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HDAL - Post Midterm > Treating the geriatric patient > Flashcards

Treating the geriatric patient Flashcards

1
Q

How much more likely our geriatric patients to be hospitalized than middle-age adults?

A

Twice as

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2
Q

How do PTs save the hospital money?

A

Shortening LOS
Reducing re-admission rates
Reducing falls and fall-related injuries
Reducing complications caused by immobility

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3
Q

When can Medicare take back money from hospitals?

A

Medicare can effectively take back money from hospitals if patients are re-admitted for the same problem within 30-days of discharge for (HRRP) diagnosis

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4
Q

What are the individual health remission reduction program diagnosis?

A
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5
Q

What are the main aspects of the acute-care PT?

A

Assess patient’s current functional mobility and risk for falls
Plan of care should maximize patient’s mobility and ability to discharge to the next level of care
Make recommendations for DME and discharge location
Communication of recommendations to the rest of the care team
Most often RN, SW, CM

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6
Q

What does geriatric acute-care require of the PT?

A

Management of patients receiving mechanical support
Recognition & management of pharmacology effects
Physiological effects of medical and surgical interventions
Monitoring patient’s responses to activity in a potentially critically ill state
Being able to anticipate and respond to patients who may begin to decompensate

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7
Q

How often do patients 65+ require postacute care?

A

70% of the time

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8
Q

What are the requirements for being admitted to inpatient rehab facility?

A

Must be able to tolerate 3 hours of therapy for 5/7 days each week or 15 hours in 7 days
Must require at least 2 therapy disciplines, with 1 being PT or OT
Qualifying medical condition
Required therapy must begin within 36 hours from midnight of the day of admission

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9
Q

What are the qualifying diagnosis is for IRF?

A
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10
Q

Were the main aspects of the inpatient rehab PT

A

Maximize functional independence to prepare for dc to home
Determine DME needs
Family training, if needed

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11
Q

How is skilled nursing facilities different from IPR’s?

A

Typically lower amount of therapy compared to IPR but can still be considered intense

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12
Q

When can a patient enter a SNF?

A

Within 30 days of the qualifying hospital stay

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13
Q

When is the baseline care plan set within admission to SNF?

A

48 hours of admission

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14
Q

Where the main aspects of the SNF PT

A

Maximize functional independence to prepare for dc to home
Determine DME needs
Family training, if needed

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15
Q

When do patients become residents of long-term care settings?

A

Decreased cognition
Frequent falls
Social issues
Unable to care for self at home
Family unable to provided necessary care

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16
Q

We are the risk factors for permanent residency in a long-term care facility?

A

Hospitalization
Advanced age
Dementia
Female gender
Frailty/pre-frailty
Discharge from hospital to SNF

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17
Q

What is considered homebound? I.e. covered under Medicaid part A for home else services

A
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18
Q

What are the main goals for the home health PT?

A

Promote independence in activities of daily living (ADLs)
Reintegrate the patient into the community
Minimize the risk for recurrent hospitalization and/or nursing home admission
Educate caregivers
HH PTs are in a unique position to monitor patient medication compliance and potential ADRs

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19
Q

What are outpatient services billed under?

A

Can be billed under Medicare Part B, Medicaid, self-pay, private insurance

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20
Q

What are the various goals of the outpatient physical therapist?

A

Maximize functional capacity & prevent loss of function
Optimize human movement
Bridge into wellness
Recover from planned or unplanned surgery
The list goes on

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21
Q

What is leading gas in the tank?

A

Getting as much benefit from session as possible, but leaving enough “gas in the tank” to make sure your patients can do what they need to do when they go home or after you leave
You don’t want them so fatigued that they can’t function, especially if they are 1RM living

Monitoring blood pressure
220/140 – In ICU for a week
Monitoring medication compliance

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22
Q

What is primary aging order the preventions?

A
23
Q

What is secondary aging and what are the preventions?

A
24
Q

What is tertiary aging and what are the preventions for?

A
25
Q

What are the possible related concerns on the caregiver is also an older adult?

A

Is the caregiver able-bodied?
Is the caregiver cognitively able?
Is this a safe situation for the patient to potentially discharge to?

26
Q

What is considered a fall?

A

An event that results in a person coming to rest unintentionally on the ground, floor, or other lower level 6
Not as a result of a major intrinsic event (syncope, MI, stroke, etc.) or overwhelming hazard
An unintentional loss of balance that leads to failure of postural stability

27
Q

What are factors that contribute to risk for falls in geriatric patients?

