Management (week 1)

Question 1

Define Ageism

Answer 1

Predjudice or discromination against a particular age group, especially the elderly

Question 2

What is the difference between successful aging vs optimal aging?

Answer 2

• Successful aging - avoiding disease and disability, maintaining high physical and cognitive function, sustain engagement in social and physical activities
  
  • PT’s impact when working iwth tenn and young adult clients
• Optimal Aging - Acheving life satisfaction despite medical condition (physical, psychological functional, cognitive, emotional, spiritual, and social domains
  
  • PTs stop the cycle of “disease-disability-new incident disease” in order to maintenance quality of life

Question 3

What are the factors that affect the experience of aging?

Answer 3

Question 4

5 most common causes of death

Answer 4

1. Heart disease
2. Malginant neoplasms
3. Verebrovascular diesase
4. Chromic lower respiratory diseases
5. Pneumonia/Influenza

Question 5

6 most common chronic health conditions

Answer 5

• Arthrits/MSK issues
• Heart/circulator issues
• Vision / Hearing
• Fractures / Joint injuries
• Diabetes
• Mental Illness

Question 6

What is the Physical Stress Theory?

Answer 6

Tolerance to stress modifiable with lifestyle adaptations (as stress increases we are buitld to handle and adapt)

Question 7

What are 3 additional factors we must consider for the aging adult?

Answer 7

• Multi-system/multi factoral involvement
• Functional status
• Support System

Question 8

Why is it important to screen for falls?

Answer 8

• Leading cause of fatal and non fatal injuries for patients over 65
• Risk increases as they get older
• icnreased chance of being in nursing home
• Questions include:
  
  • have you ever fallen?
  • how many times in the last month
  • any “near falls”

Question 9

What are some components of the home assesment?

Answer 9

• Clear path throughout home
• Rearraging obstacles and removing barriers
• flooring surfaces
• Is it appropriate for mobility level?
• any reccomendations?
• safety, medical issues, social support,

Question 10

Define “fun” in the slippery slope of aging?

Answer 10

What you want, when you want, for as long as you want

Question 11

Define “ Function “ in the slippery slope of aging?

Answer 11

Choices made based on decreased physical capacity

have mobility disability or at risk for

Question 12

Define “Frailty” in the slippery slope of aging?

Answer 12

Require help with ADLs and IADLs

Question 13

Define “failure” in the slippery slope of aging

Answer 13

Completely dependent

Question 14

Describe the “Frailty” requirements

Answer 14

3/5 = Frail

1 or 2 = Prefrail

• Unintentional weight loss >10 lbs in past year
• Self reported exhaustion 3 or more days/week
• Muscle weakness (can test grip)
• Walking speed <.08 m/sec
• Low level of activity (sitting quietly or lying down majority of the day)

Question 15

What is the most imporant factor in subsequent institutionalziation

Answer 15

Leg Strength

Question 16

What is considered “sufficient overload” in the Physical stress theory?

Answer 16

60-100% of max (Strengthening)

FITT (frequency, intensity, time, type)

Question 17

What is Polypharmacy?

Answer 17

• Adminstration of many drugs together
• Adminstraiton of excessive medicaiton
• Excessinve or inapproprate use of medications

Question 18

Describe the polypharmacy cycle

Answer 18

Question 19

What are charactistics of Polypharmacy?

Answer 19

• use medications for no reason
• duplicate medications
• concurrent use of interacting meds
• use of contraindicated medications
• Inapporpiate dosage of medications
• use drug therapy to treat ADRs
• patient improves with discontinuation

Question 20

Describe what the overall reaction for an altered response to drugs (pharmacokinetic changes)?

Answer 20

[how the body handles the drug] Drugs and metabolites remaining active for longer periods of time and prolonging during effects therepy increasing risk for toxic side effects

• distribution in fat/water soluble can end up in higher concentrations or lower concentraion in the body
• Metabolism becomes more difficult

Question 21

What are the physiologic pharmacodynamic changes?

Answer 21

• how the drugs affect the body
• Physiologic system changes
  
  • homeostatic control of circulation (cardiovascular drugs)
  • Impaired posutral control
  • decreased visceral muscle function
  • changes in thermoregulation
  • decline in cognitive ability

Question 22

What are the cellular level changes (pharmacodynamic changes)?

Answer 22

Binding receptor changes

• Increased or decreased sensitivity

Question 23

What are the biochemical response changes?

