Week 10 Flashcards
Which is the lie
A
Which is the lie
C
List some evidence based exercise programs
Tai chi
Otago
Stepping on
(SAIL) stay active and independent for life
A matter of balance (for fear of falling)
Individualized PT with progressive gait/balance/strength training
Which is the lie
C
What is cachexia?
metabolic syndrome related to underlying illness and characterized by muscle mass loss with or without fat mass loss that is often associated with anorexia, an inflammatory process, insulin resistance, and increased protein turnover
Can malnutrition, sarcopenia, frailty, and cachexia be present in weight loss
Malnutrition: yes
Sarcopenia: not necessarily
Frailty: yes
Cachexia: yes
What is the difference between sarcopenia and cachexia?
Sarcopenia and cachexia are both conditions characterized by muscle loss, but they have different underlying causes, mechanisms, and associated conditions.
1. Sarcopenia:
* Definition: Primarily refers to the loss of skeletal muscle mass and strength due to aging.
* Causes: Often related to aging, physical inactivity, and hormonal changes. It can also be influenced by poor nutrition and chronic diseases but is generally seen as a part of the natural aging process.
* Mechanism: Decline in muscle protein synthesis and an increase in muscle protein breakdown due to aging.
* Population Affected: Mostly affects older adults, especially those who are sedentary.
* Symptoms: Reduced muscle strength, decreased stamina, and increased risk of falls and fractures.
2. Cachexia:
* Definition: A complex syndrome involving severe muscle loss usually seen in people with chronic diseases.
* Causes: Commonly associated with chronic illnesses like cancer, heart failure, chronic kidney disease, or COPD. It results from an inflammatory response to these conditions.
* Mechanism: Involves an increased rate of muscle protein breakdown, often triggered by inflammation and catabolic signaling due to the underlying disease.
* Population Affected: Affects people of various ages who have chronic diseases, regardless of age.
* Symptoms: Rapid weight loss, fatigue, muscle wasting, and weakness, often seen in conjunction with other symptoms of the underlying disease.
Can malnutrition, sarcopenia, frailty, and cachexia be present in low BMI
malnutrition: yes
Sarcopenia: not necessarily
Frailty: yes
Cachexia: yes
Can malnutrition, sarcopenia, frailty, and cachexia be present in muscle loss/weakness
malnutrition: yes
Sarcopenia: yes
Frailty: yes
Cachexia: yes
Can malnutrition, sarcopenia, frailty, and cachexia be present in fat loss
malnutrition: not necessarily
Sarcopenia: not necessarily
Frailty: not necessarily
Cachexia: not necessarily
Can malnutrition, sarcopenia, frailty, and cachexia be present in inflammation
malnutrition: yes
Sarcopenia: not necessarily
Frailty: not necessarily
Cachexia: yes
Can malnutrition, sarcopenia, frailty, and cachexia be present in loss of appetite/nutrition impact symptoms
malnutrition: yes
Sarcopenia: N.A.
Frailty: not necessarily
Cachexia: yes
Can malnutrition, sarcopenia, frailty, and cachexia be present in low food intake
malnutrition: yes
Sarcopenia: N.A.
Frailty: sometimes
Cachexia: yes
Which is the lie
B
Which is the lie
A
Which is the lie
C
Which is the lie
A
List max HR for ages 60, 70, 80, 90
DO NOT USE (220 - age = HRmax) for geriatric patients because it UNDERESTIMATES capabilities
Use (0.7 x age = HRmax)
60: 166
70: 159
80: 152
90: 145
Which is the lie
B
(300-600 meters (~2000 ft) for community access
Give an example question to screen for floor transfer ability
How much difficulty in your daily routine do you think you have in getting down and up from the floor? (check the box that best applies to you.)
* I can perform the task by myself without using any support from a person or furniture.
* I can perform the task with some help or support from a person or furniture.
* I am unable to perform the task.
Label these gait patterns
1) iNPH gait
2) Normal gait
3) Parkinson’s gait
Give abnormal gait examples
1) “conservative” geriatric gait:
Step and stride length affected
Swing phase and double limb stance affected
Gait speed reduced
2) Pathology examples:
Osteoarthritis, CVA, TBI, NPH, Parkinson’s, CFH, COPD
Ex: a 75 year old female patient with Parkinson’s, falls, peripheral neuropathy, hypertension, pre diabetes, and obesity. Cancer survivor (endometrial, remission x 10 years). List the effects on activity
1) Abilities:
Moving around within home
Walking short distances
Sitting, rolling over, standing
Making decisions
Sustaining a conversation
2) limitations: (opposite of abilities)
Moving around outside home
Walking long distances
Maintaining standing position
Transferring oneself
Ex: a 75 year old female patient with Parkinson’s, falls, peripheral neuropathy, hypertension, pre diabetes, and obesity. Cancer survivor (endometrial, remission x 10 years). List the effects on participation
1) Abilities:
Religion and spirituality
Taking care of pets
2) Restrictions:
Recreation and leisure
Ex: a 75 year old female patient with Parkinson’s, falls, peripheral neuropathy, hypertension, pre diabetes, and obesity. Cancer survivor (endometrial, remission x 10 years). List the effects on body structures
mobility of joints
Muscle power functions
Tremor
Pain in back
Touch function
Proprioceptive function
Quality of voice
Ex: a 75 year old female patient with Parkinson’s, falls, peripheral neuropathy, hypertension, pre diabetes, and obesity. Cancer survivor (endometrial, remission x 10 years). List the effects on internal environment
(+)
Positive coping strategies
College education
(-)
Decreased balance confidence
Inconsistent motivation for exercise
Ex: a 75 year old female patient with Parkinson’s, falls, peripheral neuropathy, hypertension, pre diabetes, and obesity. Cancer survivor (endometrial, remission x 10 years). List the effects on external environment
(+)
Family support
Health insurance
Elevator available
(-)
Farm land uneven
Elevated home with 16 steps
Give examples of aging life roles
Work
Caregiver
Community member/leader
Grandparent
Describe the 4 Fs that can gauge an aging adults’ ability
fun: unrestricted participation in work, home, and leisure activities
Function: accomplishes activities with modification, adaptation, or self restriction
Frailty: basic activities of daily living (BADL). Assistance with IADL and community activities
Failure: assistance with IADL + BADL
Describe the mental health domain with its wellness dimensions
Mental health domain:
Emotional:
Sense of well-being and the ability to cope effectively with life’s “ups and downs”
Spiritual:
Aspect of life that provides meaning and direction that connects to something greater than one’s self
Intellectual:
Ability to learn and use information effectively and to reason and use self-efficacy in wellness endeavors
Describe the physical health domain with its wellness dimensions
physical health domain:
Physical wellness dimension:
Physical functioning to the degree that allows one to perform roles in family and society
Describe the social health domain with its wellness dimensions
social health domain:
Social:
Meaningful relationships and presence of a social support structure
vocational:
Occupational/ Purpose in life, a reason to get up in the morning
What are some example questions to gauge the patient’s health domains?
Give examples on some exercise screening questions
What are some fall screening questions?
1) Do you feel unsteady when standing or walking?
2) Do you worry about falling?
3) Have you experienced a fall in the past year? How many times? Were you injured?
What is a fall?
A clinical definition: “An event which results in a person coming to rest inadvertently on the ground or floor or at another lower level.”
Aging adult perspective:
* “It’s scary. You are fine and then all of a sudden you are on the ground.”
* “Oh my. A person loses balance and cannon remain upright. Causes include accidents, poor observation of surroundings, organic dizziness, and intoxication.”
* “A fall means fear of breaking something and having difficulty (if not impossible) doing needed life skills.”
How do you assess gait speed?
1) various distances can be used (3m, 4m, 10m)
2) compare usual vs fast (functional reserve)
3) Normal comfortable (usual) = 1.2 - 1.4 m/s
4) Meaningful changes = 0.1 m/s
What is gait speed associated with?
higher risk of bad outcomes like falls, hospitalization, discharge to nursing home, ADL dependence
When is intervention for fall risk indicated by gait?
When Gait speed is equal to or less than 1.0 m/s
Give some examples of pragmatic interview questions
