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Geriatric PT > Opposite Ends of the Spectrum: Frailty to Senior Olympics > Flashcards

Opposite Ends of the Spectrum: Frailty to Senior Olympics Flashcards

1
Q

Frail and institutionalized

“Hard to define….but_______

A

“Hard to define….but you know it when you see it.”

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2
Q

Frail people are becoming….

A

younger and younger!!!!

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3
Q

Imgs assoc’d w/ the word frail or frailty?

A

Decond’d

Fragile

Weak

Nursing home/institutional setting

Those in their 9-11th decade of life

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4
Q

Frail or Frailty defies an exact definition

Gerontologists suggest 3 or more of 5 factors to be considered Frail:

A
  1. Unintentional wt loss (10+lbs in a yr)
  2. Gen. feeling of exhaustion
  3. Weakness (measured by grip strength)
  4. Slow walking speed- gait
  5. Low lvls of phys act.
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5
Q

Proposed def. of Frailty

A

Syndrome of DECd reserve and resistance to stressors resulting from declines across mult. physiologic systems, & causing vulnerability to adverse outcomes

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6
Q

Frail older adult characterized by Three Descriptions:

A
  1. Illness-oriented
  2. Inability to carry out ADLs
  3. Diminished capacity to carry out important practical and social ADLs
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7
Q

Frailty Syndrome: Definition and Natural Hx

A

Flow Chart

KNOW IT!!!

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8
Q

Institutionalized

What do we think of

A

Nursing home

SNF

LTCH

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9
Q

Adverse Outcomes of Frailty

A
  • Falls
  • Injuries (hip fx, head inj’s)
  • Acute illness
  • Hospitalization
  • Disability
  • Dependency
  • Institutionalization
  • Death
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10
Q

Frail and Institutionalized

Complex Network of Contributory Factors

2 types of factors:

A
  1. Environmental
  2. Personal
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11
Q

Frail and Institutionalized

Contributory Factors (advance older adult to frail status)

Environmental

A
  1. Financial
    1. dec’d funds/resources
  2. Interpersonal
    1. loss of social act and family network
  3. Living situation
    1. home hazards, dist from shopping
  4. Legal
    1. POA, loss of driving priv.
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12
Q

Frail and Institutionalized

Contributory Factors:

Personal

A
  1. Cognitive
    1. diminished intellect, memory loss
  2. Physical
    1. reduced mobility, pain
  3. Psychological
    1. depress, psychiatric disorders, loss of self-esteem
  4. Spiritual
    1. loss of hope and meaning of life
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13
Q

Other dis’s and med probs play a role in frailty:

A
  • anorexia, loss of appetite
  • sarcopenia* or loss of body mass/strength
  • immobility or dec’d phys act
  • atherosclerosis
  • balance impairs
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14
Q

Core of Frailty

A

Sarcopenia***

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15
Q

Sarcopenia→ the core of frailty

Explain…

A
  • Sarcopenia is core of frailty, disability, loss of ind. in older adult
    • recent est’s suggest cost US over %18B/year
      • sum on par w/ economic conseq’s of osteoporosis****
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16
Q

Exercise EARLY====

A

Save $$$ on HC

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17
Q

Older adults who are unable to maintain IND home or comm. life

A

NEED of substantial hep and are freq’ly institutionalized in

  • Living alternatives:
    • live w/ kids or spouse
    • 24/7 care in home
    • cameras all over house
    • neighbors checking in
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18
Q

Risk Factors that serve as predictors for institutionalization

A
  • Inability to carry out BADLs or IADLs
  • Restricted mobility (ambulation, transfers)
  • Lack of social resources or support**
  • Poverty=lack of resources*
  • Decline in health perception
  • Many ep’s of illness that req extended hospital stays
  • Iatrogenic illness commonly caused by trauma, adverse drug rxns, infections
  • Prolonged bed rest and immobility
  • Under or poor nutrition
  • Elder abuse
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19
Q

Exam of Frail/Institutionalized includes…

A
  • Review:
    • medical, social, family hx==desired outcomes
  • Tests & Measures
  • Comprehensive assessment
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20
Q

Comprehensive Assessment of frail older adults who are institutionalized SHOULD comprise of:

A
  • Behavior, cog, MMSE
  • Communication skills
  • Visual tests
  • Hearing assess.
  • ROM
  • Muscle force
  • Pain
  • Muscle tone, reflexes, invol. mvmts, coord, sensation
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21
Q

Comprehensive Assessment of frail older adults who are institutionalized CAN comprise of:

A
  • Functional Assess tools
    • Frail Elderly Functional Assessment (FEFA) and questionnaire
      • 19 items to assess function at relatively low lvls in nursing homes and community settings (m-80)
    • Functional mobility or gross motor skills
    • Posture
    • Balance
    • Loco. assess including WC propulsion and gait analysis
    • Endurance
    • Comprehensive Geriatric Assessment—-READ BEFORE EXAM!!! SLIDE 11
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22
Q

