropics (rf for fall injuries) includes antipsychotics, antidepressants, sedatives
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13
Q

Approx ___ of american adults…

A

1/3
in their 60s to 70s use 5+ meds regularly

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14
Q

CDC PA Guidlines for 65 yo+

A
  • at least 150 min a week of moderate intensity or 75 min week of vigorous intensity, at 10 min at least a bout
  • 2 days a week of activities that strengthen muscles
  • activities to improve balance
  • RPE 13-16, somewhat hard
  • large muscle groups
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15
Q

Less than __ of americans aged 65+ achieve CDC guidelines

A

15%

37% of older adults meet aerobic
19% of older adults meet strength

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16
Q

Physical Stress Theory

A

predictable response of tissues, organs, and systems to mechanical and physiological stressors

changes in relative level of physical stress causes a predictable adaptive response in all biological tissues

helps explain overload and underload effects as well as lack of change if usual load is placed

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17
Q

Underload

A

tissues that lose thier ability to absorb and dissipate stress, results in atrophy

<40% of maximum

examples: bed rest, sedentary activity

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18
Q

Overload

A

tissue responds with increased ability to absorb and dissipate stress, causes hypertrophy

60-100% of max, resulting in adaptation

ex: strength training with 1 RM max

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19
Q

Excessive Stress

A

susceptible to injury or death

> 100% of max

ex: weight bearing on osteoporotic bone

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20
Q

Usual Stress

A

40-60% of maximum, causes no change. More of maintenance of muscles

ex: walking 5000-7000 steps a day

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21
Q

No stress

A

0% of max, loss of ability to adapt, resulting in death

ex: prolonged bed rest such as coma

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22
Q

Sarcopenia and Frailty

A
  • sarcopenia is a normal age related loss of skeletal muscle
  • sarcopenia thought to be main driver of frailty
  • sarcopenia 2x common as frailty
  • both increase risk for medical and disabling conditions
  • both are amenable to interventions and are reversible
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23
Q

Most common symptoms of frailty

A

muscle weakness
decreased gait speed

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24
Q

Frail Adults and Exercise

A

start with strength and balance training before aerobic to build up reserve

25
Q

Strengthening for Older Adults

A
  • can do 70-80% of 1 RM safely
  • 8-12 reps is 70-80% of 1 RM
  • true 1 RM testing is not recommended for adults
  • should do 8-10 exercises that target major muscle groups
  • 2-3 days a week that are non-consecutive
  • significant improvements in muscle strength and functional performance despite advanced age presence of chronic disease, sedentary habits, and functional disabilities
26
Q

The ___ weight that can be lifted ___ with number of repetitions

A

MAX
DECREASES

27
Q

Flexibility Principles for older adults

A
  • higher dose has same effects as younger adults
  • best to stretch after aerobic or strength b/c tissue is vascularized
  • at least 30-60s hold with slight resistance and mild discomfort
  • breathing during the stretch helps to minimize activation of muscle spindles
28
Q

Joint mobs and osteoporosis

A
  • osteoporosis is a precaution for grade 1-4
  • no clear evidence of harm
  • grade 5 is contraindicated with osteoporosis
29
Q

Frid Frailty Phenotype

A
  1. weight loss > 10 lbs in past year
  2. Self-reported exhaustion
  3. Slow walking speed <.76 m/s
  4. Weak grip strength
  5. Low physical activity

0/5 = robust
1-2/5 = pre-frail
≥ 3/5 = frail

30
Q

Falls are the leading cause of

A

injury for adults 65+
visits to ER
hospital admissions
death

31
Q

Injuries and Falls

A
  • fractures are most common injury, specifically hip, wrist, humerus, pelvis
  • other serious injuries include hematoma, jt dislocation, laceration
  • most falls don’t cause injuries that are severe enough for medical attention
32
Q

