module 9 common concerns 3 Flashcards
fall fears
most feared sequela of fall is fx
quality of life can be affected by fear of falls
falls exam
postural vital signs CV exam Neuro exam - Romberg with sternal nudge - nystagmus upper extremity function and strength cognition vision hearing Lower extremity - feet side by side, semi-tandem and tandem, balancing 10 seconds.
failure to thrive (frailty)
progressive loss of energy, strength, and stamina -> dec. function and general physical and cognitive deterioration
failure to thrive s/s
anorexia wt loss skeletal muscle loss functional decline depression impaired immune function - weakness - osteopenia - balance and gait disorders - undernutrition - deconditioning - slow gait speed
failure to thrive exam
weakness inability to care for self wt and memory loss depression - chronic disease with organ failure - GI malabsorption - cancer risk factors - infection - thyroid
elder abuse
any abuse and neglect of persons age 60 and older by a caregiver or another person in a relationship involving expectation of trust
self-neglect
behavior of an older person that results in being unable to provide for his or her needs
7 kinds of elder abuse
physical sexual psychological financial exploitation neglect abandonment self-neglect
elder abuse exam
Physical - bruises - pressure or rope marks - broken bones - burns Sexual: - bruising of genitals or breast Psychological: - sudden withdrawal from activities - change in behavior or alertness Financial exploitation - change in financial situation - checks signed by unauthorized persons Neglect/self-neglect - bedsores - unattended medical needs - poor hygiene or nutritional status - hoarding - inappropriate clothing
osteoporosis
inc. bone fragility and inc. susceptibility to fx
- dec. bone mass and deterioration of bone microarchitecture
- r/t estrogen deficiency and aging
WHO osteoporosis definition
BMD of 2.5 SD below the young normal mean
- postmenopausal women and men > 50
risk factors for fx
inc. age family hx current smoking prior fx glucocorticoid use RA excessive ETOH
bone resorption
in response to PTH and other cytokines secrete RANK
- > monocytes and macrophages to differentiate into osteoclasts and proliferate
- > break down of bone, release of calcium and phosphorus into circulation
bone formation
osteoblasts lay down osteoid
- this is a slow process
bone formation/resorption in osteoporosis
bone resorption exceeds bone formation -> net loss of bone
- most pronounced 5-10 years after menopause
glucocorticoids
causes secondary osteoporosis
- osteoblast death
- prolongs life of osteoclasts
- dec. estrogen and testosterone
- inc. metabolism of Vit. D
- dec. Ca absorption
unmodifiable risk factors for osteoporosis
age female white or asian persona hx of fx hx of fx in 1st degree relative dementia
modifiable risk factors for osteoporosis
hypogonadism smoking ETOH caffeine low Ca intake low body wt inadequate physical activity visual impairment glucocorticoids or anticonvulsant use thyrotoxicosis recurrent falls poor health or frailty
nonpharm management of osteoporosis
Adequate Ca and Vit D
wt bearing exercise
normal body wt
avoid cigarettes and ETOH
Hormone replacement for osteoporosis
only approved for the prevention of osteoporosis not for tx.
- estrogen inhibits bone resorption, dec. bone remodeling, enhances absorption of Ca
osteopenia
BMD between 1 and 2.5 SD below nml
USPSTF screening for osteoporosis women > 65
B
