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S7- Special Populations > Week 9: Intro To The Older Adult > Flashcards

Week 9: Intro To The Older Adult Flashcards

1
Q

PART 1: AGE RELATED CHANGES

A

PART 1: AGE RELATED CHANGES

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2
Q

Gerontology vs. Geriatrics

A 
Gerontology = The study of aging.
Geriatrics = Medical treatment of aging people.
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3
Q

Describe each of the following Theories of Aging:

  • Progressive Decline Model
  • Biological Time Clock
  • Free Radical Theory
  • Cross-Linkage Theory
  • Immune Theory
  • Error Catastrophe Theory
A
  • Progressive Decline Model: wear & tear
  • Biological Time Clock: finite number of cell replications
  • Free Radical Theory: oxygen radicals contribute to pathophysiological changes
  • Cross-Linkage Theory: chemical reactions cause irreparable damage to DNA
  • Immune Theory: breakdown in immune system leads to greater risk of disease and cancer
  • Error Catastrophe Theory: errors in cellular RNA transcription lead to faulty structures, especially proteins.
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4
Q

Geriatrics requires a ________ approach.

A

interdisciplinary

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5
Q

What are some other disciplines included in the care for geriatric patients? (6)

A
  • PTA
  • OT and Speech
  • Nursing
  • Case Manager
  • Physician/PA
  • Family
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6
Q

Describe each of the following roles:

  1. ) Coordinate care to address all aspects of rehab needs.
  2. ) Coordinate discharge plans and equipment needs.
  3. ) Obtain essential info on patient’s PLOF and discharge options; caregiver involvement in patient care.
  4. ) Coordinate care and exchange critical patient info.
  5. ) Coordinate care and exchange critical patient info.
  6. ) Assist in implementing treatment programs, reporting to PT on patient’s response, and help PT in determining changes necessary to treatment approach based on patient status.
A
  1. ) OT and Speech
  2. ) Case Manager
  3. ) Family
  4. ) Nurse
  5. ) Physician/PA
  6. ) PTA
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7
Q

Who should you consult?

  1. ) You want to unhook the PEG tube during PT treatment.
  2. ) The patient is coughing after drinking orange juice.
  3. ) You need clarification on the family/home situation.
  4. ) The patient is unable to manipulate utensils during meals.
  5. ) The patient shows increased confusion during treatment today.
  6. ) You want to find out what equipment the patient owns and the patient is unable to tell you.
A
  1. ) Nursing
  2. ) Speech
  3. ) Family
  4. ) OT
  5. ) Physician
  6. ) Case Manager
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8
Q

79% of people >70 have one or more of what (7) chronic conditions?

A
  • Arthritis
  • High blood pressure
  • Diabetes
  • Lung Disease
  • Stroke
  • Cancer
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9
Q

In those 65 and older, 30% have 3 or more chronic conditions leading to medically complex patients. What can add to this complexity that occurs often with old age?

A

Dimentia

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10
Q

What are the (3) major principles to consider in geriatric rehabilitation?

A
  1. ) Variability of capabilities.
  2. ) Inactivity/sedentary lifestyle.
  3. ) Concept that optimal health is directly related to optimal functional ability.
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11
Q

Geriatric rehab is directed toward:

  • Stabilizing _______ problem
  • Preventing ________ complications
  • Restoring _____ function
A
  • Stabilizing primary problem
  • Preventing secondary complications
  • Restoring lost function
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12
Q

Evaluation Considerations:

Prep:

  • ______, ___-___ examination area
  • ____ accessibility
  • Adjustable treatment table

Tools:
-Consider the patient’s _______ status when choosing assessment tools

Timing:
-Time of day may impact _____/______ status

A

Prep:

  • quiet, well-lit
  • WC

Tools:
-cognitive

Timing
-physical/cognitive

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13
Q

Evaluation Considerations:

  • Both physical and mental _____ may be limited.
  • Determine _______ status immediately to guide direction of interview questions and physical examination.
  • Use appropriate ______ scale(s).
  • Understand the difference between depression and _______.
  • Keep __________ at the forefront of clinical assessment/decisions.
A
  • endurance
  • cognitive
  • pain scales
  • dimentia
  • FUNCTION
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14
Q

Describe the homeostatic reserve and how it changes with aging and disease states.

