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Mgmt Aging Adult > Test1 > Flashcards

Test1 Flashcards

1
Q

Functional training

A

Overload the activity of interest to challenge the entire neuromuscular system

Simple -> Complex
Slower -> Quicker (or vice versa) 
Stable-> Unstable 
Eyes open -> Eyes Closed 
Form -> Intensity 
BOS -> outside BOS

True strengthening: 6-8 weeks
Motor learning: random and repetitive practice

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2
Q

Joint- normal aging

Connective tissue

A

(Ligament, capsule, cartilage)
Decreased activity of osteoblasts and chondroblasts
Increased activity of osteoclasts and chondroclasts

Decreased response to growth factors (hormones, cytokines) - Alters repair of tissues

Altered response to loading

Decreased ability to retain water (Decreased glycoconjugates that maintain fluid content.)

Fragmenting of collagen strands and decreased rate of turnover
Increased cross linking between collagen molecules (increase stiffness and decrease ability to absorb energy)

Calcification of articular cartilage (IV discs, nucleus becomes more fibrous, annulus less organized; decreased water content)

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3
Q

Chair rise: 30 seconds no hands

< 8 reps

A

Frail

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4
Q

Cane

Appropriate for…

A

Patients who need balance and stability assistance with minimal WB support (up to 25%)

Coordination needed to use effectively
May not be appropriate for older patients with cognitive or coordination impairments

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5
Q

Exercise:

Defibrillators

A

Therapist needs to know rate at which generator becomes activated

Goals of therapy to determine safe activities and proper resistance/workload for exercise to allow for high enough HR for health benefit but not too high to activate ICD

If HR Riss above present rate, pt should sit down and be instructed to cough or perform Valsalva to cause Vagal stimulation and decrease HR/prevent ICD shock
Inform physician if defibrillator delivers shock during session

80% w/ ICD have significant psychological effects: depression and anxiety

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6
Q

Cardiopulmonary and CV examination-

Tests/Measures more specific to pulmonary and cardiac patients

A

Vital signs during testing

Walk and step tests

Graded exercise

Self-reported Measures

Use of Angina, Dyspnea, Claudication scalers; RPE

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7
Q

Mini-Cog

A

3 item recall: memory

Clock drawing test (CDT) : executive function
draw time as: 10 after 11

3 minutes to administer

Scoring:
0-2 positive screen for dementia
3-5 negative screen for dementia

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8
Q

Fall Risk-
Physical exam and functional assessment :
Functional balance and gait

A

Lots of measures- skill is selecting correct assessment for patient

Gait speed, TUG, Tinetti-POMA, MiniBest, Functional reach, Functional gait, 4 step square, Berg balance, DGI, Short physical performance battery

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9
Q

Increased systemic inflammation due to immune system changes with age-
Results in

A

Muscle wasting
Loss of physical function
Underlying factor in development of age-related diseases like Alzheimer’s, atherosclerosis, cancer, diabetes

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10
Q

Normal aging: Cardiopulmonary

Other (outside lung and thorax) - functional

A

Decreased autonomic control =
Decreased responsiveness to hypoxia and hypercapnea

Decreased muscular ATP reserves =
Increased possibility of respiratory fatigue/failure

Decreased immune function =
Predisposition to pneumonia and other respiratory disease

Decreased protective reflexes (ie gag, cough) = increased aspiration risk

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11
Q

Successful aging

A

Avoid disease and disability
Maintain high physical and cognitive function
Sustained engagement in social and productive activities

PTs impact successful aging when working with teen and young adult clients

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12
Q

Common medications that reduce urethra pressure

A

Antihypertensives
Neuroleptics
Benzodiazepines

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13
Q

Gerontologists focus on those ____+ years old.

Federal government considers ___.

Researchers use subgroups….

A

Gerontologists: 60+
Government: 65

Researchers:
65-75 “younger old”
75-85 “older old”
85+ “oldest old”

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14
Q

SAIL: Stay Active and Independent for Life

A

Community program

Exercises for strength, balance and fitness

3x week for 1 hour

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15
Q

Functional UI

A

Normal bladder/urethral function, but have difficulty getting to toilet before urination occurs

Common with impaired mobility or cognitive issues

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16
Q

Normal aging gait-

Toe clearance

A

Small toe clearance

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17
Q

Muscle- normal aging

A

Whole muscle and fiber atrophy
Muscle is ~50% of total body weight in a young adult
Reduced to 25% by age 75-80

Type II atrophy > Type I

Denervation and reinnervation of alpha motor neurons

Decreased muscle activation - less agonist, more coactivation of antagonist

Decreased muscle strength and power

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18
Q

Functional implications with CNS changes

A

Delayed recall- if given time, then able
Rote memory decreases
Altered gait, balance, and fine motor control
Diminished motor learning
Decreased activity level

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19
Q

Skin tear treatments

A

Non-adherent dressings
Hydrocolloid/films NOT recommended bc risk of further damage on removal.

ISTAP- skin tear tool kit

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20
Q

Normal diastolic

A

70-90 mmHg

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21
Q

Diastolic >115

Exercise

A

Contraindication to initiating activity/exercise

Refer to physician

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22
Q

Multifactorial fall risk assessment

A

Focused history
Physical exam
Functional assessment
Environmental assessment

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23
Q

Best predictor of falls

A
  1. Activities-specific Balance Confidence (ABC) Scale
  2. Fear of Falling Avoidance Behavior Questionnaire
  3. Timed Up and Go (TUG)
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24
Q

Claudication Scale

A

1- Definite discomfort or pain, but only at initial or modest levels (established, but minimal)

2- Moderate discomfort or pain from which pt attention Chan be diverted (ex by conversation)

3- intense pain (short of grade 4) from which pt’s attention cannot be diverted

4/ Excruciating and unbearable pain

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25
Q

6MWT

200-299 m

A

Frail

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26
Q

Crutches

Appropriate for…

A

Permits more WB shift (50% or more) than a cane

Less stable than walker
Requires good balance and upper body strength
Inappropriate use can lead to brachial plexus injuries
Loftstrand crutches permit hand use and reaching

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27
Q

Decreased IV and bone height
___ loss over lifetime
Decreased ability to ….

A

2” loss over lifetime

Decreased ability to withstand compression, tension and shear
Thus more load bearing on neural arch- osteoarthritis and osteophyte formation

Thinning trabeculae of bone- increased risk for spinal deformities and fractures

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28
Q

Spinal stenosis - result of…

A

OA
Disc degeneration
Spinal ligament hypertrophy

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29
Q

Street crossing m/s

A

0.21-0.88 m/s

Average 0.49 m/s to meet traffic light timing

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30
Q

Gait exam - older adult

Ideal combo of measures

A

Speed (TUG; gait speed)

Endurance (6MWT; 2MWT)

Balance (Berg, Tinetti, 4 square step)

Postural stability

(Dual Task: TUGognitive; TUGmanual)
(Multiple Task: DGI; FGA)

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31
Q

Pathological gait-

Ankle-Foot

A

Large toe clearance OR Tripping
OR both

Forefoot or foot-flat contact during IC
Excess PF or DF

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32
Q

Fall Risk-
Physical exam and functional assessment :
Neuromuscular

A

Strength:
MMT, 5x sit>stand, 30 sec chair stand

ROM and flexibility:
Ankle, knee, hip, trunk, c-spine

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33
Q

Fall Risk Management-

Interventions

A

Assessment drives intervention
Body structure and function
Activity
Participation

