Physical Inactivity

Question 1

Nutrition

Answer 1

• Inadequate intake can result in wt loss, loss of muscle mass, dec strength and power, dec walking speed, impaired balance, and decline in activity
• Low BMI (≤ 20) or unintentional wt loss ≥10lbs in 6mos
• Calorie requirements dec, nutritional needs stay same
• Daily sodium reduced to 1500mg
  
  • Women = 1 drink/day; Men = 2 drinks/day

Question 2

Obesity

Answer 2

• BMI ≥ 30
• HTN and overweight -> restrict salt, inc physical activity, dec alc consumption -> DASH diet (fruits, veggies, whole grains, low-fat dairy products, poultry, fish

Question 3

Exercise

Answer 3

• for healthy asxatic adults of any age, USPSTF doesn’t recommend cardiac screening before initiating exercise.
• Older adults need to regularly engage in aerobic and resistive exercise weekly to optimize health
• Recommend 150mins mod intensity physical activity/wk.
  
  • Includes brisk walk, dancing, swimming, biking

Question 4

Immunizations

Answer 4

• influenza – annually
• Td/Tdap – 1 time initial dose and booster q10y with Td
• Varicella – 2 doses needed if individual never had varicella
• Zoster – 1 dose
• MMR – 1 dose if never had dz (if born before 1957, assumed immune)
• Pneumococcal – 1 dose unless high risk and then may be revaccinated once in 5yrs after initial vax
• Hep A – vaccinate only if at high risk/seeking protection from hepA (behavioral risk factors; occupational risk factors; travel to countries that have high or intermediate endemicity of hepA)
• Hep B – vaccinate only if at high risk as noted above

Question 5

Polypharmacy

Answer 5

• Use of more meds than clinically needed or indicated
• Old ppl at risk bc of multiple comorbidities and risk of seeing multiple health care providers.
• Avoid unnecessary meds and attempt to implement behavioral interventions as first line
• Provide verbal AND written instructions on how to use meds
• Drug regimens should be simplified, and meds reviewed at each provider/pt interaction

Question 6

Fall Prevention and Management

Answer 6

• Recurrent falls frequently result of same underlying cause but can also be indication of disease progression (i.e. parkinsonism, dementia, heart failure) or new acute problem
• Risk factors: weakness, gait/balance impairment, fnal and cog deficits, psychotropic meds, polypharmacy)
• Fall-prevention measures: fall-risk assessments, exercise programs, environmental inspection and modification

Question 7

Managment of Immobility

Answer 7

• Sites of care include rehab hospitals, subacute placements in long-term care, outpatient facilities
• Mobility aids such as canes and walkers, as well as functional assistive devices are helpful
• PT/OT

Question 8

Elder Abuse

Answer 8

• Abuse can be physical, sexual, psychological, emotional, or financial or it can be in the form of neglect
• Forms of abuse
  
  • Physical or sexual abuse is suspected in the presence of bruises, puncture wounds, fractures, cuts, burns, poor hygiene, soiled clothing, hair loss in clumps, weight loss or poor nutrition, dehydration, or lack of eye glasses or hearing aids, injuries from use of restraints, lack of or delay in seeking medical attention
  • Psychological abuse à manifested by threats, insults, or verbal abuse or refusal to allow travel, church attendance, attendance at social events, or family visits
  • Financial abuse à may come in form of misuse of patient’s funds
  • Neglect à withholding food, medicine, clothing, routine health care, etc