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Aging adult > Week 2 module 2 > Flashcards

Week 2 module 2 Flashcards

1
Q

What is the normal physiology of cognitive changes?

A

Loss of synaptic connections
• Creates memory impairment (slowed but intact)
• Evidence of mild decline in executive functioning

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2
Q

What is the pathological physiology of cognitive changes?

A
  • Certain growth factors in brain are inhibited
  • Death and loss of neurons
  • Dementia
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3
Q

What is the continuum of cognitive changes?

A

Normal Aging –> Mild Impairment –> Dementia

Not everyone follows the continuum

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4
Q

What are the most common types of dementia?

A
  • Alzheimer’s Disease
  • Vascular
  • Lewy Body
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5
Q

What does dementia commonly affect?

A

Commonly affect memory and language

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6
Q

What are the other cognitive deficits seen with dementia?

A
  • Aphasia
  • Apraxia
  • Disturbance of executive function
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7
Q

___ is the most common form of dementia

A

Alzheimer’s Disease is the most common form of dementia

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8
Q

What are the characteristics of Alzheimer’s Disease?

A
  • Early onset (30-60 years of age)

* Late onset

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9
Q

What are the risk factors for Alzheimer’s Disease?

A
  • Advancing age
  • Positive family history
  • Women > Men
  • > African American and Hispanic populations
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10
Q

What are the clinical presentation for Alzheimer’s Disease?

A
  • Memory impairment
  • Lapse in judgment
  • Personality changes
  • Depression possible
  • Language problems
  • Difficulty with ADLs
  • Visual spatial problems
  • Short tempered, hostile
  • Loss of motor function (swallowing, bowel/bladder)
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11
Q

___ is the second most common type of dementia

A

Vascular Dementia is the second most common type of dementia

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12
Q

What are the risk factors for Vascular Dementia?

A
  • HTN
  • Smoking
  • Hypercholesteremia
  • Diabetes mellitus
  • Cardiovascular disease
  • Cerebrovascular disease
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13
Q

What are the clinical presentation for Vascular Dementia?

A

• Memory
• Abstract thinking
• Judgement
• Impulse control
• Personality changes
• Characterized more by abrupt onset, step by step
deterioration, fluctuating course, and emotional lability

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14
Q

What is lewy body dementia?

A 
Progressive cognitive decline with
1. Fluctuations in alertness and attention
• May be drowsy or lethargic
2. Visual hallucinations
3. Parkinsonian motor symptoms
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15
Q

What are the clinical presentation for lewy body dementia?

A
  • Gait and balance issues
  • Visual spatial issues
  • Poor executive functioning
  • Sensitivity to antipsychotics
  • May be depressed
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16
Q

What is delirium?

A

Sudden, rapid change in mental function
• Often confused with Dementia
• Usually short term, temporary

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17
Q

What is delirium associated?

A
  • Medical illness
  • Recovery from surgery
  • Hospital admission
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18
Q

What are the clinical presentation for delirium?

A
  • Shouting and resisting
  • Refusal to cooperate with medical care
  • Potential to be injured falling
  • Combative
  • Pulling of lines and tubes
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19
Q

What does the treatment of delirium focus on?

A
  • Increased time OOB
  • Walking
  • Managing hydration
  • Hypoxia
  • Nutrition
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20
Q

What is a major depressive episode?

A

Depressed mood or loss of pleasure in all activities

AND at least 5 associated symptoms for at least 2 weeks that impact function, social, or occupational endeavors

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21
Q

What are the associated symptoms of major depressive episode?

A
  • Weight loss
  • Insomnia
  • Hypersomnia
  • Decreased or hyperactive motor activity
  • Fatigue
  • Loss of energy
  • Feelings of worthlessness
  • Excessive inappropriate
    guilt
  • Diminished ability to think or concentrate
  • Recurrent thoughts of death
  • Suicide ideation or attempt
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22
Q

What is an adjustment disorder with depressed mood?

A

Maladaptive reactions to identifiable psychosocial

stressors that occur within 3 months of onset of stressors

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23
Q

What does adjustment disorder with depressed mood do?

A

Impairs social or occupational function or marked

distressed in excess of normal or expected reaction.

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24
Q

What are the symptoms of adjustment disorder with depressed mood?

A
  • Depressed mood
  • Tearfulness
  • Feelings of hopelessness
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25
Q

What are the characteristics of the Two Question Depression Test?