Phys Activity vs. Exercise

A

Guidelines for Each

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23
Q

Phys Act vs. Exercise

Physical Activity:

A
  • Any bodily mvmt produced by mm’s that results in energy expenditure beyond resting
  • add to HEPs!!!
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24
Q

Phys Act vs. Exercise

Exercise:

A
  • SPECIFIC
  • A subset of phys act that is planned, structured, repetitive and purposeful in the sense that improvement or maintenance of phys fitness is the objective
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25
Q

Classifying Frailty:

Physical Performance Test

A

Max Score== 36

4pts per item

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26
Q

Modified Physical Performance Test

A

See pics

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27
Q

Client Case: 18/36=Moderately Frail (Modified Phys Performance Test)

A

Barriers vs. Real-Life Approach

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28
Q

Frail and Institutionalized

Effects of Exercise Training (ET)

A

Start: 40% MHR or 1RM

Frailty can be minimized or even reversed w/ LOW-int exercise (to start)

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29
Q

Effects of Exercise Training for Frail

What can be improved?

A
  • Gait
  • Gait speed
  • Ability to rise from chair
  • Perform transfers and stair climbing w/ a LE strengthening program
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30
Q

Effects of Exercise Training for Frail

Intensive ET includes what and what does it do?

A
  • Flexibility, resistance, endurance, balance training
  • Can improve measures of phys function and preclinical disability in older adults who have impairments in phys performance and O2 uptake as compared to HEP (Binder EF, et al.)
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31
Q

Effects of Exercise Training

Binder et al, 2008 used high resistive training program w/ machines and wts for the ET intervention group

A

RESULTS: see pics

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32
Q

Obese Frail

Explain overall…

A

Loss of skeletal mm mass assoc’d w/ EXCESS fat mass accompanied by loss of strength, power, function

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33
Q

Obesity in older adults acts synergistically w/ _______

A

Acts synergistically w/ sarcopenia to maximize disability, poor QOL

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34
Q

Obesity is an important cause of frailty in elderly:

WHY?

A
  • Weakness due to sarcopenia coupled w/ need to carry greater wt due to obesity
  • Poor muscle quality
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35
Q

Do obese, frail, older pts benefit most from exercise, wt loss, or BOTH?

BOTTOM LINE:

A
  • A combination of exercise + wt loss will provide most improvements in phys performance and wt loss in older, obese, frail pts
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36
Q

Physical Restraints

Defined:

A
  • “Any manual or phys or mech device, material, or equip. attached to the adjacent or adjacent to residents body that the indiv cannot remove easily which restricts freedom of mvmt or normal access to one’s body”
37
Q

When det’ing whether a device meets the def. of a phys restraint…..

A

assessor should NOT focus on the intent or reason behind the use of the device but the effect the device has on the resident

38
Q

Physical Restraint

Defined:

A
  • vest, waist, ankle restraints
  • Geriatric chair or wc w/ fixed tray table, or any other type of loc’ly designed devices
  • Restrictive side-rails→ two full length side rails are considered as intermed measure and analyzed separately bc they are freq’ly used to prevent bed-related falls during nighttime in LTC settings and obstruct vision
  • Most common reason given for using restraints is to prevent inj’s to people who are @ risk of accidental falls
    • HOWEVER, according to JAMA, there is no evidence that restraints reduce the risk of falls or inj’s
39
Q

Federal/Legal Guidelines for Physical Restraints

Medicare and Medicaid certified nursing homes

A

CANNOT use phys restraints UNLESS they are needed to tx the resident’s medical sx’s

40
Q

Federal/Legal Guidelines for Physical Restraints

Federal Law

A

req’s certified facilities to care for res’s in a way that maintains or enhances QOL

41
Q

RARELY does restraint use actually……

A

enhance a res’s QOL***

42
Q

Residents have a right

A

right to make decisions about their care and tx

Restraints should not be sued w/out the consent of the resident or legal rep

43
Q

Medicare/Medicaid cert’d nursing homes must ensure that a res’s abilities do NOT _____

A

do not decline unless it cannot be avoided due to a med cond.

44
Q

When regularly restrained, res’s often lose ability to……

A

Lose ability to bathe, dress, walk, toilet, eat and communicate

if restraints are necessary, they must be used in a way that does NOT cause these losses

45
Q

Residents must be released from restraints AND exercised/moved how often?

A

AT LEAST every 2 hrs

46
Q

Documentation and restraints

A

Doc in the chart req’s medical reason for restraint and time frame for use

47
Q

T/F Physician order for restraints is necessary

48
Q

Nursing homes sometimes use restraints to help what?

