Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Mgmt Aging Adult > Test2 > Flashcards

Test2 Flashcards

1
Q

Signs of elder abuse

A

Physical: injuries/trauma, bruises, emaciation

Behavioral: anger, helplessness, suicidal actions

Psychological: fear, anxiety, depression

Social: limited contacts, withdrawal

Others: trouble sleeping, messy look or unwashed hair or dirty clothes, develops preventable conditions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

PD- Late Middle Characteristics

A

All symptoms worse, but independent with ADLs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Intrinsic -

Motivation

A

Achieve goals (function, participation, etc)

To have control of their circumstances

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

TSA: technique indications and implications

A
  1. Anatomic TSA
    Must have intact rotator cuff
    For all forms of degenerative or inflammatory glenohumeral damage
2. Reverse TSA 
In presence of complete tear of rotator cuff 
Must have intact deltoid 
More common for proximal humerus fx 
Revision TSA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

PD of >15 years are ___ to fall

A

5x more likely

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Extrinsic -

Motivation

A

Please someone else

Praise, attention

Punishment (negativity)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Hypoglycemia

A

Blood glucose <70 mg/dL

Causes: OD insulin, late or skipped meals, or overexertion in exercise

S/S: headache, weakness, irritability, poor muscular coordination, inability to respond to verbal commands

Need to ingest carbs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

PD - general goals of therapy

A

Maintain/Increase activity level

Decreasing rigidity or bradykinesia

Optimizing gait

Improving balance and motor coordination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

PD - Late

Interventions

A

Physical:
Compensatory exercise; Dietar; Skin care/Hygiene; Pulmonary function

Pharmacological:
Levodopa/carbidopa (Sinemet); Dopamine agonists; Antidepressants

Psychosocial:
Dementia; Depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

TJA (total joint arthroplasty)

Therapy continuum

A

Phase I: Pre-Hab
Phase 2: TJA acute care
Phase 3: Post-Acute rehab
Phase 4: Post-rehab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

People-first language

A

Emphasizes the person first, not the disability by starting the phrase…
“Person who..” or “Person with…”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q 
Type 1 DM 
Age of onset? 
Proportion? 
Type of onset? 
Etiologic factors? 
Body weight at onset?
A

Age of onset: Usually < 20 y/o

Proportion: < 10%

Type of onset: Abrupt

Etiologic factors : possibly viral/autoimmune, resulting in destruction of Islet cells

Body weight at onset: Normal or thin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Nursing home

Reimbursement

A

Insurance
Private pay
Medicaid

Note: rehab services covered under Part B Medicare if patient has it

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

TJA- total joint arthroplasties

Who?

A

2018 - mean age 66.8 (primary and revision)

  1. 5 years THA
  2. 8 years TKA
  3. 9% F
  4. 1% M

Projected growth of 171% THA and 185% TKA by 2030

Typically elective w/ older adults (patients healthy enough for a major surgical procedure)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Key aspects of Patient Centered Care

A
  1. Patient’s values and preferences guide POC
  2. Focus on the PERSON not the illness
  3. Quality and value defined by respect for personal choices
  4. Goals driven by the patient and their functional desires
  5. Patient empowerment to take an active role in care plan
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Medicare Part A

A

Automatic- pay into system while working

Hospital, SNF, Hospice, some HHC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Prevents the body from properly using energy from food

A

DM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

PD- Late Characteristics

A

Severely disabled, impaired

Dependent with ADLs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

DM diagnosis

A

Classic symptoms + plasma glucose =>200 mg/dL

Fasting plasma glucose =>126 mg/dL

A1c > 6.5%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Rehabilitation in Reverse

A

Hospice PT

Assisting a patient and caregivers as their mobility declines

May include equipment recommendations, Ned mobility for positioning and comfort
PRN visits may be indicated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

PD- external cues

Auditory

A

Metronome
Music
Step to the count

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

PD- Early Middle Characteristics

A 
Symptoms bilateral 
Bradykinesia, Rigidity 
Mild speech
Axial rigidity 
Stooped posture 
Stiffness 
Gait impairments
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Pharmacodynamic changes

A

How drugs affect the body.