A

Sensory deficits
Urinary incontinence
Depression
Dementia/cognition
Musculoskeletal impairments
Fear of falls
Pain

Foot problems
Vision impairment
Hearing impairment
Cardiovascular
Medications
Neurological impairments
Sensory issues
Vestibular impairment

28
Q

When should you screen for falls and balance impairment?

A

Any time they come to you for treatment
Any time you notice a potential impairment
Annually, on a screening basis

29
Q

What you should you screen for in terms of falls and balance impairment?

A

Number of falls in the past 12 months: frequency, context, fall characteristics, injuries associated with falls
Balance impairment & postural instability

30
Q

What are some self reporting function performance measures?

A

Activities-Specific Balance Confidence Scale (ABC)
Falls Efficacy Scale-International (FES-I)

31
Q

What are some single test mobility measures?

A

Gait speed
SSWS
Fast-pace
30 sec sit-to-stand (STS)
Floor transfer
Stair climb test
Timed Up & Go (TUG)
6- & 2-Minute Walk Test (6MWT & 2MWT)

32
Q

What are some of the multi-activity mobility measures?

A

Short Physical Performance Battery (SPPB)
Static standing balance
SSWS
5x STS
Physical Performance Test and Modified PPT

33
Q

What are some of the balance measures?

A

Single Leg Stance (SLS)
Romberg Test
Sharpened Romberg
4-step Square Test

34
Q

What are some of the performance test batteries for functional performance?

A

Berg Balance Score
Tinetti Performance Oriented Mobility Assessment (POMA)
BESTest, Mini-BEST, Brief-BEST
Dynamic Gait Index (DGI)
Functional Gait Assessment (FGA)
Fullerton Advanced Balance Scale (FAB)
Community Balance & Mobility Scale (CBM)
Postural Assessment Scale for Stroke (PASS)

35
Q

How should you treat a fall patient afterwards?

A

Physical exercise as an intervention, including balance and postural exercises, to reduce the number of falls for patients 65+ can be effective as both a rehab and a “pre-hab” effort. 18

Exercise programs should be structured, progressed, and must achieve the minimum dose of exercise. Individuals who initiate an exercise program to improve balance, but do not achieve the minimum dose may be at a higher risk of falls. 19

Achieving the minimum dose is a challenge of fall prevention, as evidence supports long duration of intervention is required to have the desired effect:

Sun et al., 2021 found a frequency of more than 5x per week and a duration of more than 32 weeks was more effective at reducing risk for falls with an integrated approach of resistance, core, and balance training

Sherrington et al., 2008 determined that the greatest effects of exercise on fall rates were seen in programs that included a higher total dose of exercise (>50 hours)

36
Q

True or false walking is a singular balance intervention is not supported by evidence to improve balance/reduce fall risks and may actually increase the risk of falls in high risk individuals?

A

True

37
Q

How should we screen for falls and balance impairment?

A

Observational gait analysis
Functional outcome measures
Self-reported measures

38
Q

How should we screen for frailty?

A

Frailty phenotype criteria
TUG
Gait speed

39
Q

What are some screening options for frailty? And what are their uses/cutoffs?

A

Timed Up and Go (TUG)
Cutoff: >10 seconds indicates frailty

Gait Speed
Cutoff: <0.8 m/s
Ninety percent of frail individuals have walking speeds of <0.8m/s.

30 sec chair rise
Cutoff: <14
Assess lower extremity strength

6 Minute Walk Test (6MWT)
Cutoff: <548 meters
Assess aerobic capacity and endurance

40
Q

True or false lower extremity exercises should not take priority over upward Shirley exercises to maintain and improve mobility?

A

False

41
Q

What mechanism 1st strength development is primary in the older population?

A

Neuromuscular efficiency

42
Q

Where the general exercise recommendations for the older adult?

A

150 minutes of moderate intensity activity per week OR 75 minutes of vigorous intensity activity per week
At least 2 days of activities that strengthen muscles per week
About 3 days of activities to improve balance per week

43
Q

What are the guidelines for improving muscle performance/muscle performance prescription in the older adult?

A

Frequency: 2-3x per week
Intensity: 40-80% 1RM for 8-12 reps depending on desired intensity

Start at 30-40% 1RM and progress to heavier loads of 70-80% 1RM (15-18 Borg)39

1 set of 10-15 reps (if done to failure, equates to 60-70% 1RM)

Progressive resistance training, weightlifting, weight machines, resistance band use, body weight resistance, stair climbing

8-10 exercises targeting major muscle groups

Pay attention to form & comfort prior to increasing resistance

For power training, add a speed component at 40-60% of 1RM39

44
Q

What modifications should you make to muscle performance prescription and trailing chronic disease patients?

