Geriatrics Final Exam

Geriatrics Final Exam In the facts on aging quiz, which of the following "Myths" is true? a. All women develop osteoporosis as they age b. Problems with constipation is normal as you age c. Most older people are capable of operating a motor vehicle d. Most older people are set in their ways and unable to change - ANS c. Most older people are capable of operating a motor vehicle In the facts of aging quiz, which of the following "Myths" is false? a. As people grow older their intelligence declines significantly b. Memory loss is a normal part of aging c. As adults grow older, reaction time increases d. Older adults are at risk for HIV/AIDS - ANS a. As people grow older their intelligence declines significantly In the facts of aging quiz, which of the following "Myths" is TRUE? a. memory loss is a normal part of aging b. All women develop osteoporosis as they age c. Problems with constipation is normal as you age d. Most older people are set in their ways and unable to change - ANS a. memory loss is a normal part of aging Bone loss for most women starts at what age? a. 20-25 b. 30-35 c. 40-45 d. 50-55 - ANS b. 30-35 then once menopause occurs bone density decreases even more men begin bone loss at age 50-55 The loss of type 2B muscle fibers may result in the following: a. Decreased protective reactions when falling b. increased protective reactions when falling - ANS a. Decreased protective reactions when falling The effects of dehydration cause all of the following except: a. Swollen eyes b. Hypertension c. Reduced ventricular filling volume d. Decreased cardiac performance - ANS a. Swollen eyes Which factors lead to the biophysiological changes within the pulmonary system? a. Kyphotic spine b. Barrel chest c. Structural changes in the alveoli d. All of the above - ANS d. All of the above Decreased dopamine levels in the brain may lead to what? a. Lack of sleep b. Decreased appetite c. Depression d. Inability to sit still - ANS c. Depression Which condition is the older population at more risk for which affects the integumentary system? a. Herpes zoster b. Hepatitis c. Encephalitis d. Fifth Disease - ANS a. Herpes zoster - shingles The article "Aging of the Somatosensory system: A translation perspective" describes the decline seen in the somatosensory system. Which of the following is true? a. Motor fibers decline earlier than sensory fibers b. Sensory fibers decline earlier than motor fibers c. Motor and sensory fibers begin to decline at the same time d. Only some sensory fibers decline - ANS b. Sensory fibers decline earlier than motor fibers From the article 'Delirium prevention, assessment, and treatment by the PT" which of the following is true about delirium? a. Slow and steady onset b. Sudden onset c. Cannot be reversed d. Worse during the day - ANS b. Sudden onset slow and steady onset = dementia; worse during the day = depression What is the best course of action to take if we suspect our elderly patient is depressed? a. Change the topic to something cheerful if they start talking about being depressed b. Never bring up the topic of suicide c. Do not talk to them about depression but document their feelings d. Educate them about depression and refer them to a mental health specialist - ANS d. Educate them about depression and refer them to a mental health specialist Perpetrators of elder abuse are usually which of the following? a. a complete stranger b. Trusted caretaker c. an annoying neighbor d. elder abuse never happens - ANS b. Trusted caretaker hearing loss increases the risk of dementia by a. 25% b. 75% c. 40% d. 12% - ANS c. 40% All of the following are related with dementia except: a. Increased heart disease b. Difficulty swallowing c. Increased falling d. UTIs - ANS d. UTIs (delirium) i think According to the Power 9 suggestions from the World Views on Aging, which of the following are true? a. Attending faith based services 4x a month may add up to 4-14 years of life expectancy b. Moderate alcohol has a negative correlation to cognitive decline in the elderly c. The world's longest living people perform professional jobs using cognitive skills d. 95% of centenarians in the blue zones (Italy, Greece, Japan, Costa Rica, California) ate meat based diets - ANS a. Attending faith based services 4x a month may add up to 4-14 years of life expectancy Women lose 20% of bone mass in the first _____ post menopause. a. 5-7 years b. 1-2 years c. 6-12 months d. 3-8 months - ANS a. 5-7 years _________ are the highest stresses on the appendicular skeleton a. shearing and repetitive bending b. resistive bending and torsional loading c. shearing and torsional loading d. resistive bending and repetitive extension - ANS b. resistive bending and torsional loading Osteoclasts resorb in _____ what takes osteoblasts ____ to replenish a. 3 months, 1 month b. 6 months, 1 year c. 1 month, 3 months d. 4 months, 8 months - ANS c. 1 month, 3 months _____ can cause loss of 1% bone mass per week a. inactivity b. hypertrophy c. sleep deprivation d. prolonged stretching - ANS a. inactivity ______ inhibits activity of osteoclasts a. calcitonin b. TSH c. Calcitrol d. Vitamin D e. 2 of the above - ANS e. 2 of the above Calcitonin and TSH inhibit activity of osteoclasts Calcitriol and Vitamin D needed for calcium into bone What is the single most important factor in the development of osteoporosis? a. peak bone mass declines (BMD) b. mass at time of skeletal maturity c. age at menopause d. rate of bone loss with age - ANS a. peak bone mass declines (BMD) **Determinants of BMD post menopause Mass at the time of skeletal maturity Age at menopause Rate of bone loss with age True or False: Type 1 (Primary) Osteoporosis is age-related, mainly among women and men over the age of 70 - ANS False Type 1 (primary)- postmenopausal in women cause by estrogen deficiency Type 2 (secondary)- age related, mainly among women and men over the age of 70 Advanced aging results in a _____ in cutaneous sensation and proprioception a. incline b. decline c. fluctuation d. rapid change - ANS b. decline aging results in Impaired distal LE proprioception, vibration, and discriminative touch and balance Age related involvement of sensory fibers occurs earlier than motor fibers true or false: with sarcopenia there can be an increase in fat mass with a loss of skeletal muscle mass which can result in normal or near normal body weight and body mass index (BMI) - ANS true best practice for clinical diagnosis of sarcopenia includes a. imaging b. muscular strength testing using dynamometry c. physical performance measures d. all of the above - ANS d. all of the above _____ is defined as the loss of muscle mass associated with aging. a. sarcopenia b. osteoporosis c. calcification d. unsuccessful aging - ANS a. sarcopenia _______ is defined as aging with low rates of disease and disability, high cognitive and physical capacity and active engagement with life a. senescence b. usual aging c. successful aging d. poor aging - ANS c. successful aging What listed potentially inappropriate medications for older adults, stated that opioids should be avoided in individuals with hx of falls, and utilized the STOP/START screening tool? a. Beers' Criteria b. Pharmacological Risk Factors Database c. Mark's List d. none of the above - ANS a. Beers' Criteria Medications included in Beer's Criteria that would indicate an increased risk of falls with include which of the following? a. benzodiazepines b. opioids c. all of the above d. Tylenol PM - ANS c. all of the above Benzodiazepines, opioids and other meds increase risk of falls benzos can lead to the hangover effect What shows the most significant changes with aging a. drug absorption b. drug distribution c. drug metabolism d. drug exertion - ANS c. drug metabolism Occurs in the liver Most significant changes with aging, decrease ability to metabolize **Drug exertion is also affected with aging (Half life tends to be longer in older individuals- toxicity) A T score of /= 2.5 SD is indicative of hypokalemia and hypophosphotemia for what pathology? a. osteopenia b. osteoporosis c. severe osteoporosis w/ fractures d. osteomalacia - ANS b. osteoporosis Which aspect of pulmonary function INCREASES with age? a. total lung capacity b. vital capacity c. O2 saturation d. residual volume - ANS d. residual volume What is included in the clinical diagnosis of sarcopenia? a. decreased gait speed b. X-ray as the best method of imaging c. long physical performance battery d. none of the above - ANS a. decreased gait speed Gait speed 6m walk 0.8 m/s What is an intervention in Osteoporosis to avoid anterior vertebral fx? a. Knees to chest b. Sitting trunk flexion c. Decompression position lying in supine - ANS c. Decompression position lying in supine other 2 promote FLX and FLX can cause fractures What activity would be most limited due to loss of Type II fibers? a. STS b. Walking c. Manipulating small objects - ANS a. STS Type 2 fibers are needed for muscle generation of POWER and explosive movements which senses decline with age? a. ONLY smell and vision b. all 5 senses c. none of the senses - ANS b. all 5 senses What's a common cardiovascular drug used to decrease HR for the geriatric population? a. beta blockers b. DMARDs c. Levodopa d. Benzodiazepines - ANS a. beta blockers Which medication can cause GI issues in the geriatric population? a. Levodopa b. Benzodiazepines c. Advil d. Beta Blockers - ANS c. Advil Which medications contribute to fluid retention? a. Beta Blockers b. Nonopioid analgesics c. Statins d. NSAIDs - ANS d. NSAIDs if mild cognitive impairment is involved it is____ a. Positive for dementia b. Positive for delirium c. Normal part of aging d. Positive for depression - ANS a. Positive for dementia Mild cognitive impairment (MCI) and dementia- pathological changes are NOT normal aging Cognitive changes occur as continuum: Normal aging → mild cognitive impairment (MCI) → stages of dementia Which of the following is not a real life quote that a geriatric patient told Paulina? a. "you know women shouldn't get doctorates. you should be a nurse instead" b. "you're puerto rican? that's where the bad people are from" c. "why are you telling me what to do? I'm older than you" d. "Hola bonita mamacita" - 80 year old white man who has never spoken spanish before in his life e. trick question - ANS e. trick question all of these things have been said i hate working with geriatric PT with every fiber of my being ~ so do we think she likes Dr. Viti? What motion should be avoided when treating patients with osteopenia or osteoporosis? a. large amounts of spinal flexion b. large amounts of spinal extension c. large amounts of spinal rotation d. all of the above - ANS a. large amounts of spinal flexion ex: crunches What is the primary benefit of a weighted west? a. increase bone density b. decompression c. macular degeneration d. increase strength of muscles - ANS a. increase bone density Increase bone density in frail and elderly (primarily women) What exercise or position is recommended as a first step to unload the spine and stretch the anterior chest? a. crunches b. decompression position c. thread the needle/around the worlds c. doorway stretch - ANS b. decompression position What cue helps to promote good posture and proper scapulae positioning on the thoracic? a. high five b. thumbs forward c. reach back d. none of the above - ANS b. thumbs forward What exercise helps to promote contraction of the trans abdominals? a. double knee to chest b. bongos c. standing marches d. calf stretches - ANS b. bongos What exercises might you want to perform with caution if a patient is taking CIPRO? a. double knee to chest b. bongos c. standing marches d. calf stretches - ANS d. calf stretches What drugs tend to have the most concern about falls in the elderly due to adverse drug reactions (ADRs)? a. NSAIDs b. Benadryl c. Benzodiazepines d. beta blockers - ANS c. Benzodiazepines True or False: The leading cause of low vision in the geriatric population is Macular Degeneration - ANS True Which of the following is not a concern with the use of assistive technology in the geriatric population? a. Obtrusiveness b. Stigmas associated with use c. Possible lack of human contact d. Cost e. none of the above - ANS e. none of the above all of the following are cons of assistive devices True or False: The most common level of hospice care is Routine hospice care (RHC) - ANS True TRUE or FALSE: Restraints can be physical or chemical - ANS TRUE Which of the following is not a method for getting rehab facilities to reduce the use of restraints? a. have the staff try on physical restraints for 10 or 15 minutes b. invite staff from facilities already reducing the use of restraints to present how it has worked for them c. wait until all staff is onboard with accepting to reduce restraints before taking action d. stress the resident's quality of life that removing restraints can make them happier and restore dignity - ANS c. wait until all staff is onboard with accepting to reduce restraints before taking action Which medicare mandate is associated with the use of restraints? a. ADA b. EDRA c. OBRA d. PETA - ANS c. OBRA Comprehensive Geriatric Assessment (CGA) goals and interventions should be a. patient-centered b. evidence-based c. individualized d. all of the above - ANS d. all of the above Should be patient centered and individualized - Positive (regarding something lost, future family event) - Social (aging in place, maintaining social act) - Functional (independent in ADLs) - Health related goals often lower priority (focus on quality of life not length of life) Should be evidence based - Best available evidence and clinical judgment- EBP - Consider patients preferences and values - Optimize patient/client outcomes - Be effective and efficient-clinical value - Demonstrate necessity and skilled care Which component of comprehensive geriatric assessment includes the following elements: health status, comorbid conditions/disease severity, medication review, & review of systems? a. environmental assessment b. social assessment c. medical assessment d. psychosocial assessment e. functional assessment - ANS c. medical assessment Which component of comprehensive geriatric assessment includes the following elements: basic ADL and iADL, activity/exercise