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Aging adult > Week 3 > Flashcards

Week 3 Flashcards

1
Q

What are the definitions of polypharmacy?

A
  • Administration of many drugs together
  • Administration of excessive medication
  • Excessive or inappropriate use of medications
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2
Q

Why do older adults consume more drugs as compared to their younger counterparts?

A

• More illness
• More adverse drug reactions (ADRs)
- Altered response to drug therapy
• Physician reliance on drug therapy over non pharmacologic options
• Multiple prescriptions from multiple providers
• Over the counter and self-help remedies
• Sharing of medications

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3
Q

What is included in the polypharmacy cycle?

A
  • More illness in older adults leads to
  • Need/take more drugs leads to
  • Increased risk of side effects leads to
  • Side effects seen as symptoms leads to
  • More drugs administered leads to
  • More illness in older adults
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4
Q

What are the characteristics of polypharmacy?

A
  • Use of medications for no apparent reason
  • Use of duplicate medications
  • Concurrent use of interacting medications
  • Use of contraindicated medications
  • Use of inappropriate dosage of medications
  • Use of drug therapy to treat ADRs
  • Patient improves with discontinuation of medications
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5
Q

What are pharmacokinetic changes?

A

How the body handles the drug

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6
Q

What are the pharmacokinetic changes in response to drugs?

A
  • Absorption- altered gastrointestinal function
  • Distribution- changes in total body water, lean body mass, % body fat, plasma protein concentrations
  • Metabolism- reduced liver mass, decreased hepatic blood flow, decreased activity of drug metabolizing enzymes
  • Excretion- decreased renal blood flow and mass, decreased function of renal tubules
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7
Q

What do pharmacokinetic changes result in?

A

Drugs and drug metabolites remaining active for longer periods of time and prolonging drug effects thereby increasing risk for toxic side effects.

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8
Q

What are pharmacodynamic changes?

A

How drugs affect the body

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9
Q

What are the physiologic systemic pharmacodynamic changes seen in the body?

A
  • Homeostatic control of circulation – impacts cardiovascular drugs
  • Impaired postural control
  • Decreased visceral muscle function
  • Changes in thermoregulation
  • Declining cognitive ability
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10
Q

What are the cellular level pharmacodynamic changes seen in the body?

A

Binding receptor changes

• Increased or decreased sensitivity

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11
Q

What are the biochemical response pharmacodynamic changes seen in the body?

A

Subcellular structural and functional changes

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12
Q

What are the common GI symptoms seen as a result of an adverse reactions to medication in the older adult?

A

Nausea, vomiting, diarrhea, constipation

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13
Q

In what medications are GI symptoms a common adverse reaction?

A

Common with opioids, non-opioids, and NSAIDS

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14
Q

In what medications is sedation a common adverse reaction?

A

Common with opioids, analgesics, antipsychotics

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15
Q

When is excessive sedation seen as a common adverse reaction to medication?

A

With sedative-hypnotics

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16
Q

In what medications is confusion a common adverse reaction?

A

Common with antidepressants, narcotic analgesics, drugs with

anticholinergic activity

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17
Q

In what medications is depression a common adverse reaction?

A

Common with barbiturates, antipsychotics, alcohol, some

antihypertensive drugs

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18
Q

In what medications is orthostatic hypotension a common adverse reaction?

A

Most common with drugs used to treat hypertension

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19
Q

In what medications is fatigue/weakness a common adverse reaction?

A

Common with skeletal muscle relaxants and diuretics (altered electrolyte balance)

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20
Q

In what medications is dizziness/falls a common adverse reaction?

A

Common with sedatives, antipsychotics, opioid analgesics, antihistamines

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21
Q

What do anticholinergic effects do as a common adverse reaction to medications?

A

Alters response of tissues to

acetylcholine

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22
Q

In what medications is an anticholinergic effect a common adverse reaction?

A

Common with antihistamines, antidepressants, and

antipsychotics

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23
Q

What are the CNS anticholinergic effects as a result of medication?

A

Confusion, nervousness, drowsiness, dizziness

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24
Q

What are the PNS anticholinergic effects as a result of medication?

A

Dry mouth, constipation, urinary retention, tachycardia, blurred vision

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25
Q

What are the extrapyramidal symptoms seen as a result of an adverse reactions to medication in the older adult?