Maximize independence and functioning

Prevent falls
Reduce risk

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34
Q

Angina Scale

A

1- mild, barely noticeable
2- moderate, bothersome
3- moderately severe, very uncomfortable
4- most severe or intense pain ever experienced

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35
Q

Skeletal- Normal aging

A

Decline in bone mineral

Increased osteoclast activity,
Decreased osteoblast activity

Osteopenia- leads to increased risk of osteoporosis
Load absorption decreases
Decreased load dispersion to other parts of the joint
Results in increased bone loading, results in increased risk for fracture

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36
Q

PNS-
Sensory changes with aging-
Smell and Taste

A

Ability to detect smell and identify odors decreases with age
Has been linked to 3 types of dementia

High prevalence of hyposmia (decreased smell) and anosmia (loss of smell)

Can create safety risk
Impaired ability to taste food
Thirst sensation declines

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37
Q

Dementia- intervention

A

Maximize function
Prevent or slow decline (muscle strength, ROM, balance, mobility, etc)
Environmental recommendations

Exercise:
Aerobic- improved cognition
Task specific - dancing, walking, stationary bike, etc
Resistance

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38
Q

CNS changes with aging

A

Neuron loss - decreased gray matter
Myelin loss - decreased white matter
Results in decreased brain weight

Nerve cell shrinking
Delayed impulse conduction and conduction velocity
Reduction and altered balance of neurotransmitters
Decreased size of cerebellar hemispheres
Vestibular changes- decreased hair cells and receptor ganglion cells
Decreased cerebral blood flow
Decreased glucose metabolism

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39
Q

Normal aging gait-

Step width

A

Ave 1-4 inches

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40
Q

Dementia- PT Strategies

A

Use stimulus for teaching and performing (sound, scent) - Use lots of cues (tactile, sense based, non-verbal)

Simple, one step commands 
Minimize distractions 
Use positive reinforcement 
Repeat, repeat, repeat 
Provide feedback after task 
Minimize variation - Consistency is key 
Functional, meaningful, pleasant

Go slow, be patient, avoid debate/conflict

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41
Q

6 most common chronic health conditions

A
  1. Arthritis/MSK issues
  2. Heart/Circulation issues
  3. Vision/Hearing issues
  4. Fractures/Joint issues
  5. Diabetes
  6. Mental illness
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42
Q

Immune changes with age

A

Generally begins -6th decade
“Immunosenescence”
Can begin prematurely in conditions such as RA and chronic organ diseases (COPD, CKD..)

Combo of declining protective immunity and increasing incidence of inflammatory disease

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43
Q

Normal aging- CV
Blood vessels
Functional significance

A

Decreased:
Blood flow to oxygenate tissue
Cardiac output
Venous return

Increased: 
Risk of clots in venous circulation 
Risk of myocardial ischemia/infarction 
CVA, PVD and renal failure 
Resting BP
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44
Q

Pathological gait-

Speed

A

Significant decrease in free velocity (<0.85 m/s)

With loss of ability to voluntarily increase speed from self-selected

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45
Q

Matter of Balance

A

Community program

2 hour week, 8 weeks

Coping strategies to reduce fear of falling, prevention strategies, and exercise

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46
Q

Normal aging: Cardiopulmonary

Lung - functional

A

Impaired gas exchange
Air trapping
Decreased inspiratory and expiratory reserve volumes
Increased resistance to airflow in small airways
Decreased pulmonary artery pressure
Decreased pulmonary capillary network
Decreased mucous clearance

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47
Q

Systolic <100

Exercise

A

No action if asymptomatic

Refer to physician if symptomatic

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48
Q

Fall Risk-
Physical exam and functional assessment :
Aerobic

A

6MWT
2MWT
2 min step test

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49
Q

Increased systemic inflammation due to immune system changes with age

A

Increased:
Pro inflammatory cytokines
C-reactive protein (CRF)
Tumor necrosis factor

May occur bc of:
Shift in fat mass from periphery-> abdomen
Along w/ overall increase in intra-abdominal fat w/ age
Abdominal fat is metabolically active and serves as inflammatory organ
Increase inflammatory cytokines assoc w/ metabolic syndrome and decrease organ system function

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50
Q

Dementia- Caregiver challenges

A

Psychological health - increased depression and anxiety common

Discuss realistic goals 
Teach ADL strategies 
Teach behavioral modification strategies 
Encourage self-care 
Community support groups
Respite care
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51
Q

Gait speed <0.6 m/sec

A

Dependent in ADLs and IADLs

More likely to be hospitalized

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52
Q

Disability

A

Restrict use of this term only with long-term overall functional decline

Reflects the sum of interactions between:
Health condition 
Environment 
Personal factors
Impairments
Activity limitations 
Participation restrictions

Activity limitations and participation restrictions in older adults change over time… and these are subject to change with intervention

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53
Q 
“Fun” 
Gait speed? 
6MWT? 
Chair rise (30 sec no hands)? 
Climb 10 stairs? 
Floor-stand?
A

Gait speed: 0.9-1.4 m/sec

6MWT : 300-500 m

Chair rise (30 sec no hands): 8-14 reps

Climb 10 stairs: 9-30 sec (with or without rails)

Floor-stand: 11-30 sec (with or without assistance)

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54
Q

PNS motor changes with aging

A

Axonal degeneration
Greater internodal length
Slower conduction velocity
Decreased ability to adapt to environmental or visceral changes
Decreased neurons per muscle fiber (fiber grouping)
Decrease in Ruffini’s, Pacinian, and Golgi tendon-like receptors
Increased sympathetic activity
Decreased cerebral blood flow

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55
Q

PT interventions- UI

A

PFM exercises:
Quick contractions
Sustained contractions
Contractions during functional activity

Biofeedback:
Surface EMG (internal)
Palpation

Electrical stimulation (lacks evidence)

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56
Q

PNS-
Sensory changes with aging-
Vision

A

Begins to decrease in 3rd decade

Neuron loss in visual cortex

Presbyopia : Decreased flexibility of lens to accommodate far to near

Decreased elasticity of lens
Decreased recovery from glare
Decreased tear production 
Decreased acuity 
Decreased visual fields
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57
Q

Common medications that impact full bladder emptying

A

Anticholinergics

Beta blockers

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58
Q

Fall Risk Factors -

Intrinsic

A

Medical and neuropsychiatric conditions

Impaired hearing and vision

Age-related changes in NM function, gait and postural reflexes

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59
Q

Bowel incontinence - causes

A 
Age-related loss of strength and changes in tissue elasticity decrease anal resting tone (esp women) 
Loss of anal sensation 
Fecal impaction 
Psychological/Behavioral problems
Neoplasms (rare) 
Loss of normal continence mechanisms:
Local neuronal damage (ex pudendal nerve)
Impaired neurologic control
Anorectal trauma/sphincter disruption
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60
Q

4-Stage balance test

A

Assess static balance
4 standing positions that get progressively harder to maintain
Should NOT use AD and should keep eyes open.

Describe and demo position
Stand next to patient, hold their arm and help assume the position
When patient steady, let go and time how long can hold (but remain ready to assist if they lose balance)

If patient can hold for 10 sec without moving feet or needing support, move to next position
If not, STOP test

Feet together side-by-side-> instep of 1 foot touches big toe of other-> tandem -> 1 foot

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61
Q

Home assessment

A

More than just…
making sure patient has a clear path through the home
Rearranging obstacles and removing barriers
Looking at flooring surfaces

Is environment functional at current level of mobility?
What recommendations would make it functional or help pt achieve function required to live in home?
Understanding big picture- Mobility, needs, medical issues, social support, safety

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62
Q

Key history questions with older adults..

