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Special Pops (Review Q's/Re-outlined PPT) > Study Guide Q's: Age Related Changes > Flashcards

Study Guide Q's: Age Related Changes Flashcards

1
Q

Identify the roles of other healthcare team members (PTA, OT, SLP, Nursing, Case manager, physician/PA, family)

A
  • PTA: assists in implementing treatment programs for medically complex patients; reports to PT on the patient’s response; corresponding with PT in a collaborative manner to determine changes necessary to treatment approach based on patient status
  • OT and SLP: coordinate care to address all aspects of rehab needs
  • Nursing: coordinate care and exchange critical patient information
  • Case manager: coordinate discharge plans and equipment needs
  • Physician/PA: coordinate care and exchange critical patient information
  • Family: obtain essential information on patient’s PLOF and discharge options; caregiver involvement in patient care

know examples of who to consult or when a patient needs a referral

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2
Q

What is homeostatic reserve?

A

physiological resilience and ability to adapt to stress

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3
Q

In relation to homeostatic reserve, what is considered sucessful aging?

A
  • High capacity to tolerate stressors
  • Exercise causes robust, positive changes
  • Wider homeostatic window = greater physical resilience
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4
Q

In relation to homeostatic reserve, what is considered unsucessful aging?

A
  • Low tolerance, susceptible to illness
  • Positive changes occur but at smaller magnitude
  • Narrow homeostatic window = reduced adaption to even low stress
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5
Q

What changes occur in the MSK system with aging?

A
  1. Bone loss
  2. Sarcopenia including cachexia
  3. Connective tissue changes
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6
Q

Describe bone loss with aging

what accelerates in women vs. men?

what is considered osteoporosis in regards to the T score?

A
  • Advancing age favors bone catabolism rather than bone anabolism
  • Accelerated by menopause in women
  • Accelerated after age 75 in men
  • Consider nonmodifiable vs. modifiable risk factors for bone loss
  • Osteoporosis: T score between -1.0 and -2.5 in lumbar spine, total hip, and femoral neck and increased risk using FRAX
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7
Q

Describe sarcopenia

A
  • Definition: age related decline in muscle mass
    • Dynapenia: age related decline in strength
  • Consider the detrimental effects of sedentary lifestyle
  • Effects of sarcopenia
    • Loss of type II fibers –> decreased strength and power (impacts STS)
    • Loss of LBM and gain of fat mass –> decreased resting metabolic rate (1-2% every decade after 20 years old)
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8
Q

What is cachexia?

When does it occur? With what 3 conditions? What is most likely caused by?

A
  • decline in muscle/body wasting that does not respond to nutritional support
    • Occurs before death
    • Associated with:
      • Cancer
      • COPD
      • End stage disease
    • Most likely caused by massive increase in inflammatory cytokines
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9
Q

Describe connective tissue changes with aging

A
  • Decreased water content in the connective tissue
    • Results in decreased height
    • Loss of water in articular cartilage –> OA
    • Increased collagen cross links + water loss –> joint stiffness and reduced shock absorption
  • Reduced elastin
    • Results in saggy, wrinkled skin
  • Effects of CT changes:
    • Contribute to sports injuries and decreased performance
    • Contribute to displaced internal organs (uterine prolapse, hernia)
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10
Q

Exercise considerations with MSK changes in aging pop

A
  • Higher intensity exercise results in greater strength gains and LBM
  • Exercise plays a crucial role in controlling intraabdominal fat
  • Achieving end range plays a crucial role in preventing age related ROM losses
  • Connective tissue stiffness increases muscular effort required for movement, resulting in reduced muscle endurance
  • High impact exercise may not be appropriate in the presence of bone loss and dried out connective tissue
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11
Q
A
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12
Q

Changes in the CV system with aging

A
  • Decline in max HR –> smaller aerobic workload
  • Decline in VO2max –> smaller aerobic workload
  • Stiffer, less compliant vascular tissue –> higher BP, slower ventricular filling time, reduced cardiac output
  • Loss of SA node cells –> lower max HR
  • Reduced contractility of vascular walls –> slower HR, lower VO2 max, smaller aerobic workload
  • Thickened capillary basement membrane –> reduced arteriovenous O2 uptake
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13
Q

Changes in the nervous system with aging

A
  • Sloughing/loss of myelin –> slowed nerve conduction
  • Axonal loss –> fewer muscle fibers, loss of fine sensation
  • Autonomic NS dysfunction –> slower systemic function (CV, GI) with altered sensory input
  • Loss of sensory neurons –> reduced ability to discern hot/cold, pain
  • Slowed response time (reaction speed) –> increased fall risk
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14
Q

Effects of aging on the endocrine system

A
  • Altered gland function
  • Decreased hormone production
  • Decreased tissue responsiveness
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15
Q

Aging hypothalamic-pituitary-gonadal axis effects on women vs. men

A
  • Women: reduced estrogen output –> menopause
  • Men: low total and free testosterone
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16
Q

What do changes in the endocrine system have a negative effect on? (7)

A
  • Muscle mass
  • Bone density
  • Adipose accumulation
  • Insulin sensitivity
  • LDL metabolism
  • Libido
  • Cognition
  • Note: hormone therapy is still an evolving science
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17
Q

Changes in the immune system with aging

A
  • Advancing age –> systemic inflammation
    • Increased IL-1, IL-6, IL-10, CRP, TNF-alpha
  • Associated with muscle wasting, obesity, and loss of physical function
  • Also diminish other organ function –> reduced physiologic reserve
  • Exercise significantly reduces inflammatory markers
  • Habitual exercise –> less systemic inflammation
  • Sedentary –> wider window of homeostasis
  • Visceral fat secretes inflammatory markers, and exercise reduces it
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18
Q

Types of hearing loss

A
  • Presbycusis: sensorineural hearing loss
    • High tone frequencies are generally affected before low tone frequencies
    • Associated with:
      • Slower gait speed
      • Poor cognition
      • Mortality
    • High pitched consonants (s,t,f,g) are difficult to understand
  • Conductive hearing loss: dysfunction of the external ear, middle ear
    • Impairment across all frequencies
    • May need to speak directly in the person’s ear
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19
Q

What are treatment considerations for hearing loss?

A
  • Hearing aids
  • Cochlear implant
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20
Q

Checklist of hearing accomodations

A
  • Make sure hearing aids are in
  • Change batteries every 1-2 weeks
  • Make eye contact
  • Project voice, speak slowly and clearly
  • Use visual aids
  • Use rephrasing instead of repeating again and again
  • Write it out
  • Minimize background noise
  • Avoid side conversations
  • Increased bass, turn down treble on radios/TVs
  • Use of flashing light visual cues for smoke detectors, doorbells
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21
Q

what 3 levels does vision change on as we age?

A
  • Anatomic changes
  • Structures in the retina
  • Perceptual processing
22
Q

What are common conditions with aging in the visual system

A
  1. Cataracts
  2. Macular degeneration
  3. Glaucoma
  4. Diabetic neuropathy
23
Q

Aspects of vision

A
  • Visual field
  • Visual acuity
  • Illumination
  • Glare
  • Dark adaptation
  • Color
  • Contrast
  • Depth perception
24
Q

Treatment considerations for acuity (vision)

A
  • Glasses/contacts
  • Magnifiers
  • Large print text
25
Q

treatment considerations for visual field (vision)

A
  • Lower height for directional/informational signs
26
Q

treatment considerations for glare (vision)

A
  • Nonwax on vinyl floors
  • Flat paint
  • Indirect lighting
27
Q

treatment considerations for dark adaption

A
  • Red bulb night lights
  • Automatic light timers
28
Q

treatment considerations for colors (vision)

A
  • Reds
  • Oranges
  • Yellows
  • Avoid pastels and monotones
29
Q

treatment considerations for contrast (vision)

A
  • Avoid monotones
  • Highlight visual contrast
30
Q

treatment considerations for depth perception (vision)

A
  • Avoid patterned floors
  • Contrast counters and floor surfaces
31
Q

treatment considerations for illumination (vision)

A
  • Use of lamps with 200-300W bulbs
32
Q

what happens with our sense of smell as we age?

A
  • Taste bud cell regeneration slows after age 50
  • Olfactory nerve ending and mucus production decline
  • Impacted by:
    • Medical conditions
      • AD: abnormal sweet food craving
    • Medications
    • Poor oral health
  • Increased use of salt to increase food’s flavor 🡪 adverse effect on BP
33
Q

treatment considerations for sense of smell changes due to aging

A
  • Try different herbs/spices
  • Eat food at correct temperature
  • Make meals a social event
34
Q

Tactile changes with aging

A
  • Loss of touch with aging
    • Loss of touch, pressure, temperature, pain, proprioception
    • Occurs most often due to disease process rather than normal aging process
    • Impacts ability to localize stimuli
    • Impacts fine motor function
    • Reduced number of touch receptors
      • Meissner’s corpuscles: touch/texture
      • Pacinian corpuscles: pressure/vibration
      • Krause corpuscles: temperature
    • Thinning of the skin by 20% (results in decubitus injuries)
    • Senile purpura (easily bruised)
35
Q

Proprioceptive loss for tactile sensation

A
  • Receptors for movement and body position are located in muscles, tendons, and the labyrinth system
  • Loss of receptors alters joint biomechanics
  • Altered neuromuscular control –> altered postural stability
  • Cerebral cortex cell loss –> reduced sensory interpretation
  • When paired with other sensory loss (e.g. vision), increased fall risk
36
Q

vestibular deficits with aging

A
  • Vestibular deficits
    • Dizziness and imbalance are major complaints in older adults
    • Changes with aging:
      • Degeneration of sensory receptors in otoliths and semicircular canals
      • Decreased number of vestibular hair cells and neurons
    • Most common conditions
      • BPPV
      • Meniere’s Disease
  • Treatment considerations
    • Treatment techniques
      • VOR
      • Epley maneuver
    • These patients are at increased risk of falls
37
Q

swallow reflex changes

4 things that can give you dysphagia

2 most common tests to diagnose dsyphagia

A
  • Dysphagia: oropharyngeal or esophageal
    • Develops after illness/disease process that affects the swallowing mechanism
      • CVA
      • ALS
      • PD
      • MG
    • Most common tests
      • Modified barium swallow study
      • Fiberoptic endoscopic evaluation of swallowing
    • Signs
      • Coughing/choking with eating/drinking
38
Q

Treatement considerations for swallow reflex

A
  • SLP
  • Diets
    • Thickened liquids (nectar, honey, pudding)
    • Food textures (mechanical soft, moist, pureed)
39
Q

Prevelance of people with multiple sensory impairments

2+ deficits

1 deficit

no deficits

A
  • 66% have 2+ deficits
  • 27% have 1 deficit
  • 6% have no deficits
40
Q

effects of multiple sensory impairments

what is it predictive of within 5 years?

A
  • Reduced physical performance among older adults
  • Predictive of… within 5 years
    • Impaired physical function
    • Cognitive dysfunction
    • Significant weight loss
    • Mortality
41
Q

losses of sensory impairments result in (4)

A
  • Depression
  • Poor QOL
  • Cognitive decline
  • Mortality
42
Q

Describe trauma informed care and the 5 guiding principles

A

Definition: understanding neurological, biological, psychological, and social effects of trauma on an individual

  • Mental and physical trauma have implications for PT interaction
  • 5 Guiding Principles
    • Safety
    • Trustworthiness
    • Choice
    • Collaboration
    • Empowerment

Using TIC guidelines promote trust and better patient outcomes

43
Q

Describe the impact of depression and suicide with older adults

A

Depression

  • Not a normal part of aging, but it is common in older adults
  • Many medical conditions contribute to depression
  • Can be mistaken for dementia or coexist with dementia
  • Negatively affects PT outcomes
  • Exercise/activity can reduce depressive symptoms
    • Aerobic exercise is consistently recommended

Suicide

  • 17th leading cause of death in 65+
    • White men 7x more than women
  • More successful with attempts
  • PTs need to recognize risk factors and inquire about mental health
44
Q

what are the effects of the expanding older population on social services?

A
  • In short, due to baby boomers and increasing life expectancy since social security was implemented, the amount of people above 65 will rise quicker than the working population, leading to uneven distribution.
  • I.e. People need money longer, but no one is able to supply said money.
45
Q

challenges vs. opportunities of the expanding older population

A
  • Challenges of an aging population: strain on entitlement programs, labor market, and healthcare system along with family members who serve as caregivers
  • Opportunities: success of new advances in medicine and living standards to allow longer life spans and quality of life, better legislation against age discrimination
46
Q

What are the fiscal challenges of social security in exanding population

A
  • Social Security and Medicare Expenditures Are Projected to Reach a Combined 12 Percent of GDP by 2050.
  • Aging population putting fiscal strain on Medicare and Social Security programs
  • Combined, they are projected to make up 12% of the GDP by 2050 (up from 8% in 2015)
  • Elderly support ratio: at the turn of the 20th century there were about 14 working-age adults per person age 65 or older. That number dropped to 5 by the beginning of the 21st century. Projected to drop to 2 by 2060.
47
Q

What is the “Gray Divorce Revolution” and how can it impact inpatient d/c decisions?

A
  • significant increase in divorce rate in 50+ population
  • 25% of older women ages 65-74 live alone
  • 56% of those 85+ live alone
  • Older women who live alone are more likely to have lower income levels and live in poverty
  • Impact on discharge planning
    • The patient’s support group at home is a major determinant of whether or not they will be discharged home or another facility. Patients who have family/caregivers at home will be more likely to be discharged to home in comparison to their living-alone counterparts. Those living alone must be much more capable of taking care of ADLs.
48
Q

How can the geographic distribution of older and younger populations affect tax revenues and availability to public services during healthcare?

A
  • Geographical distribution
    • Older adult population most concentrated in Florida, the Appalachian region, and parts of the upper Midwest and Northwest
    • Most counties with lower older adult populations are in Alaska and western states
    • “Aging in place” locations result from younger adults leaving for better jobs, etc. This results in decreased tax revenues, shrinking school enrollment and neighborhoods, and decline in availability in services such as healthcare.
49
Q

What programs had a significant impact on reducing poverty in the 1960’s?

A
  • Programs:
    • Medicare
    • Medicaid
    • Social security
  • History of programs
    • 1935: Social Security Act passed, 1st step toward increased governmental role in social welfare concerns
    • 1940s: growth of private insurance plans
    • 1965: Medicare and Medicaid amendments to SSA
    • Title 18: Parts A and B
    • Title 19: Medicaid
    • 1972: Medicare benefits extended to those under 65 with ESRD and those with permanent disability/receiving SSDI
    • 1997: Medicare C introduced (through BBA)
    • 2001: Medicare extended to those with ALS
    • 2003: Medicare D introduced (through Medicare Drug Improvement and Modernization Act)
    • 2010: Patient Protection and Affordable Care Act
50
Q

Describe how lower socioeconomic levels impacts health outcomes.

A
    • Poverty rate in 1966 was almost 30%, dropped to 10% by 2015
      • Expansion of Social Security contributed to rapid decrease in poverty among older adults
      • Economic disparity across race/ethnicity in older adults: 8% of non-Hispanic whites living in poverty compared to 18% among Latinos and 19% among African Americans
      • Gender gap in older adults: in 2014, 12% of women were poor compared to 7% of men
      • Gender gap in earnings translates to lower Social Security payments to women in retirement
      • High out-of-pocket health care expenses (Rx drugs) contribute to higher poverty rates
      • Economic disparities among younger adults raises concerns about future health and well-being of older adults
      • Lower socioeconomic status: fewer resources, decreased safety, reduced social network/social contacts, increased risk of Alzheimer’s disease
  • Sources of income
    • Social Security accounts for about 1/3 of income for 65+ since the 1960s
    • Higher income households: higher share comes from savings, investments, rental income
    • Minority groups more dependent on SS income since they are less likely to have income from pensions, earnings or assets.
51
Q

What are advantages and disadvantages of an older retirement age before beneficiaries can receive full Social Security benefits?

A
  • Working longer
    • 55+ yr old in the workforce: 12% in 1990, 22% in 2014, projected to rise to 26% in 2022
    • Great Recession contributed to rising share of older adults in the workplace
    • Retirement age fell from 67 yrs to 62 yrs between the 1950s through the 1990s
    • Increasing retirement age since the 1990s due to reduction in employer pensions (replaced by employee-funded 401ks), abolishment of retirement ages, increased age at which beneficiaries can receive full Social Security benefits, improved health of older adults
    • Increased life expectancy requires a means to finance a longer retirement
    • 2010 study: workers who retired in early 60s had reduced cognition compared to those who worked up to or beyond retirement age
    • Those in blue-collar, physically demanding jobs may not have the option to continue working
52
Q

What is the current trend for disability free life expectancy in the US?

A
  • Disability-free life expectancy on the rise due to prevention/treatment of diseases especially cardiac conditions
  • Trend in increased obesity for men and women is a risk factor for various chronic conditions, which adversely affects disability-free life
  • Activity level among older adults lower than younger age groups
  • Cognitive impairment results in reliance on caregiver support

Alzheimer’s disease rates continue to climb: 5 million in 2013, projected to 14 million by 2050

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