SPECONLEC_S1_L3 - P14-P29 Flashcards
Reaction to drugs is always the same as in younger
age groups t or f
f, Reaction to drugs not always the same as in younger age groups
MEDICATION METABOLISM: Adverse effects
more frequent and may be more severe t or f
t
adipose tissue causes larger
volume of distribution for fat-soluble drugs
inc
increased adipose tissue leads to _
prolonged biologic
half-life
More diffused in the body for meds means
more fat stored in the body
Decreased total body water means that the meds are_
decreased volume of distribution of water-soluble
Since the hydration is low, you would expect
(inc or decrease) volume of water
decrease
low hydration means there will be
concnetration of drugs
higher
more concentrated drug means _
more potency and adverse effects of drug
Hepatic drug clearance decreased up to what percent
30%
Renal clearance decreased up to what percemt
50%
decrease in renal and heaptic clearance means that _
longer duration of drug in the body
GAIT: speed,
double limb support, stride length
dec, inc, shorter
gait is affected by:
vision,
cognition,
motor control,
balance,
peripheral sensation,
strength,
joint health,
metabolic demands
predictor of survival, possibly a biomarker of
health status in older adults
Gait speed
If able to walk faster > what are the chances of survival
more chances of survival
If slower than normal >what can be the prognosis
poor prognosis
Indicators of gait speed: what are the OMTs to be used
6-minute walk test
(6MWT)
gait speed that has relatively good function
1.0 m/sec
gait speed for predicitng median life expectancy for age &
sex
0.8m/sec
CONDITIONS & DISEASES IN THE ELDERLY (16)
frailty
disuse and immobilization
falls
osteoarthritis
osteopenia and osteoporosis
hip fx
stroke
TBI
SCI
dementia
delirium
normal pressure hydrocephalus
parkinson disease
amputation
cancer
polypharmacy
Age and disease-related loss of adaptation, such that
events of previously minor stress result in disproportionate
biomedical and social consequences
FRAILTY
Clinical Syndrome for frailty (5) (US WSL)
○ Unintentional weight loss of at least 10 lb over the
past year
○ Self-reported-exhaustion
○ Weakness (grip strength)
○ Slow walking speed
○ Low physical activity
Clinical Syndrome should have how many to be considered
as frailty
3 or more
frailty can be attributable to _ _ _
aging, diseases, and comorbidity
Exacerbates decline in body systems
DISUSE AND IMMOBILIZATION
DISUSE AND IMMOBILIZATION is a combination of
_ + _
inactivity, lack of mechanical loading
Combination of inactivity and lack of mechanical loading
lead to _
negative effects of bed rest
what will pt lose if he is predosposed to
disuse and immobilization
● Loss of muscle mass
● Loss of strength and power
disusue and immobilization:
muscle insulin resistance
increased
disusue and immobilization:
bone loss
increased
disusue and immobilization:
pulmonary function and exercise capacity
decreased
Inability of blood vessels to adapt
OH
there is _ venous return in OH
low
Impaired balance and coordination for disuse and immob
t or f
t
Increased/decreased risk for pressure ulcers for disuse
increased
Low nutrition can contribute to pressure ulcers t or f
t
Immobility from bed rest, predictor of decline in ADLs,
institutionalization & death in hospitalized older patients
DISUSE AND IMMOBILIZATION
as you age, there’s lower physiological capacity is lower t or f
t
Major cause of morbidity
falls
falls causes the majority of fx of the _ _ _
foreamr, pelvis, hip
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
RECOMMENDATION for fall and injury prevention
in the elderly (9)
● Fall risk assessment by qualified healthcare
professionals or teams
● Individualized, group, and home-based exercise
● Balance, strength, & gait training exercise (e.g tai chi)
● Home safety evaluations and modifications
● Medication review and reduction program with family
physician & patient involvement
● Careful, medically directed tapering of high-risk medications
● Addressing foot/ankle pain and dysfunction
● Treating vitamin D deficiency (at least 700 international units per day)
● Cataract surgery and dual chamber cardiac pacing if indicated.