status, mobility: gait & balance a. environmental assessment b. social assessment c. medical assessment d. psychosocial assessment e. functional assessment - ANS e. functional assessment A score 70 indicates that the person has a fear of falling in which outcome measure about anxiety? a. Activities Specific Balance Confidence Scale b. Falls Efficacy Scale c. SLUMS d. Geriatric Functional Assessment (PHQ-2) - ANS b. Falls Efficacy Scale the only other anxiety OM is Activities Specific Balance Confidence Scale but that just means 50-80 = moderate anxiety and increased risk of falls less than 67% What is the GOLD STANDARD outcome measure for dementia? a. Mini-COG b. Mini-Mental Status Exam c. Confused Assessment Method (CAM) d. Montreal Cognitive Assessment (MOCA) - ANS b. Mini-Mental Status Exam Which outcome measure used to assess depression suggests that you should refer out with a score of or = to 5? a. Geriatric Depression Scale b. Geriatric Functional Assessment (PHQ-2) c. MOCA d. SLUMS - ANS a. Geriatric Depression Scale vs Geriatric Functional Assessment (PHQ-2) has 2 questions and yes to either of those suggests referring out or doing the geriatric depression scale next True or False: A Mini-COG 4 warrants further cognitive evaluation - ANS False; LESS THAN 4 allow warrants further cognitive evaluation Tandem walk with eyes closed (10 steps) indicates increased fall risk if the pt is unable to do _____ consecutive steps. a. 5 b. 10 c. 2 d. 8 - ANS a. 5 rationale: being able to walk w/ feet close together w/ small BOS is part of functional mobility and balance More than 2 errors on which balance measure indicates increased fall risk? a. Single leg stance b. tandem walk eyes open c. tandem walk eyes closed d. mCTSIB - ANS b. tandem walk eyes open True or False: SLS 20 seconds indicates fall risk - ANS False; it indicates LE weakness (20 sec is normal) 5 sec indicates fall risk Posture declines as we age, ____ is a quick screen to look at posture from all angles a. rib-pelvis distance (thoracic extension) b. plumb line c. wall occiput distance (WOD) d. SLS - ANS b. plumb line What increases risk of vertebral fracture? a. kyphosis b. forward head posture c. thoracic flexion d. lumbar flexion e. all of the above - ANS e. all of the above use the wall occiput distance and rib-pelvis distance to assess for these 4cm in which measurement indicates fracture risk a. wall occiput distance b. rib-pelvis distance c. back scratch d. chair sit and reach - ANS a. wall occiput distance less than 2 finger widths in rib-pelvis = fracture risk Which outcome measure is used to assess lower body flexibility? a. 30 sec chair to sit b. chair sit and reach c. 8 ft up and go d. functional gait assessment - ANS b. chair sit and reach look at inches between extended fingers and tip of toe Cutoff: Men: minus 4 inches or more Women: minus 2 inches or more A person uses an AD and has a 4 square step test of 20 seconds, multi-directional reach of 5 inches sideways. Is this person a fall risk? a. yes because FSST score b. no because FSST c. yes because multi-directional reach score d. no because multi-directional reach score e. yes both FSST and multi-directional reach scores indicate fall risk - ANS e. yes both FSST and multi-directional reach scores indicate fall risk MDR less than 6-7 inches sideways = fall risk FSST 15 seconds indicates fall risk (but they can use an AD for this) Recommendations for intensity of aerobic exercise based on the Borg scale should be: a. 7-10 b. 10-12 c. 5-6 d. 12-14 - ANS d. 12-14 Which of the following is the better predictor of function with aging? a. power b. strength c. endurance d. dexterity - ANS a. power What is the appropriate strengthening exercise dosage for older adults? a. 8-12 reps 50% 1RM b. 10 reps, 3 sets light resistance c. 13-25 reps 60% 1RM d. 8-12 reps 60% 1RM - ANS d. 8-12 reps 60% 1RM Which of the following scores indicates a risk of falls? a. 24 on Tinneti b. 54 on Berg c. 21 on DGI d. 88 on Falls Efficacy Scale - ANS d. 88 on Falls Efficacy Scale Which of the following scores indicates a risk of falls? a. 21 on Tinneti b. 52 on Berg c. 18 on DGI d. 64 on Falls Efficacy Scale - ANS c. 18 on DGI Which of these scores is NOT within normal range? a. -2+ inches for women in back scratch; UE flexibility b. 65 steps for men/women in 2 min step test; aerobic endurance c. 5 curls in 30 sec with 8lbs wt for women in arm curl; UE strength d. 9 seconds for 8 ft up and go; agility/dynamic balance - ANS c. 5 curls in 30 sec with 8lbs wt for women in arm curl; UE strength women use 5 lbs wt looking for 11 curls with correct form in 30 seconds Which of the following personality characteristics has MOST been associated with successful aging? A.Responsiveness B.Resilience C.Responsibility D.Relaxation - ANS B.Resilience Which of the following older adults is MOST likely to be a successful ager? A.An older adult who graduated from high school. B.An older adult with family living nearby. C.An older adult who has many social contacts. D.An older adult with a good pension fund. - ANS C.An older adult who has many social contacts. Which of the following conditions is the MOST highly prevalent mental health problem among the elderly population? A.Depression B.Delirium C.Anxiety disorder D.Dementia - ANS A.Depression In gathering a patient's history, which of the following should you MOST likely consider as a cause for her recent falls? a.She wears corrective lenses. b.She gets SOB with activity. c.She lives alone in a two-story house. d.She takes 5 prescription medications and 2 OTC meds. - ANS d.She takes 5 prescription medications and 2 OTC meds. An older patient has osteoporosis and spinal stenosis. Which of the following exercises would be MOST appropriate to improve core strength? modified for appropriate height surface nating trunk flexion and extension in standing curl-ups in supine body extension in prone - ANS modified for appropriate height surface Which of the following exercise types has been found to be MOST effective in reducing falls among relatively healthy but sedentary older adults living in the community. a.Dance b.Pilates c.Yoga d.Tai Chi - ANS d.Tai Chi A therapist screens an older adult with the Mini-Cog. The patient recalls 2 words and draws a normal looking clock. Which of the following statements BEST describes the patient's results? a.The patient has normal cognition. b.The patient is likely to have dementia. c.The results are inconclusive and the test should be repeated. d.The patient is unlikely to have dementia. - ANS d. The patient is unlikely to have dementia. An older adult patient asks you to pray with her at the end of the treatment session. Which of the following responses is MOST appropriate? a. Refer her to a spiritual leader to pray with her b. Talk to her about other coping mechanisms c. incorporate her spiritual practices by listening while she prays d. Tell her that praying with patients is against company policy - ANS c. incorporate her spiritual practices by listening while she prays Which of the following assessments is a self-report comprehensive assessment tool that is specific to older adults? a. 36-Item Short Form Health Survey (SF-36) b. Geriatric Health Questionnaire (GHQ) c. Geriatric Functional Scale (GFS) d. APTA's Guide to PT Practice Documentation Template - ANS b. Geriatric Health Questionnaire (GHQ) Which of the following statements is TRUE regarding functional decline in older adults? a. Once it begins, functional decline is steady and chronic. b. It is an inevitable consequence of aging c. There is usually a clear precipitating event. d. It is often episodic but predictive of future health decline. - ANS d. It is often episodic but predictive of future health decline. Which of the following tests would provide a quick screen of an older patient's balance and gait? a. Tinetti POMA b. Berg Balance Scale c. Physical Performance Test d. Timed Up and Go - ANS d.Timed Up and Go Which of the following patient situations would MOST likely indicate an appropriate reason for restraint? a. Repeatedly attempts ambulation without assistance b. Has persistent delirium from polypharmacy c. Keeps pulling out their nutrition or hydration tubing d. Has dementia and keeps annoying other patients - ANS c. Keeps pulling out their nutrition or hydration tubing Which of the following is TRUE regarding restraining the elderly? a. Restraints to help to reduce fall-related injuries in nursing homes b. Bedrails and wheelchair lap trays are not considered restraints c. Can be used if the patient's caregiver is at risk of falling d. May be considered abuse without a physicians' order and clear justification - ANS d. May be considered abuse without a physicians' order and clear justification Which of the following is NOT a primary barrier to older adults adopting assistive technology? a. Lack of interest b. Cost c. Lack of awareness d. Perception it won't help - ANS a. Lack of interest Medicare A covers care in all of the following settings EXCEPT a. Home-based hospice b. Hospitals c. Physician offices d. Skilled nursing facilities - ANS c. Physician offices Which of the following clients MOST likely qualifies as homebound and is eligible for home care services under Medicare Part A? a. Relies on a motorized scooter for mobility b. Leaves home for religious services c. Lives alone and does not drive d. Leaves home to go grocery shopping weekly - ANS b. Leaves home for religious services A therapist does skilled gait training with a patient for 20 minutes and then asks an aide to walk with