A

• “Over the past two weeks, have you ever felt down,
depressed, or hopeless?”
• “Have you felt little interest or pleasure in doing things?”

An answer of yes to these two questions indicates a need for referral or follow up with MD

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26
Q

What are the characteristics of the Geriatric Depression Scale?

A

30 questions, yes (1 point), no (0 point)
• Score greater than 10, need referral or follow up
• 0-9 normal, 10-19 mild depressive, 20-30 severe depressive

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27
Q

What are the characteristics of the Center for Epidemiological Studies Depression Scale (CES-D)?

A
  • 20 questions
  • Likert scale questions > 16 points may need referral
  • The higher the number the more likely depression is an issue
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28
Q

Why is addressing depression in the aging population important?

A

• Suicide is more prevalent in the aging population (16%) than in the teenage population (14%)
• Highest suicide rates are in the greater than 65 year of age
group
• Aging adults may have been born and raised to feel that mental illness is stigmatized and emotions should not be emphasized, making them less likely to talk about it or seek help

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29
Q

What are the physical illness that aging adults may face that can increase the risk of depression?

A
  • Restricted mobility
  • Assistance with self care
  • Dependency
  • Feeling burdensome
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30
Q

What are the characteristics of depression and the older adult?

A
  • Depression can lead to further reduction in functional capacity
  • Depression can increase the risk of developing new illnesses
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31
Q

What are the different ways of managing depression?

A
  • Pharmacotherapy (SSRIs, TCAs, etc.)
  • Psychotherapy
  • Exercise and Physical Activity
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32
Q

What are the characteristics of pharmacotherapy as a method of managing depression?

A

Be aware that patient on Tricyclic or Tetracyclic Antidepressants (Amitril, Elavil, Aventyl, Pamelor), may experience hypotensive side effects.

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33
Q

What are the characteristics of psychotherapy as a method of managing depression?

A

Aging adults are less likely to seek this option, and health

professionals also often demonstrate ageism with these patients

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34
Q

What are the characteristics of exercise and physical activity as a method of managing depression?

A
  • Reduces depressive symptoms

* Improves function

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35
Q

What are the characteristics of PT with the depressed aging adult?

A

• Timeline may need to be longer to accomplish goals
• May need to focus on ADL training as these tasks require more energy and may be more difficult for the patient
• Matter of fact approach is better than overly cheerful approach
• Discourage negative self perception and emphasize
achievement
• Demonstrate a genuine and respectful regard for the patient
• Realize, these patients aren’t “fun” at times because they
appear unmotivated, but they aren’t lazy. It just takes a lot of
energy to accomplish simple tasks

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36
Q

Many CVP changes common in aging adults are due to _____

A

Many CVP changes common in aging adults are due to modifiable factors, not necessarily aging!

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37
Q

What does aging do to the cardiopulmonary and cardiovascular system?

A

Aging changes the resiliency of the system to adapt to previously silent abnormalities/latent disease or respond to system insults

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38
Q

___ is a major cause of death in > 65

A

Cardiovascular disease is a major cause of death in > 65

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39
Q

What are the morphological and structural changes that happens to the thorax due to normal aging?

A

• Calcification of bronchial and costal cartilage
• ↑stiffness of costovertebral joints
• ↑anteroposterior diameter
• ↑wasting of respiratory muscles (diaphragm and
intercostals)
• Structural changes in thoracic cage and spine

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40
Q

What is the functional significance of the morphological and structural changes that happens to the thorax due to normal aging?

A
  • ↑resistance to chest wall deformation
  • ↓forced expiratory volume (FEV1)
  • ↓forced vital capacity (FVC)
  • ↓cough force
  • ↑aspiration or choking risk
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41
Q

What are the morphological and structural changes that happens to the lungs due to normal aging?

A
  • ↑size alveolar ducts/↑alveoli size
  • ↑alveolar compliance
  • ↑mucous glands/↓mucous clearance
  • ↑stiffness of pulmonary vasculature
  • ↓bronchial smooth muscle integrity
  • ↓lung elasticity
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42
Q

What is the functional significance of the morphological and structural changes that happens to the lungs due to normal aging?

A
  • impaired gas exchange
  • air trapping
  • ↓inspiratory /↓expiratory reserve volumes
  • ↑resistance to airflow in small airways
  • ↓pulmonary artery pressure
  • ↓pulmonary capillary network
  • ↓mucous clearance
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43
Q

What are the morphological and structural changes that happens to the other cardiopulmonary organs due to normal aging?

A
  • ↓autonomic control
  • ↓muscular ATP reserves
  • ↓immune function
  • ↓protective reflexes (i.e., gag & cough)
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44
Q

What is the functional significance of the morphological and structural changes that happens to the other cardiopulmonary organs due to normal aging?

A
  • ↓responsiveness to hypoxia and hypercapnia
  • ↑possibility respiratory fatigue & failure
  • Predisposition to pneumonia and other resp. disease
  • ↑aspiration risk
45
Q

What are the physiologic and cellular changes that happens to the heart due to normal aging?

A
  • ↑fat and fibrous constituents
  • ↑mass and volume/wall thickening
  • ↑lipofuscin and amyloid content
  • ↑connective tissue & elastin
  • ↑calcification
  • ↓specialized nerve conduction tissue (ie, SA node)
  • ↑intrinsic and extrinsic innervation (ectopic pacer)
46
Q

What is the functional significance of the physiologic and cellular changes that happens to the heart due to normal aging?

A
  • ↓excitability
  • ↓max cardiac output (25-30%)
  • ↓venous return
  • ↑cardiac dysrhythmias
  • ↑risk of myocardial ischemia/infarction
  • ↓ in max heart rate
  • No change in resting HR
47
Q

What are the physiologic and cellular changes that happens to the blood vessels due to normal aging?

A

• ↑loss of normal proportion of smooth muscle to
connective tissue and elastin constituents
• ↑rigidity of larger arteries
• ↑calcification
• ↑dilation and tortuosity of veins
• ↓repair systems for vessels
• accumulated deposition of fatty deposits

48
Q

What is the functional significance of the physiologic and cellular changes that happens to the blood vessels due to normal aging?

A 
• ↓blood flow to oxygenate tissue
• ↑risk of clots in venous circulation
• ↓cardiac output
• ↓venous return
• ↑ risk myocardial ischemia/infarction (from
coronary vessels) & peripherally ↑ CVA, PVD, renal
failure
• ↑resting BP
49
Q

What are the morphological and structural changes that happens to the blood due to normal aging?

A
  • Normal aging ↓ total body water
  • ↓ speed of red blood cell production
  • ↓ neutrophils
50
Q

What is the functional significance of the morphological and structural changes that happens to the blood due to normal aging?

A
  • ↓ blood volume
  • ↓response to blood loss and anemia
  • ↓immune response/infection resistance
51
Q

What are the morphological and structural changes that happens to combined effects/other cardiovascular organs due to normal aging?

A
  • ↓ baroreceptor sensitivity

* ↓ max HR → ↓ cardiac output → ↓ tissue oxygenation

52
Q

What is the functional significance of the morphological and structural changes that happens to the combined effects/other cardiovascular organs due to normal aging?

A
  • ↑incidence of hypertension (BP control for 60+ recommended <150 SBP & <90 DBP)
  • Progressive ↓ in VO2 max beginning between ages 20-30 and ↓ by 10%/decade
53
Q

What are the characteristics of exercise capacity and normal aging?

A

• Aerobic capacity decreases with age (approx. 1%/year)
- ↓size and # of mitochondria
- ↓ capillary/fiber ratio (↓ blood flow)
- Work capacity ↓ 20-30%
• ↓ O2 uptake– ability to extract & utilize O2 on cellular level
• ↓ capacity for O2 transport
• Sedentary individuals have a two-fold ↓ in VO2 max!

Other factors:
• ↓ in skeletal muscle mass
• Lack of submax activity d/t ↓ cardiac output, ↓ age-assoc. loss in max HR, ↓ stroke volume, & O2 transport/utliization

54
Q

What are the impact of exercise in age related changes?

A

• Habitual physical activity
–>increased cardiorespiratory fitness for individuals of all ages
• ↓cardiorespiratory fitness
–>↑risk of mortality
• CV dysfunction attributed to the aging process closely mimics the ↓ in cardiac function seen w/inactivity
• Despite normal physiologic changes w/aging, positive cardiovascular changes occur the same w/exercise in older healthy individuals as with younger
• And even in the presence of disease, older individuals who have experienced MI, heart failure, restrictive/obstructive pulmonary disease can have improvement with exercise
• BUT inadequate physical activity responsible for 30% of deaths d/t heart disease and other systemic diseases

55
Q

What are some cardiopulmonary/vascular
conditions that may be more prevalent with aging and also complicate the issues
associated w/normal aging changes?

A 
• Pneumonia
  - Community-acquired
  - Aspiration
  - HAC
• COPD
• Asthma &amp; other restrictive
lung diseases
• Stroke
• Hypertension
• Heart failure
• Ischemic heart disease (angina, CAD, MI)
• Lung CA
• Peripheral vascular disease
• Conduction system disease
56
Q

What are the characteristics of orthostatic hypotension in the aging adult?

A 
Very common among aging adults
• Decrease in autonomic regulation of BP
• Combined w/physiological issues contributing to hypovolemia such as GI bleed,
diarrhea, dehydration
• Combined w/ common meds like antihypertensives, antipsychotics,
antiparkinsonian
• Increased inactivity among population
• Contributes to high fall risk!
57
Q

What are the interventions for orthostatic hypotension in the aging adults?

A
  • Ankle pumps/marching/hand clenching prior to standing
  • Counting to 5 before walking away from chair
  • Slow positional change
  • Pressure stockings
58
Q

What are the age related genito-urinary changes seen in women?

A

• Vaginal delivery-related changes to support structures of urethra & pelvic organs
• ↓estrogen causes changes in lower urinary tract
• ↓arterial flow to vagina→ thinning of vaginal mucosa & perineal skin breakdown → weakened connective tissue structures supporting bladder neck
• ↓arterial blood flow to submucosal vasculature & ↓ striated muscle fibers →
↓ urethral closure pressure (contributes to more frequent urinary tract infections)

59
Q

What are the age related genito-urinary changes seen in men?

A

During middle age, prostate enlarges (benign prostatic hypertrophy or BPH) → growth of prostatic tissue encroaches on the prostatic urethra

60
Q

What are the age related genito-urinary changes seen in both sexes?

A

• ↓Bladder sensation
• ↓detrusor contraction strength → ↓urine flow rate (“appears” to be ↓ bladder capacity, which actually doesn’t change)
• ↑post-void residual volume
• Circadian rhythm changes
- ↓ diuretic hormone vasopressin → nocturia
• Other renal system changes
- Loss of renal mass/functional glomeruli
- ↓renal blood flow/glomerular filtration rate
- Leads to ↑ sensitivity to fluid & electrolyte imbalance and ↓ drug elimination

61
Q

What us urinary incontinence?

A

Involuntary leakage of urine

62
Q

What does continence requires?

A

Neural coordination between bladder, urethra, and pelvic floor muscles (PFMs)

63
Q

What are the different types of urinary incontinence?

A
  • Stress UI
  • Urge UI
  • Overflow UI
  • Functional UI
  • Mixed UI
64
Q

What is a stress urinary incontinence?

A

Incontinence that occurs with effort or exertion; cough,

sneeze, lifting activity, Valsalva

65
Q

What are the risk factors for a stress urinary incontinence?

A 
• Childbirth (less of factor after
age 60)
• Aging changes in
muscle/connective tissues
(greater factor after age 60)
• Estrogen loss (females)
• Radical prostatectomy (males)
• Caucasian
• Family history
• Obesity
• Smoking
• Chronic cough or respiratory
disease
• Pelvic surgery
• Chronic constipation
• Neurologic disorders
66
Q

What is an urge urinary incontinence?

A

A strong desire to pass urine which is difficult to defer without involuntary leakage (i.e., can’t get to the toilet in time)

67
Q

What are the risk factors for an urge urinary incontinence?

A 
• Low bladder compliance
• Detrusor over-activity –
involuntary bladder contractions
  - Assoc. w/ neuro conditions
  - Pelvic organ prolapse (females) w/urethral obstruction
• Benign or malignant prostatic
enlargement (males)
• Advancing age
• Smoking
• Hysterectomy
• Arthritis
• Impaired mobility
68
Q

What is an overflow urinary incontinence?

A

• Bladder overly distended causing bladder
pressure > urethral pressure
• From loss of bladder sphincter after surgery or injury

69
Q

What is a functional urinary incontinence?

A
  • Have normal bladder/urethral function, but have difficulty getting to toilet before urination occurs
  • Common with impaired mobility or cognitive issues
70
Q

What are the reversible causes of urinary Incontinence?

