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197 Cards in this Set
- Front
- Back
|
How many adults are over 65?
|
36.6 million
(12.4%) |
|
Since 1900, what has happened to the number of 65 and older?
|
Number has increased 12x
(percentage has tripled) |
|
What was the number of 65 and older in 2010?
|
40 million
(15%) |
|
What will be the number of 65 and older in 2030?
|
55 million
(36%) |
|
What was the number of 85 and older in 2010?
|
6.1 million
(40%) |
|
What will be the number of 85 and older in 2030?
|
7.3 million
(44%) |
|
Who do most men over 65 live with?
|
Spouse
(72%) |
|
Who do most women over 65 live with?
|
Spouse (42%)
Alone (38%) |
|
What states have the greatest number of over 65?
|
1. California
2. Florida 3. NY 4. PA |
|
What states have the greatest percentage of over 65?
|
1. Florida
2. WV 3. PA |
|
What is Medicare part B?
|
Physician chooses fee for service
Physician gets 80% Of claim Bills patient for no more than 20% copayment |
|
Who is eligible for part B?
|
Over 65 eligible for A, US citizen, or permanent resident
|
|
How is a person enrolled in part B?
|
Enroll
Pay premiums (78/mo) from their SS checks |
|
uses regional insurance companies (intermediaries) to pay hospitals, nursing homes, home-care agencies, and hospice programs for the Medicare-covered services they provide
|
Part A
|
|
uses other regional insurance companies (carriers) to pay physicians, nurse practitioners, social workers, psychologist, rehabilitation therapist, home-care agencies, ambulances, outpatient facilities, laboratory and imaging facilities, and suppliers of durable medical equipment for the Medicare-covered goods and services they provide
|
Part B
|
|
Who is eligible for Part A?
|
Older Americans (and their spouses) who have had Medicare taxes deducted from their paychecks for at least 10 years
|
|
Federal insurance program For acute health care?
|
Medicare
|
|
Who is covered by Medicare?
|
65+
Disabled Suffering from end stage renal dx |
|
Percentage of elderly who make up hospital services?
|
36% of hospital stays
49% of all day hospital care 50% of all physician hours |
|
What does the average 75 year old have?
|
3 chronic conditions
Uses 4.5% of all prescription drugs 1 in 4 has At least one disabling condition |
|
Results in 70% of hospital stays and 60% of Medicare costs?
|
Chronic disease
|
|
17% of hospital stays are caused by?
|
Inappropriate drug prescribing
|
|
Why are there geriatrics health care provider shortage?
|
Age denial
Marginalization Lack of public awareness of geriatrics gap Scarcity of academic leaders Lack of educational infrastructures Not valued Inadequate reimbursement Lack of coordination Excluded from clinical trials Minimal research on aging |
|
What is the paradigm shift of the 21st century?
|
Patient centered
Continuous healing relationship Cooperation amongst clinicians Evidence based Decision making Transparency |
|
What are 3 pathways of the future?
|
Interdisciplinary teams
Management information systems Community based training |
|
How is the system of care redesigned?
|
•Increase reliability of care delivery process
–Information technology •Translate research into practice –Evidence-based approach •Create and maintain interdisciplinary teams •Coordinate with community-based agencies and the public health system •Performance and outcome measures |
|
Common characteristics of the new model of care?
|
•Designed to maximize health, function, quality, and satisfaction
•Interdisciplinary •Patient-centered focus –Patient part of the team –Self-management/empowerment •Based on evidence (e.g., nutrition, exercise, counseling, community-based services) •Information technology enhances care, intervention, monitoring and communication |
|
Showing the effects of time, a gradual process of change?
|
Aging
|
|
A decrease in cell divisions, Growth, and function over time
|
Senescence
|
|
Young old
|
65-74
|
|
Middle old
|
75-84
|
|
Oldest old
|
Over 85
|
|
separation of older people from society is mutually beneficial
|
Disengagement theory
|
|
Ex of disengagement theory
|
Retirement
|
|
important for older people to stay connected to society
|
Activity theory
|
|
More active in some aspects, more disengaged in other aspects
|
Selectivity theory
|
|
What are the three areas of aging?