A

Dsytonias, tardive dyskinesia,

pseudoparkinsonisms

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26
Q

In what medications are extrapyramidal symptoms a common adverse reaction?

A

Common with antipsychotics

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27
Q

What are the the general strategies for the physical therapist when treating a patient on medication?

A

• Differentiate between diagnosis/disease sequelae and
ADRs
• Identify polypharmacy and refer for reevaluation of meds
• Schedule according to drug effect and rehab needs
• Encourage adherence to prescribed medication regimen
• Provide education on why prescribed meds may be
beneficial and their potential side effects
• Implement non-pharmacologic options to manage conditions

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28
Q

What are the generalized goals of therapy when working with patients with Parkinson’s?

A
  • Maintaining or increasing activity level
  • Decreasing rigidity or bradykinesia
  • Optimizing gait
  • Improving balance and motor coordination
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29
Q

What are the benefits of exercise in patient with parkinson’s?

A
  • Increase synapses formed
  • Increased blood vessels in the brain
  • Increased cell survival factors
  • Better use of remaining dopamine
  • Lowers the risk of PD for those with +genetic & environmental factors
  • Protects vs. development of PD
  • Improves efficacy of levodopa improves cognitive function
  • Improves scores reported on QOL measures
  • Decreases depression & apathy
  • Improves stress & reported fatigue
  • Decreases rigidity and bradykinesia
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30
Q

People with PD CAN learn new tasks and improve functional performance through __ during therapy.

A

People with PD CAN learn new tasks and improve functional performance through FOCUSED PRACTICE OF
TASKS during therapy.”

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31
Q

What are the education points to address with patients with parkinson’s?

A 
• Timing of meds
• Hydration
• Diet
• Exercise
• Fall Prevention
  - Home Modifications
  - Behavior Modifications
• Proper Footwear
• Compensatory techniques
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32
Q

What does the choice of intervention for a parkinson’s patient depend on?

A

The stage of parkinson’s

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33
Q

What are the motor complications seen in patient with early stage parkinson’s?

A

Mild motor complications

• Resting tremor, bradykinesia, unilateral rigidity, falls are rare, ADL’s OK

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34
Q

What are the non-motor complications seen in patient with early stage parkinson’s?

A

Constipation, depression, apathy

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35
Q

Because early stage parkinson’s patients are high level functioning patients, what should be features of their PT sessions?

A

Creative PT sessions
• Vary your exercises regularly
• Work to preserve hobbies

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36
Q

What are the treatment interventions for early stage parkinson’s patients?

A
  • Decrease inactivity, fear, educate, improve aerobic capacity, strength,
    balance, promote active lifestyle
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37
Q

What are some examples of sensorimotor agility exercise that we want patients with early stage parkinson’s to partake in?

A

• Boxing: anticipatory postural adjustments/corrections, fast
arm/foot motions, backward walking, timing/sequencing actions
• Lunges: big steps, limits of stability, quick direction changes
• Kayaking: trunk rotation, segmental coordination, speed, reciprocal
UE movements
• Tango, Video Games, Zumba
Challenge the mind and the body simultaneously
• Multi-tasking
• Physically
• Cognitively
• Alter environment

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38
Q

What are the motor complications seen in patient with middle stage parkinson’s?

A

• Bilateral features
• Wearing off meds
• Dyskinesias
• Increased rigidity
• Hunched posture, shuffling gait
• More assistance needed with ADL’s such as fine motor tasks,
increased slowness (more difficulty with transfers)

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39
Q

What are the non-motor complications seen in patient with middle stage parkinson’s?

A
  • Cognitive decline evident with executive & visuospatial
  • Orthostatic hypotension
  • Mood disorders
  • Hallucinations are rare
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40
Q

What is the PT’s focus during the treatment of a person with middle stage parkinson’s?

A
  • Treat the ADL’s, gait, balance, & postural deficits that are being impacted
  • Assist in increasing movement speed/amplitude
  • Focus on cognitive and motor movement strategies, cueing strategies
  • Teach compensatory strategies to maintain QOL
  • Suggest a support group for the patient & caregiver
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41
Q

While treating the ADLs, gait, balance, and postural deficits that are being impacted in a middle stage parkinson’s patient, what are key things for the therapist to keep in mind?