A 
Polypharmacy 
Basic ADL assistance
Physical activity 
Falls/Fear of falling and imbalance 
AD use 
Home environment 
Vision 
CV 
Continence 
Pain 
Depression 
Skin
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63
Q

6MWT

300-500 m

A

Function

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64
Q

Pathological gait-

Step width

A

> 4 inches OR <1 inch

Or too much/too little step width variability

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65
Q

Normal aging gait-

Pelvis

A

5* forward rotation during WA
5* backward rotation at TSt/PSw

Iliac crest on reference limb >= iliac crest on opposite during MSt

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66
Q

Pathological gait-

Knee

A

Limited or excessive flexion, wobbling, extension thrust

Weight bearing increases valgus or varus moments

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67
Q

PNS sensory innervation changes with aging

A

Decreased number and density of myelinated peripheral nerve fibers

Decreased thickness of remaining fibers

Decreased nerve conduction velocity and AP

Increased H-reflex latency

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68
Q

PT with the depressed aging adult

A

Timeline may need to be longer to accomplish goals
May need to focus on ADL training as these tasks require more energy and may be more difficult for the patient

Matter of fact approach is better than overly cheery approach
Discourage negative self-perception and emphasize achievement
Demonstrate a genuine and respectful regard for the patient

Realize these pt aren’t “fun” at times bc they appear unmotivated, but they aren’t lazy. It just takes s lot of energy to accomplish simple tasks.

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69
Q

Joint ROM aging changes:

Shoulder

A

Flexion and ER

Thoracic kyphosis May also impact

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70
Q

Flexibility exercise

A

60 seconds needed for those 65 years and older to achieve long term muscle lengthening

4 reps
5-7 days a week

Muscles to consider in aging adults:
Suboccipital, pec minor, downward rotators, protractors, lumbar extensors, hip flexors and external rotators, ankle PFs

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71
Q

Many other CVP changes common in aging adults due to ___ factors, not ____

A

Many other CVP changes COMMON in aging adults due to MODIFIABLE factors, not necessarily aging

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72
Q

Orthostatic hypotension-

Interventions

A

Ankle pumps/marching/hand clenching prior to standing

Counting to 5 before walking away from chair

Slow positional change

Pressure stockings

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73
Q

Cardinal features of immune system aging

A

Weakened antimicrobial immunity
Susceptibility to respiratory infections
Deactivation of chronic viral infections (shingles)

Impaired anti-vaccine responses
Insufficient protection against malignancies
Predisposition for unopposed tissue inflammation (ie atherosclerotic disease, OA, neurodegenerative disease)
Failing wound repair mechanisms

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74
Q

8 gait observations that may signify neurological problems (TUG)

A
  1. Slow tentative pace
  2. Loss of balance
  3. Short strides
  4. Little or no arm swing
  5. Steadying self on walls
  6. Shuffling
  7. En bloc turning
  8. Not using AD properly
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75
Q

Osteoporosis

A

Systemic skeletal disease characterized by low bone mass and micro architectural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fracture

Anterior vertebral body (can be asymptomatic)
Caution: ADLs in trunk flexed position

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76
Q

Normal integumentary aging

A 
Thin, less elastic skin 
Thinner dermis 
Decreased dermal vascularity 
Flattening of rete pegs 
Decreased fibroblasts 
Loss of subcutaneous fat

Decreased:
Langerhans- 50% by age 80 (altered immunity)
Melanocytes- 8-20% every 10 years after age 30

Blood vessels become thinner/fragile

Decreased oil/sweat gland activity

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77
Q

Critical speed for crossing street

A

1.14 m/s

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78
Q

Aerobic exercise-

Absolute Contraindications

A
  1. Unstable angina
  2. Uncontrolled cardiac dysrhythmias causing symptoms of hemodynamic compromise
  3. Uncontrolled symptomatic HF
  4. Acute or suspected major CV event (severe aortic stenosis, pulmonary embolus or infarction, myocarditis, pericarditis, or dissecting aneurysm)
  5. Acute systemic infection, accompanied by fever, body aches, or swollen lymph glands
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79
Q

Orthostatic hypotension

A

Decrease in autonomic regulation of BP
Combined with physiological issues contributing to hypovolemia such as GI bleed, diarrhea and dehydration
Combined with common meds like antihypertensives, antipsychotics, antiparkinsonian
Increased inactivity

Contributes to high fall risk

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80
Q

PNS-
Sensory changes with aging-
Hearing-
Suggestions

A 
Ask what works. Eat for patient 
Use a lower tone
Face the person when possible 
Slow rate of speech appropriately 
Keep background noise to minimum

Avoid “elderspeak”
Avoid jumping from one idea/topic to another quickly

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81
Q

Systolic with exercise/activity

A

Increases in proportion to workload

> 250 is indication to stop exercise

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82
Q

Alzheimer’s - clinical presentation

A 
Memory impairment 
Lapse in judgement 
Personality changes 
Depression possible
Language problems 
Difficulty with ADLs
Visual spatial problems 
Short tempered, hostile 
Loss of motor function (swallowing, bowel/bladder)
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83
Q

Pathological gait-

Trunk

A

Forward, backward or sideways lean

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84
Q

5 most common causes of death

A
  1. Heart disease
  2. Malignant neoplasms
  3. Cerebrovascular disease
  4. Chronic lower respiratory diseases
  5. Pneumonia/Influenza
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85
Q

Joint ROM aging changes:

Ankle

A

DF decreases

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86
Q

Strengthening exercise considerations

A

“Underutilized and undermanaged”

Proper form

Watch for breath holding

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87
Q

Otago exercise program

A

Community program

17 strength and balance exercises
30 min day, 3x week

Walking program
30 min day, 3x week

Great for preparing to enter a community program or as a starter community program

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88
Q

Aerobic exercise-

Relative Contraindications

A
  1. Known significant cardiac disease (L main coronary stenosis, moderate stenosis valvular disease, hypertrophic cardiomyopathy, high-degree AV block, ventricular aneurysm)
  2. Severe arterial HTN (systolic >200 or diastolic >110) at rest
  3. Tachycardia or Bradycardia
  4. Electrolyte abnormalities
  5. Chronic infections disease
  6. Mental or physical impairment leading to inability to exercise safety
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89
Q

Frailty

A

3 out of 5 = frail
1 or 2 = pre-frail

  1. Unintentional weight loss >10 lbs in past year
  2. Self-reported exhaustion 3 or more days per week
  3. Muscle weakness: grip strength <23 women, <32 men
  4. Walking speed <0.8 m/sec
  5. Low level of activity: sitting quietly or lying down majority of day
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90
Q

Functional impact of sensory loss on balance and function

A

Errors in proprioception have a bigger effect on balance than errors in vision in older adults

With vision available, oldest older adults need accurate proprioception to maintain balance

Impairment associated with increased fall risk and functional decline

PTs need to provide older adults with sensory strategies to increase sensory information

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91
Q

Normal aging: Cardiopulmonary

Thorax - structure changes

A

Calcification of bronchial and costal cartilages

Increased stiffness of costovertebral joints
Increased A-P diameter
Increased wasting of respiratory muscles

Structural changes in thoracic cage and spine

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92
Q

Stair climbing

A

Commonly feared environmental obstacle

Successful negotiation requires greater ROM and muscle strength than level ground

Older Adult self-efficacy relates to speed
And safety precautions

May serve as significant barrier to home mobility and safety

Don’t forget about curbs and ramps

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93
Q

Normal cognitive changes

A

Loss of synaptic connections
Creates memory impairment (slowed but intact)
Evidence of mild decline in executive function

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94
Q

In general it is agreed that aging has contributions from..

