Week 11- Geriatrics 2 Flashcards by Amber Zimmer

True or false: Older adults consume a disproportionately large number of medications relative to younger people

True

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The excessive or inappropriate use of medications

Polypharmacy

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Adults over age 65 purchase over ____% of all prescription medications

30%

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Older adults are more likely to experience _________

Adverse drug reactions (ADR’s)

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Half of older people take at least _______ unnecessary drug

One

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Average older adult takes _____ medications

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Average nursing home resident takes _____ medications

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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

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Affects of aging on absorption

-Decreased gastric acid
-Decreased stomach emptying
-Decreased gastric motility

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Affects of aging on distribution

-Decreased body H2O
-Increased body fat
-Decreased plasma proteins
-Decreased lean body mass

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Affects of aging on metabolism

-Decreased liver mass
-Decreased blood flow to liver
-Decreased enzyme activity

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Affects of aging on excretion

-Decreased kidney mass
-Decreased blood flow to kidneys
-Decreased nephron function

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Medications most commonly overprescribed

-Laxatives
-BP meds
-Diuretics
-DM meds

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Common side effects

-GI symptoms
-Sedation
-Confusion
-Depression
-Orthostatic hypotension
-Fatigue/weakness

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Drug that causes GI symptoms

NSAIDS

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Drug that causes sedation

Opioids

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Drug that causes confusion

-Antidepressants
-Analgesics
-Lithium

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Drug that causes depression

-Barbiturates, antihypertensives

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Drug that causes orthostatic hypotension

-Antihypertensives

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Drug that causes fatigue/weakness

-Diuretics
-Glucocorticoids

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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

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____% of people over age 65 reported at last one fall in a year

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True or false: Medical treatment for falls costs less than $50 billion each year

False

(costs more)

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True or false: Falls can occur with or without injury

True

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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

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

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