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Gerontology > Module 7 > Flashcards

Module 7 Flashcards

0
Q

Rate of falls increases with age over

A

60

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1
Q

Falls are ___ an inevitable consequence of aging

A

Not

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2
Q

___ of those 65 and older experience a fall related incidence per year

A

1/3

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3
Q

Rate of occurance of falls is __

A

44%/year

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4
Q

In over 80 the rate is ___ times higher vs community dwelling older adults ages 70-74

A

2.5

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5
Q

Nursing home residents fall ___ times vs community dwelling adults

A

3 times

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6
Q

Having fallen in the past __ to __ months is a significant risk factor for more falls with ___% of fallers falling more than ___ per year

A

6 to 12, 40%, once

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7
Q

There is a cluster of falls observed in the

A

Few months preceding death

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8
Q

___ are the leading cause of injury death and disability over 65

A

Falls

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9
Q

Fall related injuries occur in about ___% of falls

A

15%

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10
Q

___ fracture is one of the most common fall related injuries

A

Hip

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11
Q

More than ___% of hip fractures are caused by falling

A

95

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12
Q

In 2010 there were _______ hospital admissions for hip fractures among those 65 and older

A

285,000

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13
Q

About ___ of patients who sustain a hip fracture who were independent prior to the injury never regain their former independence

A

Half

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14
Q

___% of hip fractures are related to a fall

A

90

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15
Q

What is the mortality rates for men and women within one year of a hip fracture

A

Male 31% and female 17%

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16
Q

Difficulty getting off the floor or ground after a fall is associated with ____

A

Substantial morbidity

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17
Q

Study factors in rising from a fallen position

A

Initial body position and assistive devices

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18
Q

It takes __ to __ times longer to get off the floor for elderly compared to younger

A

2 to 3

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19
Q

In tinetti’s study only __% of community dwelling fallers were able to get up after a fall without assistance

A

49

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20
Q

__ of fallers with alarms did not active their alarm

A

80

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21
Q

Researchers found __% of people who fell were unable to get up and __ % had stayed on the floor for ______ when alone

A

80, 30, over one hour

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22
Q

___% of older adults who had remained on the floor after a fall for longer than __ hours died within __ months

A

50, 6, 6

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23
Q

___% of falls occur at home

A

85

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24
Q

Most common place for a fall

A

Home

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25
Q

Falls occur most often at this time of day

A

Daytime

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26
Q

About 50% of household falls were attributed to

A

Accidental or environmental causes

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27
Q

Frailty is what kind of risk factor

A

Intrinsic

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28
Q

What is the most common intrinsic risk factor

A

Weakness

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29
Q

An intrinsic risk factor concerning gait

A

Increases in variability of stride length

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30
Q

__ risk factors contribute up to 36.9% of falls

A

Extrinsic

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31
Q

Extrinsic factors effect _____

A

More mobile adults

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32
Q

What are the extrinsic institutional risk factors

A

Time of day, staffing levels on nursing floor, room distance from nurses station

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33
Q

Functional impact may predispose to __ risk of falls

A

Increased

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34
Q

___ posture contributes to propensity to fall in osteoporotic individuals

A

Kyphotic

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35
Q

There is a link between ___ and ______

A

Declining cognition and increased number of falls

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36
Q

Physical function for falls determined by what two tests

A

Chair standing test and TUGT

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37
Q

Chair standing test of how many seconds indicated physical function

A

12.9 seconds

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38
Q

Important score for TUGT

A

12.5 seconds

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39
Q

The three psychological impacts of falls

A

Fear, anxiety and loss of confidence

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40
Q

Tinetti’s definition of the fear of falling

A

Lasting concern about falling that leads to an individual avoiding activities that the person remains capable of performing

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41
Q

What are the three levels to the fear of falling

A

Absence of fear, fearful but still active, fearful to the point of decreasing activity

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42
Q

Fear of falling is independently associated with what two things

A

Slow timed physical performance and depressive symptoms

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43
Q

Gait changes in fear of falling

A

Shorter stride length, increased base of support, prolonged double limb support time and slower gait speed

