S1L3: Conditions and Diseases in the Elderly Flashcards
Age and disease-related loss of adaptation, such that events of previously minor stress result in proportionate biomedical and social consequences
FRAILTY
To consider Fraility as a Clinical Syndrome, it should have how many of the ff?
- Unintentional weight loss of at least 10 lb over the past year
- Self-reported-exhaustion
- Weakness (grip strength)
- Slow walking speed
- Low physical activity
3 or more
To consider Fraility as a Clinical Syndrome, it should have 3 or more of the ff: (5)
- Unintentional weight loss of at least 10 lb over the past year
- Self-reported-exhaustion
- Weakness (grip strength)
- Slow walking speed
- Low physical activity
Frailty can be attributable to: (3)
aging, diseases, and comorbidity
Frailty is not included as a category for patients at risk for adverse outcomes
True or False
False
Category of patients at risk for adverse outcomes
Disuse and Immobilization exacerbates the decline in body systems
True or False
True
Disuse and Immobilization is a combination of ______(2) which lead to negative effects of bed rest
inactivity and lack of mechanical loading
Disuse and immobilization leads to decreased muscle insulin resistance
True or False
False (Increased muscle insulin resistance)
Disuse and immobilization increases bone loss
True or False
True
Disuse and immobilization decreases pulmonary function and exercise capacity
True or false
True
Major cause of morbidity
FALLS
Cause of majority of fractures of the forearm, pelvis, hip, pelvis
FALLS
Risk factors for falls in the elderly: (8)
- Age
- Physical impairments
- Cognitive impairment, dementia, depression
- Previous falls
- Medications
- Comorbid conditions
- Chronic pain & arthritis
- Poor functional status
RECOMMENDATIONS FOR FALL AND INJURY PREVENTION IN THE ELDERLY:
Treating vitamin D deficiency (at least ____ international units per day)
700
RECOMMENDATIONS FOR FALL AND INJURY PREVENTION IN THE ELDERLY:
Careful, medically directed tapering of _____
high-risk medications
RECOMMENDATIONS FOR FALL AND INJURY PREVENTION IN THE ELDERLY:
Addressing ______ pain and dysfunction
foot/ankle
RECOMMENDATIONS FOR FALL AND INJURY PREVENTION IN THE ELDERLY:
____ surgery and ____ if indicated.
Cataract
dual chamber cardiac pacing
Tai Chi can be recommended for fall and injury prevention in the elderly
True or False
True
Generalized, group, and home-based exercises can be recommended for fall and injury prevention in the elderly
True or False
False
Individualized, group, and home-based exercises can be recommended for fall and injury prevention in the elderly
Fall risk assessment by qualified healthcare professionals or teams can be recommended for fall and injury prevention in the elderly
True or False
True
ADs can be recommended for fall and injury prevention in the elderly
True or False
True
What scale can be used as a criteria for falls
Berg Balance Scale
OA is common in what demographic?
older adults
Most commonly affected parts in OA? (2)
hands and knees
What part of the body causes the most significant amount of pain in OA? (2)
Hips & spine
______ can lead to ______ which can cause nerve root impingement
Disc desiccation
spinal stenosis
Risk factors for OA: (4)
obesity, genetics, inadequate nutritional content, muscle strength
osteopenia and OA is more common in what demographic?
postmenopausal women
osteopenia and OA leads to increased risk for [] leading to pain, immobility, and functional dependence
fractures
Osteopenia bone mineral density score:
-1.0 and -2.5
Osteoporosis bone mineral density T score
≤ -2.5
Risk Factors for osteopenia and OA: (4)
increasing age, family hx, glucocorticoid therapy, smoking
Hip Fractures are more common in older or younger people?
older adults
T/F: Hip fractures are associated with increased mobility, mortality, and health care use and cost
True
T/F: Hip fx result in long-term disability and increased functional dependence
True
Risk factors for Hip fx: (4)
falls, associated risks of falls, osteoporosis, skeletal fragility
T/F: Rehab should emphasize weight bearing as soon as possible with goals of pain control & early loading while avoiding fracture dislocation & implant failure
True
What is the leading cause of acute neurologic admissions to hospitals and death?
Stroke
T/F: Stroke health outcomes are worse among older adults because of age-related comorbids and frailty
True
Rehab for stroke begins in the acute or chronic setting?
acute setting
T/F: PT management in stroke includes: Strengthening, ROM, and spasticity management. Interventions for low-vision, cognitive, and urinary incontinence are outside our roles
False
Risk factors for stroke: (6)
previous stroke, transient ischemic attack (TIA), HtN, hyperlipidemia, heart disease, DM
What age has the highest incidence of hospitalizations and death d/t TBI?
> 75 y/o
Which is a more common cause of TBI: MVA or falls?
falls
TBI have better outcomes assoc. with increasing age
true or false?
False
poorer outcomes
Risk factors for TBI: (2)
- physical and cognitive impairments
- Having multiple medical conditions & medications
____ (2) increase risk for SCI
Loss of bone mass and changes in body composition
Traumatic SCI is likely d/t ____
falls
Nontraumatic SCI is attributable to _____ d/t ______ from ______
cervical or lumbar spinal stenosis
degenerative joint processes disc herniation, or mass effect
hematomasory tumor growth
What year of survival in SCI is a good prognosis?