A

DIAPPERS
• Delirium or other altered mental status
• Infection, urinary tract, symptomatic
• Atrophic urethritis or vaginitis
• Pharmaceuticals
• Psychological disorders (esp. depression)
• Endocrine disorders (hyperglycemia or hypercalcemia)
• Restriction mobility
• Stool impaction

71
Q

What are the questions to ask when screening for an urinary incontinence?

A
  • Do you leak urine with laughing, coughing, sneezing, lifting, or exercise?
  • Do you leak urine on the way to the bathroom?
  • Do you have to strain to empty your bladder?
  • Do you feel that your bladder is still not empty after you void?

A yes to any of these questions should result in referral to PCP
or specialist for evaluation

72
Q

What are the questions for medical screening for urinary incontinence that if answered yes to might be indicative of a red flag and what are their affiliating possible medical concern?

A
  • Was there a sudden onset of incontinence (infection)
  • Did leaking occur after surgery or with a medication change? (incontinence as unexpected side effect of surgery or surgical medication)
  • Is there burning/blood with urine/stool? (infection)
  • Is there a change in vaginal discharge? odor? (infection, atrophic vaginitis)
  • Is there difficulty initiating the stream? (acute urinary retention)
  • Are there moderate/large amounts of incontinence without warning? (diabetes, heart failure, venous insufficiency, hypercalcemia, hyperglycemia)
73
Q

What are the interventions for bowel incontinence?

A
  • Referral to specialist
  • Dietary management (i.e., increasing fluid and fiber intake)
  • Toileting schedule
  • Neuromuscular re-education/biofeedback
  • Pelvic floor exercises
74
Q

What is bowel incontinence?

A

Involuntary loss of stool through the anus severe enough to cause hygienic or social problems

75
Q

What are the causes of bowel incontinence?

A

• Age-related loss of strength and changes in tissue elasticity ↓ anal resting tone (esp. women)
• Loss of anal sensation
• Fecal impaction
• Loss of normal continence mechanism
- Local neuronal damage (eg, pudendal nerve)
- Impaired neurological control
- Anorectal trauma/sphincter disruption
• Psychological and behavioral problems (severe depression, dementia)
• Neoplasms (rare)

76
Q

What are the medication side effects impacting incontinence?

A 
• Reduce urethral pressure
  - Antihypertensives
  - Neuroleptics
  - Benzodiazepines
• Impact full bladder emptying
  - Anticholinergics
  - Beta blockers
• Meds that cause constipation
77
Q

Is reducing fluid intake a good way to avoid urinary incontinence?

A

No, it can lead to constipation from dehydration or UTI and further aggravate UI

78
Q

What are the clinical symptoms or a UTI?

A
  • Unilateral costovertebral tenderness
  • Flank pain
  • Ipsilateral shoulder pain
  • Fever and chills
  • Skin hypersensitivity (hyperesthesia of dermatomes)
  • Hematuria (RBCs in urine)
  • Pyuria (pus or white blood cells in urine)
  • Bacteriuria
  • Nocturia
79
Q

What are the PT interventions for urinary incontinence?

A 
Typically focus on PFM exercises
 • Quick contractions
 • Sustained contractions
 • Contractions during functional activity
Biofeedback
 • Surface EMG (internal)
 • Palpation
Electrical Stim
 • Lacks evidence
80
Q

What are some other intervention strategies for treating urinary incontinence?

A

Bladder training (Urge UI)
• Gradual increase in time intervals between voids
- Distraction
- Deep breathing to relax
- PFM contractions to inhibit bladder contractions
• Goal is to delay voiding to every 3-4 hours
Lifestyle
• Weight loss
• Reduction in caffeine consumption
• Medications for urge UI (none for stress UI)
- Anticholinergic drugs

81
Q

What is sexuality?

A

Way we think about ourselves as sexual beings and the corresponding gender
roles/behaviors, intimacy needs, ideas about reproduction, & feelings of pleasure and excitement associated w/sex.
• Entire range of sexual behaviors including the decision to be celibate

82
Q

What are some age-associated changes affecting sexuality?

A

• General normal age-related changes
• Medical issues and surgeries common w/aging
• Cognitive issues
- Depression: decreased libido cardinal symptom
- Dementia: ranges from hyperarousal/inappropriate demands to withdrawal
• Medications treating common medical conditions impair sexual function
- Antianxiety meds: change libido, erection problems, delayed orgasm
- Antidepressants: changes in libido, delayed orgasm
- Antihypertensives: erectile dysfunction, decreased libido
- Ulcer medications: decreased libido, erectile dysfunction

83
Q

What are some age-associated changes affecting men’s sexuality?

A
  • ↓ testosterone levels→ delayed and less firm erection, more stimulation to attain erection/orgasm
  • Shorter ejaculation time
  • Rapid loss of erection
  • ↑ refractory period between ejaculations (12-48 hrs)
  • NOT synonymous with erectile dysfunction (ED)
84
Q

What are some age-associated changes affecting women’s sexuality?

A
  • ↓ estrogen levels → delayed/decreased vaginal lubrication
  • ↓ extensibility of vaginal tissue
  • ↑ refractory period between orgasms and ↓ orgasmic contractions
  • Bladder and urethra may become irritated during intercourse
85
Q

What are the sexuality implications for healthcare professionals?

A

• Serve as advocates representing the rights of older adult consensual sexual activity, provide privacy, and promote dignity
• Assess sexual concerns in the context of addressing functional limitations and general healthcare issues
• Ethical considerations
- Recognize out of scope areas, and refer appropriately
- Be aware of abusive situations, and protect those who cannot consent
- As a practitioner, boundaries equally important with those patients who may make inappropriate sexual remarks or advances

86
Q

What are the normal integumentary changes seen with aging?

A

• Thin, less elastic skin
- Thinner dermis
- Decreased dermal vascularity
- Flattening of rete pegs
- Decreased Fibroblasts
- Loss of sub-q fat
• Decreased:
- Langerhans – 50% by age 80 (altered immunity)
- Melanocytes - 8-20% every 10 yrs after age 30
• Blood vessels become thinner/fragile
• Decreased oil/sweat gland activity
• Impaired skin barrier & more susceptible to shearing &
separation of skin layers
• Further exacerbated by meds, nutrition, organ failure, disease
(DM), vascular compromise, poor nutrition, etc.

87
Q

What are the normal integumentary changes seen with aging as it relates to nerve function?

A
  • Decreased ability to thermo-regulate

* Increased pain threshold

88
Q

What are the general prevention methods for integumentary compromise?

A 
• Nutrition &amp; hydration
  - Decreases risk for integ (systemic) issues
• Environment
  - ~40% humidity
• Control of comorbidities
  - Glycemic control, etc.
• Skin care
  - Moisturize
89
Q

What are the bathing methods for integumentary compromise?

A 
• Avoid bar soaps
  - Gentle, moisturizing liquid soap
• Soft cloths, cooler water temps
• Moisturize after bathing
  - w/n 3 min to trap moisture
  - No fragrance (Eucerin, Vaseline, etc.)
• Don’t over bathe
  - 10 min daily or twice per wk
90
Q

What is a skin tear?

A

A wound caused by shear, friction, and/or blunt force
resulting in separation of skin layers (ISTAP)

  • Can be partial thickness or full thickness
  • In those at “extremes of age”, critically/chronically ill
  • older adults, neonate/pedi
91
Q

What is an ISTAP?

A

Skin Tear Tool Kit

92
Q

Skin tears occur with…?

A
  • Turning/lifting/transfers/falls
  • Sliding down in bed w/raised HOB
  • Blunt trauma/WC injuries (leg rests)
  • ~80% on UE & hands
93
Q

What are the different appearances that a skin tear may have?

A
  • Linear shape, sheared epidermis
  • Flap of epidermis covering dermis
  • Typically serous drainage, may be bloody
94
Q

What are the ways to treat a skin tear?

A 
• Approximate attached edges if possible
  - Realign skin flap
• Non-adherent dressings
  - Foam, calcium alginate, adaptic, telfa, “safetac” dressings,
hydrogel, etc.
  - Hydrocolloid/film
      - Risk of further skin damage upon removal
      - ISTAP – “are not recommended”
• Protect peri-wound
95
Q

What are some additional factors that are important to assess and consider when evaluating an aging adult?

A
  • Multi-system and multi-factorial involvement
  • Functional status
  • Support systems

This is in addition to evaluating the condition bringing the aging adult into physical therapy

96
Q

When assessing an older adult, we want to look beyond the reason for referral and do what additional things?