the patient for 10 more minutes to build endurance. Based on the 8-minute rule, how many gait training units should the PT bill Medicare Part B for? a. One b. Two c. Three d. Four - ANS a. One Which of the following statements is TRUE regarding palliative sedation? a. The intent of palliative sedation is to hasten death b. Family members should be discouraged from touching the patient during this time c. It is usually initiated at the onset of active death d. The most common indication for palliative sedation is agitated delirium - ANS d. The most common indication for palliative sedation is agitated delirium Which of the following statements is TRUE regarding pain management and hospice? a. Morphine is always given to hospice patients as it helps sedate them b. The goal of hospice is to get pain to a tolerable level within 48 hours c. Use of a pain diary is not useful in identifying triggers of breakthrough pain d. Pain meds are only given if the patient absolutely cannot tolerate their pain - ANS b. The goal of hospice is to get pain to a tolerable level within 48 hours What are some of the positive outcomes of hospice? a. Prolongs life b. Reduces Medicare expenditures c. Brings pain under control more quickly d. All of the above - ANS d. All of the above Which of the following statements is true regarding advance directives? a. It is an informal document stating a patient's desires in the event of death but doesn't hold up in a court of law b. They include a DNR document (do not resuscitate) even if the patient is on hospice c. It appoints a person to make decisions in case the patient becomes incapacitated (medical power of attorney) d. Once it is signed and witnessed, it cannot be revoked - ANS c. It appoints a person to make decisions in case the patient becomes incapacitated (medical power of attorney) What is an example of a role of a physical therapist in treating a patient on hospice? a. Strengthening training with the family to help with transfers b. Adapting a recliner to improve ease with sit to stand transfers c. Making sure the patient's heart rate stays below 100 while exercising d. Range of motion exercises/stretching to regain full shoulder flexion - ANS b. Adapting a recliner to improve ease with sit to stand transfers The loss of which of the following types of muscle fibers impairs muscle power generation and therefore may negatively affect function and balance strategies. A.Type IIa B.Type 1b C.Type 1a D.Type IIb - ANS D. Type IIb Which vision pathology leads to loss of peripheral vision? a. glaucoma b. cataracts c. diabetic retinopathy d. hemianopia - ANS a. glaucoma Which vision pathology leads to cloudy/blurry vision? a. glaucoma b. cataracts c. diabetic retinopathy d. hemianopia - ANS b. cataracts *an image of a light switch with black tape around the edges and on the switch itself* This image is an example of which type of strategy for individuals with low vision? a. contrast b. magnification c. coloring d. illumination - ANS a. contrast this can help w/ depth perception Which vision pathology presents with dark floaters and double vision? a. glaucoma b. cataracts c. diabetic retinopathy d. hemianopia - ANS c. diabetic retinopathy Agitation, confusion, nightmares and pulling at bed clothes or asking to get up are signs of which of the following conditions? a.Nearing death awareness b.Terminal Restlessness c.Awareness of dying d.Active Death - ANS b.Terminal Restlessness Which of the following sign is indicative of approaching death? a. An increase in resting blood pressure b. Slow consistent respiration c. Decreased heart rate variability d. Confusion and delirium - ANS d. Confusion and delirium Which of the following factors MOST increases the risk of adverse drug reactions (ADRs) in older adults? A.Cognitive decline B.Multiple health conditions C.Insufficient patient education D.Inadequate drug regulation - ANS B.Multiple health conditions An older adult is MOST likely to report which of the following disabilities? A.Vision impairment B.Hearing impairment C.Mobility difficulties D.Self-care limitations - ANS C.Mobility difficulties True or False: Excessive body fat is an indicator for sarcopenic obesity - ANS True frailty and decreased hand grip strength are also indicators Effective home programs for older adults: porate 3 sets of 10 repetitions. individualized and functional. on balance to prevent falls. d be performed every day. - ANS individualized and functional. Which of the following concerns is the MOST common barrier to an older adult using assistive technology? of training rns about privacy of use - ANS rns about privacy ** i think?? unsure tho A systematic review showed which of the following assessments to have the best reliability, validity, and responsiveness? a.Short