First-year
Mortality rates increase dramatically with age
True or False
True
Group of symptoms that affect the patient’s daily function
Dementia
Symptoms of Dementia (5)
Executive cognitive dysfunction, memory impairment, mood, personality, and behavior changes
Reversible vs. Irreversible cause of Dementia:
- SDH
- Alzheimer’s
- Parkinson’s
- Depression
- Hormonal Imbalances
- R
- I
- I
- R
- R
Reversible vs. Irreversible cause of Dementia:
- Drug and alcohol abuse
- Huntington’s
- severe or repetitive TBIs
- Vit deficiency
- AIDS
- repeated neurovascular insults
All are irreversible except for 1 & 4
Delayed identification is critical in dementia
True or False
False
Early identification
What is a clinically identifiable precursor to Alzheimer’s Disease?
Mild cognitive impairment (MCI)
Acute neurocognitive disorder that is transient & reversible
Delerium
Delerium is reversible
True or False
True
Delerium occurs more commonly among older or younger individuals?
older
Diagnostic criteria for delerium:
○ Disturbance in [] and [] that develops over a short period of time and [] and [] during the course of the day
○ Disturbances in []
○ Disturbances in [] and [] are not
better explained by a pre-existing neurocognitive
disorder
○ Evidence that the disturbance is directly d/t a
pathophysiologic process such as [] or drug-related []
- Disturbance in attention and awareness that develops over a short period of time and waxes and wanes during the course of the day
- Disturbances in cognition
- Disturbances in attention and cognition are not better explained by a pre-existing neurocognitive disorder
- Evidence that the disturbance is directly d/t a pathophysiologic process such as a medical condition or drug-related toxicity
PTs cant treat individuals c delerium
True or False
True
Treatment is pharmacologic & should be referred back to MD
Cause of normal pressure hydrocephalus
Idiopathic or related to previous meningitis or subarachnoid (SA) hemorrhage
Hallmark signs of normal pressure hydrocephalus: [], [] disturbance, [] along with ventriculomegaly with [] CSF pressures
dementia, gait disturbance, urinary incontinence along with ventriculomegaly with normal CSF pressures
Ataxia is not present in normal pressure hydrocephalus
True or False
False
What do you call the gait in severe normal pressure hydrocephalus
Magnetic gait
Progressive neurodegenerative disorder with Ataxia, bradykinesia, tremor, cog-wheel rigidity
Parkinsons Disease
type of rigidity in Parkinsons
cog-wheel
Parkinsons pts do not usually have dementia
True or False
False
May have dementia
What type of tremor is present in Parkinsons?
What can worsen this tremor?
Resting tremor increases with stress
Type of gait seen in Parkinsons
Parkinsonian gait (can be Festinating)
Results to positive effects of strength & function for mild to moderate PD
Resistance training
Amputation is attributable to what?
vascular disease
Life expectancy is shorter after amputation
True or False
True
Prognosis for successful prosthetic rehabilitation is influenced by what?
number and type of comorbidities
Increased energy demands in amputation result in better outcomes
True or False
False
Increased energy demands in amputation result in poor outcomes
Amputation c comorbid respiratory disease affects _____
gait retraining
End Stage Renal Disease (ESRD), miss rehab schedule d/t ____ and frequently affect _____
dialysis commitments
limb volume
_____ is a more important predictor of successful prosthetic rehab
Premorbid function
The remaining limbs will perform the function; _____ (increase or decrease) energy expenditure causing _____
increase
higher physiologic demands
Not all skills will increase p amputation
True or False
True
_____ miss rehab schedules d/t dialysis commitments and frequently affect _____
End-Stage Renal Disease (ESRD)
limb volume
Cancer is more prevalent at what age?
> 65 y/o
Prevalence of cancer increases with increasing elderly population
True or False
True
Cancer treatment considerations: (3)
Comorbidities and cognitive/functional status, cancer type
Multiple comorbidities increase the likelihood of death d/t cancer related causes
True or False
False
d/t non-cancer related causes
Effects of treatment may compete with the patient’s interest and wishes
True or False
True
Moderate physical activity, ___ mins/week decreases ___ by __% among breast CA survivors & __% among colorectal CA survivors
150
total mortality risk
24
28
Use of multiple drugs
polypharmacy
Causes adverse drug reactions from multiple drug regimens
polypharmacy
Common ADRs of polypharmacy include: (7)
dizziness, insomnia, confusion, sedation, nausea, changes in bowel habits, balance problems
Medication side effects can be confused as ____ in polypharmacy
symptoms of a new illness
“The prescribing cascade”
polypharmacy
polypharmacy increases the risk for: (2)
falls & delirium
What are the 8 management issues?
Medication management
Pain management
Nutrition
Physical exercise
Ambulatory assistive devices
Orthoses & footwear
Psychosocial support
Modifying the environment
ACTIVITY RECOMMENDATIONS IN OLDER ADULTS WITH NO LIMITATIONS:
Moderate-intensity aerobic activity: enough to result in noticeably increased heart rate and breathing, for at least ___ minutes ___ days a week.
30
5
ACTIVITY RECOMMENDATIONS IN OLDER ADULTS WITH NO LIMITATIONS:
Resistance training (calisthenics, weight training): at least one set of ____ repetitions of an exercise that trains the major muscle groups on ____ nonconsecutive days each week.
10 to 15
2 or 3
Resistance training of at least one set of 10 to 15 repetitions of an exercise that trains the major muscle groups can be done on 2 or 3 consecutive days each week.
True or False
False
non-consecutive days
ACTIVITY RECOMMENDATIONS IN OLDER ADULTS WITH NO LIMITATIONS:
Flexibility: at least ____ minutes of stretching major muscle and tendon groups at least ___ days each week; ____ seconds of ____ stretches and ____ repetitions for each stretch. Ideally performed every day that aerobic and resistance training is performed.
10
2
10 to 30
static
three to four
ACTIVITY RECOMMENDATIONS IN OLDER ADULTS WITH NO LIMITATIONS:
Balance exercise ____ times a week (ideal type, frequency, and duration has not been defined)
three
