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Geriatrics Eval > Week 7 (after midterm) > Flashcards

Week 7 (after midterm) Flashcards

1
Q

balance involves the integration of which 4 systems?

A
  • visual
  • vestibular
  • somatosensory
  • musculoskeletal
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2
Q

ability to maintain balance requires adequate what?

A

reaction time

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3
Q

name 2 righting mechanisms of balance.

A
  • postural sway

- vestibular righting response

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4
Q

balance is restored using which 4 adjustments?

A
  • ankle, knee, and hip adjustments

- stepping

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5
Q

the pattern of ___ ___ for balance differs in older adults.

A

muscle activation

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6
Q

approx. what percent of adults 65 and older fall each year?

A

30%

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7
Q

what percent of older adults suffer moderate to severe injuries including hip fractures and head trauma from falling?

A

20-30%

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8
Q

the risk for falls increases with age, rises steadily after which age?

A

75

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9
Q

name 13 common causes of falls.

A
  • decline in visual, auditory, and vestibular system
  • slower reaction time
  • inadequate LB strength
  • decreased joint flexibility
  • medications
  • specific diseases
  • postural changes
  • incontinence
  • demands of the task
  • behaviors
  • gait changes
  • environment
  • fear of falling
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10
Q

contributes to fall risk

A

fear of falling (FOF)

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11
Q

name 7 components that can affect fear of falling.

A
  • female gender
  • gait disorder
  • impaired physical function
  • use of a mobility aid
  • previous falls
  • depressive symptoms
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12
Q

recognized as important and preventable but may not be viewed as personally relevant

A

senior’s perceptions of fall risk

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13
Q

___ ___ are perceived as likely causes of falls, but not other factors.

A

environmental features

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14
Q

which types of falls are more likely to be precipitated by environmental causes?

A

outdoor falls

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15
Q

when do outdoor falls usually occur?

A

while walking in a particular area and in the presence of others

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16
Q

name 6 predictors of indoor falls.

A
  • physical disability
  • deficits in ADLs
  • medication use
  • cognitive impairment
  • depression
  • low falls efficacy scale scores
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17
Q

name 7 predictors of outdoor falls.

A
  • male
  • younger age
  • depressive symptoms
  • psychotropic medications
  • moderate to high alcohol consumption
  • fast gait speed
  • frequent participation in leisure time physical activity
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18
Q

the ___ ___ contributes to perceived fall risk and fear of falling.

A

built environment

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19
Q

name 5 consequences of falls.

A
  • physical injuries
  • long lies
  • self imposed restriction in activity
  • increases likelihood of dependency and institutionalization
  • social isolation
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20
Q

name 4 AGS/BGS guidelines.

A
  • older adults who have fallen should have an assessment of their gait and balance
  • older adults who present for medical attention bc of a fall, report recurrent falls in the past year, or report difficulties in walking balance should have a multifactorial fall risk assessment
  • multifactorial fall risk assessment should be performed by a clinician with appropriate skills and training
  • the multifactorial fall risk assessment should be followed by direct interventions tailored to identified risks
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21
Q

name 4 aspects of an assessment per AGS/BGS clinical guidelines.

A
  • focused history
  • physical function tests
  • functional assessment
  • environmental assessment
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22
Q

history of falls, medications, risk factors: arthritis, incontinence, pain, hypertension, self-rated health)

A

focused history

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23
Q

balance, gait, mobility, lower extremity strength, visual acuity, feet & footwear, cognition, cardiovascular status

A

physical function tests

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24
Q

ADL, fear of falling

A

functional assessment

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25
Q
  • operationalizes AGS/BGS guidelines

- includes algorithm for screening and assessment, fact sheets, functional assessments

A

CDC Steadi Initiative

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26
Q
  • measures concern about falling during physical and social activity (indoors and outdoors)
  • likert scale ranging from “not at all concerned” to “very concerned”
  • ex: walking on an uneven surface, getting up from a chair, taking a bath, going shopping, cleaning the house
A

falls efficacy scale international (FES-I)

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27
Q
  • measure of physical mobility
  • used as a fall risk screening tool
  • stand from a chair, walk 3 meters, turn around come back and sit down. time measured in seconds
A

timed up and go (TUG)

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28
Q
  • “yard stick” is secured to the wall at the height of the right acromion
  • client is asked to stand with feet apart, make a fist and place arm parallel to measuring device. placement of the end of the 3rd metacarpal is recorded. client asked to reach as far forward as possible without taking a step or losing their balance. placement at the end of the third metacarpal is recorded again.
A

functional reach test

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29
Q

what indicates a fall risk on the functional reach test?

A

less than or equal to 6 inches

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30
Q
  • fourteen item assessment of static and dynamic balance
  • sit to stand, standing unsupported, sitting with back unsupported, stand to sit, transfers, standing unsupported with eyes closed, etc.
A

berg balance test

31
Q
  • designed to be used by any health professional in home, hospital or primary care setting
  • abbreviated version of original tool with items most predictive of fall risk included
A

FROP-Com screen

32
Q

name the 3 items included in the FROP-Com screen.

A
  • fall history
  • balance
  • ADL
33
Q

what is the purpose of the 30-second chair stand test?

A

to test leg strength and endurance

34
Q

name the equipment used in the 30-second chair stand test.

A
  • a chair with a straight back without arm rests
  • seat 17 inches high
  • stopwatch
35
Q
  • community-based, OT led 7-week program with follow-up home visit and 3 month booster
  • group-based intervention that includes: balance and strength exercises, home hazards, community safety and footwear, vision and falls, vitamin D and calcium, hip protectors, medication management, and mobility mastery
  • group sessions include reflection, sharing accomplishments, homework assignments, action planning
A

stepping on

36
Q

what is the % reduction of falls for Stepping On program participants as a result of increased protective behavior practices?