|
Physical
Psychological Social |
|
Life expectancy of a male
|
75.7
|
|
Life expectancy of a female
|
80.6
|
|
Max age (life Span) of a human
|
120
|
|
Worldwide life expectancy
|
79 and 86
|
|
Factors of biological/physiological theories?
|
Genetics
Environment Lifestyle |
|
Three social theories
|
Disengagement
Activity Selectivity |
|
Cell damage accumulates over time and eventually destroys the cell
|
Error theory
|
|
7 error theories
|
1.Mutation accumulation theory
2.Free radical theory 3.Cross-linkage theory 4.Somatic Mutation theory 5.Viral theory of aging 6.Cumulative waste theory 7.Autoimmune theory |
|
•Aging results from chance events that escape proof reading mechanisms which gradually damage the cell’s DNA.
|
Mutation accumulation theory
|
|
What causes mutation accumulation?
|
Radiation
Lifestyle environment |
|
What can increase free radical productIon
|
Diet, lifestyle, radiation
|
|
Where is free radical theory most important
|
Mito
Cell membrane |
|
Help bind free radicals and stabilize them
|
Antioxidants
|
|
– Reacts with healthy molecules in a destructive manner.
|
Free radicals
|
|
Any molecule with a free electron, unstable and highly reactive
|
Free radical theory
|
|
Ex of free radical theory
|
Superoxide
|
|
Chance mutation over time
|
Error theory
|
|
Way it goes from birth to death: biological clock
|
Programmed theory
|
|
4 programmer theory
|
1.Telomerase theory
2.Reproductive cell cycle theory 3.Immune system theory 4.Evolutionary theory |
|
the number of times a population of cells will divide before it stops
|
Hayflick limit
|
|
Fibroblasts maximum passages
|
50
(not how old but number of divisions) |
|
regions of DNA at the end of the chromosomes
|
Telomeres
|
|
Not dependent on chronological time but number of cell division
|
Hayflick limit
|
|
What do the telomeres do?
|
•serve to protect the chromosome
•Important in cell division |
|
An enzyme that increases the number of cell divisions and can result in cancer
|
Telomerase
|
|
What happens to the telomeres with each cell division?
|
Becomes shorter
(until no longer can divide) |
|
–Aging is regulated by reproductive hormones that act via cell cycle signaling, promoting growth and development early in life.
–Later in life, becomes nonproductive and advances senescence |
Reproductive cell cycle theory
|
|
Neuroendocrine theory
|
Reproductive cell cycle theory
|
|
Increased risk of infection and decreased ability to stop tumor cells observed during aging
|
Immune system declines
|
|
Aging results from an increase in autoantibodies that react with the body's tissues
|
Autoimmune theory
|
|
genes that are involved in aging and lifespan
|
Gerontogenes
|
|
Example of cross linking theory?
|
Glycation
|
|
binding of glucose to proteins decreases protein function
|
Glycation inc w age
|
|
What can help prevent glycatiom and cross linking theory?
|
Caloric and dietary restriction
|
|
Is aging a disease?
|
No
|
|
Are there specific symptoms of aging?
|
No
|
|
4 characteristics of mammalian aging?
|
Cellular and physiological deterioration
Increased mortality Increased Dx Dec ability to respond to stress (decreased homeostasis) |
|
3 normal aging
|
Optimal
Usual Universal |
|
4 things that influence normal aging
|
Genetics
Lifestyle Physiology Socioeconomic |
|
Problems with normal aging
|
Heterogeneity
Normal does not imply no risk Normal does not imply natural |
|
Aging breakdown
|
Dx vs Non Dx
(usual vs successful) |
|
Helps patients to understand what to expect
|
Normalization (clinical approach)
|
|
2 parts of normalization
|
Adjust to likely changes
Identify potential symptoms of disease |
|
How does the clinician maintain or improve modifiable causes of age-related change
|
Dec exposure (radiation)
Psychological well-being (Dec isolation) Cognition (Dec mental inactivity) Nutrition Exercise |
|
How does body composition change as we age?