A

General whole body inflammatory response

Genetics

Consequences of lifestyle- primarily decline in physical activity

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95
Q

Slippery slope of aging

A

Fun: what you want, when you want, for as long as you want

Function: choices made based on decreased physical capacity
Have mobility disability or at risk for

Frailty: require help for ADLs and IADLs

Failure: completely dependent

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96
Q

Diastolic with exercise/activity

A

Remains similar to resting or may drop slightly

Increase >115 is indication to stop exercise

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97
Q

SpO2 86-89%

Exercise

A

Consider adding or increasing supplemental oxygen

Refer to physician if previously undiagnosed

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98
Q

HR >150

Exercise

A

Contraindication to initiating activity/exercise

Refer to physician immediately

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99
Q

Immune system changes with age-

Approaches to address total-body inflammation

A

Anti-inflammatory drugs
Antioxidants
Caloric restriction
Exercise

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100
Q

Systolic >200

Exercise

A

Contraindication to initiating activity/exercise

Refer to physician

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101
Q

Hip fractures

A

300k+ hospitalized each year for hip fractures

Greater than 80% caused by falling- usually sideways

Chances breaking hip increase w/ age

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102
Q

Normal aging gait-

Trunk

A

Erect

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103
Q

Normal aging gait-

Speed

A

Decreased self-selected speed and fast speed

Ability remains to voluntarily increase speed from self-selected to fast speed

Increased gait variability

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104
Q

Floor-stand

Under 10 seconds, No assistance

A

Fun

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105
Q

Falls among older adults are…

A

Common; 1 in 4 each year

Cost $50 billion annually

Preventable- clinicians can use STEADI to prevent falls and reduce cost

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106
Q

Cycle of fear of falling

A

Fear of falling->
Restricts activity->
Physical capabilities reduced (moves slower; avoids movement) ->
Restricts more activities->
More impaired physical capabilities (becomes deconditioned; decreased strength and endurance) ->
Fear of falling

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107
Q

Fall Risk-

Environmental (home) Assessment

A

Often overlooked
Key for safety and prevention of falls at home

Consider all areas of living environment: Physical environment, level of assistance, support, adaptations using and needed

Include other family members living in home and caregivers/caretakers present in home.

108
Q

HR <60

Exercise

A

No action if asymptomatic and normal ECG

Refer to physician if symptomatic, or of no ECG available and no history of dysrhythmia or chronotropic medication use

109
Q

Osteoarthritis (OA)

A

Failure of articular cartilage

Load bearing joints 
UE: hands 
LE: hips, knees, feet 
Spine: cervical and lumbar 
(Can compromise diameter of canal...spinal stenosis)

Joint destruction
May lead to need for total joint arthroplasty

110
Q

Multi-factorial impairment-based interventions

Flexibility

A

Change what you can, adapt/compensate what you can’t

Address obvious structural limitations caused by pathology or surgical procedures

111
Q

Functional implications with PNS changes

A

Increased recruitment of motor units- more work to do a task
Increased co-contraction at the ankle
Altered motor control and postural stability
Decreased LE proprioception, vibration, discriminative touch, and balance
Increased risk of falls
Resting BP rises with age
Delayed response to pain

112
Q

Joint ROM aging changes:

Hip

A

Extension decreases

Decreased walking speed

113
Q

SpO2 normal

A

=>90%

114
Q

Physical stress theory

A

Too much stress
>100% max
Injury or tissue death

Sufficient overload
60-100% max
Strengthening

Usual stress
40-60% max
No change in tissues

Too little or no stress
0-40% maximum
Atrophy and loss of ability to adapt

115
Q 
“Frail” 
Gait speed? 
6MWT? 
Chair rise (30 sec no hands)? 
Climb 10 stairs? 
Floor-stand?
A

Gait speed: 0.3-0.8 m/sec

6MWT : 200-299 m

Chair rise (30 sec no hands): <8 reps

Climb 10 stairs: 31-50 sec (with rails)

Floor-stand: >30 sec (with assistance)

116
Q

Age-Related changes affecting sexuality-

Men

A

Decreased testosterone->delayed and less firm erection, more stimulation required to attain erection/orgasm

Shorter ejaculation time
Rapid loss of erection
Increased refractory period between ejaculations (12-48 hours)

NOT synonymous with ED

117
Q 
“Fun” 
Gait speed? 
6MWT? 
Chair rise (30 sec no hands)? 
Climb 10 stairs? 
Floor-stand?
A

Gait speed: >1.5 m/sec

6MWT: >500 m

Chair rise (30 sec no hands): >15 reps

Climb 10 stairs: under 10 sec, no rails

Floor-stand: under 10 sec, no assistance

118
Q

Vascular dementia

A

2nd most common type of dementia

Risk factors:
HTN 
Smoking
Hypercholesteremia 
Diabetes 
CV disease 
Cerebrovascular disease

Deterioration may be select with other functions left completely intact

119
Q

Delirium- treatment focuses on

A

Increased time OOB
Walking
Managing hydration, hypoxia, and nutrition

120
Q

MSK conditions impacting aging adults

A

Osteoporosis (fractures)

Osteoarthritis (joint arthroplasty)

Spinal stenosis

Frailty

121
Q

Relative contraindications for stopping exercise (7)

A
  1. Drop in systolic >10 from baseline despite increased workload in absence of other evidence of ischemia
  2. Increasing chest pain
  3. Hypertensive response (systolic >250 or diastolic >115)
  4. Fatigue, SOB, wheezing, leg cramps, claudication
  5. ST or QRS changes such as excessive ST depression (>2 mm)
  6. Arrhythmias other than sustained ventricular tachycardia
  7. Development of bundle-block or intraventricular conduction delay that cannot be distinguished from ventricular tachycardia
122
Q

Normal aging- CV
Blood
Functional significance

A

Decreased total body water =
Decreased blood volume

Decreased speed of RBC production =
Decreased response to blood loss and anemia

Decreased neutrophils =
Decreased immune response/infection resistance

123
Q

Fall risk-

Considerations for every space

A

Surface: Concrete, wood, tile, carpet, gravel, grass, dirt, throw rugs, rugs, runners…

Lighting: Adequate, dim, bright, glare…

Steps/Stairs (handrails, number, height, condition)

Door widths and direction of open/close
Thresholds
Objects: clutter, cords, furniture…
Phone- accessible

124
Q

Posture Changes- Cause

A

Besides habitual posture, age related changes in bone, disc, cartilage, muscle etc…

Decreased IV and bone height
Decreased elastin in ligaments of spine

125
Q

MMSE

A

Must purchase
Mini mental state exam

11 questions to assess:
Orientation, registration, attention, calculation, recall, language, and visual construct

Scoring:
0-17 = severe impairment
18-24 = mild impairment
24-30 = no impairment

126
Q

Factors contributing to aging gait changes-

Physiological

A 
System changes:
MSK changes 
Higher level neural processing 
Sensory and perceptual changes 
Individual sensory systems

