lifespan development unit 2

types of prevention

stage of disease development. Primary, Secondary, Tertiary.

Primary Prevention

Preventing chronic diseases via health promotion, advisory, and counseling services

Secondary Prevention

Screening and assessments to diagnose chronic diseases early.

Tertiary Prevention

Management of disease and rehab to slow down disease progression.

screening definition

finding disease before person would seek care

surveillance definition

looking at health info for a specific population, group, or workplace.

components of medical history

• personal or family hx of cancer

• recent infection

  • neurological symptoms'

  • Gullian-Barre Syndrome

• Recurrent Colds or flu

• trauma

• immunosuppressants

• injected drug use

clinical presentation red flags

• no known cause for problem/no pattern

• unrelieved by PT or worse/gets better but then comes back

• significant wt loss or gain w/o effort

• gradual, progressive, or cyclical presentations of symptoms

• unrelieved by rest - no position is comfortable

  • symptoms out of proportion to injury.

• persisting and unaltering symptoms

• doesn’t fit Neuro/MSK pattern

• growing mass = tumor

• postmenopausal bleeding

• bilateral symptoms

• muscle tone (paralysis)

bilateral red flags

• edema

• clubbing

• numbness/tingling

• nailbed changes

• skin pigmentation changes

• skin rash

pain pattern

• back or shoulder pain

• night pain

• pain made worse by activity and better with rest (intermittent claudication)

• throbbing, boring, deep aching

• poorly localized = more systematic

  • S+S of GI, GU, GYN, Cardiac, pulm, endocrine

Constitutional Symptoms (red flags)

• diaphoresis

• night sweats

• nausea, vomiting, diarrhea

• pallor, dizziness/syncope

• fatigue, malaise

• wt loss

• fever

• dec appetite

What question should we ask for constitutional symptoms?

“Are there ANY OTHER symptoms or problems anywhere else in your body that might not seem related?”

Review of Systmes (ROS)

• CV - HTN, A-fib, risk factors for CVD

• Pulm - COPD

• Integumentary

• MSK - arthritis? (degenerative/rheumatoid)

• NM - history of falls, balance issues

• GI + GU

• pyshosocial

Interviews for Falls

• History

  • when, what time, where, task

  • why do they think they fell?

• Effects of fall

  • LOC (loss of consciousness)

  • injuries - fractures/lesions/bruises

Past Medical History

• CV

• Pulmonary

• Cancer

• Diabetes, Hypertension

• Infection

• Recent Srugery

• Trauma

• Prego, birth, miscarriage, abortion

• psychosocial screen

  • Orientation (time place person) x3

  • Anxiety, depression, panic

• Meds

Risk Factors (general)

• Substance use/abuse

• age

• BMI

• Gender

• Alc use/abuse

• occupation/environmental exposures

• domestic violence

• hysterectomy/oophorectomy (ovariectomy)

• race/ethnicity

• tobacco use

• overseas travel

• sedentary lifestlye

• exposure to ratiation

• multiple sexual partners

risk factors for nutritional deficiency

• economic status

• living alone

• older age

• depression, anxiety

• eating disorders

• lactose intolerance

• alc/drug addiction

• chronic diarrhea

• nausea

• GI impairments

• chronic endocrine/metabolic disorders

• liver disease

• dialysis

• meds

• chronic disability impacts ADLs

• Burns

• difficulty chewing/swallowing

signs and symptoms of malnutrition

• muscle wasting

• alopecia

• dematitis

• chapped lips

• lesions at corners of mouth

• brittle nails

• abdominal distention

• dec phys activity/energy level; fatigue, lethargy

PT Screening Kit

• stethoscope

• sphygomamnometer

• thermometer

• pulse oximeter

• reflex hammer

• penlight

• cotton-tipped swab

• 2 test tubes

• familiar objects

• tuning fork (128 Hz)

• watch, second hand

• gloves

• tape measure

• goniometer

• safety pin

components of PT screening

• Body + breath odors

  • fruity (diabetic ketoacidosis) (acetone)

  • scent of alcohol

  • halitosis (dental decay, pulm infection, throat or sinus infection, liver fail, uremia)

• Vital Signs

  • pulse, BP, Temp

  • Respiration

  • pulse oximetry

  • skin temp

  • pain

• posture

• strength

• balance

• flexibility

• hearing/vision

• MMSS (mini-mental state exam)

• skin check

pulse abnormality

• intensity

  • weak pulse mixed with strong beats

  • thready

  • bounding pulse

• Irregular

  • 2 quick beats followed by pulse

  • irregular rhythm

• Regular but doesn’t fit context

  • too fast (>100bpm)

  • too slow (<60 bpm)

Body Temperature Norms

• oral - 37C, 96.4-99.1F (98.6F)

• rectal - 0 0.7-0.9 higher than oral temp

• axillary - 1 deg than lower temp

• hypothermia = <35C, 95F rectally

• body temp varies over lifespan

mini mental status scale (MMSS)

1. what is the date today?

