OAT Geriatrics Flashcards
The aging MSK system from a biomechanical perspective, including changes in muscle mass, bone density, height, lean body mass, body water, and body fat
Loss of muscle mass (decreased strength)
Loss of bone mineral density (osteoporosis, fractures)
Osteoarthritis
Decreased height, decreased lean body mass, decreased body water, increased body fat (changes in pharmacokinetics)
Common mechanical and inflammatory MSK complaints in geriatric pts
Mechanical: cervical stenosis, OA, osteoporosis, postural imbalance, gait changes, low back pain, CTS
Inflammatory: RA, PMR, psoriatic arthritis
Important considerations regarding MSK physical exam in geriatric pts
Evaluate gait
Assess posture
ROM for upper and lower extremities
Evaluate feet for ulcers/nail care
OSE of mm. and joints for somatic eval
Neck pain is related to anatomy in that the intervertebral discs are ______ anteriorly than posteriorly. Greatest pressure in the neck occurs with ______ of the C-spine. After the age of 50, the nucleus pulposus becomes more _______ and has characteristics similar to the annulus fibrosis
Thicker; extension; fibrocartilaginous
Neck pain comorbidities
CV disease Dizziness Low back pain OA osteoarthritis Orthostatic hypotension Shoulder pain
[others include autonomic failure, concentration problems, digestive system disease, headaches, TMJ, trapezius mm. ischemia]
The most common form of arthritis, often affecting hands, feet, knees, and hips, and is the leading cause of LE disability in older adults; severe dz can interfere with ADLs
Osteoarthritis
The incidence of osteoarthritis is higher in women, and there is a rapid increase in incidence at age ______ that levels off around age 80. Risk factors include older age, obesity, genetics, occupation, and prior injury
50
Common complaints with osteoarthritis in geriatric pts
Initial symptoms = pain in one joint; can progress over time to multiple joints
Deep ache, usually with use
Joint stiffness after periods of inactivity, just after waking, and sitting
Night pain may interfere with sleep
Medical treatment options for OA include weight management, walking aids, braces, NSAIDs, duloxetine, topical capsaicin, intraarticular injections, and orthopedic intervention as a last resort. Prevention is also of high importance. What are some research findings regarding benefits of OMT in geriatric pts with osteoarthritis?
During and after treatment, subjects who had received OMT demonstrated continued improvement in their ROM, while ROM in the placebo group decreased
Manual therapy group had significant and clinically important sustained improvements at 1 year; exercise therapy had similar result
Case study of female with knee OA had resolution of effusion within a couple days post-treatment with articulatory, CS, MET, and MFR
What are some considerations regarding the aging nervous system in geriatric pts?
Decrease in brain weight (drug toxicities, delirium)
Alterations in CNS NT’s
Decrease in memory
Decreased reaction time
Altered sleep with decreased deep sleep and increased wakefulness
Decreased vibratory sense (altered gait)
Decreased righting reflex, increased postural instability, altered gait all lead to increased accidents and falls
Common neurologic complaints in elderly populations
MS Parkinson disease Stroke Dementia Sciatica Vertigo
Important neurologic PE considerations in elderly pts
Evaluate vibration — may be normal
Reflexes
Observe for asymmetrical test results — could suggest stroke
Mini mental status exam to evaluate cognition
What reflex may be absent in older adults?
Ankle reflex
Fastest-growing source of disability due to neurologic disorder in elderly pts; risk factors include older age and family hx, evidence may show that smoking is protective
Parkinson disease
PE findings of Parkinson may include tremor, bradykinesia, rigidity, postural instability, and gait changes. Nonmotor sxs include cognitive dysfunction, dementia, mood d/o, sleep d/o, fatigue, autonomic dysfunction, olfactory dysfunction, and pain. Symptomatic tx may include levodopa, amantadine, MAO-B inhibitors and/or anticholinergics. What are some important non-pharmacologic treatment considerations?
Education
Emotional/psychological support
Exercise
PT/OT/speech therapy
Meditation
Nutrition
Parkinson disease OMT research findings
Those treated with OMT had significant increases in stride length, cadence, and max velocities of upper and lower extremities
Tremors, balance, mobility improved post-treatment
Pts with PD may be more susceptible to SD in head/cranial and cervical regions
Pulmonary changes seen in aging population
Decreased chest wall compliance (increased work of breathing)
Loss of lung parenchymal support
Decreased resp muscle strength (decreased effective cough)
Increased alveolar dead space
Increased perception of SOB —> anxiety!
Calcification of costal cartilages
Decreased PaO2
[overall result is decreased secretion clearance, effects of hypoxemia, and increased risk of pulmonary complications]
Cardiovascular changes seen in aging population
Calcification and sclerosis
Increased sympathetic tone
Decreased hemodynamic response to inotropic agents —> fatigue, decreased endurance, depression
[clinical predisposition to HTN, LVH, orthostatic hypotension, valvular stenosis, endocarditis, conduction abnormalities, decreased hemodynamic response to stress, decreased response to stress]
4 major complications/comorbidities of HTN
Heart attack
Stroke
Chronic heart failure
Kidney disease
HTN prevalence is higher in _____ until age 45, then it is similar in both sexes until age 64, and in 65+ the prevalence is higher in ____
Men; women