A

31%

37
Q

a home eval. is effective for those with what 2 things?

A
  • low vision

- high risk of falls

38
Q

__ __ is effective in reducing risk of falls, but less so for those at high risk.

A

tai chi

39
Q

exercise programs that reduce falls primarily involve ___ and ___ exercises.

A

balance, functional

40
Q

programs that are likely to reduce falls include ___ ___ ___.

A

multiple exercise categories

41
Q

name the sequence of regaining balance.

A
  1. ankle adjustment
  2. knee adjustment
  3. hip adjustment
42
Q

why is decline in hearing a risk factor for falls?

A

awareness of environment is different - someone is telling you to watch out and you don’t hear them, hearing loss is linked to cognitive status which can cause falls, can’t hear signals in environment, feet sound different on different floors

43
Q

why is decreased joint flexibility a common cause of falls?

A

limited knee or ankle range when climbing up a step

44
Q

name 5 specific diseases that can be risk factors for falls.

A
  • OA - specifically knees
  • Parkinson’s
  • Diabetes - neuropathy, vision
  • status post CVA/stroke
  • dementia - wandering, poor safety awareness
45
Q

why are postural changes a common cause of falls?

A

center of gravity is more forward

46
Q

why is incontinence a common cause of falls?

A

rushing to the bathroom

47
Q

describe proper footwear.

A
  • heal should not be higher than an inch
  • heal counter should be pretty firm
  • laces are better than slip-on shoes
48
Q

people don’t clear their toe as well and often get caught

A

toe off

49
Q

describe senior’s perceptions of fall risk.

A
  • less likely to identify their own vision, balance, or muscle strength as fall risks
  • identify environmental factors more
50
Q

name a risk for indoor falls.

A

multiple medications

51
Q

name a risk for outdoor falls.

A

moderate to high alcohol consumption - head injuries, don’t have good reaction time

52
Q

name 4 personal strategies used to adapt to fall risks.

A
  • change their gait
  • lift up feet when walking
  • walking around metal grates
  • use of social environment to decrease risk - crossing guards, asking strangers to help them, following groups of young people to walk in a group
53
Q

name 2 barriers to physical activity and exercise.

A
  • dog walkers

- going to a local gym but the level of class is not for you

54
Q

exercise programs online or at local gyms - can participate in classes or get a membership

A

silver sneakers program

55
Q

name 3 unmet educational and training needs for knowledge of outdoor fall risks and prevention practices.

A
  • didn’t understand the risks associated with wearing progressive glasses
  • didn’t recognize stairs as being problematic
  • didn’t understand how to carry items safely - better if hands are free - backpacks are good if you’re carrying lightweight items
56
Q

muscle wasting from being in an extended period for too long

A

rhabdomyolyses

57
Q

full on assessment for one’s fall risk - assessed by clinicians

A

multifactorial fall risk assessment

58
Q

how do you calculate reaction time on the Ruler Drop Test?

A

take the square root of 2 times gravity divided by distance in meters

59
Q

what is the cut off score for the TUG (timed up and go) test?

A

14 secs - if someone tasks more than 14 seconds = high fall risk

60
Q

how many seconds on the TUG indicates need for AD and ADL assistance?

A

more than 30 secs

61
Q

what is a limitation of the TUG?

A

will pick up older, more frail people but doesn’t tell us much about people at risk for falling outside (fast walkers)

62
Q

checklist given to client or family member to look at their home environment and make sure there are no hazards

A

CDC “Check for Safety”

63
Q

combines interview with observation and task performance, takes an hour to complete - time consuming, looks at abilities to safely store food, smoke detectors, etc.

A

SAFER-HOME v3

64
Q

44 cards with pictures, person is asked to sort the cards into piles into things they don’t do and don’t want to do, things they do now with no problem, things I want to do but have trouble doing, things I want to do but don’t do, ranked from least to most important

A

I-HOPE

65
Q

worn under clothes, significantly reduce risk of hip fractures

A

hip protectors

66
Q

one on one, for one person, addresses all impairments or risks identified

A

multifactorial assessment

67
Q

group-based programs, single-component - one on one focuses on one aspect

A

multicomponent assessment

68
Q

name 3 effective medical interventions to reduce fall risks.

A
  • pacemakers
  • cataract surgery
  • medication adjustments
69
Q

name 6 steps for assessing someone with a fall.

A
  1. interview - fall(s) history
  2. questions about home environment
  3. vision and hearing from chart or ask questions
  4. cognitive screen (ex: MOCA)
  5. self-report measure - fall efficacy scale
  6. performance measure - TUG or BERG
70
Q

when can the TUG not be used?

A

if someone requires physical assistance (from OT or other)

71
Q

name some ways to provide interventions to prevent fall risk for clients with dementia at an adult day health center.

A
  • chair yoga/tai chi/modified exercise program - part is seated and part is holding onto back of chair
  • educating staff on fall prevention risks
  • modifying the environment
  • home assessments - help caregivers make the environments as safe as possible
72
Q

who is the Stepping On program good for and who is it not good for?

A

good for individuals in the community, not good for individuals with dementia

73
Q

what does a higher score on the FES-I indicate?

A

greater fear of falling

74
Q

name 3 ways to address fear of falling.

A
  • pt. education - if you do fall, what is the safest way to get up, safety alert gadgets
  • help establish different routes or times to travel
  • self-advocate for any issues or problems in the community

Geriatrics Eval (12 decks)

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