Physical therapy and the older adult

Question 1

Age related changes in muscle

Answer 1

• 0.5% loss/year > 40 years of age
• 1-2% loss/year >50 years of age
• 3% loss /year > 60 years of age
• rate increased with sedentary behaviour

Question 2

strength changes related to age

Answer 2

• 50% decrease

Question 3

age related changes in muscle: power

Answer 3

• loss begins at age 30
• power losses greater than strength losses
• 75% decrease

Question 4

Age related muscle mass:

Answer 4

• reduction selectively targets type 2 fibers
• lower limb muscle loss 2 times greater than UE
• 25-59% of thigh musculature cross sectional area may be los
• 8-49% loss from age 18-80

Question 5

Age related changes in flexibility

Answer 5

• 6 degree/decade loss in ROM at shoulder and hip joints

Question 6

changes with aging: cardiovascular

Answer 6

decrease in:

• max HR
• aerobic capacity
• sensitivity of baroreceptors
• arterial compliance

Question 7

Changes with aging: pulmonary

Answer 7

decrease:

• vital capacity
• resp muscle strength
• aveolar surface area
• lung expansion

Question 8

changes in musculoskeletal with aging

Answer 8

decrease

• type 2 fibers
• elasticity of muscles
• vertebral disc height
• bone mineral density
• muscle strength/power/endurance
• muscle mass

Question 9

changes in Neuromuscular system with aging

Answer 9

decrease:

• systems
• cognitive processing
• speed

Question 10

changes with hormonal system:

related to age

Answer 10

decreased

• estrogen/progesterone
• testosterone
• glucose tolerance
• growth hormone

Question 11

Changes in the integumentary system

Answer 11

decrease

• vitamin D
• melanocytes
• mast cells sweat glands
• vascularity
• elastin/collagen
• epidermal turnover

Question 12

changes in nutrition related to age

Answer 12

decreased

• resting metabolic rate
• protein synthesis rate
• GI motility
• appetite
• body water

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Question 13

What are some red flags in a system review especially with older adults

Answer 13

• resting heart rate: >120
• resting SBP: >200 or < 90
• resting diastolic: >110
• weight gain: >1-2 lbs/day or 5lbs/week
• ankle: edema
• anginal pain: acute
• dizziness: acute

Question 14

What are the geriatric 5 Ms to keep in mind with a client

Answer 14

• mind/mentation
• mobility
• medication
• multicomplexity
• what matters most to the person

Question 15

APTA geriatric guiding principles

Answer 15

• utilize person-centered care-preferences, values, goals to drive POC
• strive for anti-ageist practice
• conduct holisitc assessment w/ sound outcome measures
• use interventions that are based on the best available evidence
• champion interprofessional collaborative practice inclusive of patients and caregivers

Question 16

How can you utilize person-cenetered care especially with older adults

Answer 16

• individualized, meaningful goals to ensure patient engagement
• mutual trust and respect
• active listening
• acknowlegding patient’s concerns/view points
• environment to ensure self-efficacy
• ensure freedom of choice

Question 17

how can you conduct an anti-agest practice

Answer 17

• resist stereotypes
• avoid paternalism (parent)
• avoid persuasion/coercion
• avoid images/language that portray youth as positive and aging as negative
• words matter

Question 18

What should be included in a holisitic assessment with sound outcome measures

Answer 18

• comphrehensive falls/fall risk assessment
• assessment of functional mobility
• curent and recent changes in medications and side effects
• bowel and bladder incontinence
• vision and hearing assessment
• mental health (feeling down or depressed/anxious)
• detailed parrticipation in physical activity and exercise
• extent of social network and support
• societal roles
• environmental factors that impact

Question 19

How to assess a fall risk

Answer 19

3 questions:

• have you fallen in the past year
• are you afraid of falling
• are you unsteady when standing or walking

Question 20

risk factors for falls

Answer 20

• weakness
• visual changes
• chronic conditions
• polypharmy (>4)
• improper use of AD
• environmental concerns (hand rails, lighting, obstacles)
• alcohol

Question 21

functional mobility assessment:

Answer 21

• sit to stand
• SPPB (gait speed, 3 stage balance, 5x STS)
• TUG
• gait speed
• handgrip
• balance with challenge (four stage balance, four suqare step test, tinetti)
• endurance (6 minute walk; 2 minute step)
• getting up off the ground
• time to ascend stairs/curbs

Question 22

1. gait speed Norm
   fall risk cut of for:
2. TUG
3. 5x STS
4. grip strength
5. 6 minute walk

Answer 22

1. 1.2-1.4 m/s
2. > 12 sec
3. > 15 sec
4. Women: 21 kg = decreased mobility; Men: 33 kg = decreased mobility
5. community dwelling adults: 60-69 males 572 m, females 538m

Question 23

exercise recommendations: strength

Answer 23

• at least 2 sessions/week
• 60% 1 RM =12-15 reps of REP 12-13 “fairly light”
• 80% 1RM

Question 24

exercise recommendation: aerobic

Answer 24

• 150 minutes of moderate intensity (able to maintain a conversation)
• 75 minutes of vigorous intensity

Question 25

Exercise recommendation: flexibility

Answer 25

- low intensity, long duration (60 seconds) - include daily activities moving UE, trunk, neck, LE

Question 26

Exercise recommendation: balance

Answer 26

- 15-20 minutes per day and progress as able to tai chi

Question 27

fracture risk

Answer 27

- FRAX toll: fracture risk assessment tool screening for fall risk - country - bone mineral density - age - gender - clinical risk factors

Question 28

clinical risk factors for a fracture

Answer 28

- low body mass index - prior fragility fracture - parental history of hip fracture - use of glucocorticoids - current smoking - ETOH >3 unit/day - RA - Other causes of osteoporosis

Question 29

Osteoporosis exercise considerations: recommendations

Answer 29

- perform WB, strengthening ex and resistance ex that emphasize posturaal extension 2-3/ week - begin 40-60% 1 RM and progress slowly if indicated - endurance, weightbearing activities 3-5x/week - core and abdominal strengthening in non flexed position - good body mechanics with spine in neutral

Question 30

osteoporosis exercise considerations: contraindications/precautions

Answer 30

- avoid high intensity high volume weight training - avoid trunk flexion with rotation and end range resisted flexion of spine - avoid high impact activities - avoid high velocity movements - avoid LE WB exercises with torsional motions at the hips - guard/instruct in safe balance interventions to avoid falls

Question 31

Medications/polypharmacy in the older adult

Answer 31

- polypharmacy: use of 3-4 medications - prescribing cascade: a new drug is prescribed to counter the adverse reaction of a current dug - beers check list/medication appropriateness index/screening tool of older persons prescriptions anad screening tool to alert to right treatments

Question 32

what medications should specifically be screened for the older adult

Answer 32

- benzodiazepines - opioids - anticholinergic medications - sedatives - muscle relaxants - tricycle antidepressants - antipsychotics

Question 33

Mentation outcome measures for dementia, delirium, depression

Answer 33

Dementia: - MMSE: < 17 also fall risk - MOCHA - SLUMs Delirium: - 2 item ultra-brief delirium screen - confusion assessment method (CAM) Depression: - geriatric depression scale - GDS short form - patient health questionnaire (PHQ-2)

Question 34

# Older adult interventions that are evidence based

Answer 34

- high intensity exercise whenever possible - strength, balance, endurnace, functional training - over 50 hours of progressive and challenging balance exercise needed to obtain optimal balance outcomes - exercise should be progressive, creative, variable, and challenging to enhance outcomes