A
  • Screen for falls and risk factors for other conditions (DM, Osteoporosis, etc) & make appropriate referrals
  • Identify characteristics of frailty, depression, abuse/neglect, geriatric syndromes & make proper referrals
  • Plan for sustainable outcomes and increase in safe physical activity/participation through education and exercise prescription
  • Ascertain the role of social support in the older adult’s condition or limitation
  • Consider the older adult’s health literacy and education contribution to his or her condition or limitation
97
Q

A disability reflects the sum of interactions between…?

A
  • Health condition
  • Environment
  • Personal factors
  • Impairments
  • Activity limitations
  • Participation restrictions
98
Q

When assessing history, the key history questions should target areas like…?

A
  • Polypharmacy
  • Basic ADL assistance
  • Physical activity
  • Fear of falling and imbalance
  • AD use
  • Home environment
  • Vision
  • Cardiovascular
  • Continence
  • Pain
  • Depression
  • Skin
99
Q

What are the questions to ask when doing the home assessment of a patient?

A

• Is this environment functional for the patient at his current level of mobility?
• What recommendations would make the environment functional or help the pt achieve function required to live in home?
• Understanding the bigger picture of the patient’s mobility, needs, medical issues, social
support, and ultimately SAFETY!

100
Q

What are some questions to ask when discerning if a patient’s presentation is as a result of aging, a pathology, or both?

A

• What is the onset and trajectory of the problem?
• Does it fit the pattern of normal aging or pathology?
- Weakness
- Balance deficits
- Memory loss
• How are co-morbidities impacting the problem?
• How are medications impacting the problem?
• What are the psychosocial components of the problem?
• Can my intervention change the impairment or improve function?

101
Q

What are the screening tools for assessing dementia?

A
  • Mini-Cog
  • Montreal Cognitive Assessment (MOCA)
  • Mini Mental State Exam
102
Q

What are the characteristics of the mini-cog?

A 
• Consists of:
  - 3 item recall: memory
  - Clock drawing test (CDT): executive function (10 after 11)
• 3 minutes to administer
• Scoring
  - 0-2 positive screen for dementia
  - 3-5 negative screen for dementia
103
Q

What are the characteristics of the MOCA?

A

• 16 item test, 10 minutes
• Includes tests for executive function, naming,
memory, attention, language, abstraction, delayed
recall, and orientation
• Scores > 26 = Normal

104
Q

What are the characteristics of the MMSE?

A 
• Must purchase
• 11 questions to assess:
  - Orientation, registration, attention, calculation, recall,
language, and visual construct
• Scoring
- 24-30: no impairment
- 18-24: mild impairment
- 0-17: severe impairment
105
Q

What are the motor learning strategies for normal patients?

A 
• Practice
• Practice Conditions: Massed, variety, random
  - Whole vs part- depends
  - Specificity- able to transfer
  - Mental practice- good
  - Discovery vs guidance discovery
• Feedback: Carefully
provided, more initially and
then weened
106
Q

What are the motor learning strategies for patients with dementia?

A 
• Practice:
• Practice Conditions: Massed,
constant, blocked
  - Whole vs part- depends
  - Specificity- unable to transfer
  - Mental practice- no
  - Discovery vs guidance- guidance
• Feedback: Simple, lacking intrinsic, skillfully given
107
Q

What are the parameters of P strategies to use for patients with dementia?

A 
• Use stimulus for teaching and performing
  - Sound, scent
• Simple, one step commands
• Minimize distractions
• Use positive reinforcement
• Repeat, repeat, repeat
• Provide feedback after task
• Minimize variation
• Consistency is key
• Functional, meaningful, pleasant
• Go slow
• Be patient
• Use lots of cues
  - Tactile, senses based, non-verbal
• Intervene in patients living environment
• Safety, safety, safety
• Avoid debate or conflict
• Find a connection (hobbies, recreation, previous occupation)
108
Q

What are the intervention methods to use for patients with dementia?

A 
• Maximize function
• Prevent or slow physical decline
  - Muscle strength, ROM, balance, mobility, etc.
• Environmental recommendations
• Exercise
• Aerobic: improved cognition
• Task specific: dancing, walking, stationary bike etc.
• Resistance
109
Q

What are the caregiver challenges that are associated with patients with dementia?

A 
• Psychological Health
  - Increased depression and anxiety common
• Discuss realistic goals
• Teach ADLs strategies
• Teach behavior modification strategies
• Encourage self-care
• Community support groups
• Respite care

Aging adult (5 decks)

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