Management (week 1) Flashcards
Define Ageism
Predjudice or discromination against a particular age group, especially the elderly
What is the difference between successful aging vs optimal aging?
- 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
What are the factors that affect the experience of aging?
5 most common causes of death
- Heart disease
- Malginant neoplasms
- Verebrovascular diesase
- Chromic lower respiratory diseases
- Pneumonia/Influenza
6 most common chronic health conditions
- Arthrits/MSK issues
- Heart/circulator issues
- Vision / Hearing
- Fractures / Joint injuries
- Diabetes
- Mental Illness
What is the Physical Stress Theory?
Tolerance to stress modifiable with lifestyle adaptations (as stress increases we are buitld to handle and adapt)
What are 3 additional factors we must consider for the aging adult?
- Multi-system/multi factoral involvement
- Functional status
- Support System
Why is it important to screen for falls?
- 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”
What are some components of the home assesment?
- Clear path throughout home
- Rearraging obstacles and removing barriers
- flooring surfaces
- Is it appropriate for mobility level?
- any reccomendations?
- safety, medical issues, social support,
Define “fun” in the slippery slope of aging?
What you want, when you want, for as long as you want
Define “ Function “ in the slippery slope of aging?
Choices made based on decreased physical capacity
have mobility disability or at risk for
Define “Frailty” in the slippery slope of aging?
Require help with ADLs and IADLs
Define “failure” in the slippery slope of aging
Completely dependent
Describe the “Frailty” requirements
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)
What is the most imporant factor in subsequent institutionalziation
Leg Strength
What is considered “sufficient overload” in the Physical stress theory?
60-100% of max (Strengthening)
FITT (frequency, intensity, time, type)
What is Polypharmacy?
- Adminstration of many drugs together
- Adminstraiton of excessive medicaiton
- Excessinve or inapproprate use of medications
Describe the polypharmacy cycle
What are charactistics of Polypharmacy?
- 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
Describe what the overall reaction for an altered response to drugs (pharmacokinetic changes)?
[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
What are the physiologic pharmacodynamic changes?
- 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
What are the cellular level changes (pharmacodynamic changes)?
Binding receptor changes
- Increased or decreased sensitivity
What are the biochemical response changes?
Subcellular structural and functional changes
List common ADRs with GI tract
- Nausea, comiting, diarrhea, constipation
- common with opiods, non opiods, NSAIDS
List common ADRs with Sedation
Common with opiods, analgesics, antipsycotics,
sometimes excessive sedation seen with sedative hypotics
What are common ADR’s with confusion
Common with antidepressants, narcotic analgesics, drigs with anticholinergic activity
What are common ADRs with depression
- Common with barbituates, antipsychotics, alcohol, and some antihypertensive drugs
What are common ADRs with orthostatic hypotension?
Most common with drugs that treat hypertension
Common ADR’s with fatigue and weakness
Common with skeletal muscle relaxants and diuretics (altered electrolyte balance)
What are common ADR’s associated with dizziness and falls?
Common with sedatives, antipsychotics, opiod analgesics, antihistamines
Common ADRs associated with anticholinergic effects?
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
Describe extrapyramidal symptoms with ADRs
Dystonia, tardive dyskinesia, pseudoparkinsonisms
- common with antipsychotics
What are some general strategies for PT’s to use in polypharmacy?
- 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
When do immune system chagnes typically happen in an adult?
- 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)
What are some cardinal features of immune system aging?
- 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
What are 3 changes due to increased systemic inflammation due to immune system changes?
- Increased proinflammatory cytokines (interlukin 1 and 10)
- Increased C reactive protien (CRF)
- Increased Tumor necrosis factor
What are some reasons why changes in the immune system occur?
- 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
What are the resluts of increaseed systemic inflammation?
- muscle wasting
- loss of physical function
- underlying factor in development of age related sieases like alzheirms, atherosclerosis, cancer, diabetes
What occurs during a reduction of lymphoctye development? (immune system change)
- Decreased T and B Cell development
- Decreased qualuty and composition of lympocyte pool
- decreased Thymuc epithelial cells
What is the result of a reduction in lymphocyte development?
- 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)
What are some ways to address total body inflammation?
- antiinflamatory drugs
- Antioxidants
- Caloric Restriction
- Exercise
What are some exercise benefits with immune system changes?
- 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
What is infectious deisease detection difficult in the aging adult?
- Difficult due to
- lack of fever
- lack of leukocytosis
- in UTI, absent or masked clinical manifestations as dysuria, frequency, suprapubic tenderness
What are the 1st signs of illness that are present?
- 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
What are 2 most common types of infectious disease in aging adult?
UTI
Bacterial Pneumonia
Others: Heart failure
Acute bowel obstruction
Biliary or liver disorder
(Cognitve dysfunction or confusion is common in ALL)