Physiologic system changes

Cellular level changes (Increased/decreased receptor sensitivity)

Biochemical response changes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Older adults consume more drugs compared to younger counterparts.
Because…

A

More illness
More adverse drug reactions (ADRs) - altered response to drug therapy
Physician reliance on drug therapy over non-pharmacologic options
Multiple Rx from multiple providers
OTC and self-help remedies
Sharing of medications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

PD- Bradykinesia

Impact on mobility

A

Slow, small movements

Narrow BOS

Lack of arm swings

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

DM

Long term consequence - Kidneys

A

Leading cause of end-stage renal disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

ALF: assisted living facility

A

Patients that need housing, supports and health care

Not to be confused with senior independent living apartment communities
Some offer a continuum of care

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

9 physiological signs of death

A
  1. Confusion, delirium, disorientation
  2. Increased time sleeping
  3. Anxiety, restlessness
  4. Weakness, functional loss, fatigue
  5. Reduction in BP, variable irregular HR
  6. Rapid breathing w/ periods of apnea
  7. Cool distal extremities
  8. No interest in food
  9. Constipation, diarrhea, incontinence, reduced urine output
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q 
Nursing home (long-term care) 
2 avenues of entrance
A
  1. Pt may need 24 hour care, but has no primary need or does not qualify for skilled nursing therapy

Nursing staff available around the clock.
Rehab services available as OP
Services billed under part B

  1. Pt may initially have Part A services either by being admitted to facility:
    As a prior non-resident under skilled nursing status and then transition to residency
    As a resident w/ a qualifying hospital stay that requires follow-up skilled nursing services and/or rehab with eventual transfer back to LTC status
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

PD- Freezing

Impact on mobility

A

Decreased anticipatory postural adjustment

Abnormal mapping of body and movement

Abnormal visual-spatial maps

Divided attention affects mobility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Post-acute setting?

More complicated dx and ability to tolerate at least 3 hours a day therapy

A

IPR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Prediabetes

A

Body can’t use glucose correctly
Body cells don’t recognize all insulin
Or
Cells stop responding to action of insulin

Rise in blood glucose

May have trifecta of prediabetes, HTN and dyslipidemia- increases risk of Type 2 DM and heart disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

VA healthcare

A

Free for veterans with service-connected conditions
Must apply and qualify
Must receive services at a VA facility

Co-pays for veterans with non-service connected conditions and based on income

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

PD- Bradykinesia

Exercise principles

A

Fast, large steps

Large arm swings
During ambulation, in semi-tandem…

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

LADA

A

Latent autoimmune diabetes in adults

Slow progressing form of autoimmune diabetes
Similar etiology to Type 1, but onset usually >30 y/o
Don’t need insulin for several months to years after diagnosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Pre-fracture factors indicating poor functional recovery

Hip fractures

A 
Decreased pre-fracture functional independence 
Greater co-morbid disease burden
Cognitive impairment 
Affective status/depression 
Poor nutritional status 
Poor social support 
Presence of frailty
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Medicare Part D

A

Premium

Prescription drug coverage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q 
Type 2 DM 
Age of onset? 
Proportion? 
Type of onset? 
Etiologic factors? 
Body weight at onset?
A

Age of onset: usually >40 y/o, but increasing number in all ages, including kids

Proportion: >90%

Type of onset: gradual

Etiologic factors: obesity-associated insulin resistance

Body weight at onset: majority (80%) obese

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Type 2 DM

Cardinal s/s

A

May have polyuria and polydypsia
Visual blurring

Neuropathic complications
Infections
Significant blood lipid abnormalities

Often asymptomatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Rock Steady Boxing

A

Founded in 2006
Classes offered at affiliates (gym, T, Sr centers..)
Usually 2x week
Small fee per class

Improvements in balance, gait speed, and perceived QOL, and maintained it.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Characteristics of polypharmacy

A

Use of meds for no apparent reason
Use of duplicate meds
Concurrent use of interacting meds
Use of contraindicated meds
Use of inappropriate dosage of meds
Use of drugs to treat ADRs (adverse drug reactions)
Patient improves w/ discontinuation of meds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Balance in PD

A

Balance exercises should begin in early stages of disease
Equilibrium reactions in all planes of movement

Rhythmical stabilization to increase static balance
As long as resistance doesn’t increase truncal rigidity
Timing of resistance must be gradual

Dynamic balance techniques

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q 
Hypoglycemia 
Onset?
Mood? 
Mental status? 
Skin? 
Pulse? 
Respiration? 
Breath?
A 
Onset: rapid 
Mood : labile, irritable, nervous, weepy
Mental status: difficulty concentrating, speaking, focusing, coordinating 
Skin: pale, sweating 
Pulse: tachycardic
Respiration: shallow
Breath: normal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

PD- functional assessment

A
  1. Sit to stand
  2. Bed mobility
    Rolling
    Supine <> Sit (Key is in Knees- Knee flexion rotations for everyone.)
  3. Gait
    Different environments and challenges
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Skilled Maintenance