|
Fat increases
Cell mass decreases Bone mass decreases |
|
Where does fat accumulate as we age?
|
Central
|
|
Domains of Geriatric evaluation
|
Physical/medical
Psychological Socioeconomic |
|
Basic activities of daily living
|
Dressing
Eating Tolieting Anguishing Hygiene |
|
Instrumental activities of daily living
|
Driving
Shopping Driving Cooking Cleaning |
|
Functional lost
|
Final common pathway for Dx
Quality of life |
|
What does functional loss predict
|
Length of stay
Discharge place Readmission Mortality |
|
Goal of comprehensive geriatric approach
|
Promote wellness and independance
|
|
Focus of comprehensive geriatric approach
|
Function and performance
|
|
Scope of comprehensive geriatric approach
|
Physical
Cognitive Psycho social domains |
|
Approach of comprehensive geriatric approach
|
Multidisciplinary
|
|
Efficiency of comprehensive geriatric approach
|
Ability to perform Rapid scans to identify target areas
|
|
Coming to rest inadvertently on the ground or at a lower level
|
Falls
|
|
One of the most common geriatric syndromes
|
Falls
|
|
Are most falls associated with syncope
|
No
|
|
What population of +65 fall more often?
|
Long term care facilities
|
|
Annual history of falls with people who have a history of falls?
|
60%
|
|
Leading cause of death from injury in persons aged ≥65
|
Complications of falls
|
|
What percentage of falls by older adults result in fracture or other serious injury
|
10-15%
|
|
Death related to falls increases in proportion to?
|
Increased age
|
|
4 sequelae associated with falls?
|
Fear of falling
Increased use of medical services Nursing home placement Decline in functional status |
|
What predicts lasting decline in functional status
|
Long lie (Can't get up without help)
|
|
What are the costs of falls?
|
ED
Hospitalizations |
|
What are the causes of falls?
|
Not usually single cause
Impairment in multiple domains Interaction of intrinsic, Postural control, and mediating factors |
|
Intrinsic causes of falls
|
Age related decline (Dec vision)
Chronic disease (Parkinson) Acute illness Medication use |
|
What meds cause falls
|
ØBenzodiazepines
ØAntidepressants ØAntipsychotic drugs ØCardiac medications ØHypoglycemic agents Inc number of meds |
|
How do you perform a fall assessment?
|
History of falls
Single fall (check for balance) Recurrent falls (Med hx, PE) |
|
How do you obtain a history of falls?
|
Describe fall
Ask about syncope Look into etiology of falls |
|
What should you look at during the physical exam?
|
Bp and pulse
Vision Cardiovascular exam Musculoskeletal exam Neurological exam |
|
Components of a neurological exam
|
–Mental status
–Cranial nerves –Motor, muscle strength –Coordination –Reflexes (DTRs, primitive) –Sensation –Gait |
|
Physical evaluation of falls
|
Motor
Balance Coordination |
|
What do you assess With the motor assessment in falls?
|
Quad strength (rise from chair wo using arms)
|
|
What is the balance assessment of falls?
|
3 stances (including one leg stance)
|
|
What is the coordination assessment of falls?
|
Abnormal if:
Hesitant start Broad-based gait Path deviates Heels do not clear toes of other foot Extended arms |
|
Gait and balance assessment of falls
|
Romberg
Berg balance Tandem gait Timed get up and go test |
|
What are most gait disturbances related to?
|
Underlying disease
|
|
How do you measure gait speed?
|
Over a short distance (10 ft)
As a distance walked over time (6 min) |
|
What does comfortable gait speed predict?