Intrinsic Risk Factors for Falls

A
  • age
  • previous falls and fear of falling
  • age related somatosensory and neuro changes
  • congitive
  • mental health
  • behvaior and life choices
  • medications
33
Q

Extrinsic Factors for Falls

A
  • environment
  • clothing, shoes, glasses
  • equipment
  • social influences
  • siutational
    *medications
34
Q

Medical history questions that predict falls

A
  • any previous falls
  • psychoactive meds
  • requiring any ADL assistance
  • self-reported fear of falling
  • AD device used
35
Q

Berg Balance Cut off

A

≤ 50

36
Q

Mini best cut off

A

< 16

37
Q

TUG Cut off

A

≥ 12 sec

38
Q

Gait Speed Cut off

A

< 1.0m/s

39
Q

Measurements of Thoracic Kyphosis

A

Kyphotic Index
Occiput to Wall distance

40
Q

Interventions to address fall risk factors

A

rehab
environment
medical

41
Q

Interventions to address fall risk need to include

A
  • strength training
  • balance training
  • gait training
  • correction of environmental hazards
  • correction of footwear
42
Q

Ramps that are ADA approved

A

1/12 slope
for every 1 inch of rise, you need 1 foot of ramp

43
Q

Physical Activity

A
  • not just exercise
  • voluntary body movement that involves skeletal muscle contraction that results in energy expenditure
  • encompasses all activities and intensity levels
  • typically low intensity
44
Q

Exercise definition

A

higher intensity
sub category of PA
planned, structured, repetitive

involves improvement or maintenance of PF

45
Q

Physical Fitness

A

state of well-being and overall health

can be measured with 5xSTS, TUG, etc

46
Q

Physical Inactivity

A
  • significant rf for developing chronic health condition
  • can cause sedentary death syndrome
  • 9.9% of deaths for 40-70 and 7.8% of deaths for 70+ are attributed to not meeting CDC PA guidelines
47
Q

Imediate Benefits of Exercise

A
  • improves sleep
  • reduces anxiety
  • reduces BP
48
Q

Other benefits of exercise

A
  • reduces risk of dementia and depression
  • lowers risk of heart disease, diabetes, stroke
  • lowers risk of cancers
  • reduces risk of weight gain
  • helps people live independently longer
  • improves bone health
  • reduces risk of falls
  • boosts immune function
49
Q

Don’t underdose older adults. Instead…

A

match frequency, intensity, and duration of exercise to abilities and goals

50
Q

Frailty Definition

A
  • decreased reserve across organ systems leading to alterations in function
  • multidimensional, gives rise to vulnerability
51
Q

Failty Prevalence

A
  • F > M
  • higher incidence in racial minorities
  • higher incidence in lower income
52
Q

in high risk adults, interval training

A
  • reduces BP
  • improves endothelial function
  • improves lipid profiles
  • improves VO2 max
  • improves LV function
  • improves myocardial function
  • reverses left ventricular modeling
53
Q

When is lower intensity better for older adults?

A
  • acute conditions
  • post surgical
  • extremely frail
  • RA
  • other medical conditions that limit intensity
54
Q

Bone Mineral Density

A
  • RET and AET both positively impact BMD
  • higher intensity, progressive, and novel are best
  • avoid spinal flexion and rotation, initially supervise other actions
55
Q

Aquatic Exercise

A
  • buoyancy allows deconditioned individuals to exercise by lessening impact
  • can improve all aspects of fitness
  • reduces pain, good for those with OA, balance disorder, obesity, post surgical
  • use RPE not HR for aquatic
56
Q

Home Health Exercise

A
  • similar to healthy individuals
  • maximize home space for safety
  • think about how to best use environment for the pt
57
Q

Exercise in Inpatient

A
  • restorative or maintenace programs
  • may benefit from group exercise for socialization
58
Q

Frail Individuals should perform

A

Mostly Aerobic exercise, and 45 minutes a session

7 Geriatrics (9 decks)

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