A

Hospice PT

Maintenance of QOL unable to be performed safely by other caregivers

Ex: ambulation and transfers that a caregiver can’t manage 2ndary to severe weakness and balance limitations in conjunction w/ caregiver limitations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

DM

Long term consequence - skin

A

Neuropathic Ulcers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

DM

Exercise education

A

Glucose before and after to determine needed levels of intake

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

PF- Middle Stage

PT focus

A

Treat ADLs, gait, balance, and postural deficits that are being impacted
Optimize postural alignment
Maintain postural stability
Reduce multi-tasking to prevent falls

Increasing movement speed/amplitude

Focus on cognitive and motor movement strategies, cueing strategies

Teach compensatory strategies to maintain QOL

Suggest support group for patient and caregiver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

PD- Freezing

Occurs when…

A 
Approaching doorways, obstacles, or chairs
When turning or changing direction 
When distracted while walking 
Crowded or cluttered places 
Medication isn’t working well
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

DM

Long term consequence - Eyes

A

Retinopathy: damage to retina did to abnormal blood flow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Blood glucose cautions with exercise

A

250-300 mg/dL = Caution

Do NOT exercise with => 250 mg/dL with evidence of ketoacidosis

Do NOT exercise >300 mg/dL

< 100mg/dL consider snack and retest or make decision based on symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Home health

Reimbursement

A

Medicare Part A

PPS

60 day national episode payment (certification period)
OASIS (outcome and assessment information set) - assessment tool
Health condition and care needs

In past therapy has impacted payment for HHC, however this is changing (2020)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Patient-centered goal setting

A

Primary way to enhance patient centeredness

Improved outcomes and satisfaction

Can be critical for motivation

Highly personal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

PD-Late Middle

Interventions

A

Physical:
Corrective and compensatory exercise
(Speech and Occupational therapy)

Pharmacological:
Levodopa/carbidopa (Sinemet) ; Dopamine agonists; Selegiline; Antidepressants

Psychosocial:
Caregiver issues (medications, mobility); Monitor for dementia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

PD- balance

Functional

A

Specific practice

Compliant surfaces 
Uneven surfaces 
Incline/Decline 
Stairs/Curbs 
Obstacles 
Dynamic BOS
Visual modification 
Dual task
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

PD- Late Stage

Non-motor

A 
Dementia 
Incontinence 
Skin changes 
Sexual dysfunction 
Pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

PD- external cues

Attention

A

Visualize movements
Focus on each step of the task
Counting 1,2,3…
“Look through the doorway”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

What influences motivation?

A

Self-efficacy expectations
Belief in capabilities

Outcome expectations
Belief personal action will produce certain consequence

Enhanced by:
Successful performance 
Verbal encouragement- “you are capable of this”
Vicarious experience 
Physiologic and affective states
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

TJA Pre-operative educational classes

A

Multidisciplinary format w/ goals of:
Prepare for surgery and recovery related issues, including surgery procedure, therapy expectations and post-op routine

Decrease post-op complications
Increase likelihood of d/c home vs facility and decrease LOS/hospital costs
Help identify post-op support system and decrease anxiety
Encourage patient’s active role in recovery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

6 things

Individualized care

A
  1. Recognizing individual needs and differences
  2. Using kindness and humor
  3. Empowering to take active part
  4. Gentle verbal persuasion
  5. Positive reinforcement
  6. Be genuinely interested
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

OA in the older athlete

A

Common in aging adult
Equally common in the older athlete

Strong flexible muscles act as shock absorbers
Treatment should focus progressive resistance exercise, education on functional activities that minimize compression and shear:
Cycling, rowing, swimming, walking, cross training

Increase in total joint arthroplasties w/ expectation of return to sport

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Aging and motivation

A

Greater self-regulatory

Focus on positive
Immediate benefits of behavior

Stronger adherence

Positive self-concept

Social supports

Information-seeking behavior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Modifiable risk factors for Type 2 DM

A

Physical inactivity
High body fat or body weight
High BP
High cholesterol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

PD- balance exercises

Dynamic

A

Bosu ball
Lunges
Step-ups
Wii balance board

65
Q

Hip fractures-
FNF (femoral neck fractures)
Typical repairs

A

< 65 years old : internal fixation

THA: older individuals or those with already limited mobility

66
Q

Festination and Propulsion (PD)

A

COG too far forward over BOS

Slow velocity of gait

If doing this…
STOP -
Use cue to start again: “BIG” step, reach for your heel

(U-Step walker: brake to stop)

Add weight posteriorly to walker or belt - trying to move COG posteriorly- if needed