Others:
Specific and individual pathologies
Adaptive and anticipatory mechanisms
Intricately related to balance responses

127
Q

Dementia is development of multiple cognitive deficits including

A

Memory and at least one other:

Aphasia
Apraxia
Disturbance of executive function

128
Q

Look beyond the reason for referral

A
  1. Screen for falls and risk factors for other conditions (DM, osteoporosis, etc) and make appropriate referrals
  2. Identify characteristics of frailty, depression, abuse/neglect, geriatric syndromes and make proper referrals
  3. Plan for sustainable outcomes and increase in safe physical activity/participation through education and exercise prescription
  4. Ascertain the role of social support in their condition or limitation
  5. Consider their health literacy and education contribution to condition or limitation
129
Q

PT interventions-
Balance
Progressions

A 
Static -> Dynamic 
Incorporate head, arm, leg movements 
Change/advance environment 
Single task -> Dual Task 
Surface changes 
Add resistance 
Change speed
130
Q

Climb 10 stairs

9-30 seconds, with or without rails

A

Function

131
Q

Posture- aging

A

Changes are not inevitable- but are common

Habitual postures often lead to…
FHP- forward head posture

Thoracic kyphosis
Increases >40 y/o; women>men
Associated with osteoporosis and vertebral fractures

Lumbar flattening (reduction of lordosis) 
Decreased IV space = decreased diameter of IV foramen : impact nerve root integrity
132
Q

TUG

Instructions

A 
Identify a line 3 m (10 feet) away. 
Instruct:
When I say “Go” I want you to:
1. Stand up from chair 
2. Walk to line at your normal pace. 
3. Turn
4. Walk back to chair at normal pace. 
5. Sit down again.

> =12 seconds to complete = at risk for fall
(Stay by patient for safety)

133
Q

Normal aging gait-

Single Limb support

A

Increased double limb support, but generally equal stance time B LE

134
Q

Absolute contraindications for stopping exercise (8)

A
  1. Drop in systolic >10 from baseline despite increased workload when accompanied by other evidence of ischemia
  2. Moderately severe angina (>2/4 on scale)
  3. Increasing nervous system symptoms
  4. Signs of poor perfusion
  5. Subject’s desire to stop
  6. Technical difficulty with monitoring equipment
  7. Sustained ventricular tachycardia
  8. ST elevation (+1.0) in leads without diagnostic Q waves
135
Q

Pathological gait-

Hip

A

Limited flexion or extension

“Past retract” (visible forward then backward movement of thigh during TSw)

Excessive ABD or ADD
Excessive or limited IR or ER

136
Q

Community ambulation

A

More than typically quoted goal of 150 ft

137
Q

Falls screening

A

Determine if low, moderate or high fall risk

“Stay independent” brochure 
OR
3 key questions:
1. Have you fallen in past 12 months?
2. Do you feel unsteady when standing or walking? 
3. Do you worry about falling?

> 4 on “Stay independent” OR if “yes” to any of the 3 questions above
= should receive full assessment

138
Q

Age-Related Genitourinary Changes

Males

A

During middle age, prostate enlarges (BPH: benign prostatic hypertrophy)
->
Growth of prostatic tissue encroaches on prostatic urethra

139
Q

Dual task training

Motor

A

Multidirectional

Balancing (dynamic weight shifts, perturbations)

External cueing (speed, stride length, timing)

Carrying/picking up/teaching for objects

140
Q

Normal aging gait-

Step/Stride length

A

Smaller steps and stride length, but symmetrical

141
Q

Fall Risk-
Physical exam and functional assessment :
Perceived functional ability and fear of falling

A

Falls efficacy scale,
Activity specific balance scale,
Fear of falling,
Avoidance behavior questionnaire

142
Q

Seated step test

A

Stage 1: alternate placement of feet onto step/bar at 6 inch., rate = 1/sec

Stage 2: 12 inches
Stage 3: 18 inches
Stage 4: 18 inch step and add alternating arms

HR, BP monitored; at 2 min below 75% HRmax continue for 5 minutes
After 5 minutes, if <75% the progress to next stage

143
Q

Multi-factorial impairment-based interventions

Focus/Incorporate

A

Focus on:
Reduce deviations
Improve gait efficiency and safety
Increasing endurance

Incorporate:
Specificity, Task-oriented, Dual-tasking, Task and environmental constraints

Rehab ALL components

144
Q

Pathological gait-

Step/Stride length

A

Significant decrease in step and stride length and/or non-symmetric steps

145
Q

Delirium, clinically may see ____.

A 
Shouting and resisting 
Refusal to cooperate with medical care 
Potential to be injured falling 
Combative 
Pulling of lines and tubes
146
Q

RPE

A 
0= nothing 
1 = very light 
2 = fairly light 
3 = moderate 
4 = somewhat hard 
5 = hard 
7= very hard 
10 = very, very hard
147
Q

Vascular dementia- clinical presentation

A 
Impairments May include:
Memory 
Abstract thinking 
Judgement 
Impulse control 
Personality changes

Characterized by more abrupt onset, step by step deterioration, fluctuating course, and emotional lability

148
Q

Speed requirements by population density

A

Rural : 0.5 m/s

Urban: 1.375 m/s

149
Q

Gait speed

D/C to SNF

A

<= 0.1 m/sec

150
Q

Screening for UI

A

Do you leak urine with laughing, coughing, sneezing, lifting or exercise?
Do you leak urine on the way to the bathroom?
Do you have to strain to empty your bladder?
Do you feel that your bladder is still not empty after you void?

A “yes” to any = refer to PCP or specialist

151
Q

PT interventions-
Balance
Intensity

A

50 hours of training over 3-6 months

152
Q

Decreased elastin in ligaments of spine

A

Converts into cartilaginous tissue for scarring

Become thickened- spinal stenosis

153
Q

6MWT

Over 500 m

A

Fun

154
Q

Aerobic exercise

A 
Dosing: 60-90% 
Measured using:
Target HR (220-age) X 60% to 90%
Karvonen Method 
RPE: 12-16 = 60-90% on 6-20 scale; 5-8 = on 10 point scale (good for those w/ blunted HR response) 
Talk test

Joint pain, muscle weakness- May limit
May need strengthening exercise first; Aquatics may also be option

155
Q

Normal aging- CV
Heart
Functional significance

A 
Decreased:
Excitability 
Max cardiac output (25-30%) 
Venous return 
Max HR

Increased:
Cardiac dysrhythmias

No change in RHR

156
Q

Infectious disease in aging adults-

Therapy implications

A

Be sensitive to descriptions of unusual changes and observant of subtle changes with older adult patients in every setting- especially OP setting

Be prepared to treat older patients in hospital with medical dx of infectious disease for the effects of deconditioning

Realize may not be able to challenge them- but return to basic function and prevent functional decline remain high priority

Prepare for functional setbacks with acute illness
Prepare for exacerbation of previously compensated system deficits after acute illness

157
Q

Diastolic BP <70

Exercise

A

No action if asymptomatic

Refer to physician if symptomatic

158
Q

Major depressive episode

A

Depressed mood or loss of pleasure in all activities
AND
At least 5 associated symptoms for at least 2 weeks that impact function, social or occupational endeavors

Associated symptoms: weight loss, insomnia, hypersomnia, decreased or hyperactive motor activity, fatigue, loss of energy, feelings of worthlessness, excessive inappropriate guilt, diminished ability to think/concentrate, recurrent thoughts of death, suicide ideation or attempt

159
Q

SpO2 with exercise/activity

A

Should remain =>90%

86-89% relative indication to stop exercise

=<85% absolute indication to stop exercise

160
Q

Climb 10 stairs

Under 10 seconds, no rails

A

Fun

161
Q 
“Failure” 
Gait speed? 
6MWT? 
Chair rise (30 sec no hands)? 
Climb 10 stairs? 
Floor-stand?
A

Gait speed: <0.3 m/sec

6MWT : <200 m

Chair rise (30 sec no hands): unable
Climb 10 stairs: unable
Floor-stand: unable

162
Q

Medications treating common medical conditions impair sexual function

A

Anti anxiety:
Change libido, erection problems, delayed orgasms

Antidepressants:
Changes in libido, delayed orgasm

Antihypertensives:
ED, Decreased libido

Ulcer medications:
Decreased libido, ED

163
Q

Normal aging- CV

Decreased max HR..