How else can you do this?

A
  • Sometimes use restraints to help res’s maint. proper body align. or pos.
    • However, proper pos. can often be achieved using:
      • pillows
      • pads
      • comfy chairs
49
Q

Medicare/Medicaid certified nursing homes and using restraints for positioning/comfort

A
  • Medicare/Caid cert’d nursing homes CANNOT use restraints to help pos. a res. unless it has first consulted w/ approp. health pros to det. whether less restrictive support devices could meet res’s needs
50
Q

Adverse Cons’s Assoc’d w/ Use of Phys Restraints

A

see pics

NOTE: starred items

51
Q

Reducing Use of Restraints

A
  • Meet ID’d phys needs according to residents routine rather than the facility’s
    • hunger
    • toileting
    • sleep
    • thirst
    • exercise
  • Train staff mbrs to meet indiv’d needs
  • Staff @ lvls high enough to respond to indiv needs
  • Companionship and supervision→ volunteers, family and friends
  • Phys and diversionary act’s such as exercise, outdoor time, other acts of interest
  • Adapt environment
    • alarms
    • good lighting
    • indiv’d seating
    • mattresses on floor
  • remove hazards such as over-bed tables w/ wheels
52
Q

Reducing Use of Restraints

A
  • Restorative care
    • walking
    • walking to dine programs
    • B&B training
    • indep eating
    • dressing
    • bathing programs
  • Wandering programs→ secured areas to walk
  • WC mgmt programs
  • Indiv’d seating programs for res’s who do not need wheels for mobility
  • Video visits w/ family
53
Q

Reducing Use of Restraints

A
  • Outdoor program daily
  • Rehab in dining room
  • Preventative program for calming aggressive behaviors
  • Use of chair/bed alarms, nightlights
  • reg. toileting
  • reg nap/rest
  • music ***
54
Q

The Senior Athlete

Guccione, 2001 (personal favorite of his…KNOW THIS!!!)

Who is the Older Athlete?

A
  • 3 Categories:
    1. former competitive athlete who cont’d to exercise
    2. life-long rec athlete who participates in a few sports and acts such as tennis or running→ never stopped=awesome
    3. the non-athlete who began to exercise later in life (after age 40) who typ decided to change their health status bc of a unhealthy lifestyle
  • All older athletes, regardless of type of events and activities they participate in have exp’d some generic age-related changes
55
Q

Senior Athlete

Changes that WE KNOW HAPPEN

A
  • Age changes how seniors utilize O2 (VO2max)
  • Age related limitations reside in skeletal mm
    • Lose Type II’s (POWER)
  • Recovery can take longer
  • Train smarter, not harder***
56
Q

Senior Athlete

More susceptible

A
  • Older athletes more susceptible to chronic and overuse inj’s
    • # of older adults w/ MSK impairs at all time high
57
Q

Senior Athlete

Explain the acute or overuse inj’s

A

acute or overuse injuries are superimposed on the aging MSK system and takes longer to recover

58
Q

Senior Athlete

MOST IMPORTANT role in this population is….

A

PREVENTION

  • Proper training tech’s and the use of approp. equip.
    • acute trauma
    • overuse
    • OA→ esp knee
    • Shoulder, knee, LB, ankle probs
59
Q

According to Chen and colleagues…

Proper dx and tx of MSK probs in aging athletes will help them what?

A

Maintain function and safely return to sports via indiv’ly-tailored exercise programs

60
Q

Besides sarcopenia and DEC bone mass (osteoporosis) what else are older athletes prone to

A

Tendons/ligs lose elasticity

wear and tear inj’s

  • age assoc’d declines in hearing, memory, balance, motor skills, sensation, proprio, cognition also further affect athletic participation
61
Q

_____, _______ sports often better suited to older athletes

A
  • Low-impact, endurance
  • *BUT many choose to pursue high-impact acts→ skiing
62
Q

With regular WHAT, aging athletes- well into their 80s- can minimize or reverse age-related declines in muscle mass

A

Regular, intensive muscle training***

63
Q

Common over-exercise inj’s in older runners

A
  • back pain
  • bursitis
  • stress fx
  • HS inj
  • kneecap probs
  • shin splints
  • Achille tendonitis
  • heel pain
  • Morton’s neuroma
  • calluses
  • bunions
  • other leg/foot probs
64
Q

Older runners

surfaces recommended

A

Grass, dirt and wooden tracks are less stressful to body and are recommended

65
Q

Older runners and fall-related inj’s

A

Far more susceptible to fall-related inj’s such as head trauma, fx

66
Q

Senior Athletes: Swimmers

Explain Swimmer’s Shoulder

A
  • 60% of competitive swimmers
  • Repeated rubbing of the RTC mm’s against the AC
67
Q

Older swimmers and RTC inj’s + more common injuries in older swimmers

A
  • MORE likely to suffer RTC rupture vs younger
  • Another more common injury→ Rupture of LHB tendon
68
Q

Older swimmers and hand paddles/fins

A
  • AVOID using due to risk of impingement syndromes and knee probs
69
Q

Older swimmers and Hypothermia

A

Older swimmers should be very careful of hypOthermia when in cold water

*ANS dysf→ temp reg.

70
Q

Senior Athlete: Cyclists and Brachioplexopathies

A
  • MORE likely to suffer from compressive or inflamm syndromes→ brachioplexopathies
    • over-exercise
71
Q

Other cycling inj’s common in older people

A
  • upper limb fx→ wrist, forearm, clavicle
  • shoulder disloc’s
  • sprains
  • lacerations
  • abrasions
  • *use correct seat ht, padded gloves, not resting on hands while riding
72
Q

Senior Athlete: Climbers

A
  • INCd risk for inj’s caused by weather→ dehydration in the summer and exposure to cold in the winter or @ hight alts
73
Q

Senior Athlete: Climbers and Acute Alt Sickness

A
  • Can occur as low as 6000 ft
  • more common older climbers
  • MORE risk of becoming delirious
  • MORE likely to develop bone fx
74
Q

Senior Athlete: Golfers

MOST common injs?

A

Overuse/repetitive strain inj’s

75
Q

Senior Athlete: Golfers

more injuries

A
  • Wrist pain→ bc of continual EXT and TWISTING of the wrist during golf swing
  • *GOOD IDEA for older golfer to give his body a break by moving for a time from the golf course and the driving range to the putting green
76
Q

Senior Athlete: Screening/Exam

As a therapist, what is the proactive role?

A

Screening and prevention

77
Q

Senior Athlete: Screening/Exam

REVIEW what?

A

Warm-up acts consisting of low intensity acts

78
Q

Senior Athlete: Screening/Exam

Survey the athletes playing habits to det the types of acts performed before they engage in play:

A
  • review form/tech
  • strength, flex, ROM
  • jt+skin integrity
  • CV and Muscular endurance
  • investigate prev pain issues
  • discuss meds and PMH, CMH, Physical med hx
  • co-morbs such as DM and CVD and limitations
  • review mods to limit or restrict acts that can cause further inj’s
79
Q

Senior Athlete: Intervention

Most common inj’s among aging athletes…..

A

Chronic, overuse injs

Muscle strains and tendonitis

80
Q

Frequent inj among older athletes and causes

A
  • Shoulder inj’s
  • Common cause of prolonged shoulder pain, weakness, and disability→ Torn RTC
81
Q

Bc majority of older athletes have been phys active since very young age, they are esp vulnerable to _____________

A

Osteoporosis→ leads to jt pain + stiffness

82
Q

Senior Athlete: Intervention

______ is KEY

A

PREVENTION!!!

83
Q

Senior Athlete: Interventions

Guidelines?

A

LOW int warm-ups

Stretching AFTER strengthening or workout program

84
Q

Senior Athlete: Intervention

Adapting the interventions

traditional tx vs modifications needed

A

Trad tx strategies are used to return athlete to PLOF

*mods in equip or freq/duration needed

85
Q

Senior Athlete: Intervention

Equipment ideas

A

Lighter resist or equip w/ hydraulic or pneumatic resist may be req’d to tx this pop as well as TM’s that have LOWER velocities

86
Q

Senior Athlete: Interventions

Phys agents and modalities?

A

Phys agents and electrotherapeutic modals are always helpful in reducing sx’s as well as therapeutic pools and hydroTx tanks for larger joint dysf

87
Q

Senior Athlete: Some Advice

88
Q

Aerobic/Endurance Activities

MODERATE ACTIVITIES

“I can talk while I do them, but I can’t sing”

3/5 RPE

60-75% MHR

150mins/wk

A
  • ballroom/line dancing
  • biking on lvl ground or w/ few hills
  • canoeing
  • gen gardening
  • sports where you catch and throw
  • tennis (doubles)
  • using manual WC
  • hand cyclers (UBE)
  • walking briskly (30mins @ 3mp=100METS)
  • water aerobics
89
Q

Aerobic/Endurance Acts

VIGOROUS ACTIVITIES

“I can only say a few words without stopping to catch my breath”

75mins/wk

A
  • aerobic dance
  • biking faster 10mph
  • fast dancing
  • heavy gardening
  • hiking uphill
  • jumping rope
  • martial arts
  • race walking, jogging, running
  • sports w/ lot of running
  • swimming fast or swimming laps
  • tennis (singles)

Geriatric PT (7 decks)

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