67
Q

OP therapy

Reimbursement

A

Medicare Part B
80% covered

Cap has been removed

PT bills for services for reimbursement
Reimbursement based on Medicare fee schedule

68
Q

8 considerations when teaching new information or skills to older adults

A
  1. Accommodate for slower speed of mental processing
  2. Present one new item at a time, if possible, before moving to the next item
  3. Encourage “errorless” learning
  4. Incorporate compensatory strategies as needed
  5. Incorporate multimodal sensory inputs
  6. Encourage formation of a “habit”
  7. Have older adult verbalize new habit to encourage formation of intentions to be completed in the future (prospective memory)
  8. Have older adult paraphrase the info or demo the new skill
69
Q

Social support

A

Need to investigate and understand what their social support is

Teach those involved in supporting patient

Use social support in goal setting

70
Q

5 reasons why many aging adults have difficulty understanding verbal and written health communication

A

Sensory deficits

High stress and/or anxiety

Language barrier

Communication at TOO HIGH LEVEL

Lower health literacy

71
Q

Injuries in older athletes

Macrotrauma (Acute, Traumatic)

A

Trauma occurs less frequently
Participation in less contact sports
Exceptions: cycling, hiking, climbing, skiing (falls and accidents common with these sports)

More likely to sustain a fracture than rupture ligament (2ndary to decreases in bmd)

More likely to tear or avulse muscle than strain muscle - bc increased collagenous stiffness

Increased recovery time needed- deconditioning occurs faster 2ndary to normal age related changes (can be frustrating)

72
Q

Exercise and DM- evidence

A

Improved skeletal muscle glucose transport
Improved whole body glucose homeostasis
Increase insulin sensitivity 12-72 hours post exercise
Increases carbohydrate metabolism
Reduced risk of CV mortality

73
Q

DM stats

A

14.6 million Americans diagnosed
Appx 6.2 million undiagnosed

25% adults in US have prediabetes
Nearly 50% with DM are older than 60
Nearly 25% over 65 have DM
Projected to be 1 in 3 with DM by 2050

Most common endocrine disorder
A leading cause of death
Leading cause of blindness and renal failure in adults

74
Q

The pancreas has 2 functions:

A
  1. Endocrine gland secreting hormones: insulin and glucagon

2. Exocrine gland producing digestive enzymes

75
Q

Hip fractures- therapy considerations

Acute stage

A

Goal: resort mobility asap

Pt likely has pre-existing lower function, fall-risk

High likelihood of limited WB
PWB requires 30-50% > energy than normal ambulation

Higher stakes for bed rest, immobility complications
Consider other areas of osteoporosis risk when planning mobility

76
Q

PT in hospice care - types

A

Rehabilitation Light

Rehabilitation in Reverse

Skilled Maintenance

77
Q

PD- Rigidity

Impact on mobility

A

Loss of spinal flexibility is seen in early stages and correlated w/ functional performance tasks
Reaching, supine to sit, balance control

Agonist/Antagonist Co-Contraction

Flexed trunk
Decreased trunk rotation
Decreased joint ROM
High axial tone

78
Q

Hyperglycemia

A

Causes: infection, missed insulin doses, surgery, pregnancy, renal failure, uncontrolled DM

Can occur in those w/ or w/o DM
High intensity aerobic exercise

79
Q

PD- external cues

Visual

A

Visual:
Laser
Tape lines or Xs on the floor

80
Q

Both of these serve as a bridge between living at home and being hospitalized, especially those with functional decline (sometimes serve as a “testing ground” for whether home even an option eventually)

A

SNF and IPR

81
Q

Ketoacidosis

A

Typically occurs from
Prolonged hyperglycemia
(More common in Type 1)

Fruity breath (acetone), dehydration, weak and rapid pulse, Kussumal respirations

82
Q

Hip fracture surgery is considered…

A

Urgent
To significantly lower risk of death

Followed by early mobilization-
Up in chair w/in 24 hrs, walking in 48 hrs

83
Q

PD- gait training

A 
LSVT “BIG” theory 
Locomotor training 
Split belt treadmill 
Obstacle courses
Inside vs Outside 
Environment (quiet vs crowded) 
Attention (focus vs divided; add dual tasking)
84
Q

DM

Long term consequence - CV

A

CVD leading cause of M/M in DM

1.5-4 fold increased risk of CAD, stroke, or MI

Diabetic cardiomyopathy

Atherosclerosis begins earlier and is more extensive in Type 1

Higher risk of CAD, stroke and PVD in Type 2

85
Q

Geragogy recognizes older adulthood as a developmental stage with key elements concerning…