A
  • Optimize postural alignment
  • Maintain postural stability
  • Reduce multi-tasking to prevent falls
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42
Q

What are the motor complications seen in patient with late stage parkinson’s?

A

Falls, retropulsion, freezing, choking, aspiration, axial rigidity, drooling, decreased breath support

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43
Q

What are the non-motor complications seen in patient with late stage parkinson’s?

A

Dementia, incontinence, skin changes, sexual dysfunction,

pain

44
Q

What is a feature in patients that have had a parkinson’s diagnosis for over 15 years?

A

5x more likely to fall

45
Q

What is the PT’s focus during the treatment of a person with late stage parkinson’s?

A 
• Provide appropriate equipment
• Simplify tasks
  - Break down movements
  - Repetition, repetition, repetition
• Sensory stimulation and movements
• Educate caregiver
  - Body mechanics with transfers
  - Floor transfers (falls will happen)
• Home evaluation
46
Q

What impact does rigidity have on mobility as seen in a patient with parkinsons?

A
  • Agonist/ antagonist co-contraction
  • Flexed trunk
  • Dec trunk rotation
  • Dec joint range of movement
  • High axial tone
47
Q

What are the exercise principles implemented when treating rigidity as seen in a patient with parkinsons?

A
  • Trunk rotation
  • Reciprocal movements
  • Rhythmic movements
  • Erect alignment
  • Large movements
48
Q

What impact does bradykinesia have on mobility as seen in a patient with parkinsons?

A
  • Slow small movements
  • Narrow BoS
  • Lack of arm swings
49
Q

What are the exercise principles implemented when treating bradykinesia as seen in a patient with parkinsons?

A
  • Fast, large steps

- Large arm swings

50
Q

What impact does freezing have on mobility as seen in a patient with parkinsons?

A
  • Dec anticipatory postural adjustments
  • Abnormal mapping of body movement
  • Abnormal visual-spatial maps
  • Divided attention affects mobility
51
Q

What are the exercise principles implemented when treating freezing as seen in a patient with parkinsons?

A
  • Improve weight shifting
  • Understand role of external cues
  • Exercise in small spaces
  • Practice dual tasks
52
Q

When does rigidity really become a problem in patients with parkinsons?

A

Loss of spinal flexibility is seen in early stages and correlates
with functional performance tasks
• Reaching, supine to sit, balance control

53
Q

What are the rigidity treatment examples in patients with parkinsons?

A

• Manual therapy
- Stretching/PROM/AROM
- Joint compression/ approximation/traction
• Deep breathing/relaxation: counteract impact of rigidity
• PNF techniques
• Core strengthening
• Tai Chi (rhythmical diagonal movements)
• Kayaking exercise (reciprocal limb and trunk activity)
• Large amplitude steps with directional changes

54
Q

What are some HEP exercises to address rigidity for patient with parkinsons?

A 
• Cervical Rotations
• Chin Tucks
• Shoulder Abd/ER
• Shoulder Flexion
• Knee Flexions Rotations
• Bridges &/Or Pelvic Tilts
• Hib Abd/Add (knees flexed)
• Knee to Chest Stretch
• Hamstring Stretch
• Ankle Pumps
 - 10-20x each
• Deep Breaths
55
Q

According to research, what happens if you give more than 2 HEP for a patient with parkinsons?

A

Compliance severely decreases

56
Q

What is bradykinesia?

A

Slow, small movements which impact quality and efficiency of

movement, and affecting quality of life

57
Q

What are the presentations of bradykinesia in patients with parkinsons?

A 
• Narrow BOS
• Lack of arm swing
• Exercise Principles
  - Fast, large steps
  - Large arm swings: during ambulation, in semi tandem,, etc
58
Q

When does freezing occur in patients with parkinsons?

A
  • Approaching doorways, obstacles, or chairs
  • When turning or changing direction
  • When distracted while walking
  • Crowded or cluttered places
  • Medication is not working well
59
Q

What should a patients with parkinsons do when they experience freezing?

A

• Stop, take a deep breath, weight shift side to side, try a
side or backwards step before trying to take a “BIG” step
forward
• Try different cues
• Frustration or stress = worse

60
Q

How does cueing work?

