Week 11- Geriatrics 2 Flashcards
True or false: Older adults consume a disproportionately large number of medications relative to younger people
True
The excessive or inappropriate use of medications
Polypharmacy
Adults over age 65 purchase over ____% of all prescription medications
30%
Older adults are more likely to experience _________
Adverse drug reactions (ADR’s)
Half of older people take at least _______ unnecessary drug
One
Average older adult takes _____ medications
5
Average nursing home resident takes _____ medications
7
Characteristics of polypharmacy in older adults
-Use of medications for no apparent reason
-Use of duplicate medications
-Concurrent use of interacting medications
-Use of contraindicated medications
-Use of inappropriate dosage
-Use of therapy to treat adverse drug reactions
Affects of aging on absorption
-Decreased gastric acid
-Decreased stomach emptying
-Decreased gastric motility
Affects of aging on distribution
-Decreased body H2O
-Increased body fat
-Decreased plasma proteins
-Decreased lean body mass
Affects of aging on metabolism
-Decreased liver mass
-Decreased blood flow to liver
-Decreased enzyme activity
Affects of aging on excretion
-Decreased kidney mass
-Decreased blood flow to kidneys
-Decreased nephron function
Medications most commonly overprescribed
-Laxatives
-BP meds
-Diuretics
-DM meds
Common side effects
-GI symptoms
-Sedation
-Confusion
-Depression
-Orthostatic hypotension
-Fatigue/weakness
Drug that causes GI symptoms
NSAIDS
Drug that causes sedation
Opioids
Drug that causes confusion
-Antidepressants
-Analgesics
-Lithium
Drug that causes depression
-Barbiturates, antihypertensives
Drug that causes orthostatic hypotension
-Antihypertensives
Drug that causes fatigue/weakness
-Diuretics
-Glucocorticoids
When reviewing a patient’s medication list, you should…
-Look for any possible adverse drug reactions
-Does their medication list make sense with their comorbidities?
-Think about how medications with affect PT
-Provide patient education
____% of people over age 65 reported at last one fall in a year
29
True or false: Medical treatment for falls costs less than $50 billion each year
False
(costs more)
True or false: Falls can occur with or without injury
True
True or false: Falls are the leading cause of death or hospitalization from injury in older adults
True
Falls are associated with…
-Pain
-Loss of confidence
-Functional decline
-Institutionalization
Risk factors of falls
-Prior falling
-Age over 65
-Polypharmacy
-Fear of falling
-Use of an assistive device
-CVA or neuro diagnosis
-Recent hospitalization
-Impaired balance, gait
-Incontinence
-Poor sensation
-LE weakness (STS: must use hands)
-Depression or anxiety
-Pain
-Frailty
-Foot problems
-Difficulty with ADLs
-Orthostatic hypotension
-Cog impairment
-Certain medications (benzodiazepine, diuretics, sedatives)
Environmental risk factors for falls
-Slippery/uneven surfaces
-Rugs
-Poor lighting
-Obstacles in path (ex: cords, clutter)
-Lack of grab bars or handrails
-Poorly arranged furniture
This is also known as the 6th vital sign
Gait speed
Gait speed is correlated with multiple outcomes such as…
-Re hospitalization
-ADL performance
-Number of medications
-Depressive symptoms
-Discharge location from hospital
-History of multiple falls
Cut off for community ambulation is ____ m/s
0.8
Cut off speed for fall risk
1 m/s
Interventions for fall prevention
-Balance training
-Cardiovascular endurance training
-Assistive Device Training
-Home environment modification
Balance training consists of training…
Somatosensory, vestibular, and visual systems
Aspects of balance training
-Dynamic and static balance training
-Lower extremity strengthening and endurance training
-Coordination
-Flexibility and ROM
The Sharpened Romberg is this type of test
Balance
The TUG is a screening for __________ and is this type of test
-Fall risk
-Functional
The BERG is this type of test
Balance
5xSTS is this type of test
Functional
Cut offs for fall risk:
TUG- ______
5xSTS - ______
BERG - ______
TUG - 13.5s (greater than 8.5s indicated high risk of falls in community dwelling adults)
5xSTS- 11.4s
BERG- 45/56
A mental or physical impairment that limits major activities in one or more ways
Disability
Types of disabilities
-Ambulation
-Cognitive
-Visual
-Hearing
-Medical
-Age 65 or older OR people with disabilities
-Part A: IP, SNF, HH, Hospice
-Part B: OP, DME
Medicare
-Low income
-Pregnant or responsible for a minor
-People with disabilities
Medicaid
Ambulation distance for independent living/community
400m
Gait speed for independent living/community
1.2 m/s
Carrying object requirement for independent living/community
One gallon of milk is around 8 lbs
True or false: You do not have to be able to ambulate on variable terrains
False
(ex: carpet, grass, uneven surfaces)
True or false: You must be able to encounter obstacles (ex: stairs, curbs, doors, elevators) in independent living/community
True
Other requirements for independent living/community include…
-Postural transitions
-Head orientation
-Stop/start
-Backing up
-Side stepping
PT setting:
-3 hours of therapy per day (PT, OT, SLP)
-High prior level of function
-Not safe to go home
-Moderate complexity of medical needs
Inpatient rehab
PT setting:
-Unable to participate in 3 hours of PT per day
-Moderate functional prognosis
-Variable prior level of function
Skilled Nursing Facility
PT setting:
-High prior level of function
-Stable complexity of medical needs
-Must be able to travel through community to OP facility
Outpatient
PT setting:
-Limited ambulation for community
-Safe to go home
-Good functional prognosis
Home health
PT setting:
-High complexity of medical needs
-Poorer prognosis
-Less need for skilled therapy
Long term acute care
PT setting:
-Typically for patients with chronic and serious illnesses
-Aims to treat pain and suffering
-Addresses psychological, social, and spiritual problems
Palliative care
PT setting:
-End of life care (terminal illnesses)
-Expectation: 6 months or less to live
-Aims to manage pain and other symptoms
-Can take place at home or a facility
Hospice
Allows individuals to identify their preferences for care when they are unable to do so themselves
Advanced care directives
General indication of preferences, recommended for all adults
Living wills
Do not resuscitate
DNR
Medical/Physician orders for life sustaining treatment
MOLST/POLST
Appoints an individual to make decisions on one’s behalf
Power Attorney
__________ is the most powerful intervention for maintaining well-being
Exercise
True or false: Some exercise is better than nothing
True
Ways to help patients exercise:
-Make it attainable for the patient
-Encourage them to meet their goals
-Consider family support and what is available in their community
-Make it something that patients can do on their own eventually
Types PT interventions for geriatrics
-Group exercise
-Resistance exercise
-Aquatic exercise
-Balance training
-Power
Added benefit of socialization, supervision, and peer support
Group exercise
Resistance exercise is important because adults lose as much as ____% of their strength between 60-90
40
Good option for aerobic and strength training for patients who cannot tolerate weight bearing on land
Aquatic exercise
Training that reduces fall risk
Balance training
__________ is a better indicator than strength for functional activities such as stair climbing, sit to stands, and gait
Power training
Power training for beginners
Frequency: 1-2 days
Loading: Low; low-to-moderate; moderate
Volume (sets): 1-2
Rest intervals: 60-120
Power training for trained
Frequency: 3 or more days
Loading: Low; low-to-moderate; moderate; high
Volume (sets): 3 or more
Low loading
20% of RPE
Moderate loading
50% of RPE
High loading
80% of RPE
True or false: Underdosing of osteoporosis is a problem
True
__________ exercises are important when combating osteoporosis
Loading
True or false: If a patient as osteoporosis, they must strengthen bones in a safe environment
True
PT interventions for patients with loss of visual acuity
-Use large print books and computer software
-Color: use bright, warm colors, avoid pastels, avoid monotones
-Depth perception: avoid patterned floor surfaces, use warm colors to highlight handrails and steps
-Contrast: use bright details on dark backgrounds
PT interventions for patients with hearing loss
-Minimize background music
-Say the person’s name before beginning the conversation
-Try rephrasing if repeating is not effective
PT interventions for patients with loss of taste/smell
Use additional spices and colors to enhance food
PT interventions for patients with environment problems
Avoid temperature extremes from air conditioning or heating