A

Age-related
Sensory, Physical, Psychological, Cognitive, and Psychosocial
Changes

86
Q

Acute care

Reimbursements

A

IP PPS (inpatient perspective payment system)

DRG method (diagnostic related group) 
Medicare Part A 
Lump sum based on diag 
Severity of illness considered 
Co-morbidities considered

Consideration- must be cost effective, productivity matters
PT does not impact payment

87
Q

Rehabilitation Light

A

Hospice PT

PT once a week or biweekly
Slow, easy strengthening exercises and functional activities
Issue an HEP…very light, but essential to slow progression

88
Q

DM

Long term consequence - MSK

A

Distal joints/segments
Syndrome of limited joint mobility and stiff hand syndrome
Dupuytren contracture
Adhesive capsulitis
DISH: diffuse idiopathic skeletal hyperostosis
Arthritis
Osteoporosis

89
Q

LTAC

Reimbursements

A

Medicare Part A

PPS based on length of stay >25 days
Number of days based on dx and co-morbidities
Full payment received at 5/6th of Stay
Money made this way
Money list if patient stays past assigned length of stay

Consideration- must be cost effective, productivity matters
PT does not impact payment

90
Q

PD- external cues

Proprioceptive

A

Weight shifting/Rocking
Side step
Backward step

Tapping your leg

91
Q

Hospice care

A

Covered by Medicare Part A
Terminal condition w/ 6 or less months to live
No longer seeking cure

92
Q

Limitation in the ability to obtain, process, and understand basic health information and services necessary to make appropriate health decisions and follow treatment instructions

A

Health literacy

93
Q

Two-hour oral glucose tolerance test
Normal?
Prediabetes?
Diabetes?

A

Normal
< 140 mg/dL

Prediabetes
140-199 mg/dL

Diabetes
> 200 mg/dL

94
Q

3 physical settings of subacute care

A

LTAC
IPR
SNF

95
Q

Assisted Living

Reimbursement

A

Insurance
Private pay

Note: rehab services covered under Part B if patient has it

96
Q

PD- Sensorimotor Agility Exercise

Early stage

A

Boxing: anticipatory postural adjustments/corrections, fast arm/foot motions, backward walking, timing/sequencing actions

Lunges: big steps, limits of stability, quick direction changes

Kayaking: trunk rotation, segmental coordination, speed, reciprocal UE movements

Tango, Video games, Zumba

Challenge mind and body simultaneously: Multitasking (physically, cognitively, alter environment)

97
Q

Post-acute setting?
Single joint replacement, conditions requiring much longer recovery period, or pt who can’t tolerate 3 hours therapy per day

A

SNF

98
Q

Polypharmacy

A

Administration of many drugs together

Administration of excessive medication

Excessive or inappropriate use of medications

99
Q

TJA Pre-operative PT

A

High-intensity strength training
Patient training on walking devices
Planning for recovery
Managing patient expectations

Value NOT from:
Multiple intensive training sessions for strength and ROM
May or may not decrease hospital LOS or d/c disposition
May or may not affect post-op function

100
Q

Acute care PT

THA/TKA

A

Early intensive rehab (decreases physiological disturbances)
As early as POD zero
May be at a day surgery facility
Associated w/ decreased DVT/PE, chest infections, urinary retention, HAI risks
Results in accelerated functional recovery and earlier hospital d/c

Within first 24 hours of surgery- optimally POD zero
Emphasize function for optimal d/c - home
Early strengthening
Education very important

101
Q

IRF

Reimbursements

A

Medicare Part A
PPS- predetermined fixed amount
Payment based on inpatient rehab facility patient assessment instrument (IRF-PAI)- FIN Scores

Distinct groups based on clinical characteristics and expected needs

Consideration- if patient unable to be seen 3 hours say on average 5-7 days a week, payment will be impacted
Patient will need to d/c to another location
Therapy impacts payment

102
Q

To control DM, exercise must be done with ___ between sessions

Exercise best ___.

Avoid exercise….