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44
Q

In a tinetti’s study they found that the number of persons falling increased from __% with no risk factors to ___% with ___ or more risk factors

A

8%, 78%, 4

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45
Q

The use of __ or more medications increases fall risk by

A

4,30%

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46
Q

5 risk factor hierarchy for falls

A

Muscle weakness>history of falls> gait deficit> balance deficit> use of an AD for ambulation

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47
Q

The postural control system receives

A

Information from receptors in proprioceptive, visual and vestibular systems which must be intact for optimum balance control

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48
Q

What are the three postural control system sensory sources

A

Somatosensory, vestibular, visual

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49
Q

The three proprioceptive factors in PCS

A

Static awareness of joint position, kinesthetic awareness, closed loop efferent reflex response required for regulation of muscle tone and activity

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50
Q

What is kinesthesia

A

Perception of motion and joint position sensibility or perception

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51
Q

PCS postural synergies function in either ___ or _____

A

Feedback or feed forward

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52
Q

What is feedback

A

The reaction to a specific stimulus, mechanoreceptor detection of Altered support surface

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53
Q

What is feed forward

A

Preparation for voluntary movement which requires balance adjustment, anticipating center of mass change from previous experience

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54
Q

Quickly adapting receptors are responsible for proving ___ and ___ kinesthetic sensation in response to _____ or ______

A

Conscious and unconscious, joint movement or acceleration

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55
Q

____ adapting mechanoreceptors provide continuous feedback and thus proprioceptive information relative to joint position

A

Slowly

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56
Q

The ankle strategy uses type ______ mechanoreceptors

A

II Pacinian

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57
Q

The hip strategy proximal uses type ____ mechanoreceptors

A

I Ruffinini

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58
Q

Hip strategy is used with

A

Larger perturbations

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59
Q

In the hip strategy the hip works with the ___ and ___ to maintain COG over BOS

A

Trunk and ankle

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60
Q

The stepping strategy is commonly used in ______ and it

A

Older adults and it re aligns the BOS over COM

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61
Q

The biggest cervical limitations in the older adult

A

Rotation and extension

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62
Q

What are the concerns of dehydration on the vestibular system

A

Self restricting fluids to prevent in continence , medical restriction of fluids related to diuretics, medications may cause dehydration

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63
Q

Impairments of _____ and ______ mobility were significantly related to gait speed variability

A

Dynamic balance and upper extremity mobility

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64
Q

Increased ______ is associated with CNS impairment

A

Stance time variability

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65
Q

______ is associated with sensory impairment

A

Decreased step width variability

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66
Q

Gait speed is a strong predictor for ___ and ___

A

Fall risk and disability

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67
Q

By age _____ gait speed declines at a rate of ____ per decade

A

60, 12-16

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68
Q

A person will be dependent on one or more ADLs with a gait speed of

A

Less than 1 mph

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69
Q

Optimal control of balance is maintained until age

A

60

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70
Q

After age 60 the ___ becomes less automatic

A

PCS

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71
Q

After age 60 there is a ___ increase in latency

A

50%

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72
Q

What is the least important of the three vestibular, somatosensory, and visual

A

Vestibular

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73
Q

The component of motor function controlled by vestibular system input is

A

Muscle activity

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74
Q

What are the four basic domains of fall assessment

A

Specific patterns and injuries, physical function and functional activity level, psychological consequences and their activity restrictions and health related quality of life

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75
Q

The screening tool for fall risk you should use for frail elderly

A

TGUG

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76
Q

The screening for fall risk you should use for a new patient

A

Morse fall scale

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77
Q

Two important cardiovascular symtoms that may cause a fall

A

Syncope and orthostatic hypotension

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78
Q

How do you measure supine and sitting BP

A

Measure BP and HR after they have been lying supine for 5 minutes, then measure again immediately after they stand and then again after 3 minutes of standing

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79
Q

The three medications most commonly associated with falls by community dwelling older adults

A

Benzodiazepines, beta blockers and diuretics

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80
Q

Study of drug risk reduction helped reduce falls by __% in combination with gait training and reducing environmental hazards

A

30

81
Q

What is sensitivity

A

The ability to detect falls when they are present

82
Q

In higher sensitivity…

A

Fewer people are incorrectly classified as non fallers who go onto fall ( false negative)

83
Q

What is specificity

A

the ability to correctly identify the absence of falls

84
Q

Higher specificity means

A

fewer peaople are incorrectly classified as fallers who do not go on to fall (false positives)

85
Q

You want both predictive values to be..

A

high

86
Q

what is positive predictive value

A

how well the tool predicted falls compared to the actual number of falls

87
Q

what is negative predictive value

A

how well a negative test correctly predicts the abscence of falls

88
Q

The Morse Fall Scale is currently used in

A

VA facilities and acute care settings

89
Q

The Morse Fall Scale takes how long to complete

A

less than 3 minutes

90
Q

The Morse Fall Scale takes into account

A

history of falls, AD, gait/transfer status and mental status

91
Q

Total score on the Morse Fall Scale is

A

125

92
Q

No risk on the Morse fall scale is between

A

between 0 and 24

93
Q

Low to moderate risk on the Morse Fall Scale is

A

25-45

94
Q

High risk on the Morse Fall Scale is

A

46+

95
Q

What is the sensitivity of the Morse Fall Scale

A

72%

96
Q

The Morse Fall Scale has a - Predictive value of ___ and a + predictive value of _____

A

81% and 38%

97
Q

the limitations of the Morse Fall Scale are

A

it has a low ceiling effect and over estimates potential fallers

98
Q

What is an aspect missing from the Morse Fall Scale

A

does not take into account medications that may increase fall risk

99
Q

The Timed Single Legged Stance Test is excellent for

A

community dwellers

100
Q

What is the normal for the timed singled legged stance

A

10 seconds with eyes open

101
Q

The percent of community dwellers that get to the norm on the Timed Single Legged Stance

A

89%

102
Q

The percent of nursing home residents that get to the norm on the Timed Single Legged Stance Test

A

45%

103
Q

The Timed Single Legged Stance is specific or sensitive

A

sensitive

104
Q

The most common balance scale used

A

Berg Balance

105
Q

The Berg Balance Scale is used to

A

screen for individuals who would benefit from a PT referral and predict multiple falls in community dwelling and institutionalized older adults

106
Q

How many tasks are on the Berg Balance Scale

A

14

107
Q

How long does the Berg Balance take to administer

A

15 minutes

108
Q

What is the scale on the Berg Balance

A

5 point scale 0-4

109
Q

A score of 0-20 on the Berg Balance means

A

the patient is wheelchair bound

110
Q

A score of 21-40 on the Berg Balance means

A

they are walking with assistance

111
Q

A score of 40-56 on the Berg Balance means

A

they are independent

112
Q

On the functional Reach test, a person who’s reach is less than ____ is twice as likely to fall

A

25.4 cm

113
Q

On the Functional Reach Test, a person who’s reach is less than ____ is 4 times more likely to fall

A

15.2 cm

114
Q

People who are unable to reach in the Functional Reach Test are __ times more likely to fall

A

8

115
Q

The Modified Clinical Test of Sensory Interaction on Balance was designed to

A

assess how well an individual is able to avalanche when one or more of their balance related sensory inputs are compromised

116
Q

The set up of the mCTSIB

A

Individual stands on both feet under 4 different and progressively more difficult conditions

117
Q

What are the 4 conditions of the mCTSIB

A

1) on solid, level surfaces with Eyes open 2) on solid level surface with eyes closed, 3) on foam with eyes open, 4) on foam with eyes closed

118
Q

How do you calculate the score on the mCTSIB

A

add the times for each of the 4 conditions

119
Q

What are the limitations of the mCTSIB

A

cannot discern the specific patterns of sensory dysfunction and it does not predict falls in active community dwelling adults

120
Q

The DGI focuses specifically

A

on postural stability during walking activities and evaluates gait in response to changing tasks

