OCTA 236 (Geriatrics Exam 2) Flashcards
level of detail with which a person can see objects
vision acuity
total area one sees in a single view
vision field
the capacity to distinguish between similar shades of light and dark and to distinguish similar colors
contrast sensitivity
capacity to regulate light, control glare, and adapt to changing light conditions (light to dark)
light modulation
correctly processing and interpreting info the brain receives from eyes
visual perception and interpretation
vision is impaired and every day tasks are difficult
low vision
visual acuity of 20/200 or worse in the better eye with corrective lenses
Legal blindness
decreased ability to see details
diminished acuity
decreased ability to tell background from foreground
figure ground
Changes noted with vision and aging:
- Diminished acuity
- Diminished ability to accommodate for changes that occur with light/dark
- Decreased figure ground
- Decreased ability to discriminate between colors
- Visual field narrows
- Decreased depth perception
Glaucoma:
- Occurs when the aqueous (fluid behind the cornea) builds up within the eye
- Result is low blood flow to the optic nerve and hence reduces vision
- Person losses peripheral vision and visual fields
- If not treated, one can go blind
- Treated with drops/surgery
Muscular Degeneration:
- Leading cause of blindness in people over 60 years old
- The eye structure involved in the retina
- A person’s central vision is affected
- A person can not read standard print
Cataracts:
- The eye structure affected is the lens
- The lens become opaque and thickens
- A person may complain of hazy/cloudy vision or blurred vision
- A person may have to get reading glasses for near vision
Diabetic Retinopathy:
- Leading cause of blindness of all ages
- Usually occurs in an individual with poorly controlled diabetes
- Blood vessels rupture in the eye causing blind spots in the central vision field
- Can cause retinal detachment
Parkinson’s
- may have difficulty with eye movement (up gaze and converging)
- problems with convergence can cause double vision
Alzheimer’s
difficulty with color perception as well as depth perception
What needs to be considered when a person have low vision?
- Lighting
- Contrast (Dark/Light)
- Uniformity (keep things in same place)
- Magnification
- Auditory helpers (talking clocks, watches, message machines)
- Encourage elderly to keep all eye appointments
- Remove unnecessary clutter for safety
- Install auditory helper
- Pre-program phones with frequently used numbers
Principles of treatment for low vision:
- Magnification
- Hand held/computer
- Contrast
- Lightening
- Add an auditory component when possible
Technology for low vision:
Bioptic telescope system
- many states (39) allow persons with low vision to wear the bioptic telescope on their glasses for driving
- OT role is to train a client how to use them
What are the 3 categories of hearing loss?
- Conductive
- Presbycusis
- Mixed
results when the external ear can’t conducts sound waves to the inner ear (wax build up or fluid in middle ear)
Conductive
“old hearing” hearing loss which is the result of damage in the inner ear structures such as the cochlea or basil membrane
Presbycusis
combination of conductive and presbycusis
Mixed
Types of Presbycusis:
- sensory
- neural
- metabolic
- mechanical
type of hearing disorder that involves ringing, whistling, or buzzing in the ear
Tinnitus
- inner ear disorder that causes attacks of dizziness
- increase in fluid in the ear
- hearing loss or ringing in the ear may result
Meniere disease
Psychosocial Issues:
- isolation
- loss of sense of security
- interfere with day to day conversations
- Lead to frustration, depression, and in senses causes paranoia
Behaviors Associated with decrease hearing:
- Increase volume of TV/radio
- Constantly asking the same question
- Constantly asking someone to repeat self
- Constantly reporting the person is talking too softly
- Give an inappropriate response to question
- May appear to have a short attention span
Treatment Intervention for Hearing Loss:
- Five minute hearing test
- Hearing aids
- Hearing aid dog
- Assistive listening devices and systems
- Lip reading
- Visual aids within the environment
Integrative Strategies for hearing loss:
- make changes in the social and physical environment of the elder
- go out to eat between the busy times of the day
- add drapes, carpet, wall to ceiling coverings to reduce ambient sounds in the home
Mutation Theory:
- genetic, nonprogrammed
- accumulated errors of DNA/mtDNA
- Baseline for cancer
DNA-RNA Theory:
- disassociation of the RNA from the DNA
- Results in cell death and then organ failure
elders typically withdraw from previous activities in preparation for death
Disengagement Theory
Free Radical/Oxidative Stress Theory
- nongenetic, nonprammed
- accumulation of damage from highly reactive agents
Current US senators
Ben cardin and Chris Van Hollen
Who can introduce a bill?