|
Disease activity
|
|
1.Rise from a hard-backed chair with arms
2.Walk 10 feet (3 meters) 3.Turn 4.Return to the chair 5.Sit down |
The timed get up and go test
|
|
Normal timed get up and go
|
10 sec
|
|
Timed get up and go test greater than 14 sec
|
Inc risk of falls
|
|
Timed get up and go test greater than 20 sec
|
Comprehensive evaluation
|
|
Pain-induced limp with shortened phase of gait on painful side
|
Antalgic gait
|
|
Outward swing of leg in semicircle from the hip
|
Circumduction
|
|
Excessive plantar flexion and inversion of the ankle
|
Equinovarus
|
|
Acceleration of gait
|
Festination
|
|
Loss of ankle dorsiflexion secondary to weakness of ankle dorsiflexors
|
Foot drop
|
|
Early, frequent audible foot-floor contact with steppage gait compensation
|
Foot slap
|
|
Hyperextension of knee
|
Genu recurvatum
|
|
Tendency to fall forward
|
Propulsion
|
|
Tendency to fall backward
|
Retropulsion
|
|
Hip adduction such that the knees cross in front of each other with each step
|
Scissoring
|
|
Exaggerated hip flexion, knee extension, and foot lifting, usually accompanied by foot drop
|
Steppage gait
|
|
Shift of the trunk over the affected hip, which drops because of hip abductor weakness
|
Trendelenburg gait
|
|
Moving the whole body while turning
|
Turn en bloc
|
|
Treatment of falls
|
Health screening And targeting intervention
Multidisciplinary Reduce intrinsic and environment factors |
|
Most commonly studied & consistently effective treatment
|
Multifactorial assessment and targeted intervention
|
|
Effective components of multifactorial assessment and targeted intervention?
|
•Balance training
•Gait, assistive device •Environmental Modification •↓Psychoactive meds •↓Other meds •Manage orthostasis •Manage other CV & medical conditions •Cardiac pacing |
|
How do you prevent falls
|
Identify patients at risk
Assess and manage The health problems that increase falls |
|
How do you reduce Postural hypotension?
|
Hydrate
Reduce salt Reduce contributing meds Tell patients to switch positions slowly |
|
PT evaluation of falls
|
Look at footwear
Balance train Gait assessment and training Give assistive devices |
|
What are environmental modification?
|
Home safety evaluation
Reduce hazards (clutter) |
|
How do bones remodel themselves?
|
ØBone resorption (osteoclasts)
ØBone formation (osteoblasts) |
|
How does the bone remodeling become unbalanced?
|
Bone resorption increases more than bone formation, resulting in net bone loss
|
|
Skeletal Disorder Characterized by Compromised Bone Strength Predisposing to an Increased Risk of Fractures
|
Osteoporosis
|
|
What does bone strength equal?
|
Bone density + bone quality
|
|
Who gets Osteoporosis more often?
|
Post menopausal women
|
|
Osteoporosis causes?
|
Hip fractures
Vertebral fractures Wrist fractures |
|
Risk factors for osteoporosis?
|
Genetics
Race Women Smoking Age Impaired vision Dementia Poor health Low estrogen Falls Low calcium intake Alcohol Sedentary |
|
Diseases that cause osteoporosis
|
Parkinson
Celiac |
|
Meds that cause osteoporosis
|
Glucocorticoids
Aromatase inhibitors PhenoBarbital Phenytoin |
|
Central focus of geriatric medicine
|
Fraility
|
|
Old-old
Disabled/dependent Co-morbid disease |
Frailty
|
|
Symptom of frailty
|
HOMEOSTENOSIS
|
|
biologic syndrome of decreased reserves in multiple systems that results from dysregulation that can occur with aging
|
Fraility
|
|
What declines with aging and can lead to frailty?
|
Sarcopenia
Inactivity Disuse Disease Inflammation Under-nutrition |
|
Neuroendocrine changes that can lead to frailty?
|
•Decreased Growth Hormone & IGF-1
•Decreased DHEA-S •Decreased testosterone •Decreased estrogen •Increased cortisol •Increased sympathetic nervous system activity- norepinephrine |
|
What inflammation changes can lead to frailty?
|
•Elevated levels of IL-6 and C-reactive protein
•IL-6 may inhibit production of erythropoetin or interfere with iron metabolism •IL-6 is associated with loss of muscle mass and osteoporosis |
|
What 5 things demonstrate frailty according to Williamson and Fried?