A

Frail & chronic disease: start with 1-3 sets of 10-15 reps, 30-60% 1RM

Older adults with certain diagnoses should exercise at lesser intensities (30-60% 1RM at 12-25 reps per set)
Acute musculoskeletal conditions
Extremely frail or deconditioned individuals
Rheumatoid arthritis
Comorbidity-limiting exertion including cardiopulmonary or progressive degenerative neuromuscular disorder
Post-surgical healing tissue, especially reconstructive (follow surgical protocols when present)

45
Q

Person considerations for strength training and the older adult?

A

If you make your patient sore after the very first session, they may not come back
Be conscious of DOMS and prepare the patient they may experiences soreness
If you prepare them, it will not be as frightening to them
Many of the them will assume that if they have ANY pain, something is wrong
Allow 48 hours rest between strength/power training sessions
Make it functional
Monitor vital sign

46
Q

For the general guidelines for aerobic exercise in the older adult?

A

Frequency: 3-7x per week
Walking, dancing, swimming, water aerobics, speed walking or jogging , aerobic exercise classes, bicycle riding (non-recumbent stationary or on a path), elliptical machines, some gardening activities such as raking & pushing a lawnmower, tennis, and golf (without a cart)
Healthy Aging: Bouts of at least 10 minutes, working up to 30-60 minutes per day for a total of 150-300 minutes per week for Moderate intensities (40-60% HRR; 5-6/10 RPE)
Healthy Aging: Bouts of at least 10 minutes, working up to 20-30 minutes per day for a total of 75-100 minutes per week for Vigorous intensities (60-90% HRR; 7-8/10 RPE)

47
Q

What modifications should be made to aerobic exercise for chronic disease and frailty?

A

Chronic disease: 40-60% HRR for at least 20-60 min
Frail: 40-60% HRR for at least 20 min
Borg Scale recommended for these populations initially is 11-14

48
Q

What are considerations for aerobic training in the older adult?

A

Be aware of any comorbidities that may affect performance, particularly cardiac-, respiratory-, or anxiety-related pathology
Use RPE scales to determine intensity, especially for patients on beta blockers or with pacemakers
Monitor vital signs

49
Q

How should you approach flexibility training in the older adult?

A

Frequency: at least 2-7x per week
Stretch to the point of feeling tightness or slight discomfort. Avoid ballistic movements.
Stretch major muscles groups and targeted areas for 30-60 seconds, 3-4x each

50
Q

How should you approach balance training in the older adult?

A

Frequency: at least 2-7x per week
Minimum Dose: 50 hours over 3-6 months
1-2 sets of 4-10 exercises emphasizing static and dynamic balance & postures
Multiplanar walking, obstacle negotiation, head movements with walking, transitioning to different height surfaces, moving in different environments, proprioception challenges with altering surface, taking away visual input, sudden stopping/starting, perturbations, narrowing BOS, reaching to different heights

51
Q

Consideration should you make for valid training in the older adult?

A

If you don’t challenge your patients, they won’t improve
At the same time, you may need to gain trust with your patient prior to increasing challenges
Make it functional
Static to dynamic, narrowing BOS, remove sensory input, perturbations, dual tasking
When balance training, try to end treatment on a positive note for the patient

52
Q

How does high intensity interval training work in the older adult?

A

Efficient way to deliver exercise in a time-constrained environment
Safe and feasible for older adults34
Can prevent or delay the onset of comorbidities34
Improvement in cardiorespiratory fitness in independent older adults35 and octogenarians with disease36
Effective to improve health of obese older adults37
Better improvements than Moderate Intensity Continuous Training on functional capacity, lean mass and various skeletal muscle markers of mitochondria37
“Enhances skeletal muscle mass in octogenarians with disease, with up‐regulation of muscle protein synthesis and mitochondrial capacity” 36

53
Q

When why and how should you use intentional under dosage?

A

Why:
Your patient’s goals and your goals may conflict at times
It’s still important to address their wants
Sometimes we need to show value to our patient in a way they care about first

When:
Patient coming from a very sedentary level
When the patient is highly irritable (symptom-wise)
Consider prior experiences with physical activity, exercise, or physical therapy

How:
No weight or very light weight
Increase ROM with a lower load
Use RPE

HDAL - Post Midterm (4 decks)

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