A
  • When the body is subjected to stress, it uses physiologic reserves to maintain homeostasis. The greater the stress, the more physiologic reserves are engaged. With age, the physiologic reserves of each organ system diminish.
  • As a result, an insult, easily buffered by the young organ, may push the older organ’s ability to maintain homeostasis beyond the “physiologic limit,” leading to an acute injury or disease state.
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15
Q

Describe the difference between successful and unsuccessful aging.

A

Successful Aging:

  • HIGH capacity to tolerate stressors.
  • Exercise causes ROBUST, POSITIVE changes.
  • WIDER HOMEOSTATIC WINDOW = greater physical resilience.

Unsuccessful Aging

  • LOW capacity to tolerate stressors. (susceptible to illness)
  • Positive changes occur but at SMALLER magnitude.
  • NARROW HOMEOSTATIC WINDOW = reduced adaptation to even low stress.
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16
Q

Changes in the MSK System:

Bone:

  • Does advancing age favor bone catabolism or anabolism? What disease can this lead to?
  • Women: bone loss accelerated by __________.
  • Men: bone loss accelerated after age ____.

Muscle:

  • What is sarcopenia?
  • Loss of Type ___ fibers affect strength and power.
  • What is cachexia?
  • Cachexia occurs before death (associated with cancer, COPD, end-stage disease) and is most likely cause by massive increase in what?
A

Bone:

  • Catabolism, can lead to osteoporosis
  • menopause
  • 75

Muscle:
Sarcopenia = age related decline in muscle mass.
-Type II
-Decline in muscle/body wasting that does not respond to nutritional support.
-inflammatory cytokines

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17
Q

Changes in the MSK System:

  • Decreased water content in CT = ____________
  • Loss of water in articular cartilage = __________
  • Increased collagen crosslinks + water loss = ___________
  • Reduction of elastin = _____________
  • Aging CT contributes to sports injuries, decreased performance, and displaced internal organs.
A
  • decreased height
  • osteoarthritis
  • joint stiffness and reduced shock absorption
  • saggy, wrinkled skin
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18
Q

What are some exercise considerations for the MSK System? (5)

A
  • HIGHER-INTENSITY exercise leads to greater strength gains and LBM.
  • Exercise plays a crucial role in controlling intra-abdominal fat.
  • Achieving end-range prevents age related ROM losses.
  • CT stiffness increases muscular effort required for movement, leads to reduced muscle endurance.
  • High-impact exercise may not be appropriate in presence of bone loss and dried out CT.
19
Q

Do high or low intensity exercises lead to better outcomes?

A

High Intensity

20
Q

Changes due to aging can affect what (5) other systems besides the MSK System?

A
  • Cardiovascular
  • Nervous
  • Sensory
  • Immune
  • Endocrine
21
Q

List some anatomic/physiologic CV System changes that occur due to aging and the clinical consequence of each. (5)

A
  1. ) Decline in max HR and VO2 = smaller aerobic workload
  2. ) Stiff, less compliant vascular tissue = higher BP, slower ventricular filling time, reduced CO
  3. ) Loss of SA node cells = Lower max HR
  4. ) Reduced contractility of vascular walls = decreased HR/VO2, smaller aerobic workload
  5. ) Thickened capillary basement membrane = reduced arteriovenous O2 uptake
22
Q

List some anatomic/physiologic Nervous System changes that occur due to aging and the clinical consequence of each. (5)

A
  1. ) Sloughing/loss of myelin = slowed nerve conduction
  2. ) Axonal loss = fewer muscle fibers, loss of fine sensation
  3. ) ANS dysfunction = slower systemic function (CV, GI) with altered sensory input
  4. ) Loss of sensory neurons = reduced ability to discern hot/cold, pain
  5. ) Slowed response time = increased fall risk
23
Q

Changes in Sensory Function:

  • What peripheral sensory systems can be affected by aging? (5)
  • What vision difficulties can be seen?
  • What hearing difficulties can be seen?
  • What can loss of these sensory systems lead to? (4)
  • Is it common to have multisensory impairments?
A
  • visual, proprioception, auditory, tactile, and vestibular
  • loss of acuity, visual field, contrast sensitivity
  • presbycusis (age-related loss of hearing)
  • depression, poor QOL, cognitive decline, mortality
  • Yes, 66% have 2+ deficits.
24
Q

Changes in Immune System:

  • Advancing age leads to increased systemic _________.
  • Do we see an increase or decrease in inflammatory biomarkers? What helps to decrease these?
  • Associated with muscle ______, _______ and loss of ________ function.
  • Also diminishes other organ function leading to reduction in ________ _______.
  • Habitual exercise results in less systemic inflammation and creates a ______ window of homeostasis.
A
  • inflammation
  • increase, exercises reduces biomarkers
  • muscle wasting, obesity, and loss of physical function
  • physiologic reserve
  • wider window
25
Q

Changes in Endocrine System:

  • Altered gland function, ________ hormone production and tissue responsiveness.
  • What are the negative effects of this?
  • Hormone therapy is still an evolving science!
A
  • decreased
  • Negative effects on muscle mass, bone density, adipose accumulation, insulin sensitivity, LDL metabolism, libido, and cognition.
26
Q

Successful Aging:

  • “Adding life to the years”, achieving _____.
  • Is it an outcome or a process?
  • Is it based on subjective health (individuals’ values and perception of their aging) or objective health (physical and cognitive health, physical function)?
  • _______ and _________ play a role.
  • Positive attitude about aging in younger people can help them embrace changes with age!
A
  • QOL
  • BOTH outcome and process
  • Based on both subjective and objective health.
  • Adaptation and resilience
27
Q

What are some ways we can motivate patients to achieve their desired outcomes?

A
  • Make it personal.
  • Use social supports.
  • Make patient-centered goals.
  • Reduce unpleasant sensations as much as possible.
  • Educate patient on disease/condition and benefits of exercise/activity.
28
Q

Trauma Informed Care:

  • What is Trauma Informed Care?
  • What are the (5) guiding principles for trauma informed care?
A
  • Trauma-Informed Care recognizes the presence of trauma symptoms and acknowledges the role trauma may play in an individual’s life- including service staff.
  • safety, trustworthiness, choice, collaboration, and empowerment
29
Q

Mental Health:

Depression:

  • Is it common in older adults?
  • What can contribute to depression?
  • What can help with depression?
  • Can be mistaken for or coexist with __________.

Suicide:

  • 17th leading cause of death in 65+. Is it more common in men or women?
  • More successful with attempts.
  • PTs need to recognize risk factors and inquire about mental health.
A

Depression

  • Not normal part of aging but is COMMON.
  • medical conditions, medications
  • exercise/activity
  • dementia

Suicide:
-Men 7x > Women

30
Q

PART 2: CHANGES IN SENSORY FUNCTION

A

PART 2: CHANGES IN SENSORY FUNCTION

31
Q

What sensory functions can be affected by aging?

A
  • Hearing
  • Vision
  • Smell
  • Taste
  • Touch
  • Proprioception
  • Vestibular Dysfunction
  • Swallowing Reflex
32
Q

Loss of Hearing:
-What are the (2) types of hearing loss?

Presbycusis (sensorineural hearing loss):

  • ______-tone frequencies generally affected before low-tone frequencies.
  • Associated with slower ________, poor ________, and _______.
  • High pitch consonants such as s, t, f, and g are difficult to understand.

Conductive hearing loss (dysfunction of external/middle ear):

  • Impairment across ______ frequencies.
  • What may you need to do when talking to this patient?
A

Presbycusis (sensorineural hearing loss):

  • High-tone
  • slower gait speed, poor cognition, mortality

Conductive hearing loss (dysfunction of external/middle ear):

  • all frequencies
  • May need to speak directly in person’s ear.
33
Q

What are some amplification techniques used for hearing loss? (2)

A
  • Hearing aids

- Cochlear implants

34
Q

What are some ways we can accommodate for hearing loss? (10)

A
  1. ) Make sure hearing aids are in!
  2. ) Make eye contact
  3. ) Project voice, speak slowly and clearly
  4. ) Use visual aids
  5. ) Use rephrasing instead of repeating again and again
  6. ) Write it out!
  7. ) Minimize background noise
  8. ) Avoid side conversations
  9. ) Increase bass, turn down treble on radios/TVs
  10. ) Use of flashing light visual cues for smoke detectors, doorbells, etc.
35
Q

Loss of Vision:

  • What are the 3 levels visual changes occur across?
  • What are some common conditions associated with visual changes? (4)
A
  • Anatomic changes, structures in retina, perceptual processing
  • Cataracts, macular degeneration, glaucoma, diabetic retinopathy
36
Q

Listed below are the 8 aspects of vision. What are some ways we can accommodate for each?

