Lecture 4 Flashcards
Adults over 65 purchase __% of all perscription medication
30%
Also older adults are more likely to experience adverse drug reactions
The average older adult takes _ medications
The average nursing home resident takes _ medications
Older Adult: 5
Nursing home resident: 7
Polypharmacy definition
Excessive/Inappropriate use of perscription medications
____ of all old people take atleast one unnecessary drug
half
How does aging effect drug absorption?
Decreased gastric acid
Decreased stomach emptying
Decreased gastric motility
How does aging effect drug distribution
Decreased Body H20
^ Body fat
Decreased plasma proteins
Decreased lean body mass
How does aging effect drug metabolism
Decreased liver mass
decreased bloodflow to liver
decreased enzymatic activity
How does aging effect drug excretion
Decreased kidney mass
Decreased bloodflow to kidneys
Decreased nephron function
What kind of medications are most commonly overperscribed
Laxatives
BP medication
Diuretics
Diabetes medication
What is the common side effect of NSAIDS
GI symptoms
What is the common side effect of opiods
sedation
What is the common side effect of antidepressants/ analgesics/ lithium
Confusion
What is the common side effect of barbiturates and antihypertensive medication
Depression
What is the common side effect of antihypertensives
orthostatic hypotension
What is the common side effect of Diuretics and glucocorticoids
Fatigue/weakness
–% of adults 65+ report a fall once a year
29%
Medical treatment for falls costs about ____ a year
50billion
Fall risk factors
Besides the obvious:
Polypharmacy
Use of Assistive Device
Depression/Anxiety
Fear of falling
Recent hospitalization
What is the 6th vital sign
Gaitspeed
What is the cutoff for community ambulation
0.8m/s
What is the cutoff gaitspeed for being dependent in ADLs AND more likely to be hospitalized
Under 0.6m/s
Whats the gaitspeed cut off for being independent and less likely to be hospitalized
Over 1m/s
What outcome measures are for balance
BERG balance scale
Sharpened romberg
4 square step test
functional reach test
MiniBEST
What outcome measures are best for “Functional” measurement
5xSTS
30s STS
TUG
10mWT
What tests are best for measuring endurance
6MWT
2min step test
What outcome measures are considered self report
MFES
fear of falling avoidance questionarre
What is the cutoff in gaitspeed for being D/Ced to a skilled nursing home vs being D/Ced back home
0.1m/s
What is the cutoff gaitspeed for needing intervention to reduce fall risk
1m/s
Household walker gait speed
0.4 m/s
limited community ambulator gait speed
0.4-0.8m/s
community ambulator gaitspeed
0.8-1.2
Cross street ambulator gait speed
1.2m/s+
The sharpened romberg uses what 3 stances?
Feet together
Semi tandem
Tandem
How far do you walk before you turn around in the TUG test?
3m
What is the cutoff value for fall risk during a TUG test
13.5
What is the cutoff fall risk for a 5xSTS?
11.4s
What are the different categories of disability
Ambulation
Cognitive
Visual
Hearing
Medical
What percent of people over 65 have atleast one disability
34%
What percent of people over 65 have an ambulatory disability
21%
What activities are ADLs
Bathing
Dressing
Toileting
Transfering
Eating
what activities qualify as IADLs
Shopping
Preparing meals
Taking medications
Housekeeping
Using transportation
Managing finances
Using the phone
Medicare is for
People over 65 or people with disabilities
Medicaid is for
Low income
Persons responsible for minor/pregnant
Disability
Requirements for independent community living
1.2m/s gait speed
Ambulation distance 400m
Carrying objects around 8lbs (gallon of milk)
Ambulate varions terrain
Stairs/curbs
Inpatient rehab
3 hours of therapy per day (PT OT SP)
high prior level of function
Moderate complexity
Skilled nursing facility
Unable to participate in 3 hours of therapy
Moderate functional prognosis
Variable level of prior function
Long term acute care
Poor Prognosis
High complexity of medical needs
Less need for skilled therapy
Hospice care
Life expectancy under 6 months
MOLST/POLST
advanced care directives for physician to order life sustaining care
DNR
Advanced care directive: do not resuscitate
Adults lose __% of their strength between 60-90
40%
Review this
K
FITT recommendations for geriatric w/ osteoporosis
Aerobic 4-5 times a week, Moderate intensity
Resistance. 1-2 nonconsecutive days. Adjust weight so last two repetitions are challenging. High intensity is beneficial if they can tolerate it.
Flexibility 5-7 days a week, hold static stretch for 10-30 seconds, 2-4 repetitions
Review this
K