A

Decreased HR max ->
Decreased CO ->
Decreased tissue oxygenation

Resulting in
Progressive decrease in VO2max beginning between ages 20-30, decreases 10%/decade

164
Q

Normal aging- CV

Baroreceptor sensotivity

A

Decreased->

increasing incidence of HTN

165
Q

Gait speed

0.9-1.4 m/second

A

Function

166
Q

Muscle-
Metabolic changes-
Normal

A

Decreased resting metabolic rate
Less lean muscle mass

Insulin resistance (common in older adults) 
Increased body fat further contributes 
Regulator of protein metabolism and important for protein gain and muscle growth

Decreased growth hormones
Decreased estrogen and testosterone
Vitamin D deficiency

167
Q

Integumentary compromise-

General prevention

A

Nutrition and hydration

Environment:
~40% humidity

Control of comorbidities:
Glycemic control, etc

Skin care:
Moisturize

168
Q

PT interventions-

Balance

A

Reactive postural control:
Ankle, hip, knee, stepping strategies
Weight shifts; Perturbations

Anticipatory postural control:
Expected changes and learned experience
Functional and Dynamic activities

Stability limits: Reaching and Functional activities

Sensory orientation: Surface changes, Functional activities, Eyes open/closed

169
Q

Integumentary- Bathing advice

A
  1. Avoid bar soaps
    Use gentle, moisturizing liquid soaps
  2. Soft cloths, cooler water temps
  3. Moisturize after bathing
    Within 3 minutes to trap moisture
    No fragrance (eucerin, Vaseline, etc)
  4. Don’t over bathe. 10 min daily or 2x week
170
Q

Climb 10 stairs

31-50 seconds, with rails

A

Frail

171
Q

Chronological age is not ___.

A

Not biologically uniform

172
Q

The continuum of cognitive

A

Normal aging->
Mild impairment->
Dementia

Not everyone follows the continuum
Mild impairment and dementia are pathological

173
Q

Normal aging gait-

Hip

A

15-20* flexion during WA and 15-20* apparent hyperextension at TSt

174
Q

Gait speed “community ambulatory”

A

0.8-1.2 m/sec

175
Q

Urinary incontinence

A

Involuntary leakage of urine

Continence requires: neural coordination between bladder, urethra, and pelvic floor muscle muscles (PFMs)

Types:
Stress UI
Urge UI
Overflow UI 
Functional UI
Mixed UI
176
Q

Dementia-

Motor learning

A

Practice conditions: Massed, constant, Blocked
(No variety, No random)

Whole vs Part - Depends

(Opposite from normal cognition:)
Specificity- Unable to transfer
Mental practice- NO
Discovery vs Guidance- Guidance

Feedback: Simple, lacking intrinsic, skillfully given

177
Q

Urge UI

A

Strong desire to pass urine which is difficult to defer without involuntary leakage (can’t get to toilet in time)

Low bladder compliance
Detrusor over-activity- involuntary bladder contractions: assoc with neuro conditions; pelvic organ prolapse with urethral obstruction in Femalee.
Prostatic enlargement in males

Smoking, hysterectomy, arthritis, impaired mobility

178
Q

Pathological gait-

Pelvis

A

Limited or excessive rotation forward or backward

Pelvic drop or hiking

179
Q

Exercise and immune/inflammation

A

Just 1 exercise bout results in significant decrease in inflammatory markers

Cumulative exercise sessions further decrease inflammation- enables regular exercisers to resist fatal infections and aggressive pathogens

Results in wider window of homeostasis
Enhances systemic “reserve”
Decreases risk for disease
Delays functional decline

180
Q

Conditions that may present atypically in older adult:

HF

A 
Confusion 
Agitation 
Anorexia
Insomnia 
Fatigue
181
Q

Gait speed

< 0.3 m/second

A

Failure

182
Q

Moving for Better Balance

A

Community program

2 hour class, 1x week, 12 weeks

Slow, therapeutic Tai Chi movements

183
Q

Ageism

A

Prejudice or discrimination against a particular age-group and especially the elderly

184
Q

Infectious disease in aging adults-

Most common types

A

Bacterial pneumonia

UTI

185
Q

Conditions that may present atypically in older adult:

Acute bowel obstruction

A

Acute confusion

Minimal or absent abdominal pain and tenderness

186
Q

30-sec chair stand

Instructions

A

To test leg strength and endurance
Straight back chair, without arm rests, seat 17” high

  1. Sit in middle of chair
  2. Place hands on opposite shoulder crossed, at wrists
  3. Keep feet flat on the floor
  4. Keep back straight and arms against chest
  5. On “Go” rise to full standing, then sit back down
  6. Repeat for 30 seconds

Below average scores = fall Risk

Age 60-64 M: <14 W: <12 …
Age 90-94 M: <7 W: <4

187
Q

Optimal aging

A

Modified version of “successful aging”
Not all can avoid the effects of disease and disability

Capacity to function across several domains to one’s satisfaction and in spite of medical conditions

188
Q

Sarcopenia

A

Age related loss of skeletal muscle mass and strength

Not completely age related
Decreased physical activity
Co-morbidities

Results in decreased protein reserves
Challenge to meet protein synthesis demands with injury or disease
This even worse sarcopenia

189
Q

Joint- Normal aging:

Most common changes

A 
Decreased joint space 
Increased laxity 
Altered load dispersion 
Altered joint forces 
Decreased joint ROM (not uniformly)
190
Q

Joint ROM aging changes:

Knee

A

In absence of pathology, knee ROM remains fairly stable

191
Q

Walkers

Appropriate for…

A

Provides greater WB shift (50% or more) than a cane but with more stability than crutches
Difficult to maneuver on stairs

Standard offers greater stability but can be difficult for older adults to maneuver
Requires more attentional demand and has greater destabilizing effect compared to RW

RW less stable than std but easier to propel w/upper body weakness; decreased energy cost over std walker (5%)

Rollators have brakes
Platform walkers are heavy- increased energy but permit WB

192
Q

Pathological gait-

Toe clearance

A 
Either large toe clearance 
OR
Tripping 
OR 
Both
193
Q

Floor-stand

> 30 seconds, With assistance

A

Frail

194
Q

Dementia most commonly affects

A

Memory and language

195
Q

Multi-factorial impairment-based interventions

A

Flexibility training
Strength, power, and agility
Cardiovascular
Speed

196
Q

Lewy body dementia- clinical presentation

A 
Gait and balance issues 
Visual spatial issues 
Poor executive functioning 
Sensitivity to antipsychotics 
May be depressed
197
Q

SpO2 =<85%

Exercise

A

Add or increase supplemental oxygen

Contraindication to initiating activity/exercise

Refer to physician if remains <90%

198
Q

Altered posture: Altered function

A

Hyperkyphosis:
Spine extensors lengthened - weakened (Lifting difficultly)

FHP:
Challenges swallowing, breathing, supine/prone position

Decreased lumbar lordosis:
Pain nerve root impingement symptoms, spinal stenosis: standing, walking painful- limits activity

199
Q

Fall Risk Factors -

Extrinsic

A

Medications

Improper prescription and/or use of AD for ambulation

Environmental hazards

200
Q

Ask patients about fluid intake (UI)

A

If they are reducing to avoid UI, can lead to constipation from dehydration or UTI and further aggravate UI

201
Q

Fall risk- Focused History

A

History of falls- need details
Medication review
Review of risk factors for falls- current and past medical history
Living environment- gather info from patient/family/caregiver

202
Q

Joint ROM aging changes:

Cervical spine

A

All motions decrease

Greatest reduction in extension and lateral flexion

203
Q

Delirium

A

Sudden, rapid change about mental function (often confused with dementia)

Associated with:
Medical illness; recovery from surgery; hospital admission

Usually short-term, temporary

204
Q

HR 120-150

Exercise

A

Precaution to initiating activity/exercise

Refer to physician

205
Q

Major cause of death in >65 years old

A

Cardiovascular disease

206
Q

Reversible causes of urinary incontinence

A

DIAPPERS
D- delirium or other altered mental status
I- infection, UTI, symptomatic
A- Atrophic urethritis or vaginitis
P- Pharmaceuticals
P- Psychological disorders (esp depression)
E- Endocrine disorders (hyper- calcemia or glycemia)
R- Restriction Mobility
S- Stool impaction

207
Q

Multi-factorial impairment-based interventions

Strength, power and agility training

A

Achieve mobility with stability prior to emphasizing increased velocity

Target PF, DF, quads, abductors, and extensors
UE strength in lats and triceps when patient using AD

Pre-gait activities can be done to focus on strength and control

208
Q

Fall Risk-

Modifications to environment

A 
Enhance lighting 
Remove rugs or secure them 
Add hand rails 
Change room layout, furniture 
Remove clutter, trip hazards.. 
Change accessibility of food, utensils, clothing..
Widen doors 
Obtain elevated toilet, shower chair/bench, non-slip surfaces
209
Q

Age-Related Genitourinary Changes

Both genders

A

Decreased bladder sensation

Decreased detrusor contraction strength -> Decreased urine flow rate

Increased post-void residual volume

Circadian rhythm changes
Decreased diuretic hormone vasopressin -> nocturia

Other renal system changes:
Loss of renal mass/functional glomeruli
Decreased renal blood flow/glomerular filtration rate

Leads to increased sensitivity to fluid and electrolyte imbalance and decreased drug elimination

210
Q

Normal aging: Cardiopulmonary

Thorax - functional

A

Increased resistance to chest wall deformity
Increased choking/aspiration risk

Decreased FEV1 (forced expiratory volume) 
Decreased FVC (forced vital capacity) 
Decreased cough force
211
Q

Alzheimer’s disease

A 
Most common form of dementia 
Early onset (30-60) 
Late onset (after 60) 
Risk factors:
Advancing age
Positive family history 
Women > Men 
African-American and Hispanic populations
212
Q

Factors contributing to aging gait changes-

Psychological

A 
Depression 
Self-efficacy/confidence 
Appearance 
Older adults perception of his/her mobility 
Anxiety/Fear 
Perceived risks of community mobility 
Access to or barriers in community
213
Q

Gait speed

0.3-0.8 m/second

A

Frail

214
Q

Stress UI

A

Occurs with effort or exertion; cough; sneeze; lifting activity; Valsalva

Childbirth 
Aging changes in muscle/connective tissues
Estrogen loss
Radical prostatectomy 
Caucasian 
Family history 
Smoking 
Obesity 
Chronic cough/respiratory disease 
Pelvic surgery 
Chronic constipation 
Neurologic disorders
215
Q

Floor-stand

11-30 seconds, With or without assistance

A

Function

216
Q

Joint ROM aging changes:

Thoracic and lumbar spine

A

Extension becomes most limited

No or very little change in rotation

217
Q

What is a generation?

A

Cohort born in specific time period (18-22 year increments)

Each generation develops a collective world view based on prevailing cultural influences in first 18 years of life.

6 current:
GIs : 1901-21
Veterans/Greatest generation: 1922-45
Boomers: 1946-60
X: 1961-81
Y (millennials): 82-04
Z: 04...
218
Q

Gait speed “limited community ambulatory”

A

0.4-0.8 m/sec

219
Q

Common visual diagnosis and functional implications in old age

A

Cataracts

AMD (age-related macular degeneration)

Glaucoma

DR (diabetic retinopathy)

Retinal detachment

Dry eyes

220
Q

Normal aging gait-

Ankle-Foot

A

Mild decrease in force at push-off and/or

Slight decrease in PF and DF ROM

221
Q

Geriatric depression scale

A

30 Q
Yes = 1 point
No = 0 point

> 10 need referral or follow up

0-9 = normal 
10-19 = mild depressive 
20-30 = severe depressive
222
Q

Screening tools for dementia

A

Mini-Cog
MOCA: Montreal cognitive assessment
Mini mental state exam

223
Q

Fall Risk-
Physical exam and functional assessment :
Movement analysis

A

Bed mobility, transfers, use of AD and adaptive equipment

The Barthel index

224
Q

PNS-
Sensory changes with aging-
Hearing

A

Presbycusis: hearing declines with age
Effects both genders
Men especially lose hearing for higher frequencies

Difficulty tuning out background music

225
Q

HR with exercise/activity

A

Increases in proportion to workload

Significant drop is indication to stop exercise

226
Q

Consequences of falls

A

Injury and/or death:
Hip, wrist, compression fractures
Head trauma, TBI
Bruises, contusions, lacerations

Psychosocial: 
Fear of falling
Anxiety 
Isolation 
Depression
227
Q

Pathological gait-

Single limb support

A

Short, shuffling steps
Unequal stance time
Antalgic pattern

228
Q

Pathological cognitive changes

A

Certain growth factors in brain are inhibited
Death and loss of neurons
Dementia

229
Q

MOCA

A

Montreal cognitive assessment

16 item test
10 minutes

Includes tests for executive function, naming, memory, attention, language, abstraction, delayed recall and orientation

Score >26 = normal

230
Q

Infectious disease in aging adults

A

1/3 of all deaths in 65+

Early detection difficult due to absence of typical s/s : Lack of fever, leukocytosis. In UTI, absent/masked clinical manifestations

1st sign of illness is:
Change in mental status or cognitive impairment
Decline in function
Falls
Weight loss/anorexia
Slight increase in respiratory rate
Vague symptoms: nausea, vomiting, decreased urine output

231
Q

Fall Risk-

Physical exam and functional assessment

A 
Sensory 
NM
Aerobic endurance 
Movement analysis 
Functional balance and gait 
Perceived functional ability and fear of falling 
Footwear
232
Q

Strengthening exercise

A

60-80% of 1RM for strength gains

Determine by:
Select weight think pt will experience fatigue at ~10 reps
Have them perform 1-2 reps and assess RPE
11-15 on 6-20 point scale
“Somewhat hard to hard” = 70-80%

8-12 reps should result in momentary muscle fatigue
Observe for: concentration, slight tremor, mild increase in respiration.