|
–Weight loss or Sarcopenia
–weakness, –Low exercise tolerance/endurance, –Slowed task performance (such as walking speeding), –Low activity levels. |
|
What are the three things that change physiologically in frailty?
|
Inc IL-6, IL-8, and cortisol
|
|
What are the 4 outcomes of frailty?
|
Disability
Dependence Falls Death |
|
Predicted a group at high risk of adverse outcomes that geriatricians clinically associated with being frail
|
Cardiovascular heart study
|
|
What 5 things were looked at in the cardiovascular heart study?
|
–Weight Loss
–Exhaustion –Physical Activity –Walk Time –Grip Strength |
|
The cohort that were frail in the cardiovascular heart study were at increase risk of?
|
high risk of mortality, falls, hospitalization, and incident or worsening of disability
|
|
Does frailty depend on age, disability, or disease.?
|
No
|
|
difficulty or dependency in carrying out activities essential to independent living
|
Disability
|
|
Frailty causes?
|
Disability
|
|
concurrent presence of two or more medically diagnosed diseases in the same individual
|
Co-morbidity
|
|
Affects the cycle if frailty?
|
Disease state
|
|
wasting syndrome that can occur as the end stage of a number of chronic disease
|
Frailty
|
|
How do you treat frailty?
|
Prevent
Target people w reversible conditions or who would benefit from stabilization Assessment Intervention Implementation Evaluation |
|
age related losses of lean body mass and strength are influenced by inflammatory cytokines
|
Roubenoff and Rall
|
|
Health care provider team
|
Physician
Speech pathologist Physical therapist Occupational therapist Psychiatrist Social worker Neuropsychologist Nurse Therapeutic recreation therapist Repiratory therapist Dietician Social worker |
|
Team members for each patient depends on?
|
Diagnoses, problems, and setting of rehab
|
|
Uses skills from different disciplines and each discipline approaches the patient from theirmown perspective. Little collaboration
|
Multidisciplinary team
|
|
Uses skills of different disciplines. Everyone collaborates and are interdependent
|
Interdisciplinary team
|
|
Members share knowledge, skills, and responsibilities across traditional boundaries in assessment, diagnosis, planning, and implementation. Confidence
|
Trans disciplinary
|
|
States preference and priorities to the team
|
Patient
|
|
Assists with the goals of the team
|
Patient's family
|
|
Team leader
|
Physician
|
|
Works on communication, cognitive, and swallowing
|
Speech pathologist
|
|
Strengthens, endurance, and mobility of patient
|
Physical therapist
|
|
Teaches ADLs
|
Occupational therapost
|
|
Leisure skills
|
Therapeutic rec
|
|
Family issues and discharge planning
|
Social workers
|
|
Testing and counseling
|
Neuropsychologist
|
|
Medications
|
Psychiatrist
|
|
Interdisciplinary team principles
|
Need family and patient participation
Primary roles of team members but reduced boundaries Roles overlap Education for staff/patient/family Rehab is responsibility of all members |
|
Characteristics of teams
|
Skills/competence
Mentors for new staff Ability to prioritize needs of patients Knowledge of EBP in area of expertise Interpersonal skills of members New education of staff Ability to eliminate boundaries and territories |
|
Most important characteristics of a team
|
Collaboration
Cooperation Creativity |
|
Physical impairments generally remediate more quickly than
|
Communication and cognitive impairments
|
|
•What team member would take the lead for communication?
|
Speech pathologist
|
|
Evaluates and determines what techniques facilitate expression and comprehension (Primary leader of communication)
|
Speech pathologist
|
|
disorder that is characterized by impairment of memory and at least one other cognitive domain (aphasia, apraxia, agnosia, executive function). These must represent a decline from previous level of function and be severe enough to interfere with daily function and independence
|
Dementia
|
|
How do you treat dementia?
|
Rehab is appropriate
Uses principles of cognitive dysfunction |
|
Communication and cognitive therapy involves who?
|
•Requires team approach for best outcome
•Requires therapist to accommodate patient •And requires therapist to be creative |