Answer 23

Subcellular structural and functional changes

Question 24

List common ADRs with GI tract

Answer 24

• Nausea, comiting, diarrhea, constipation
  
  • common with opiods, non opiods, NSAIDS

Question 25

List common ADRs with Sedation

Answer 25

Common with opiods, analgesics, antipsycotics,

sometimes excessive sedation seen with sedative hypotics

Question 26

What are common ADR’s with confusion

Answer 26

Common with antidepressants, narcotic analgesics, drigs with anticholinergic activity

Question 27

What are common ADRs with depression

Answer 27

• Common with barbituates, antipsychotics, alcohol, and some antihypertensive drugs

Question 28

What are common ADRs with orthostatic hypotension?

Answer 28

Most common with drugs that treat hypertension

Question 29

Common ADR’s with fatigue and weakness

Answer 29

Common with skeletal muscle relaxants and diuretics (altered electrolyte balance)

Question 30

What are common ADR’s associated with dizziness and falls?

Answer 30

Common with sedatives, antipsychotics, opiod analgesics, antihistamines

Question 31

Common ADRs associated with anticholinergic effects?

Answer 31

Alters response of tissues to acetylcholine

• common with antihistamines, antidepressants, and antipsychotics
  
  • CNS effects: Confusion, nervousness, drowsiness, dizziness
  • Periperhal effects: Dry mouth, constipation, urinary retention, tachycardia, blurred vision

Question 32

Describe extrapyramidal symptoms with ADRs

Answer 32

Dystonia, tardive dyskinesia, pseudoparkinsonisms

• common with antipsychotics

Question 33

What are some general strategies for PT’s to use in polypharmacy?

Answer 33

• Differentiates between diagnosis and disease (disease or medications?)
• ID polypharmacy and refer for reevaluation of meds
• schedule according to drug effect and rehab needs
• encourage adherence to prescribed medication regimen
• provide education on +ves and -ves of medicaitn (Side effects)
• use on pharmacologiv options to manage conditions

Question 34

When do immune system chagnes typically happen in an adult?

Answer 34

• Beings in the 6th decade of life “immunosenescence”
• can begin prematurely in some clinical condtions such as RA and w/ chornic organ diseases (COPD, CKD)

Question 35

What are some cardinal features of immune system aging?

Answer 35

• weakened antimicrobial activity
  
  • susceptibility to respiratory infections
  • reactivation of chronic viral infections (Shingles)
• Impaired anti vaccine response
• insufficent protection against malignancies
• predisposition for unopposed tissue inflmmation (Atherosclerotic disease, OA)
• Failing would repair mechanism

Question 36

What are 3 changes due to increased systemic inflammation due to immune system changes?

Answer 36

• Increased proinflammatory cytokines (interlukin 1 and 10)
• Increased C reactive protien (CRF)
• Increased Tumor necrosis factor

Question 37

What are some reasons why changes in the immune system occur?

Answer 37

• shift in fat mass from periphery to abdomen along with general increase in intraabdominal fat with age
  
  • abdominal far metabollically active and serves ans inflammatory organ
• Increase in inflammatory cytokines associated with metabolic syndome and decreased organ system function

Question 38

What are the resluts of increaseed systemic inflammation?

Answer 38

• muscle wasting
• loss of physical function
• underlying factor in development of age related sieases like alzheirms, atherosclerosis, cancer, diabetes

Question 39

What occurs during a reduction of lymphoctye development? (immune system change)

Answer 39

• Decreased T and B Cell development
• Decreased qualuty and composition of lympocyte pool
• decreased Thymuc epithelial cells

Question 40

What is the result of a reduction in lymphocyte development?

Answer 40

• Decreased efficiency of response to novel or previously encoutered antigens (increased vulnerability to influenza in people > 70 years)
• Decreased responsiveness to vaccines (except for shingles)

Question 41

What are some ways to address total body inflammation?

Answer 41

• antiinflamatory drugs
• Antioxidants
• Caloric Restriction
• Exercise

Question 42

What are some exercise benefits with immune system changes?

Answer 42

• Decrease inflammatory markers in one bout
• resist fatal infections and aggressive pathogens
• results in wider window of homeostasis
• enhances system “Reserve”
• decreases risk for disease
• delays functional decline

Question 43

What is infectious deisease detection difficult in the aging adult?

Answer 43

• Difficult due to
  
  • lack of fever
  • lack of leukocytosis
  • in UTI, absent or masked clinical manifestations as dysuria, frequency, suprapubic tenderness

Question 44

What are the 1st signs of illness that are present?

Answer 44

• change in mental status/cognition
• decline in function
• falls
• weight loss/anorexia
• slight increase in respiratory rate
• vague symptoms such as nausea, comiting, decreased urinary output

Question 45

What are 2 most common types of infectious disease in aging adult?

Answer 45

UTI

Bacterial Pneumonia

Others: Heart failure

Acute bowel obstruction

Biliary or liver disorder

(Cognitve dysfunction or confusion is common in ALL)