A
  • Basal ganglia acts as an internal cue to enable movement sequences to be carried out implicitly, automatically, and without attention
  • Cues replace lost internal cues with an external cue
  • Bypass the BG dysfunction path
  • Learning shifts from implicit to explicit
  • Cueing = motor learning tool
61
Q

What are some attention cues we can give our patients with parkisons?

A
  • Visualize movements
  • Focus on each step of the task
  • Counting “1, 2, 3…”
  • “Look through the doorway”
62
Q

What are some visual cues we can give our patients with parkisons?

A
  • Laser

* Tape lines or X’s on the floor

63
Q

What are some auditory cues we can give our patients with parkisons?

A
  • Metronome
  • Music
  • Step to the count
64
Q

What are some proprioceptive cues we can give our patients with parkisons?

A

• Weight shifting/Rocking
- Side Steps
- Backwards Step
• Tapping your leg

65
Q

Festination and propulsion is as a result of what?

A

COG too far forward over BOS in people with slow velocity of gait

66
Q

What should a patient do when they notice they are going into festination or propulsion?

A 
• STOP
• Use cue to start again
  - “BIG” step
  - Reach for your heel
• If they have a U-step walker: brake to stop
• Add weight posteriorly
67
Q

What are the functional assessments to do in a patient with parkinsons?

A

• Sit to stand
• Bed Mobility: rolling, supine <> sit
• Gait
- Different environments and challenges

68
Q

The key to supine to sit transfers is in the ___

A

The key to supine to sit transfers is in the KNEES, knee flexion rotations for everyone!

69
Q

What are some specific practice that we can implement to make exercise functional for our patients with parkinsons?

A
  • Compliant surfaces
  • Uneven surfaces
  • Inclines/declines
  • Stairs/curbs
  • Obstacles
  • Dynamic BOS
  • Visual modification
  • Dual tasks
70
Q

What are some static balance exercise we can do for our patients with parkinsons?

A
  • Wobble board
  • Air-ex/Foam Pad
  • EO/EC
  • Head turns/head nods
  • Reaching outside BOS
  • Perturbations + Protective Step Response
  • Seated on Physioball
71
Q

What are some dynamic balance exercise we can do for our patients with parkinsons?

A
  • Bosu ball
  • Lunges
  • Step-ups
  • Wii balance board
72
Q

What are the characteristics of balance in a patient with parkinsons?

A
  • Balance exercise should begin in early stages of the disease
  • Equilibrium reactions in all planes of movement
  • Rhythmical stabilization to increase static balance, as long as resistance does not increase truncal rigidity
  • Timing of resistance must be gradual
  • Dynamic balance techniques
73
Q

What are some types of gait training exercises we can do for our patients with parkinsons?

A 
LSVT “BIG” Theory
• Locomotor Training
• Split Belt Treadmill
• Obstacle Courses
• Inside vs. Outside
• Environment
  - Quiet vs. Crowded
• Attention
  - Focus vs. divided
  - Add dual-tasking!
74
Q

What are some types of dynamic gait training exercises we can do for our patients with parkinsons?

A
  • Tandem
  • Backwards
  • Side Steps
  • Grapevine
  • Stopping
  • Starting
  • Turning
  • Changing Directions
75
Q

What is an example of functional training exercise that we can do for our patients with parkinsons?

A 
Sit to stand
• Break the task into parts
1. Bend forward
2. Lift pelvis up
3. Extend knees and hip
4. Maintain standing
• Repeated practice of the impaired “parts”
• Neuroplasticity – correct the impaired “part”. Encourage repetition
76
Q

What are some examples of core strengthening exercises that we can do for our patients with parkinsons?

A
  • Bridges
  • Pelvic Tilts
  • Prone Press Ups
  • Posture/extensors
77
Q

What are some examples of UE strengthening exercises that we can do for our patients with parkinsons?

A
  • Wall Push-ups
  • Rows
  • RTC IR/ER
  • PNF D1/D2 UE
78
Q

What are some examples of LE strengthening exercises that we can do for our patients with parkinsons?

A 
• Squats
• Lunges
• Clamshells
• Side Steps vs Band
• Standing Leg
Raises
• Heel Raises
• Toe Raises
• Leg Press
79
Q

What is LSVT “BIG”?

A

Training program designed to promote high amplitude/BIG
movements of the limbs and body
• Designed to improve speed, balance, and QOL
• Program: 4 times per week x 4 weeks
• Intense program with many repetitions
• “Must be certified as a “BIG” therapist to document “BIG”
treatment
- “High amplitude training” when not certified

80
Q

What are the fundamentals of LSVT “BIG”?

A

• Target: BIG – large amplitude whole body movement
• Mode
- High intensity: modulated by LSVT specialist
- Requires consistency over 4 week period
• Calibration
- Calibration of perception of movement
- Mismatch between patient perception of output and how
others perceive it.
• 7 BIG exercises for HEP

81
Q

What are the characteristics of rock steady boxing as it relates to parkinsons?

A

• Boxers condition for optimal agility, speed, muscular
endurance, accuracy, hand-eye coordination, footwork and
overall strength
• Improvements in balance, gait speed, and perceived quality
of life, and they maintained it

82
Q

What are the basic 4 Parkinson’s Wellness Recovery (PWR) moves and what do they target?

A 
Targets skills impaired in PD with mobility
• Antigravity extension – PWR!UP
• Weightshifting – PWR!ROCK
• Axial Mobility – PWR!TWIST
• Transitions – PWR!STEP
83
Q

What are the components for later in life planning that should be done by patients with parkinsons?

A
  • Insurance
  • Senior living communities
  • Advanced directives
  • Address the topic BEFORE it is too late!
  • HELP the family PLAN for progression
84
Q

What are the characteristics of pre-operative PT for a total hip/knee arthroplasty in an aging adult?

A

• High-intensity strength training
• Patient training on walking devices
• Planning for recovery
• Managing patient expectations
• Value not from:
- Multiple intensive training sessions for strength and ROM
- May or may not decrease hospital LOS or d/c disposition
- May or may not affect post-op function

85
Q

What are the goals of pre-operative educational classes for a total hip/knee arthroplasty in an aging adult?

A

Conducted prior to surgical date in multidisciplinary format w/goals of:
• Prepare patients for surgery and recovery related issues, including surgery procedure, therapy expectations and
post-operative routine
• ↓post-operative complications
• ↑ likelihood of discharge to home vs a facility & ↓ LOS/hospital costs
• Help patient identify post-op support system & ↓ anxiety
• Encourage pt’s active role in recovery process

86
Q

What are the general benefits of pre-op PT and education for a total hip/knee arthroplasty in an aging adult?

A

• Shorter LOS!!
• EARLY mobilization
• Shorter overall therapy time
frame

87
Q

What are the characteristics of early intensive rehab for the acute care of a total hip/knee arthroplasty in an aging adult?

A

Decreases physiological disturbances
• As early as POD zero
• May even be at a day surgery facility or a short-stay hospitalization
• Associated w/↓ DVT/PE risk, chest infections, urinary retention, HAI
• Results in accelerated functional recovery & earlier hospital d/c

88
Q

When should acute care PT for a total hip/knee arthroplasty in an aging adult be done and what type of PT should be done?

A
  • At least within 1st 24 hours of surgery, but optimally POD zero
  • Emphasize function for optimal d/c dispo of home
  • Education very important (and remember, not all THA’s have posterior prec)
  • Early strengthening (possible e-stim TKA)
89
Q

When is the largest proportion of therapy time help for a total hip/knee arthroplasty in an aging adult?

A

Post-Acute

90
Q

What are the characteristics of post-operative PT for a total hip/knee arthroplasty in an aging adult?

A

Optimal d/c dispo to home and commence home health or OP PT
• May need dispo other than home at first
• Be the advocate in acute care
• Be aware of other issues (family, insurance, post-acute qualifications, home
environment)
• D/C dispo planning starts on admission and even before!

91
Q

Why may an older adult have a complicated and longer recovery following a total hip/knee arthroplasty?

A
  • B TKA (sometimes B THA depending on approach, health status)
  • Co-morbidities affecting recovery
  • Slow post-surgical recovery (TKA > THA, BUT more lingering gait abn s/p THA)
92
Q

What are the indications and implications of an anatomic total shoulder arthroplasty?

A
  • Must have intact rotator cuff

* For all forms of degenerative or inflammatory glenohumeral damage

93
Q

What are the indications and implications of a reverse total shoulder arthroplasty?

A
  • In presence of complete tear of rotator cuff
  • Must have intact deltoid
  • More common for proximal humerus fx
  • Revision TSA
94
Q

What are the therapy considerations for a total shoulder arthroplasty?

A

• No extensive pre-op education pathway exists like THA/TKA
• Don’t get caught up in “I can’t do anything while the patient is in a sling!”
- Gait disturbances primary issue w/aging adult
• Remember the patient does not have the ability to perform contralateral UE swing— Balance? Need for AD?
• Before they leave the hospital!! Many times, MD may not order PT!
• Joint mobility at other shoulder complex components– AC joint, SC joint??– and “good” shoulder
• Functional reach using alternate strategies
• Core strengthening
• One-armed ADL strategies
• Functional mobility and bed mobility strategies
• May need OT referral

95
Q

Which type of fracture surgery is considered urgent and why?

A

Hip fx surgery is considered urgent (not elective like TJA) to
significantly lower the risk of death

96
Q

What are the complicating issues seen in an aging adult post orthopedic surgery?

A

• Have a longer hospital LOS
• Slight increased risk of falls while hospitalized, particularly in bathroom
• Have a larger number of pre-existing co-morbidities (DM, CHF, COPD, renal failure) or
social disadvantages (live alone, require additional social support)
• Have a prior TJA or debilitating OA in the contralateral joint or other joints
• Have pre-existing cognitive and sensory impairments
• Have reduced functional aerobic capacity
• Have marked reductions in muscle mass and strength (particularly those who are frail or experienced a fall)
• Require adaptation to usual movement patterns
• Experience post-op complications (MI, DVT/PE, surgical site infection, sepsis,
hemorrhage, mortality), and medical complications (UTI, pressure ulcers, nutritional
deficiencies)
• Experience more side effects from medications and general hospitalization (particularly
anesthetics, opioid pain meds)
- Delirium/cognitive impairment
- Perioperative acute pain
- Pulmonary complications
- Fall risk
• Be admitted to the ICU
• Discharge to a skilled care facility

97
Q

What are the pre-fracture factors indicating poor functional recovery in the therapy considerations of a hip fracture in an aging adult?

A
  • Decreased pre-fracture functional independence
  • Greater co-morbid disease burden
  • Cognitive impairment
  • Affective status/depression
  • Poor nutritional status
  • Poor social support
  • Presence of frailty
98
Q

What are the major types of hp fractures in an aging adult?

A
  • Intracapsular, involving the femoral head and neck (approx. 45%)
  • Intertrochanteric (approx. 45%)
  • [Others (approx. 10%): subtrochanteric]
99
Q

What does the surgical management of a hip fracture in an aging adult depend on?

A
  • Type and severity of fx
  • Preference of ortho MD
  • Pt age
  • Co-morbid conditions
  • Prognosis
100
Q

What type of patients are non-operative management used for after sustaining a hip fracture?

A

For those who may gain only min function from stabilization because they were either not ambulatory to begin w/ or have severe dementia, those with contraindications to anesthesia or medical conditions prohibiting surgery

101
Q

What are the types of surgery done for a femoral neck fracture in an aging adult?

A
  • <65 years of age: internal fixation

* Older individuals or those with already limited mobility: THA

102
Q

What are the types of surgery done for an intertrochanteric fracture in an aging adult?

A
  • Sliding hip screws
  • Intermedullary nails (done percutaneously w/less surgery time needed, less blood loss)
  • Often PWB
103
Q

What are the types of surgery done for a subtrochanteric fracture in an aging adult?

A

Hemiarthroplasty

104
Q

What are the therapy considerations for a hip fracture repair in the acute stage?

A
  • Goal: restore mobility ASAP!
  • Pt likely has pre-existing lower function, fall-risk
  • High likelihood of limited WB (PWB req. 30-50% > energy than normal ambulation)
  • Higher stakes for bed rest, immobility complications
  • Consider other areas with risk of osteoporotic changes when planning mobility
105
Q

What are the therapy considerations for a hip fracture repair in the post- acute stage?

A
  • Likely will require post-acute inpatient stay (many hip fx >85 yrs old qualify for IPR)
  • Focus on precipitating factors to the causative agent for hip fx (Fall? Osteoporosis? Cognitive deficits? Dangerous home environment? Frailty? Social support?) AND how normal aging changes have augmented these factors
  • Fear of falling!

Aging adult (5 decks)

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