1 vs 3 sets

233
Q

Normal integumentary aging-

Nerve function

A

Decreased ability to thermo-regulate

Increased pain threshold

234
Q

Exercise:

Pacemakers

A

Mode of pacing programmed into device affects patient’s CV tolerance to exercise

Exercise tolerance dependent on underlying disease, type of pacemaker, and degree to which patient dependent on pacer to maintain CO
Fixed rate pacemakers : cannot elevate HR to accommodate higher demand
Pacemaker set on dual mode can allow HR to vary according to demand

Patient c/o lightheadedness, syncope, Low BP, and decreased activity tolerance should trigger referral back to cardiologist to check pacemaker function

235
Q

Systolic normal

A

100-140 mmHg

236
Q

“Entryway to frailty”

A

Muscular system

Leg strength - most important factor in subsequent institutionalization

PT key point- must apply appropriate principles of exercise prescription

237
Q

Gait speed - need intervention to reduce fall risk

A

<1 m/sec

238
Q

6 key motor learning concepts

A
  1. Need to practice to build experience
  2. Error is necessary
  3. Intrinsic vs Extrinsic feedback
  4. Task analysis- where is the problem
  5. Does it require reactive or anticipatory postural response
  6. Consider environment
239
Q

Chair rise: 30 seconds no hands

8-14 reps

A

Function

240
Q

6MWT

<200 m

A

Failure

241
Q

Multi-factorial impairment-based interventions

Cardiovascular training

A

Continue to assess vitals to determine response to training

Remember while AD can increase stability, they can also increase energy demands

242
Q

Dyspnea scale

A

1- light, barely noticeable
2- moderate, bothersome
3- moderately severe, very uncomfortable
4- must severe or intense dyspnea ever experienced

243
Q

CES-D

A

Center for epidemiological studies depression scale

20 Q
Likely scale questions

> 16 points may need referral

Higher score = more likely depression is an issue

244
Q

Common pathology of the CNS

A

CVA
TBI
Parkinson’s
Dementia

245
Q

Normal aging- Exercise capacity

A

Aerobic capacity decreases with age (appx 1% per year)

Decreased size and number of mitochondria
Decreased capillary/fiber ratio (decreased blood flow)
Decreased work capacity 20-30%

Decreased O2 uptake and transport

Sedentary individuals have a 2-fold decrease in VO2max.

246
Q

Depression screening

2 question depression test:

A
  1. Over the past 2 weeks, have you ever felt down, depressed or hopeless?
  2. Have you felt little interest or pleasure in doing things?

Yes to either of these indicates a need to refer or follow up with MD

247
Q

Conditions that may present atypically in older adult:

Biliary or Liver disorders

A

Nonspecific mental and physical deterioration

No jaundice or abdominal pain

248
Q

Clinical symptoms of UTI

A

Often silent, no fever

Unilateral costovertebral tenderness 
Flank pain
Ipsilateral shoulder pain
Fever and chills 
Skin hypersensitivity 
Hematuria (RBC in urine) 
Pyuria (pus or WBC in urine) 
Bacteriuria 
Nocturia
249
Q

Adjustment disorder with depressed mood

A

Maladaptive reactions to identifiable psychosocial stressors that occur within 3 months of onset of stressors

Impairs social or occupational function or marked distress in excess of normal/expected reaction

Symptoms: depressed mood, tearfulness, and feelings of hopelessness

250
Q

Age-Related Genitourinary Changes

Females

A

Decreased estrogen causes changes in lower urinary tract

Decreased arterial flow to vagina ->
Thinning of vaginal mucosa and perineal skin breakdown->
Weakened connective tissue structures supporting bladder neck

Decreased arterial flow to submucosal vasculature and decreased striated muscle fibers ->
Decreased urethral closure pressure (contributes to more frequent UTI)

251
Q

___ Americans age 65 and older fall each year (less than half tell dr)

__ in every __ falls causes significant injury

Falls are most common cause of __.

A

25% or 1 in 4 fall annually

20% or 1 in 5 falls causes significant injury

Falls are most common cause of TBI, and leading cause of fatal injury among older adults.

252
Q

Normal aging: Cardiopulmonary

Lung- structural

A

Increased alveolar duct and alveoli size
Increased alveolar compliance
Increased mucous glands
Decreased mucous clearance
Increased stiffness of pulmonary vasculature
Decreased bronchial smooth muscle integrity
Decreased lung elasticity

253
Q

Normal aging gait-

Knee

A

ROM from 5* flexion during WA to 60* flexion during swing limb advancement

254
Q

Dual task training

Cognitive

A

Listening to music or talk-radio

Verbal fluency

Answer autobiographical questions

Subtraction by 3

Visuospatial task of pattern matching

255
Q

Bladder training

A

For Urge UI

Gradual increase in time intervals between voids:
Distraction
Deep breathing to relax
PFM contractions to inhibit bladder contractions

Goal is to delay voiding to every 3-4 hours

256
Q

3 most common types of dementia

A

Alzheimer
Vascular
Lewy body

257
Q

Immune system changes with age-

Reduction in lymphocyte development

A

Decreased:
T- and B- cell development
Quality and composition of lymphocyte pool
Thymic epithelial cells

Results in decreased:
Efficiency of response to novel or previously encountered antigens (ex: increased vulnerability to flu >70)
Responsiveness to vaccines (except shingles vaccine)

258
Q

Gait speed

Over 1.5 m/second

A

Fun

259
Q

Age-Related changes affecting sexuality-

Women

A

Decreased estrogen levels ->
Delayed/Decreased vaginal lubrication

Decreased extensibility of vaginal tissue

Increased refractory period between orgasms and decreased orgasmic contractions

Bladder and urethra May become irritated during intercourse

260
Q

Age-Associated Changes Affecting Sexuality :

Cognitive issues

A

Depression: decreased libido cardinal symptom

Dementia: ranges from hyperarousal/inappropriate demands - to withdrawl

261
Q

Gait speed “household walker”

A

<0.4 m/sec

262
Q

Fall Risk-
Physical exam and functional assessment :
Sensory

A

Vision: acuity, contrast, depth, visual field

Vestibular

Somatosensory: vibration, proprioception, cutaneous

Sensory integration: interaction between above 3 (mCTSIB and CTSIB)

263
Q

In 2016, life expectancy at birth ___. (Males ___, Females ___)

Those who love to 65 can expect to live an additional ___ years.

Between now and 2030, the 65+ population is expected to make up close to ___%

A

At birth:
78.8
Males 76.3
Females 81.2

If live to 65, can expect to live average of 19.1 more years.

Between now and 2030, the 65+ Population is expected to make up close to 20%

264
Q

Lewy body dementia

A

Progressive cognitive decline with

  1. Fluctuations in alertness and attention (may be drowsy or lethargic)
  2. Visual hallucinations
  3. Parkinsonian motor symptoms
265
Q

Overflow UI

A

Bladder overly distended causing pressure > urethral pressure

From loss of bladder sphincter after surgery or injury

266
Q

Chair rise: 30 seconds no hands

Over 15 reps

A

Fun

Mgmt Aging Adult (2 decks)

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