2. what day of the week is it?

3. what is the name of this place?

4. what is your telephone number? what is your address?

5. how old are you?

6. when were you born?

7. who is the president of the US now?

8. Who was the president before him?

9. What is your mother’s maiden name?

10. Subtract 3 from 100 and keep subtracting by 3

back depression inventory

21 questions

scoring depression

• minimal - 0-13

• mild - 14-19

• mod 20-28

• severe 29-63

karnofsky performance scale

100% - normal no signs of disease

70% - caring for self, not capable of normal activity/work

50% - need help often, need frequent med care

40% - disabled

0% death

dehydration signs

• mild

  • thirst

  • dry mouth/dry lips

• mod

  • very dry mouth, cracked lips

  • sunken eyes, swollen fontanelle

  • poor skin turgor

  • postural hypotension

  • headache

• severe

  • mod signs +

  • rapid weak pulse (>100bpm)

  • rapid breathing

  • confusion, lethargy, irritablity

  • cold hands + feet

  • unable to cry/urinate

integumentary screening

hands, arms, feet, legs

changes in

• texture

• color

• temp

• clubbing

• circulation

• edema

MSK System Screening

• obvious deformities, abnormalities, disabilties, asymmetries

• front, back, R/L

• upper quad/lower quad screen

• ROM

• muscle strength

• joint mobility

sensitivity

true positive rate - correctly identified as pos by a test

specificity

true negative rate - not disease found negative as test

posture screen

plum line

• mid line bw mastoid process

• point just in front of shoulder joints

• hip joints/just behind

• point just in front of center of knee joints

• slight anterior to ankle joint

balance screen

• romberg-feet together (30 sec)

  • eyes open and closed

• sharpened romberg (30 sec)

  • heel toe, eyes open and closed

• single leg stance (30 sec)

  • eyes open and closed

• TUG test

• Functional Reach

Timed Up and Go Test (TUG Test)

sitting chair → stand up → walk 3 meters → turn around → walk back → sit down

TUG Cognitive

ability for brain to coordinate movement and cognition at the same time

TUG manual

complete task while carrying a full cup of water

TUG Test Benefits

good correlation to other functional mobility

good interrater reliability

Cutoff levels of TUG Test

• TUG - 13.5s or longer (90%)

• TUG Manual - 14.5s (90%)

• TUG Cognitive - 15s (87%)

Predict Falls

• 87% sensitivity (greater than 87% time - likely fall)

Functional Reach

reach as far faorward as you can without taking a step

limited functional balance - <6-7 in

normal - >10 in more

gait screening

• gait assessment

• sit to stand

• stairs climbing

neurological screen

mental/emotional status

cranial nn.

motor function

sensory function

deep tendon reflexes (DTRs)

normal aging definition

physiological changes that lead to a decrease in homeostasis and loss of adaptability (NOT a disease)

age definition

chronological time someone has existed.

whole body inflammation definition

inflammatory markers: erythroctye sedimentation rate (ESR), C-Reactive Protien (CRP)

wear and tear definition (theory)

progressive damage to cells/body systems

genetic regulation definition (theory)

telomeres and junk dna falls off

MSK Aging Effects

decrease muscle mass, bone density, and reaction time

loss of motor units - reduced NMK reserve and impaired motor control over time, collateral reinnervation

CV Aging Effects

Decrease max HR, VO2 max, Stiffer compliant vascular tissues (general flexibility)

More work to remain at the same activity level

Pulm Aging Effects

Lungs become less elastic

diminished max breathing cap

asthma

COPD

dysfunctional breathing patterns

hearing aging effects

decreased ability to hear low intensity and high frequency sounds,

difficulty to distinguish consonants

change in ear wax composition (drier and harder)

conductive loss: dysfunction at ext or middle ear (ear wax build up)

sensoinural loss: inner ear dysfunction (decreased sound wave conversion to electrical signals)

visual aging change

presbyopia - eye lens stiffens with age

less contrast sensitivity - colors

decreased dept perception

narrow visual field

decreased acuity

balance aging changes

3 systems:

1. visual

2. vestibular (inner ear)

3. proprioceptors (position sense)

postural control

smell aging effects

decreased saliva and number of tast buds

foods may not be appetizing and can lead to malnutrition

safety concerns

integumentary system aging effects

decreased sensitivity of cutaneous receptors

decreased elasticity

mental function aging effects

learning new things takes longer - but it exercises the brain

capacity to multi-task + process info from multiple sources at one time decreases

ageism defintion

systematic stereotyping of and discrimination against people because they are old

successful ageing (definition)

absence of disease and disability, high cognitive and physical functioning, active engagement with life

optimal ageing domains

physical, functional, cognitive, emotional, social, spiritual

empathy definition

capacity to recognize what another person is feeling, to recognize what someone is feeling, ask questions, and listen carefully