Physical Performance Battery (SPPB) b.Performance-oriented mobility assessment (POMA) c.Physical Performance Test (PPT) d.Continuous Scale Physical Functional Performance (CS-PFP) - ANS a.Short Physical Performance Battery (SPPB) True or False: OASIS is for home health only - ANS True what are the 3 components of successful aging - ANS 1. low rates of disease/disability 2. high cognitive and physical capacity 3. active engagement with life age-related loss of muscle mass accompanied by impairments of strength, power, and functional performance - ANS sarcopenia why may individuals with sarcopenia have a normal body weight or BMI - ANS increase in fat mass with loss of skeletal muscle when does sarcopenia usually set in and what is the rate of decline - ANS 45 yo & 1%/year what are 3 reasons for the 1% muscle mass decline of sarcopenia - ANS 1. protein deficiency 2. lack of exercise 3. increased frailty what is the best practice for diagnosing sarcopenia and frailty - ANS decreased gait speed 0.8 m/s with 6MWT difference between primary and secondary sarcopenia - ANS primary - advanced age causes secondary - age + other factors cause what are the other best practices for clinical diagnosis of sarcopenia - ANS 1. imaging 2. dynamometry strength testing 3. physical performance measures what are the best ways to manage sarcopenia - ANS weight bearing exercise, aerobics, weight resistance restores muscle strength, increase stamina, and stabilize balance/minimize falls what is osteoporsois associated with - ANS increased age ~70 more common in women how is osteoporosis typically measured - ANS bone mineral density via DXA test what T score correlates with osteoporosis - ANS BMD 2.5+ SD below the mean what are risk factors with osteoporosis - ANS genetics (white/asian) vitamin D deficiency smoking alcohol immobilization hyperparathyroidism (reduces Ca2+) what are various prevention strategies for osteoporosis - ANS - adequate calcium intake in one's teens and after menopause - adequate vitamin D to absorb calcium - WB exercise - hormone replacement therapy - smoking cessation - decreased alcohol, protein, salt, and caffeine what are important intervention considerations with osteoporosis - ANS 1. spinal FLX (PPT) promotes anterior compression and fractures so don't do 2. back extensor strengthening (spinomed brace) 3. posture what are the 3 components of the meeks methods with osteoporosis - ANS 1. decompression position 2. stretching: morning stretches, 4 limb stretch, supine hip FLX 3. core strengthening: head/shoulder/leg pressors, bongos, TB walk back/lateral group of disorders that affect the brain and present as sx that most commonly affect memory and language - ANS dementia main difference between dementia, delirium, and depression - ANS onset - dementia = gradual - delirium = rapid - depression = 2 wks what is the most common cause of dementia - ANS Alzheimer's what OMs are used for dementia - ANS screen = miniCOG (not diagnostic) assessment = MMSE (gold standard) how is the miniCOG conducted and scored - ANS repeat 3 words, draw clock 10 after 11, recall 3 words recall all words = WNL unable to recall any = dementia likely recall 1-2 works = use clock - normal = dementia unlikely - abnormal = dementia likely gold standard assessment for dementia that is used to identify moderate to severe cognitive impairment - ANS mini mental state exam what is scoring of the MMSE indicates increased odds of dementia - ANS 21 how should PTs communicate with and treat patients with dementia - ANS focus on ADLs and communicate with positive reinforcement - visual verbal tactile cues when is delirum often acquired - ANS in the ICU due to UTI or other disease (one of the most common complications of medical illness or recovery from surgery) what OM is used for delirium and why - ANS CAM = screening tool what is PTs role with delirium - ANS must address delirium first changes in personality and activities due to decreased dopamine in the brain - ANS depression one of the most prevalent mental health problems among the elderly and can lead to poor health - ANS depression what are the different symptoms of depression and what is needed for a diagnosis - ANS mood, physical, and cognitive symptoms need 5+ symptoms in same 2 weeks & a change from previous function what can depression result from - ANS 1. medical conditions (hypothyroidism) 2. medication side effects 3. significant events what OMs are used for depression - ANS 1. screening questions - feeling down, depressed, hopeless in last month - little interest or pleasure in last month 2. geriatric depression scale if postive how should depression be treated - ANS pharm + psychotherapy + PT PT: mind-body (yoga), aerobic, and resistive what medication class is often problematic for