A

No more than 2-3 days between sessions

Exercise best about 1 hour after a meal

Avoid exercise at night and alone

103
Q

LSVT “BIG”

A

Training program designed to promote high amplitude/BIG movements of limbs and body

Designed to improve speed, balance, and QOL

4x week for 4 weeks

Intense program with many repetitions

Must be certified as a “BIG” therapist to document “BIG” treatment
“High amplitude training” when not certified

104
Q

Medicaid

A

Low income coverage for those over age 65
< $1025 month

Provides coverage for premiums, out of pocket expenses, nursing home care, prescription drugs

Medicare pays first then Medicaid pays

Administered by federal and state governments
May have different names
Must check eligibility often

105
Q

“Carpe Diem” HEP

A 
Cervical rotations
Chin tucks 
Shoulder ABD/ER and FLEX 
Knee FLEX rotations 
Bridges and/or pelvic tilts
Hip ABD/ADD (knees flexed) 
Knee to chest stretch 
Hamstring stretch 
Ankle pumps (10-20x each) 
Deep breaths
106
Q

Hip fractures- therapy considerations

Post-Acute stage

A

Likely will require post-acute IP stay
(Many hip fx >85 qualify for IPR)

Focus on precipitating factors to the causative agent for hip fx. (Fall, osteoporosis, cognitive deficits, home environment, support…)
AND how normal aging changes/augments

Fear of falling

107
Q

Injuries in older adults-

Microtrauma (Overuse injuries)

A

Muscle strains, bursitis, tendinopathies

May be more prone to these injuries when compared to younger athletes
Stiffer, less flexible
Arthritic changes
Less shock absorption and protection

Joint pain and edema more common in older athletes as compared to their younger counterparts (structural changes)

108
Q

7 Common ADRs

adverse drug responses

A
  1. GI symptoms (Opioids, non-opioids, NSAIDS)
  2. Sedation (Opioids, analgesics, antipsychotics)
  3. Confusion (Antidepressants, narcotics, anticholinergic)
  4. Depression (Barbiturates, antipsychotics, antihypertensive)
  5. Orthostatic hypotension (HTN drugs)
  6. Fatigue/Weakness (diuretics and muscle relaxers)
  7. Dizziness/Falls (sedatives, antipsychotics, opioids, antihistamines)
109
Q

PD- Early stage

Characteristics

A

Fully functional
May have unilateral tremor (resting), unilateral rigidity, bradykinesia

Non-motor: constipation, depression, apathy

110
Q

Hip fractures-
Intertrochanteric fractures
Typical repairs

A

Sliding hip screws

Intermedullary nails (done Percutaneously w/ less surgery time and less blood loss)

Often PWB

111
Q

Aging adults may require a ___ assessment to determine specific needs.
Usually __ in nature
Essential the older adult receive ___

A

Comprehensive assessment

Interdisciplinary in nature

Essential to receive the level and types of services required to address needs

112
Q

PD - Late Stage

Motor

A 
Falls 
Retropulsion 
Freezing 
Choking 
Aspiration 
Axial rigidity 
Drooling
Decreased breath support
113
Q

Hip fractures- types

A
  1. Intracapsular (45%)
    Involving femoral head and neck
  2. Intertrochanteric (45%)
  3. Other : (10%) subtrochanteric
114
Q

Non-modifiable risk factors for Type 2 DM

A

Family hy of DM
>45 y/o
Race/ethnicity
Hy of gestational diabetes

115
Q

Post-Acute PT THA/TKA

A

Largest proportion of therapy time

Optimal d/c home and start HH or OP PT
May need dispo other than home first - be aware of other issues (family, insurance, home environment etc)

Sometimes older adults have complicated and longer recovery. Co-morbidities.
Slow recovery TKA > THA but more lingering gait abnormalities THA

116
Q

Assessment of senior athletes

A

Norm referenced tests:
Senior fitness test
YMCA fitness test
ACSM fitness test

Sport or movement specific exam:
Selective Functional Movement Assessment
whole body functional approach

117
Q

PD- Early

Interventions

A

Physical:
Preventative exercise program

Pharmacological:
Anticholinergics (tremor)
Selegiline (neuro-protection)

Psychosocial:
Education; Information

118
Q

SNF

Reimbursements

A

Medicare Part A
100 days of coverage
Days 1-20 paid in full
Days 21-100 copay up to $164.50 day

Per diem PPS
Covers all costs (routine, ancillary, capital)
Resource utilization groups III (RUGs)
Based on resident assessment and classification using MDS 3.0
Number of therapy minutes and day’s impacts reimbursement

119
Q

Motivating the older adult-

Challenges

A

Overcoming fear
Graded exposure
Building on baseline tolerance

Apathy
Medication may be necessary first step
Focus on activities that can be done successfully

120
Q 
Hyperglycemia
Onset?
Mood? 
Mental status? 
Skin? 
Pulse? 
Respiration? 
Breath?
A 
Onset: gradual 
Mood: lethargic 
Mental status: dulled sensorium, confused
Skin: flushed, dehydrated 
Pulse: less rapid, weak 
Respiration: deep, rapid (Kussmaul)
Breath: fruity
121
Q