Congress
Jimmo vs. Sibelius 2013
- Lifted the improvement standard
- Therapy can be used to maintain
what presbycusis is loss of high frequency sounds which is a result of degeneration of the basal end of the organ neurons
sensory presbycusis
what presbycusis is progressive degeneration of the auditory neurons in the auditory pathway of the cochlea
neural presbycusis
what presbycusis is stiffening of the basilar membrane. interferes with vibration mechanism with the cochlea duct. can lead to a loss of hearing of all frequencies
mechanical presbycusis
what presbycusis is a result of atrophy of the blood vessels in the cochlea’s wall. reduction in pure tone sensitivity of all frequencies is accompanied by rapid increase in loudness as the sound intensifies.
metabolic presbycusis
what are some examples of how hearing loss can affect function
- unable to hear whistling of the tea kettle
- unable to hear fire alarm *
- unable to hear the approach of a car
a specific tool or instrument used during an evaluation
assessment
obtaining/reviewing data relevant to potential client to determine further evaluation
screening
the process of obtaining and interpreting data necessary for intervention
evaluation
ones ability to navigate the community using public/private transportation
community mobility
Medical-Fitness-To-Drive
older people are at greater risk of health conditions that can comprise safe driving
an in-depth evaluation of driving performance skills and client factors related to driving
Comprehensive driving evaluation
an individual who meets the educational and experimental requirements and successfully complete certification provided by the associate
Certified driver rehabilitation specialist (CDRS)
a person who specializes in teaching driving education/traffic safety (classroom setting)
Driving educator
a person who completes training and is licensed as driving instructor by MVA
Driving instructor
What are some age factors that have negative impact on driving?
- decreased visual acuity
- decreased color discrimination
- decreased peripheral vision
- increased sensitivity to glare
- decreased reaction time
- medicine
- decreased decision making
What are some driving issues with old age
- merging
- yielding
- intersection
- back up
- reading signs
What are some pedestrian issues with driving?
- difficult step down (curves)
- difficult crossing street with time limit
- quick maneuvers
- difficulty managing WC and walker around
What is OT role in community mobility?
- resources
- mobility screening
- driving pre-screen assessment
- driving training (done by CDRS)
- carfit
- advocate
Cybernetic Theory:
- neuro-endo theory
- CNA= pacemaker of body
- changes in both endocrine and hypothalamus result in end organ changes
Non Genetic Theory:
- “wear and tear theory”
- cumulative damage to vital parts of the body lead to death of cell, tissue, organs, and eventually organisms
What are the 4 theories of aging?
- disengagement theory
- activity theory
- continuity theory
- life span theory
Activity Theory:
- believe disengagement is unnatural
- importance of an ongoing interaction.
- prefer high activity level
Continuity theory
- Adapt to change
Life Span Theory
- expected experiences
the pursuit of influencing outcomes-including public policy and resource allocation decisions with in political, economic and social systems and institution that directly affect peoples lives
Advocacy
What are the 5 types of advocacy?
- ideological advocacy
- mass advocacy
- interest
- legislative advocacy
- media advocacy
group fights to advance their ideas in the decision making circles
Ideological advocacy
any type of action taken by a large group (petitions, demonstrations)
Mass advocacy
lobbying is the main tool used in this type of advocacy
Interest-group-advocacy
reliance on the state/federal legislative process
Legislative advocacy
strategic use of mass media to influence policy and policymakers
Media advocacy
What happens if there is the same bill twice?
conference commitee
What are the steps for a bill?
- congress introduce bill
- committee role-consider bill in detail approves or denies
- sub committee- more study decide if should recommend to full committee. full committee vote on bill
- floor action-floor debate both house and senate have to approve bill
- final action-sent to president
Telomere Shortening
a sequence of DNA at the end of a linear chromosomes that protect the DNA from mutation and ID strand for replication.
- Reduce replication which eventually can lead to cell death.
a type of incontinence that is sudden and is usually caused by an illness or condition
Acute Incontinence
involuntary loss of urine due to intr-abdominal pressure (ex. coughing, laughing, exercise)
Stress Incontinence
bladder muscles are overactive- creating a sense of urgency
Urge Incontinence
e bladder is always full. The elderly person can never fully empty it. Constant dribbling of urine and/or voiding only small amounts noted.
Overflow Incontinence
Stress ( intra-abdominal ) and Urge (urgency/void low volumn)
Mixed Incontinence
lose all awareness of the need to void ( SCI)
Reflex Incontinence
loss of urine due to cognitive ( dementia - Alzheimer’s) or
•Mobility reasons ( walk slow, walker , etc) Will see the elderly rush to the bathroom .
Functional Incontinence
increases production of urine and hence the bladder fills more rapidly
Diuretics
relax muscles and decrease awareness for the need to void
Sleeping Pills
tighten the pelvic floor muscles. This makes it difficult to void
Decongestants
relax the bladder and prevent it from contracting properly
Antidepressants
What approach is used by OT’s for incontinence?
Behavioral Approach