in treating vitamin D deficiency, how many
international units per day
at least 800 internaltional units per day
Criteria for falls
berg balance scales
OSTEOARTHRITIS is common amoong older adults t or f
t
Most common affected in OA
hands and knees
what are the signficant source of pain and disabilitty for OA
hips and spine
_ can lead to spinal stenosis which can
cause _
Disc desiccation,nerve root impingement
Risk factors. for OA (4)
obesity, genetics, inadequate nutritional content, muscle strength
Low bone density
OSTEOPENIA AND OSTEOPOROSIS
OSTEOPENIA AND OSTEOPOROSIS is more comon in _
postmenopausal women
men can also get osteopenia or osteoporosis t or f
t
inc or dec? risk for fractures leading to pain, immobility, and
functional dependence
increased
bone mineral density score -01.0 and 2.5
Osteopenia
bone mineral density T score -2.5 or less
Osteoporosis
Risk factors for osteopenia and osteoporosis
increasing age, family hx, glucocorticoid therapy, smoking
HIP FRACTURES are also more common in older adults t or f
t
hip fx is associated with _ _ _
increased mobility, mortality, and health
care use and cost
HIP FRACTURES result in _ _
long-term disability and increased functional
dependence
Not all elderly are recommended for hip arthroplasty t or f
t
Risk factors for hip fx
falls, associated risks of falls, osteoporosis, skeletal fragility
Rehab should emphasize weight-bearing as soon as possible with
goals of pain control & early loading while avoiding fracture
dislocation & implant failure t or f
t
Rehab should emphasize _ as soon as possible with goals of pain control
& _ while avoiding fracture dislocation & implant failure
WB, early loading
Leading cause of acute neurologic admissions to hospitals and death
stroke
Health outcomes are worse among older adults because of
age-related comorbiditiess and frailty
STROKE
Rehab begins in the _ setting for stroke
acute
what interventions for stroke?
Strengthening, ROM, spasticity management, low-vision, cognitive, and urinary incontinence interventions can be performed
Risk factors for stroke:
previous stroke, transient ischemic attack (TIA), HtN, hyperlipidemia, heart disease, DM
TRAUMATIC BRAIN INJURY: age
> 75 y/o
highest incidence of hospitalizations and death is d/t _
TBI
traumatic brain injury is more attributable to _ than MVA
falls
_ outcomes assoc. with increasing age for TBI
poorer
Risk factors for TBI
physical and cognitive impairments
Loss of bone mass and changes in body composition increase risk for _
SCI
Traumatic SCI likely d/t _
falls
Nontraumatic SCI attributable to _
cervical or lumbar
spinal stenosis
Nontraumatic SCI attributable to cervical or lumbar
spinal stenosis d/t
degenerative joint processes disc herniation, or mass effect from
hematoma or tumor growth
Spinal stenosis is degenrative t or f
t
First-year survival is bad in SCI t or f
f, First-year survival is good
Mortality rates increase dramatically with age in SCI t or f
t
Group of symptoms that affect the patient’s daily function
DEMENTIA
dementia affects
Executive cognitive dysfunction, memory impairment, mood,
personality, and behavior changes
Reversible causes of dementia
SDH
NPH
depression,
hormonal imbalances,
drug and alcohol abuse,
vit D Deficiency
Irreversible causes of dementia
alzheimer’s,
parkinson’s,
huntington’s disease,
AIDS,
repeated neurovascular insults,
severe or repetitive TBIs
Early identification for dementia is critical t or f
t
Mild cognitive impairment (MCI), clinically identifiable precursor to AD
DEMENTIA
dementia isnt noticed immediately t or f
t
Hallmark of Alzheimer’s:
plaques are seen in MRI –
point of no return
dementia pts need to start early c increased physical activity:
how many minutes per week
150
mins of moderate physical activity and resistance
exercises
Acute neurocognitive disorder
DELIRIUM
delirium is _ and _
transient, reversible
delirium occurs more commonly among the elderly t or f
t
Diagnostic criteria of delirium
○ 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
treatment for delirum:
Treatment is pharmacologic & should be referred back
to MD
