Midterm Flashcards
What are nutrients specially required in elderly?
Vit D (800-2000 IU), Ca++ (1200-1500 mg), and B12
What number of women > 75 are osteoporotic?
1/3
Definition of Osteoporotic
2.5 Standard deviations below the mean young adult reference population on a DEXA scan of hip/low back
What forms of calcium are best?
What warnings exist with calcium supplementation?
Calcium citrate (cit's in the stomach) Dairy: yogurt and lowfat milk
Don’t take more than 500mg at one time
Non-Modifiable risk Factors for OP
Female Fair-skinned Small-framed or small-boned Of European or Asian descent Family history of osteoporosis Hysterectomy before the age of 40, or early menopause
Best exercise for OP
Axial loading Walking Stair stepping Free weights Zumba 3x/week for 15-20 minutes
Delirium
Acute confusion of a rapid onset lasting a short period of time that is temporary.
Dementia
Chronic confusion gradual loss in memory. (Alzheimer's). Unable to carry out ADLs. Not curable. Involves neurofibrillary tangles Develops over months to years
Depression
MC mental health concern among older adults
80% are fully reversed with treatment
Delirium causes
I-WATCH-DEATH
Infections, Withdrawal, Acute metabolic, Trauma, CNS pathology, Hypoxia
Deficiencies, Endocrinopathies, Acute Vascular, Toxins/Drugs, Heavy metals
Modifiable Risk factors for OP
Avoid or dislike dairy products
Eat meat more than twice a day, on most days
Drink coffee/tea, or other caffeinated beverages more than twice a day
Drink alcohol more than 3 times per week
Drink soda (pop) more than once a day
Participate in walking, running, aerobics etc. less than 3 times a week
Smoke cigars or cigarettes
Take steroid medications
Primary Prevention of OP
Counsel pts about diet and physical activity at all ages, to maximize bone density in the third decade of life and slow the rate of bone loss after that.
Most important factor = physical activity!!!!
Get plenty of Vit. D (sun, food & supplements)t
Secondary Prevention of OP
Screen all patients: OP checklist
- Identify preventable risks
- Get baseline bone mineral density test (Dexa scan of the hip is the gold standard)
- Design a prevention plan suited to patient’s risk factors
Tertiary prevention of OP
Employ safe chiro. adjusting strategies Fall prevention (IMPORTANT!) Keep patients physically active Monitor lifestyle and behaviors, Encouraging healthy dietary choices Supplementation!! Sun (caution related to skin cancer!)
of elderly below poverty level in US
1/10
Weight loss good or bad?
What about calories?
BAD in elderly, leads to death “fat frail” or “obese sarcopenic”
NEVER calorie restrict
Daily recommended of fiber
Sources?
30g
9-10 g: Canned beans (e.g: chili or kidney beans)
7-9 g: Popcorn
4-15 g: Hi Fiber cereals (check the label)
Colon Cancer
1 in 17 people get colon cancer in the US
• 55,000 deaths/year in US alone
• Almost all colon cancer is in people over 50
• High fat, low fiber diet, & alcohol (low Ca) increase risks
Dietary Balance between
Decreased need for ____?
Greater need for ____?
Carbs, proteins, fats
Decreased need for proteins
Greater need for Fiber, vitamins, mineral
Recommended type of weight loss in elderly?
Physical Activity
Want nutrient dense diet
Water & Fiber
Areas to assess
Physical Assessment Functional Assessment Cognitive Assessment Nutritional/Oral Health Assessment Safety Others
Functional Assessment tools
Barthel Index Functional Status Index Get Up ‘N Go ADLs Observation and other useful strategies
Cognitive Assessment Tools
Mini Mental Status exam ( Orientation, Registration, Attention/Calculation, Language)
3 item recall
Clock drawing test
Injuries Occur where?
More serious among?
Due to?
Kill who?
Home
More serious in older adults
Most often due to falls
Kills even healthy patients
How to assess fall risk?
Home Safety checklist
How much weight loss should worry us?
> 10 lbs w/o trying
What race has 2x average incidence of disability due to LBP in the US and higher rates of diabetes $$$
Native America
Uterine fibroids and prostate CA are more prevalent among which race?
African American
Which ethnicities are at greatest risk for OP?
Caucasian (northern European) & Asian
What groups might culturally be accustomed to physical touch in greetings or for reassurance?
Who might be less comfortable with physical ‘touchiness’?
Mediterranean, middle east same gender
Asian (Japanese, Chinese)
What groups have markedly higher incidences of heart disease, HTN, and diabetes
Mexican, African American
Which ethnicities are more likely to include family in making health decisions?
Hispanic
What group in the US believes in the concept of “beautiful talk”, feeling that framing health talks in the negative context of disease risk may skew health outcomes negatively?
Native American
Students of which ethnicitis/cultures would consider it disrespectful to make direct eye contact w/ and instructor, elder, or member of the opposite sex
Asian, Middle eastern
Over 200 cultural groups believe that this phenomenon (the ________ _____) is responsible for sudden unexplainable onset of illness or disability. In the US we might just think of it as a superstition
evil eye
Which cultural/religious group in the midwest and rural east coast areas is perhaps the highest utilizer of chiropractor for many 1º healthcare needs?
Amish
Which ethnic groups (3) would be more likely to believe in the importance of a balance between “hot” and “cold” foods or herbs in their diet?
Middle Eastern, Meditteranean, Chinese
Aside from race and ethnicity, name other aspects of a patient’s background or life-circumstance that may impact the way they respond to you as a doctor or your care recommendations
Socio-economic status
Age
Education
Religion
At least one-tenth of the aged are living in long-stay institutions (i.e. nursing homes, mental hospitals, homes for the aged, etc.).
T/F
False
Aged drivers have fewer accidents than those under 65
T/F
True
The majority of people are seldom bored. T/F
True
Over 15% of the US population is now 65 years or older. T/F
False
Most medical practitioners give low priority to the aged T/F
True
The majority of older people have incomes below the poverty level T/F
False
10% below Poverty level
Older people tend to become more religious as they age. T/F
False
Older persons have more acute (short-term) illness than people under 65 T/F
False
Social security benefits automatically increase with inflation T/F
True
Older persons have more injuries in their home than those under 65 T/F
False
Supplemental Secur. Income guarantees a minimum income for needy aged. T/F
True
The proportionate of blacks among the elderly is growing T/F
True
The rate of poverty among aged blacks is 3x higher than whites T/F
True
About 3% more of the aged have incomes below the official poverty level thanthe rest of the population. T/F
False
More of the aged vote than any other group T/F
False
Which drugs are more likely to send people to the ER?
Anticoagulants, Diabetes
Adverse effects are responsible for __#__ of all ER visits in those over 65
1/4
Risks associated w/ NSAIDs
What cause do people take multiples
2 or more dangerous
GI bleed (even more increased risk with alcohol use)
kidney toxicity
Arthritic pt. 26% use 2 or more
How do you best prevent future falls?
Ask what caused previous falls SPLATT Symptoms Previous Falls Location Activity Trauma Time
T/F More of the aged vote than any other group
False
T/F The proportion widowed is decreasing among the aged
True