121
Q

How many tasks are there in the DGI

A

8

122
Q

Each item on the DGI is rated from __ to __

A

0 to 3, 0 being severe impairment and 3 being normal

123
Q

What is a high risk for fall on the DGI

A

less than or equal to 24

124
Q

The DGI is reliable for

A

effectiveness of intervention for community dwelling older adults and vestibular disorders

125
Q

The test that was derived from the DGI

A

The Functional Gait Assessment

126
Q

How many items are on the Functional Gait Assessment

A

10

127
Q

Items on the Functional Gait Assessment are scored on a scale of

A

0 to 3

128
Q

What is the max score on the Functional Gait Assessment

A

30

129
Q

Higher scores on the Functional Gait Assessment represent

A

better balance and gait ability

130
Q

The Functional Gait Assessment has good construct ___ for patients with ____

A

validity, parkinson’s disease

131
Q

The Functional Gait Assessment can be used to predict falls within the next ____

A

6 months

132
Q

Fall Efficacy Scale (FES) is used for these kinds of people

A

fear of falling for elderly in long term care

133
Q

The Modified FES is used for these kinds of people

A

community dwelling older adults

134
Q

The two other fear of falling and falls efficacy scales

A

survey of activities and fear of falling in Elderly (SAFE) Scale and the Activities specific Balance Confidence (ABC) Scale

135
Q

The FES is what mode of testing

A

self report screening

136
Q

There are how many ADLs talked about on the FES

A

10

137
Q

What is the scoring on the FES

A

1 -10, 1 is totally confident and 10 is not confident at all and you total and average the score

138
Q

A score of greater than or equal to ____ is considered indivative of fear of falling

A

7

139
Q

The modified FES added

A

4 outdoor activities to make the tool more useful for community dwelling older adults

140
Q

the modified FES uses what kind of scale

A

visual analog scale

141
Q

the modified FES scoring scale

A

0-10, 0 being not confident/not sure and 5 being fairly confident/sure and 10 being completely confident and sure

142
Q

the Modified FES rates are totaled from ______ and divided by ____

A

0 to 140 and 14

143
Q

A score of less than ___ indicates FOF on the mFES

A

8

144
Q

a score of over ___ indicates lack of fear on the mFES

A

8

145
Q

The SAFE has how many items representing what

A

11 items, ADLs and IADLs

146
Q

what 2 subscales are used on the SAFE

A

activity level and fear of falling

147
Q

activity level sub scale ranges on the SAFE are

A

0 is no and 1 is yes

148
Q

the fear of falling sub scale on the SAFE ranges from

A

0 is not worried at all and 3 is very worried

149
Q

Higher total SAFE scores indicates

A

more fear of falling

150
Q

ABC scale is what kind of assessment

A

self report measure of balance confidence

151
Q

How many items are on the ABC Scale

A

16

152
Q

The items on the ABC are rated from

A

0% (no confidence) to 100% (complete confidence) during ADLs

153
Q

A score of less than 50 on the ABC indicates

A

low level of functioning

154
Q

A score between 50 and 80 on the ABC indicates

A

medium level of functioning

155
Q

A score greater than 80 on the ABC indicates

A

high level of functioning

156
Q

the ABC discriminates better than the ____ scores of _____

A

FES, high versus low mobility participants

157
Q

the Center for Epidemiological Studies Depression Scale is a

A

short, self report scale used to assess general psychological impairments (depression)

158
Q

How many statements are on the CES-D

A

20

159
Q

The maximum score on the CES-D is

A

60

160
Q

A score of greater than or equal to ___ indicates a probable major depression on the CES-D