  1. ) Acuity
  2. ) Visual Field
  3. ) Glare
  4. ) Dark Adaptation
  5. ) Colors
  6. ) Contrast
  7. ) Depth Perception
  8. ) Illumination
A
  1. ) Acuity = glasses/contacts, magnifiers, large print
  2. ) Visual Field = lower height for directional/informational signs
  3. ) Glare = nonwax on vinyl floors, flat paint, indirect lighting
  4. ) Dark Adaptation = red bulb night lights, automatic light timers
  5. ) Colors = reds, oranges, yellows; avoid pastels and monotones
  6. ) Contrast = avoid monotones and highlight visual contrast
  7. ) Depth Perception = avoid patterned floors; contrast counters and floor surfaces
  8. ) Illumination = use of lamps with 200-300W bulbs
37
Q

Loss of Smell:

  • Less ______ with age.
  • Can it go unnoticed by the individual?
  • Associated with _________ system disease.
  • May be an early indicator of what 2 diseases?
A
  • less acute
  • Yes
  • respiratory system disease
  • Parkinson’s and Alzheimer’s
38
Q

Loss of Taste:

  • What are the 5 basic taste sensations?
  • Taste bud cell regeneration slows after age ___.
  • Olfactory nerve endings and mucus production decline.
  • Medical conditions, medications, and poor oral health can impact taste. What do patient’s with Alzheimer’s crave?
  • Increased use of salt for flavor can lead to what?
A
  • sweet, sour, bitter, salty, umami
  • 50
  • Alzheimer patient’s have an abnormal craving for sweet food.
  • Can lead to increased BP
39
Q

Loss of Touch:

  • Is loss of touch, pressure, temperature, pain, and proprioception often due to a disease process or is it a normal part of aging?
  • Results in reduced number of touch receptors. What are the (3) corpuscle types and what they sense?
  • Thinning of skin by 20% which can result in what?
  • Can result in senile purpura, what is this?
A
  • Often due to disease process rather than normal aging process.
  • Meissner’s corpuscles (TOUCH/TEXTURE), Pacinian corpuscles (PRESSURE/VIBRATION), Krause corpuscles (TEMPERATURE)
  • decubitus injuries
  • Senile purpura = easily bruised
40
Q

Loss of Proprioception:

  • Receptors for movement and body position are located in what (3) areas?
  • Loss of receptors/function changes joint biomechanics and postural stability. When loss of proprioception is paired with other sensory loss, risk of what can occur?
A
  • muscles, tendons, labyrinth system

- Risk of fall!

41
Q

Vestibular Dysfunction:

  • _________ and _______ are major complaints in older adults.
  • Occurs from degeneration of sensory receptors in _______ and ___________.
  • What are the most common vestibular conditions?
  • What are these patients at high risk for?
A
  • dizziness and imbalance
  • otoliths and semicircular canals
  • BPPV and Meniere’s Disease
  • Fall Risk!
42
Q

Loss of Swallow Reflex:

  • What are the (2) types of dysphagia?
  • What are the (2) most common tests utilized?
  • What are the S/Sx?
  • What are 2 treatment methods for loss of swallow reflex?
A
  • oropharyngeal and esophageal
  • Modified Barium Swallow Study and FEES
  • cough/choke with eating/drinking
  • SLP and modified diets
43
Q

Is it common to have multiple sensory deficits? If so, what does this result in?

A

Yes
-Results in reduced physical performance among older adults. Predictive of impaired physical/cognitive function, significant weight loss, and mortality within 5 years.

S7- Special Populations (18 decks)

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