4 Habits Model

1. Invest in the beginning

2. Ellicit the patient’s perspective

3. Demonstrate empathy

4. Invest in the end

Motivational Interviewing

exploring and resolving ambivalence and centers on motivational processes within the individual that faciliate change

exercise decreases:

• CVD

• Osteoarthritis

• diabetes

• vascular disease

• metabolic syndrome

• pain

cognition definition

memory processes involved in acquiring and processing information

components of cognition

• memory

• language

• perception

• reasoning

• perceptual speed

• spatial manipulation

  • executive skills

types of memory

• working memory (short term) -

• episodic memory (scenes)

• semantic memory (long term)

• procedural memory (doing things)

• remote memory

brain plasticity

learn new things

delirium definition

disturbance of consciousness with impaired attention, disorganized thinking (ACTUE AND FLUCTUATES)

dementia definition

condition marked by the development of multiple cognitive deficits that affects the ability to perform everyday activities (SLOW MONTHS TO YEARS)

Depression definition

mood disorder characterized by extreme sadness, poor concentration, anhedonia, feelings of guilt and hopelessness (ACUTE/SLOW)

caregiver burnout

emotional stress, physical and financial strain, and impacts on health

elderspeak definition

speech style used by younger adults to communicate with older adults

• slower vocab

• overly-endearing terms

• slower and louder

• “we”

communication skills

• distancing behavior

• facial expressiveness

distancing behavior components

• not smiling

• looking away

• shrugging

• decrease in PA and COG function

Facial Expressiveness components

• smiling

• nodding

• frowning

• ass. with short and long term improvements

stages of change model

1. precontemplation

2. contemplation

3. determination

4. action

5. relapse

6. maintenance

4 Habits Model

1. Investing in the beginning

2. Elicit the patient’s perspective

3. Demonstrate empathy

4. invest in the end

Motivational Interviewing

1. Reflective Listening

2. Avoid argument/confrontation

3. Adjust to client’s resistance rather than opposing it directly

4. Support self-efficacy and optimism

framework of motivational interviewing

Motivational Interviewing Core Principles

• Express empathy

• roll with resistance

• develop discrepancy

• support self-efficacy

Motivational Interviewing Techniques

• open ending questions

• affirming

• reflective listening

• summarizing

• informing and advising (with permission)

Optimal Aging Domains

• physical

• functional

• cognitive

• emotional

• social

• spiritual

Guidelines for activity levels age 65+

• 150 min/wk or mod intensity

• strengthening 2 times a week

• balance training

Frailty (Fried’s phenotype) Criteria

1. low grip strength

2. low energy

3. slowed walking speed

4. low PA

5. unintentional weight loss

(3/5 = frail)

(intervene at the pre-frail stage (1-2/5)

gait speed (6th vital sign)

• functional objective measure for almost all pt

• 10 meter walk test

• measurable

age related joint change in gait

• decrease speed of motion

  • decreased gait velocity

• decreased range of motion

  • decreased stride

  • decreased arm swing

• decreased balance

  • decreased heel-toe

  • wider base of support

  • decreased stride and strep length

• connective tissue changes

  • leading to joint stiff

functional decline of senses

• Hearing and Visions

• decreased contact with the world

• communication with others

• perception and response to the environment

• ease in accomplishing tasks

• sense of self

functional tests

• sit to stand

  • indicator of LE strength and power

• times up and go (TUG)

• balance

  • forward reach

  • single leg stance (SLS)

• cardioresp fitness

  • decreased max o2 consumption

  • decreased max HR

  • skeletal muscle endurance

  • step test (HR and BP + MET level)

IADL (Instrumental Activities of Daily Living)

• all the other things for things that contribute to ADLs.

SENIOR ATHLETE FITNESS EXAM (SAFE) Components

1. CV Health (HR, BP, SpO2)

2. Flexibility (shoulder flexion, hip extension, ankle dorsiflexion, posture)

3. Strength (grip strength, 5x sit to stand)

4. Balance (SLS (EO,EC, Foam), walking speed (10m)

Systems for Postural Control

Muscular System, Neuromotor, sensory, anticipatory mechanisms, adaptive mechanisms, internal representations

musculoskeletal components of postural control

• joint ROM

• flexibility

• muscle property

• biomechanical relationship among segments

neuromotor/individual sensory system for postural control

• motor processes

• muscle synergies

• sensory/perceptual processes

• higher level processes

adaptive mechanisms for postural control

modifying the sensory and motor systems in response to changing task and environmental demands

anticipatory mechanisms for postural control

pretune sensory and motor systems for postural demands based on previous experience and learning

definition fo postural control

controlling body’s position in space for stability and orientation

stability defintion

ability to control the center of mass (COM) in relationship to its base of support

orientation defintion

ability to maintain an appropriate relationship between body segments, and bw the body and environment for the task

base of support definition

area of the body that is in contact with the support surface

definition of COM (center of mass)

point that is the center of the total body mass

COG definition (center of gravity)

vertical projection of the COM to the ground