A

22

161
Q

A score of __ to __ indicates mild to moderate depression on the CES-D scale

A

15-21

162
Q

A score of less than ___ indicates absence of depression on the CES-D scale

A

15

163
Q

The Geriatric Depression Scale Long Form is a

A

30 item questionnaire

164
Q

The Geriatric Depression Scales asks

A

yes or no questions about how they felt over the past week

165
Q

The Short form GDS has __ questions

A

15

166
Q

score of _ to _ indicates normal on the GDS

A

0-4

167
Q

Score of _ to_ indicates mild depression on the GDS

A

5-8

168
Q

Score of _ to _ indicates moderate depression on the GDS

A

9-11

169
Q

Score of _ to _ indicates severe depression on the GDS

A

12-15

170
Q

The maximum score on the Mini Mental State Exam is

A

30

171
Q

A score of below __ indicates cognitive decline on the Mini Mental State Exam

A

24

172
Q

precaution for OA strength

A

start with isometric strength

173
Q

most important joint for mobility in balance

A

ankle

174
Q

Three types of balance exercises

A

1) Postural control or response to perturbations 2) Weight shifting 3) anticipatory adjustments to limb movements

175
Q

Perturbations provoke postural adjustment that brings the ____ back over the ____

A

COG , BOS

176
Q

pushing on the shoulders or the sternum with a small backward force will stimulate

A

ankle DF and hip flexor activation

177
Q

A Forward push from back facilitates

A

ankle PF and hip extensor activation

178
Q

The first motor response occurs in ___

A

50 ms

179
Q

The first motor response uses the _____ to activate _____

A

spinal cord, automatic reflexes

180
Q

In the first motor response what reacts unconsciously

A

proprioception and neuromuscular control

181
Q

the impulse technique isometric stabilization uses a

A

medicine ball for perturbations to activate the first motor response

182
Q

The Oscillating Technique Isometric Stabilization uses

A

bad resistance and body blade

183
Q

Two techniques for first motor response training

A

Impulse Technique Isometric Stabilization (ITIS) and oscillating Technique Isometric Stabilization (OTIS)

184
Q

The 2nd motor response occurs in what time

A

70-120 ms

185
Q

The 2nd motor response uses the _____ to activate ________

A

brainstem, co contraction

186
Q

The progression in the 2nd motor response starting from bilateral

A

Bilateral to SLS to Eyes open to eyes closed

187
Q

The progression in the 2nd motor response starting from stable

A

stable to unstable to head turning

188
Q

Mechanoreceptor fire increases muscle _______ stabilizing the joint

A

co-contraction

189
Q

the OTIS stimulates what two kinds of activity

A

mechanoreptor activity and muscle spindle activity

190
Q

the OTIS facilitates increased _____ and _____ by using ___, ____ pulling of bands in an _____ manner

A

joint stability and automatic reflexes, short, rapid, oscillating

191
Q

Example of OTIS in single leg

A

leg is stabilized and doesn’t move, it reacts to weight shifting generated by the arms increasing proprioception

192
Q

ITIS uses ___ and _____ , ____ and ______ or impulses by tossing a ___

A

quick and repetitive loading and unloading, med ball

193
Q

the ITIS med ball toss facilitates the _______ which stimulates ______ and ______

A

mechanoreceptors, joint proprioceptors and reflex adaptation

194
Q

Researchers found that older adults when walking use less _________ and generate more energy from the ____ and _____ as a compensation for reduced _______ power output

A

Ankle power, hip and low back, plantar flexor

195
Q

Fallers demonstrated only __% knee extensor strength and _% ankle plantar flexor strength compared to non falling peers l

A

37% and 10%

196
Q

How long of an exercise program is recommended to increase LE strength, walking endurance and function in those at risk for disability

A

3 months

197
Q

Studies show resisted lateral stepping around the ______ was effective for ________

A

Ankle, frontal plane strengthening for the glut medius

198
Q

During gait the glut med fires rapidly during ____ and must develop an adequate level of force in milliseconds while producing an ______ contraction

A

Mid stance, isometric-eccentric

199
Q

Placing the band around the forefoot is selective for the ___ over the ____ by adding an ___ effort to the hips

A

Glut med, TFL, ER

200
Q

Tai Chi uses

A

A set of movements that stresses balance, controlled movement, synchronized breath control and awareness of body alignment

201
Q

Participants of tai chi felt an increase in q

A

Confidence

Gerontology (12 decks)

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