older adults due to side effects of drowsiness and confusion as well as dry mouth, constipation, urinary retention, tachycardia and blurred vision - ANS anticholinergics Common adverse reaction to CIPRO and how that relates to PT practice - ANS increased risk of tendon rupture (achilles) what medication has the highest impact on fall risk - ANS benzodiazepines what 3 medication classes increase fall risk - ANS 1. psychotropic: sedative-hypnotics and anti-anxiety 2. pain/inflammatory: coagulant meds 3. respiratory: decongestants and anti-histamines what are 2 variations of restraints - ANS physical and chemical what medicare mandate is associated with restraint use - ANS OBRA what are 7 risk factors for elder abuse - ANS 1. Age 80+ 2. Female non-hispanic black race 3. 3+ medical conditions 4. MMSE 23 5. Difficulty with stairs 6. Depressive symptoms 7. A social network 2 what are 5 types of elder abuse - ANS Physical Sexual Psychological Caregiver neglect Financial exploitation what is 10MWT used for and what are the cut off scores - ANS gait speed (normal = 1.2-1.4 m/s) full community = 0.8 m/s limited community = 0.4-0.8 m/s household 0.4 m/s what is BBS used for and what are the cut off scores - ANS static and dynamic sitting and standing balance ≤ 45 = fall risk what OMs allow the use of ADs - ANS tinetti, DGI, 10MWT what are the difference cut off scores for the DGI and FGA - ANS DGI 19 = fall risk FGA 23 = fall risk what 2 scales can be used for fear of falling and anxiety - what scores go with them - ANS falls efficacy ( 70) ABC (50-80% = mod anxiety and increased risk of falls 67%) what outcome measure is used for LE flexibility and scores - ANS chair sit and reach men = 4+" between fingers and toes women = 2+" what is the purpose of the 30 second chair stand - ANS test leg strength and endurance what is the purpose and score for the TUG - ANS assess mobility ≥ 12 seconds to complete = fall risk what is the purpose and score for the 4 stage balance test - ANS to assess static balance feet together, modified tandem, tandem, SL ~ all EO if can hold for 10 seconds move on what do the 4 parts of medicare correlate with - ANS A = inpatient, SNF, hospice B = OP & DME C = combo D = drug what are the specifics for medicare regarding inpatient services - ANS deductible met & daily copay if 60 days what are the specifics for medicare regarding SNF services - ANS must have 3 nights in IP hospital first medicare covers first 20 days but then copayment what is the difference in PT for inpatient and SNF - ANS IP = 3 hours/day, 5 days/week SNF = 1-2 hours/day what part of medicare does the 8 minute rule fall under - ANS part B explain what is covered with part C - ANS combines A & B (sometimes D) covers everything originally except hospice additional covers vision, dental, and wellness must stay in-network where can hospice care be offered and receive full care - ANS wherever the patient lives what is the most common type of hospice - ANS routine hospice care what is hospice comfort care measure - ANS palliative care what are the purposes of hospice - ANS maintain function, stay safe, use equipment, problem solving, family education what is the goal of hospice - ANS get pain to tolerable level in 48 hours (pain diary can be used) what are 3 positive outcomes of hospice - ANS 1. prolong life 2. reduce medicare expenditure 3. control pain quicker who should have an advanced directive - ANS everyone regardless of age but especially when discussing discharge planning in face of decline or referring patient for palliative care consult what is used to appoint a person to make decisions (living will and medical power of attorney) - ANS advanced directive 20/70 vision or visual field affecting ADLs - ANS low vision leading cause of vision loss in older adults - ANS macular degeneration central vision loss due to destruction of part of retina responsible for clear vision - ANS macular degeneration 2nd leading cause of vision loss in older adults - ANS glaucoma 20/20 central vision but peripheral vision loss caused by optic nerve damage due to intraocular pressure - ANS glaucoma leading cause of low vision in adults under 50 - ANS diabetic neuropathy presents with blurred or double vision and dark floaters - ANS diabetic neuropathy cloudy areas in the lens so vision is blurry - ANS cataracts what % of individuals over 80 have cataracts or have had surgery to replace lens - ANS 50% what interventions/adaptations to the environment can be done for decreased depth perception - ANS 1. outlining objects with contrast colors 2. manipulate contrast of environment (ex. coffee in white cup) what interventions/adaptations to the environment can be done for decreased ability to adapt to the dark - ANS 1. night lights 2. motion detection lights