PD- Early Middle

Interventions

A

Physical:
Corrective exercise program

Pharmacological:
Levodopa/carbidopa (Sinemet)
Selegiline (neuro-protection)

Psychosocial:
Counseling; Support groups; Monitor for depression

122
Q

Hip fracture- facts

A

Initial mortality following hip fx is high
In-hospital mortality 2.3-13.9%
For women, 5-fold increase for all cause mortality first 3 months after fx
For men, 8-fold
1/3 of elderly patients dead 1 year after hip fx

123
Q 
PD- gait training 
Dynamic exercises (8)
A 
Tandem
Backwards 
Side steps 
Grapevine 
Stopping 
Starting 
Turning 
Changing directions
124
Q

TSA: therapy considerations

A

No extensive pre-op education pathways like THA/TKA

Patient in sling- what can do:
Gait disturbances primary issue w/ aging adult
(Pt can’t swing arm…balance? Need for AD?)

Joint mobility at other shoulder
Functional reach using alternate strategies
Core strengthening
One-armed ADL strategies
Functional mobility and bed mobility strategies

May need OT referral

125
Q

PD- 7 Rigidity treatment examples

A 
1. Manual therapy 
Stretching/PROM/AROM
Joint compression/approximation/traction 
2. Deep breathing/relaxation 
3. PNF 
4. Core strengthening 
5. Tai Chi 
6. Kayaking 
7. Large amplitude steps w/ directional changes
126
Q

PD- Freezing

What to do…

A

Stop,
take a deep breath,
weight shift side to side,
try a side or backwards step before trying to take a “BIG” step forward

Try different cues

Frustration or stress = worse

127
Q

8 communication tips

A
  1. Slow down, allow extra time
  2. Use plain, nonmedical language
  3. Show or draw pictures
  4. Limit amount of info and repeat it
  5. Use the teach-back technique
  6. Create a shame-free environment; Encourage questions
  7. Sit face to face, use eye contact
  8. Listen w/o interrupting
128
Q

MODY

A

Maturity onset diabetes of the young

More likely to be inherited, stronger genetic risk factor
Shares Type 2 symptoms
NOT linked to obesity

Develops before age 25

129
Q

Fasting plasma glucose test
Normal?
Prediabetes?
Diabetes?

A

Normal
< 100 mg/dL

Prediabetes
100-125 mg/dL

Diabetes
> 125 mg/dL

130
Q

Fundamentals of LSVT “BIG”

A
  1. Target
    BIG- large amplitude whole body movements
  2. Mode
    High intensity: modulated by LSVT specialist
    Requires consistency over 4 week period
  3. Calibration
    Calibration of perception of movement
    Mismatch between patient perception of output and how others perceive it
  4. 7 BIG exercises for HEP
131
Q

Rehab considerations

A

Proximal stability will facilitate distal mobility- Don’t forget the core

Generalized strengthening is important -
Don’t forget appropriate exercise prescription

Stretching:
Warm up imperative and may include some stretching
Cool down stretching is better
60 seconds is better than 30 in the older adult

132
Q

PD- balance exercises

Static

A 
Wobble board
Air-ex/Foam pads 
EO/EC 
Head turns/nods
Reaching outside BOS 
Perturbations + protective step response 
Seated on physioball
133
Q

Self efficacy beliefs

A

Verbal encouragement of capability

Expose to role models

Decrease unpleasant sensations associated w/ activity

Encourage actual PRACTICE

Educate on benefits and reinforce those benefits

134
Q

PD- Middle stage

Motor

A 
Bilateral features 
Wearing off meds
Dyskinesias 
Increased rigidity 
Hunched posture 
Shuffling gait 
More assistance needed w/ ADLs such as fine motor tasks, increased slowness (more difficulty w/ transfers)
135
Q

PD- How does cueing work?

A

Basal ganglia acts as an internal cue to enable movement sequences to be carried out implicitly, automatically and w/o attn

Cues replace these lost internal cues w/ an external cue
Bypass BG dysfunction path
Learning shifts from implicit to explicit

Cueing = motor learning tool

136
Q

Defective ___ function in pancreas results in DM

A

Endocrine

137
Q

Goals should be…

A

Related to specific behavior

Challenging but realistic and attainable

Achievable in the near future

138
Q

TSA (total shoulder arthroplasty)

A

3rd most common after THA and TKA

300% increase in past 15 years
Mean age 68.9
56% men

Higher rates of complications w/ advancing age and female gender

Men with first procedure <59 more likely to new revision procedures

139
Q

Elder abuse %

A

Estimates as high as 10%

Most frequently verbal 9%
Financial 3.5%,
Physical <1%

140
Q

Sit to stand

PD Functional training example

A

Break task into parts:

  1. Bend forward
  2. Lift pelvis up
  3. Extend knees and hip
  4. Maintain standing

Repeated practice of impaired “parts”

Neuroplasticity - correct the impaired “part”
Encourage repetition

141
Q

Pharmacokinetic changes

A

How body handles the drug. Drugs and metabolites remain active for longer periods of time- increasing risk for toxic side effects

Absorption- altered GI function

Distribution- changes in total body water, lean body mass, % body fat, plasma protein concentrations

Metabolism- reduced liver mass, decreased hepatic flow, decreased activity of drug metabolizing enzymes

Excretion - Decreased renal blood flow and mass, decreased function of renal tubules

142
Q

Anticholinergic effects

A

Alters tissue response to ACh

Common w/ antihistamines, antidepressants, antipsychotics

CNS effects: confusion, nervousness, drowsiness, dizziness

Peripheral effects: dry mouth, constipation, urinary retention, tachycardia, blurred vision

Extrapyramidal symptoms: dystonias, tar dive dyskinesia, pseudo-parkinsonian (antipsychotics)

143
Q

PD - Middle Stage

Non-Motor

A

Cognitive decline evident with executive and visuospatial

Orthostatic hypotension

Mood disorders

Hallucinations are rare

144
Q

PD- symptom based treatments
Rigidity
Exercise principles

A 
Trunk rotation 
Reciprocal movements 
Rhythmic movements 
Erect alignment 
Large movements

Loss of spinal flexibility is seen in early stages and correlated w/ functional performance tasks
Reaching, supine to sit, balance control

145
Q

Simplified metabolism

A

Food broken down into glucose

Glucose provides energy body needs

Pancreas releases insulin- signals cells to absorb glucose from bloodstream

W/O insulin, glucose can’t be utilized by cells for energy and glucose remains in blood (hyperglycemia)

146
Q

PD- Late Stage

PT focus

A

Appropriate equipment

Simplify tasks: breakdown movements; repetition, repetition

Sensory stimulation and movements

Educate caregiver: body mechanics w/ transfers; floor transfers (falls will happen)

Home evaluation

147
Q

Hip fractures-
Subtrochanteric
Typical repairs

A

Hemiarthroplasty

148
Q

Non-operative mgmt - hip fractures

A

For those who may gain only minimal function from stabilization because they were either…
Not ambulatory to begin with OR
Have severe dementia OR
Contraindications to anesthesia or medical conditions prohibiting surgery

149
Q

Type 1 DM

Cardinal s/s

A

Polyuria (excessive urination)
Polydipsia (excessive thirst)
Weight loss with polyphagia (excessive hunger)
Blurred vision

150
Q

Geragogy

A

Teaching approach recognizing special needs of older adults related to learning

Need to fine-tune adult teaching and instructional styles for olde adults who:
Are post-career
No longer raising families
Are often frail

151
Q

Medicare

A

> 65 years old and some disabled

Has 4 parts A, B, C, D

152
Q

Medicare Part C

A

Medicare advantage plans

Provide both A and B and other services
Provided through private insurance companies
Locked in for certain periods of time, not able to use original Medicare

153
Q

DM

Long term consequence - Nerves

A

Sensory, motor and autonomic neuropathy

154
Q

Aging in place

A

Allowing an older adult to live in their residence of choice for as long as they are able

Living in a community with some level of independence instead of residential care

155
Q

PD- Freezing

Exercise principles

A

Improve weight shifting m

Understand role of external cues

Exercise in small spaces

Practice dual tasks

156
Q

The __ are cells of the pancreas involved in endocrine function

A

Islets of langerhans

Alpha: release glucagon- raises blood glucose
Beta: releases insulin- lowers blood glucose

157
Q

Medicare Part B

A

Premium, deductible, co-insurance, co-pay

Doctor’s services, OP care, some HHC, labs, X-rays, DME

158
Q

PWR: Parkinson’s Wellness Recovery

A

Founded by a founder of LSVT BIG

Basic4 PWR!Moves- targets skills impaired in PD w/ mobility

  1. Antigravity extension (PWR!up)
  2. Weight shifting (PWR!rock)
  3. Axial mobility (PWR!twist)
  4. Transitions (PWR!step)

Moves performed differently to target different symptoms. (Rigidity, bradykinesia, incoordination and automaticity.)

159
Q

Hip fracture- statistics

A

Typically low trauma/low energy occur at mean age 80

75% older than 70

3 in 4 hip fx assoc deaths may be causally related to pre-existing medical conditions rather than fx itself

Mgmt Aging Adult (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions