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Aging adult > Week 4 > Flashcards

Week 4 Flashcards

1
Q

What are the dual functions of the pancreas?

A

• Endocrine gland secreting hormones – insulin and
glucagon
• Exocrine gland producing digestive enzymes

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2
Q

Islets of Langerhans are cells of pancreas involved in _____ function

A

Islets of Langerhans are cells of pancreas involved in

endocrine function

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3
Q

What causes diabetes mellitus?

A

Defective endocrine function in pancreas
• Pancreas produces little or no insulin
• Pancreas makes insulin, but insulin doesn’t work as it should

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4
Q

What is diabetes mellitus?

A

Disease that prevents body from properly using energy from food

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5
Q

What is a simplified review of metabolism?

A
  • Food broken down to glucose (simple sugar)
  • Glucose provides energy our body needs
  • Pancreas releases insulin which attaches to and signals cells to absorb glucose from bloodstream
  • Without insulin, glucose can’t be utilized by cells for energy and glucose remains in the blood (hyperglycemia)
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6
Q

What is the normal fasting plasma glucose level?

A

< 100 mg/dL

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7
Q

What is the prediabetes fasting plasma glucose level?

A

100-125 mg/dL

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8
Q

What is the diabetes fasting plasma glucose level?

A

> 125 mg/DL

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9
Q

What is the normal two-hour oral glucose tolerance plasma glucose level?

A

< 140 mg/dL

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10
Q

What is the prediabetes two-hour oral glucose tolerance plasma glucose level?

A

140-199 mg/dL

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11
Q

What is the diabetes two-hour oral glucose tolerance plasma glucose level?

A

> 200 mg/DL

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12
Q

What are the characteristics of type 1 DM?

A
  • Previously called insulin dependent DM
  • Absolute deficiency of insulin production and secretion
  • Require exogenous insulin
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13
Q

What are the characteristics of type 2 DM?

A
  • Previously called non-insulin dependent DM
  • Much more prevalent
  • Caused by combination of cellular resistance to insulin action and an inadequate compensatory insulin secretory response
  • Can be controlled with diet, exercise, and oral hypoglycemic agents
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14
Q

What are the features of type 1 DM?

A
  • Age at onset: Usually < 20 y/o
  • Proportion of all cases: < 10%
  • Type of onset: Abrupt
  • Etiologic factors: Possible viral/autoimmune, resulting in destruction of islet cells
  • Body weight at onset: Normal or thin
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15
Q

What are the features of type 2 DM?

A
  • Age at onset: Usually > 40 y/o; increasing number of cases in all ages, including kids
  • Proportion of all cases: > 90%
  • Type of onset: Gradual
  • Etiologic factors: Obesity-associated insulin resistance
  • Body weight at onset: Majority are obese (80%)
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16
Q

What are the characteristics of Latent Autoimmune Diabetes in Adults (LADA)?

A
  • Slow progressing form of autoimmune diabetes
  • Similar etiology to Type 1, but onset usually > 30 y/o
  • Don’t need insulin for several months up to years after diagnosis
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17
Q

What are the characteristics of Maturity onset diabetes of the Young (MODY)?

A
  • More likely to be inherited, stronger genetic risk factor
  • Shares type 2 diabetes symptoms
  • NOT linked to obesity
  • Develops before age 25
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18
Q

What is pre-diabetes?

A

When body can’t utilize glucose correctly
• Body cells do not recognize all of the insulin
• Cells stop responding to action of insulin

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19
Q

What does pre-diabetes result in?

A

In rise of blood glucose (high but not high enough)

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20
Q

What are the characteristics of pre-diabetes?

A

May have trifecta of prediabetes, HTN, and dyslipidemia – increases risk of developing Type 2 DM and heart disease

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21
Q

What are the cardinal signs and symptoms of type 1 diabetes?

A
  • Polyuria (excessive urination)
  • Polydipsia (excessive thirst)
  • Weight loss with polyphagia (excessive hunger)
  • Blurred vision
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22
Q

What are the cardinal signs and symptoms of type 2 diabetes?

A
  • May have polyuria and polydipsia
  • Visual blurring
  • Neuropathic complications
  • Infections
  • Significant blood lipid abnormalities
  • Often asymptomatic
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23
Q

What are the non-modifiable risk factors for type 2 diabetes?

A
  • History of gestational diabetes
  • Race/ethnicity
  • Age over 45 years
  • Family history of diabetes
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24
Q

What are the modifiable risk factors for type 2 diabetes?

A
  • Physical inactivity
  • High body fat or body weight
  • High blood pressure
  • High cholesterol
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25
Q

How is DM diagnosed?

A

• Classic symptoms + plasma glucose concentration ≥
200 mg/dL
• Fasting plasma glucose ≥ 126 mg/dL
• A1c > 6.5%

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26
Q

What are the long term consequences of DM to the eye?

A

Retinopathy: damage to retina due to abnormal blood flow

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27
Q

What are the long term consequences of DM to the kidney?

A

Leading cause of end-stage renal disease

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28
Q

What are the long term consequences of DM to the MSK system?

A
  • Distal joints/segments
  • Syndrome of limited joint mobility and stiff hand syndrome
  • Dupuytren contracture
  • Adhesive capsulitis
  • Diffuse idiopathic skeletal hyperostosis (DISH)
  • Arthritis
  • Osteoporosis
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29
Q

What are the long term consequences of DM to the nerves?

A

Sensory, motor and autonomic neuropathy

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30
Q

What are the long term consequences of DM to the cardiovascular system?

A
  • CVD leading cause of M/M in DM
  • 1.5-4 fold increased risk of CAD, stroke, or MI
  • Diabetic cardiomyopathy
  • Atherosclerosis begins earlier and is more extensive in Type 1
  • Higher risk of CAD, stroke, and PVD in those with Type 2
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31
Q

What are the long term consequences of DM to the skin?

A

Neuropathic Ulcers

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32
Q

At what blood glucose level does hypoglycemia occur?

A

At blood glucose of <70 mg/dl

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33
Q

What are the causes of hypoglycemia?

A

Overdose of insulin, late or skipped meals, or

overexertion in exercise

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34
Q

What are the s/s of hypoglycemia?

A

Headache, weakness, irritability, poor muscular

coordination, inability to respond to verbal commands

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35
Q

What is needed to be done in order to combat hypoglycemia?

A

Need to ingest carbohydrates

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36
Q

What are the causes of hyperglycemia?

A

Infection, missed insulin doses, surgery, pregnancy,

renal failure, uncontrolled DM

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37
Q

When does hyperglycemia occur?

A

Can occur in those with/out DM

• High intensity aerobic exercise

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38
Q

What is Ketoacidosis?

A

Typically occurs with prolonged

hyperglycemia (more common in type I)

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39
Q

What are the presentation of Ketoacidosis?

A

Fruity breath (acetone), dehydration, weak and rapid pulse, Kussmaul respirations

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40
Q

What are the PT Considerations for Exercise in those with

DM?

A

• To control DM, exercise must be done with no more than 2-3 days between sessions
• Avoid exercise late at night
- Delayed hypoglycemic reactions can occur during sleep
• Blood glucose levels of 250-300 mg/dl- CAUTION
- Do not exercise if >250 with evidence of ketoacidosis
- >300 generally considered a no go point
- < 100 mg/dl consider a snack and retest or make decision based on symptoms
• Exercise is best about 1 hour after meal
• Do not inject insulin in muscles that will be involved in exercise
• Those with DM should not exercise alone

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41
Q

What are the benefits of exercise in diabetes?

A
  • Improved skeletal muscle glucose transport
  • Improved whole body glucose homeostasis
  • Increase insulin sensitivity 12-72 hours post exercise
  • Increases carbohydrate metabolism
  • Reduced risk of cardiovascular mortality
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42
Q

What do we do when we have patients with diabetes?

A

• Educate:
- Online resource: diabetesselfmanagement.com
• Exercise: Glucose before and after to determine needed levels of intake
• Safety: higher risk for falls secondary to peripheral neuropathy
• Exercise!!!

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43
Q

What are the characteristics fo hypoglycemia?

A
  • Onset: Rapid
  • Mood: Labile, irritable, nervous, weepy
  • Mental Status: Difficulty: concentrating, speaking, focusing, coordinating
  • Skin: Pale, sweating
  • Pulse: Tachycardic
  • Respirations: Shallow
  • Breath: Normal
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44
Q

What are the characteristics fo hyperglycemia?

A
  • Onset: Gradual
  • Mood: Lethargic
  • Mental Status: Dulled sensorium, confused
  • Skin: Flushed, dehydrated
  • Pulse: Less rapid, weak
  • Respirations: Deep, rapid (Kussmaul)
  • Breath: Fruity
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45
Q

What is the continuum of care?

A

The system of services supporting the well-being of older adults at every stage of
function

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46
Q

What are the characteristics of continuum of care?

A

• Doesn’t necessarily start w/an entry point in the hospital
• Services range from adults w/o service needs to those requiring total care or
assist
• Services vary from community-based, transportation needs, housing, medical
facilities, and so on
• May require a comprehensive assessment to determine specific needs
- Usually interdisciplinary in nature
- Essential that older adults receive the level and type of services required to address needs

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47
Q

What are the physical settings included in the continuum of care of the older adult?

A 
• Acute Care
• Subacute Care
  - Long term acute care (LTAC)
  - Inpatient rehabilitation hospital (IPR)
  - Skilled nursing facility (SNF)
• Post-acute Care or Home Care
  - Long term care (nursing home) (LTC)
  - Assisted living (ALF)/ group home
  - Memory care home
  - Personal home
  - Family home
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48
Q

What is aging in place?

A

Allowing an older adult to live in their residence of choice for as long as they are able.

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49
Q

What are the components of aging in place?

A

• Provision for daily life needs
• Maintain quality of life
• Requires planning
• Living in a community with some level of independence instead of residential care
• Community-based collaborations between healthcare and social service
agencies

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50
Q

What are the characteristics of aging in place?

A

Can involve livable communities, facilities with range of care options, or personal home:
• Available alternative modes of transportation
• Increase opportunities for safe, regular physical activity
• Increase accessibility of home
• Develop walkable communities
• Promote pedestrian safety and safe driving for older adults
• Funding for home and community-based services
• Improve end of life and palliative care services

51
Q

What does the admission to a post-acute inpatient therapy settings(Inpatient Rehab vs Skilled Nursing) depend on?

A

Diagnosis, ability to tolerate intensity of services,

and insurance arrangements

52
Q

What type of patients are admitted into an inpatient rehab?

A

In general, more complicated dx and ability to tolerate at least 3 hrs/day therapy

53
Q

What type of patients are admitted into Skilled Nursing?

A

Single joint replacements, conditions requiring much longer recovery period, or pt who cannot tolerate 3 hrs/day therapy

54
Q

What are the characteristics of an inpatient rehab and skilled nursing?

A
  • Both covered by Medicare Part A
  • Both serve as bridge between living at home and being hospitalized, especially those with functional decline (sometimes serve as “testing ground” for whether home even an option ultimately)
55
Q

What are the avenues of entrance into a nursing home (long-term care)?

A

• Patient may need 24 hour care, but has no primary
need or does not quality for skilled nursing therapy
- Nursing staff available around the clock
- Rehabilitation services available as an outpatient for residents (services billed under part B)
• Patients may initially have Part A services either by being admitted to
facility:
- As a prior non-resident under skilled nursing status and then
transition to residency
- As a resident with a qualifying hospital stay that requires follow-up skilled nursing services and/or rehabilitation with eventual transition back to LTC status

56
Q

What are the characteristics of an Assisted Living Facility (ALF)?

A 
• Patients who need housing, support services, and health care
• Services/Amenities (Facility dependent)
 - 3 Meals/day in common dining area
 - Housekeeping
 - Transportation
 - Laundry services
 - Exercise/Wellness programs
 - Social/Recreational activities
 - Assistance with ADL’s
 - Medication assistance
 - Rehabilitation services
 - Emergency call systems
• Not to be confused with senior independent living
apartment communities
 - Often house ALF’s
 - Some offer continuum of care
57
Q

What are the characteristics of Non-Institutional Living

Arrangements: Memory care Assisted Living Facility (ALF)?

A

Some in form of apartment communities or group residential homes

58
Q

What are the characteristics of Non-Institutional Living

Arrangements: home?

A
  • Usual residence in house– age-restricted communities w/high level of amenities and activities becoming popular
  • Apartment/townhome– age-restricted apartments growing in popularity
  • Alone, with significant other, or family
59
Q

What patients qualify for medicare?

A

> / 65 years old and some disabled

60
Q

What are the characteristics of part A of medicare?

A

Hospital, SNF, Hospice, some HHC

• Automatic- pay into the system while working

61
Q

What are the characteristics of part B of medicare?

A

Doctor’s services, OP care, some HHC, labs, x-rays, DME

• Premium, deductible, co-insurance, co-pay

62
Q

What are the characteristics of part C of medicare?

A

Medicare Advantage Plans
• Provide both part A and B and other services
• Provided through private insurance companies
• Locked in for certain periods of time, not able to use Original Medicare

63
Q

What are the characteristics of part D of medicare?

A

Prescription Drug Coverage

• Premium

64
Q

What are the characteristics of medicaid?

A

• Low income coverage for those over age 65
- < $1025/month
• Provides coverage for premiums, out of pocket
expenses, nursing home care, prescription drugs
• Medicare pays first then Medicaid pays
• Administered by federal and state governments
• May have different names
• Must check eligibility often

65
Q

What are the characteristics of Veterans Administration (VA) Healthcare?

A

• Free for veterans with service-connected condition
• Must apply and qualify
• Must receive services at a VA facility
• Co-pays for veterans with non-service connected
conditions and based on income

66
Q

What are the payment options in an acute care setting?

A 
Inpatient Perspective Payment System
• Diagnostic Related Group (DRG) Method
• Medicare Part A
• Lump sum based on diagnosis
• Severity of illness considered
• Co-morbidities considered
67
Q

What are the considerations of care at an acute care facility?

A

Must be cost effective, productivity matters

• PT does not impact payment

68
Q

What are the payment options in a long term acute care hospital?

A

• Medicare Part A
• PPS based on length of stay >/ 25 days
• # of days based on dx and co-morbidities
• Full payment received at 5/6th of stay
- Money made this way
- Money lost if patient stays past assigned length of stay

69
Q

What are the considerations of care at a long term acute care hospital?

A

Must be cost effective, productivity matters

• PT does not impact payment

70
Q

What are the payment options in an inpatient rehabilitation facility (IRF)?

A
  • Medicare Part A
  • Perspective Payment System (PPS)- predetermined fixed amount
  • Payment based on Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI) - FIM Scores
  • Distinct groups based on clinical characteristics and expected needs
71
Q

What are the considerations of care at an inpatient rehabilitation facility (IRF)?

A

If patient unable to be seen 3 hours a day on average 5-7 days a week, payment will be impacted
• Patient will need to DC to another location
• Therapy impacts payment

72
Q

What are the payment options in a skilled nursing facilities (SNF)?

A

• Medicare Part A
- 100 days of coverage: Days1-20 paid in full, Days 21-100 copay up to $164.50/day
• Per Diem PPS
- Covers all cost (routine, ancillary, capital)
- Resource Utilization Groups III (RUG’s)
• Based on resident assessment and classification using MDS 3.0
• Number of therapy minutes and days impacts reimbursement

73
Q

What are the payment options in home health care?

A

• Medicare Part A
• PPS
• 60 day national episode payment (certification period)
- Outcome and Assessment Information Set (OASIS)-
assessment tool
- Health condition and Care needs
- In the past, therapy has impacted payment for HHC,
however this is changing

74
Q

What are the payment options in outpatient?

A 
• Medicare Part B – Outpatient Therapy
  - 80% covered
• Cap- No more!!!
  - $1980 PT and ST combined
  - $1980 OT
  - $3700 Manual Medical Review
• PT bills for services for reimbursement. Reimbursement is based on the Medicare Fee Schedule
75
Q

What are the payment options in a nursing home?

A
  • Insurance
  • Private Pay
  • Medicaid
  • Note: Rehab services covered under Part B Medicare if the patient has it.
76
Q

What are the payment options in assisted living?

A
  • Insurance
  • Private Pay
  • Note: Rehab services covered under Part B Medicare if the patient has it
77
Q

What are the intrinsic factors that impact motivation and compliance in the aging adult?

A
  • Achieve goals (function, participation, etc.)
  • To have control of their
    circumstances
78
Q

What are the extrinsic factors that impact motivation and compliance in the aging adult?

A
  • Please someone else
  • Praise, attention
  • Punishment (negativity)
79
Q

What are the characteristics of aging and motivation?

A 
• Greater self-regulatory capacity
• Focus on positive
  - Immediate benefits of behavior
• Stronger adherence
• Positive self-concept
• Social supports
• Information-seeking behavior
80
Q

What influences motivation? in patients

A

• Self-efficacy expectations
- Belief in capabilities
• Outcome expectations
- Belief personal action will produce certain consequence

81
Q

What enhances motivation?

A
  • Successful performance
  • Verbal encouragement – “you are capable of this”
  • Vicarious experience
  • Physiologic and affective states
82
Q

What are the keys to motivating the older adult?

A 
• Caring and confidence
• Patient Centered
• Ensure success
• Attend to the setting
• Challenges: Overcoming Fear
  - Graded exposure
  - Building on baseline tolerance
• Apathy
  - Medication may be necessary first step
  - Focus on activities that can be done successfully
83
Q

What are the characteristics of goals to set for patients?

A

Goals should be:

  • Related to specific behavior
  • Challenging, but realistically attainable
  • Achievable in the near future
84
Q

What are the characteristics of social support in the patient care?

A

• Need to investigate and understand what their social
support is
• Teach those involved in supporting patient
• Use social supports in goal setting

85
Q

What are the characteristics of patient-centered goal setting?

A
  • Patient-centered goal setting is primary way of enhancing patient centeredness
  • Improves outcomes and satisfaction
  • Recommended and/or required in practice
  • Highly personal
  • Can be critical for motivation
86
Q

What does people-first language mean?

A

Emphasizes the person first not the disability by starting

the phrase with the words “person who” or “person with.”

87
Q

What are the key aspects of Patient-Centered Care?

A
  • Patient’s values and preferences guide plan of care
  • Focus on the PERSON, not the illness
  • Quality and value defined by respect for personal choices
  • Goals driven by the patient and their functional desires
  • Patient empowerment to take an active role in care plan
88
Q

What is patient centered care?

A

Providing care that is respectful of, and responsive to, individual patient preferences, needs and values, and ensuring that patient values guide all clinical
decisions.

89
Q

What are the characteristics of individualized care?

A
  • Recognizing individual needs and differences
  • Using kindness and humor
  • EMPOWERING to take active part
  • Gentle verbal persuasion
  • Positive reinforcement
  • Be genuinely interested
90
Q

What are the characteristics of self-efficacy beliefs in patients?

A

• Verbal encouragement of capability
• Expose to role models
• Decrease unpleasant sensations associated with
activity
• Encourage actual PRACTICE
• Educate on benefits and reinforce those benefits

91
Q

What is health literacy?

A

Limitation in the ability to obtain,
process, & understand basic health information & services necessary to make appropriate health decisions and follow treatment instructions

92
Q

How does health literacy apply to the older adult?

A

• Older adults at especially high risk for misunderstanding
• Health literacy declines with age
• Independently associated with greater risk of hospital admission,
lower use of preventative health services, poor physical and mental health and higher all-cause mortality

93
Q

Why do aging adults have difficulty understanding verbal and written health communication?

A
  • Sensory deficits
  • High stress and/or anxiety
  • Language barrier
  • Communication at TOO HIGH LEVEL
  • Lower health literacy
94
Q

What are some communication tips to use when interacting with an aging adult?

A 
• Slow down, allow extra time
• Use plain, nonmedical language
• Show or draw pictures
• Limit amount of information and repeat it
• Use the teach-back technique
• Create shame-free environment; encourage questions
• Sit face to face, use eye contact
• Listen without interrupting 
• Frequently summarize key points
• Frame conversation first
• Encourage older adult to bring a friend or family member
• Plain language info in writing
  - What to do
  - How to do it
  - Why
• Give patient chance to ask questions
• Don’t assume the patient can’t hear you!
95
Q

What are the characteristics of the content of information being given to an older adult?

A
  • Accurate, up-to-date, LIMITED

* Focus on behavior

96
Q

What are the characteristics of the assessment of learning in an older adult?

A

• Don’t assume learning occurred just because you taught!
• Must evaluate the effectiveness of your teaching
• Must document whether learning has occurred and to what extent
• How do we do this:
- Return demo
- Repeat back
- Checklists and diaries

97
Q

What are the barriers to learning in an older adult?

A

• Our desire to exert control
• Cure model versus Care model
- Cure = Paternalism – we are acting in “best interest of patient”
- Care = Values autonomy and collaboration of /with pt
• Self perception of older adult
- Don’t really see themselves as learners
- Sensitive to failure
- Resistance to change and skepticism
• And, honestly, impatience on both parts!

98
Q

What are the Considerations When Teaching New

Information or Skills to Older Adults?

A

• Accommodate for slower speed of mental processing
• Present one new item at a time, if possible, before moving to the next item
• Encourage “errorless” learning
• Incorporate compensatory strategies as needed
• Incorporate multimodal sensory inputs
• Encourage formation of a “habit”
• Have older adult verbalize new habit to encourage formation of intentions to be
completed in the future (prospective memory)
• Have older adult paraphrase the information or demonstrate the new skill

99
Q

What are the teaching strategies for older adults (65+)?

A

Geragogy
• Teaching approach recognizing special needs of older adults related to learning
• Refers to need to fine-tune adult teaching & instructional styles for older adults
who:
- Are post-career
- No longer raising families
- Are often frail
• Recognizes older adulthood as a developmental stage with key elements concerning age-related sensory, physical, psychological, cognitive, and
psychosocial changes

100
Q

What are the characteristics of the appearance/appeal of information being given to an older adult?

A
  • Attractive
  • Easy to read
  • Smallest font 14 point type (might even go higher)
101
Q

What are the characteristics of the writing style of information being given to an older adult?

A
  • Talk directly to reader
  • Positive, friendly tone
  • Short words common in spoken language
  • Clearly explain any medical terms
  • Short sentences
  • Active voice
  • Provide examples
102
Q

What are the characteristics of the structure/organization of information being given to an older adult?

A
  • Most important info first
  • Create small chunks
  • Clear action messages
103
Q

Who are the senior athlete?

A
  • Former Competitive Athletes
  • Lifelong athletes
  • Non-athletes
104
Q

What are the CDC descriptions of a senior athlete?

A
  • Sedentary
  • Recreational
  • Competitive
  • Elite
105
Q

Masters athletes are ___ older adults

A

Masters athletes are not always older adults

106
Q

What are the MSK considerations of an older athlete?

A

• OA- common with normal age related changes
• Bone mineral density loss
- Less loss in the older athlete with weightbearing and resistance exercise
• Changes result in an athlete that looks a little different
- Muscle fiber changes, addition of fat
• Less force production secondary to less type II fibers, somewhat activity specific
- Weight lifters experience less strength decline
- Runners experience less of a decline in endurance

107
Q

What are the cardiopulmonary considerations of an older athlete?

A
  • Physically active show less decline in VO2 max

* Smaller changes in physiologic functional capacity are seen in those who exercise with increased volume and intensity

108
Q

What are the characteristics of a macrotrauma (acute, traumatic) seen in an older athlete?

A

• Trauma occurs less frequently
- Participation in less contact sports
- Exceptions: cycling, hiking, climbing, skiing (falls and accidents common with these sports)
• More likely to sustain a fracture than rupture ligament
- Secondary to decreases in bmd
• More likely to tear or avulse muscle than strain muscle
- Increased collagenous stiffness
• Increased recovery time needed
- Deconditioning occurs faster secondary to normal age related changes

109
Q

What are the characteristics of a microtrauma (acute, traumatic) seen in an older athlete?

A

• Muscles strains, bursitis, tendinopathies
• May be more prone to these injuries when compared to
younger athletes
- Stiffer, less flexible
- Arthritic changes
- Less shock absorption and protection
• Joint pain and edema more common in older athletes as
compared to their younger counterparts
- Structural changes

110
Q

What are the characteristics of a OA seen in an older athlete?

A

• Common in the aging adult
- Equally common in the older athlete
• Strong flexible muscles act as shock absorbers
- Treatment should focus progressive resistance exercise, patient education
on functional activities that minimize compression and shear
- Cycling, rowing, swimming, walking, cross training
• Increase in total joint arthroplasties being seen with expectation of
return to sport
- Procedures at younger ages
- Associated with improved function, quality of life, and longer life
- Return to sport can take up to 6 months after surgery

111
Q

What are assessments of the senior athlete?

A 
• Norm Referenced Tests
  - Senior Fitness Test
  - YMCA Fitness Test
  - ACSM Fitness Test
• Sport or movement specific examination
- Selective Functional Movement Assessment
    - Whole body functional approach
112
Q

What are the rehab considerations of a senior athlete?

A

• Recovery is slower; rate of tissue repairs slows with age.
• Treat the injury not the age
• Be aware of co-morbidities and screen/monitor/educate
• Don’t be too quick to blame OA as the cause of an older athlete’s
problem
• Joint mobility and soft tissue restrictions can be addressed with
manual therapy as long as not contraindicated
- Once mobility is improved corrective exercises can be initiated
• Don’t forget stability
- Taping, supports, braces, stabilization techniques, functional corrective exercises

113
Q

What are the important things to focus on during the rehab of a senior athlete?

A

• Proximal stability will facilitate distal mobility
- Don’t forget the core
• Generalized strengthening is important
- Don’t forget appropriate exercise prescription
• Stretching
- Warm up is imperative and may include some stretching
- Cool down stretching is better
- 60 seconds is better than 30 in the older adult

114
Q

What are the definitions of abuse?

A
  • “Intentional act, or failure to act, by a caregiver or another person in a relationship involving the expectation of trust that causes or creates a risk of harm to an older adult.”
  • “Physical, sexual, or psychological abuse as well as neglect, abandonment, and financial exploitation of an older person by another person or entity that occurs in any setting either in a relationship where there is an expectation of trust or when an older person is targeted based on age or disability.”
115
Q

What are the different types of abuse?

A
  • Physical- bodily harm
  • Emotional (psychological)- verbal: hurtful words, yelling, threatening, ignoring; isolation
  • Neglect: caregiver fails to respond to needs
  • Abandonment: left alone without plan for care
  • Sexual: forcing to watch or partake
  • Financial: money or belongings are stolen – forging checks, retirement or SS benefits, credit cards or bank accounts without consent, etc.
116
Q

What are the signs of elder abuse?

A

• Physical: injuries/trauma, bruises, emaciation
- Challenging
• Behavioral: anger, helplessness, suicidal actions
• Psychological: fear, anxiety, depression
• Social: limited contacts, withdrawal
• Others: has trouble sleeping, messy look or unwashed
hair or dirty clothes, develops preventable conditions

117
Q

What do you do when you suspect elder abuse?

A

Report it!
• Most states require mandatory reporting by healthcare workers
of suspected elder abuse to Adult Protective Services (APS).
• Immediate danger: 911
• Local APS
• Eldercare Locator

118
Q

What are the characteristics of “good death”?

A
  • Pain or discomfort free
  • With those they love
  • Location or environment of choice
119
Q

What is the role of the PT in end of life?

A

Assist in pain reduction, optimizing function, and addressing quality of life remaining
• Safe mobility
• Energy efficiency
• Sleep quality
• Stress
• Respiratory function
• Reduction in medications needed for pain

120
Q

What is death?

A

Decline or failure of all major organ systems

121
Q

What are the physiologic signs of death?

A
  • Confusion, delirium, disorientation
  • Increased time sleeping
  • Anxiety, restlessness
  • Weakness, functional loss, fatigue
  • Reduction in BP, variable irregular heart rate
  • Rapid breathing with periods of apnea
  • Cool distal extremities
  • No interest in food
  • Constipation, diarrhea, incontinence, reduced urine output
122
Q

What are the components of planning for end of life?

A

Advance Directives
• Legal document
• States patients desires in the event of imminent death
• Appoints a medical power of attorney
- Decision maker on the patients behalf if the patient becomes incapacitated
• Optional element of orders for “Do not resuscitate” (DNR)- Note not required for hospice care
- Physical therapists need to be aware of the DNR
• Also known as a Living Will

123
Q

What are the characteristics of a hospice care?

A 
• Death is a physical, psychological, and spiritual event
• Covered by Medicare part A
  - Terminal condition with 6 or less months to live
  - No longer seeking cure
• Interdisciplinary team:
 - Nurse
 - Chaplain
 - Social Worker
 - Physical Therapist
 - Volunteers (caregiver respite)
124
Q

What are the characteristics of PT in a hospice care?

A

• Rehabilitation Light
- PT once a week or biweekly
- Slow, easy, strengthening exercises and functional activities
- Issue an HEP…very light, but essential to slow progression
• Rehabilitation in Reverse
- Assisting a patient and caregivers as their mobility declines. May include equipment recommendations, bed mobility for positioning and comfort, PRN visits may be indicated
• Skilled Maintenance
- Maintenance of quality of life unable to be performed safely by other caregivers Example: Ambulation and transfers that a caregiver can not manage secondary to severe weakness and balance limitation in conjunction with caregiver limitations

Aging adult (5 decks)

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