needs final - SEM 4 - Aging (wk 1-6)

Frailty is associated with which of the following?

Increased physiological reserves

Increased vulnerability to adverse events

Increased functional mobility

Increased resistance to stressors

Increased vulnerability to adverse events

Chronic conditions are the leading cause of death among adults aged 65 and older in the U.S. Whal conditions pose the greatest threat?

A Cancer and Stroke

B Heart disease and Cancer

C Heart disease and Diabetes

D Heart disease and Stroke

B Heart disease and Cancer

An aging adult patient ambulates at a gait speed of 1.0 m/s. This gait speed would be classified within which of the following categories?

A	Community ambulator
B	Household walker
C	Increased risk of falls
D	Limited community ambulator

community ambulator

Which of the physiological changes associated with the aging adult population is MOST LIKELY to impact nuttion?

A Dental problems

B Impaired balance

C Social isolation

D Vision challenges

Dental problems

Physical activity guidelines for older adults recommend which of the following in addition to aerobic and muscle strengthening activities?

A Balance training

B A well balanced diet

C Walking daily

D Functional mobility training

Balance training

Which of the following should be considered relating to the role of the physical therapist in diet and nutrition?

A Physical therapists should charge or bill insurance when nutritional advice is provided

B Physical therapists should be familiar if nutrition is included within their state practice act

C Physical therapists should prescribe supplements for the aging population

D Physical therapists should not consider a patient's nutrition as it does not have an impact on the physical therapy plan of care

B Physical therapists should be familiar if nutrition is included within their state practice act

Chronic pain can have which of the following effects in the aging adult population

A Decrease suicidal ideation

B Improve mental health and sleep quality

C Increase difficulty in initiating sleep

D Reduce prevalence of depression

C Increase difficulty in initiating sleep

Which type of aging is described as the capacity to funcon across multiple domains to one's satistaction and despite one's medical conditions?

A Successful aging

B Optimal aging

C Typical aging

D Unhealthy aging

Optimal aging

An older adult is referred to physical therapy due to their history of falls in the home (four in the past 2 months with minor injury). Which oulcome measure is best to evaluate gait, strength, and dynamic postural stability/balance?

30-Second Chair Stand

Stops Walking While Talking

Four Stage Balance Test

Timed Up and Go

Timed Up and Go

An aging adult with ataxic gait, balance difficulty, and a history of recent falls is referred for physical therapy examination and evaluation. During the initial examination, what should the therapist first examine?

A Cardiovascular endurance during 6-minute walking test

B Level of dyspnea during functional transfers

C Sensory losses and sensory organization of balance

D Spinal musculoskeletal changes secondary to degenerative joint disease (DJD)

C Sensory losses and sensory organization of balance

An 85 year-old patient with mild osteoarthritis and decreased reaction time roports that she recently stopped driving after a near-miss accident. She lives alone and expresses concern about maintaining independence, particularly getting to medical appointments and grocery shopping. Which of the following is the MOST appropriate initial recommendation for the physical therapist to make?

A Instruct the patient to rely exclusively on family members for all transportation needs

B Refer the patient to her physician for reassessment of driving ability

C Provide information on local paratransit services and community senior transportation programs

D Recommend the patient relocate to an assisted living facility with on-site transportation

C Provide information on local paratransit services and community senior transportation programs

As adults grow old, reaction time increases

True

False

True

Question 18

A 78 year-old individual presents for a balance assessment. The physical therapist notes decreased vibration sense in the feet, slowed reaction time, and mild difficulty with dual task activities

These findings are MOST consistent with which of the following age-related changes in the nervous system?

A Decreased neurotransmitter production leading to enhanced synaptic efficiency

B Hypertrophy of motor neurons resulting in increased motor unit recruitment

C Increased conduction velocity of peripheral nerves leading to faster reflex responses

D Loss of myelin and decreased nerve conduction velocity contributing to delayed responses

D Loss of myelin and decreased nerve conduction velocity contributing to delayed responses

A 70-year-old man fives independently and presents for a fall risk screening and physical therapy examination. His history includes mild cataracts, well-controlled hypertension on one medication, and occasional use of a cane for long distances. During the examination, he demonstrates decreased lower extremity strength and impaired static balance during tandem stance.

Which of the following is the MOST significant contributor to his fall risk?

	A Lower extremity weakness and impaired balance
	B Mild visual impairment from cataracts
	C Use of an antihypertensive medication
	D Use of an assistive device for community ambulation

A Lower extremity weakness and impaired balance

A frail older adult has poor vision. The patent recently returned home from a 2 week hospitalization for diabeles complications. The PT's goal is to mobilize the patient and increase ambulation and safety. What is the best intervention strategy for this patient?

A. Color code stairs with pastel shades of blue and gray to highlight steps

В Keep window shades wide open to let in as much light as possible

C Practice walking in areas with high visibility and low clutter

D Practice walking by having the patient look down at all times

C Practice walking in areas with high visibility and low clutter

An aging adult patient with congestive heart failure is referred to physical therapy for an examination of functional mobility skills and safety in the home environment. The family reports that the patient is consistently demonstrating some memory deficits. The therapist suspects Mild Cognitive Impairment (MCI). During the examination, what would the therapist expect to find?

A Imparments in short-term memory

B Impairments in long-term memory

C Mild impairments with ADL's

D Periods of agitation and wandering, especially in late afternoon

A Imparments in short-term memory

A 67- year-old patient presents to outpatient physical therapy following a recent hospitalization for a hip fracture. The clinic manager is reviewing the patient's insurance coverage to determine eligibility and reimbursement for services. Which of the following is the primary type of health insurance covering most older adults in the United States?

A Medicaid

B Medicare

C Private commercial insurance

D TRICARE

Medicare

A physical therapist is assessing fall risk in an 80-year-old patient with mild dementia. Which of the following statements is MOST accurate regarding fall risk in this population compared to cognitively intact oider adults?

A	Cognitive impairments do not influence fall risk when functional mobility is within normal limits
B	Falls are approximately twice as common in individuals with cognitive impairments
C	Falls occur half as often in individuals with dementia
D	Fall risk is similar between individuals with and without cognitive impairments

Falls are approximately twice as common in individuals with cognitive impairments

Which of the following is considered a genatic syndrome?

A Depression

B Frailty

C Heart failure

D Urinary tract infection

Frailty

A 72-year-old woman is referred to outpatient physical therapy due to decreased community mobility and a recent reduction of participation in social activities. She lives alone, reports no fails, and ambulates independently without an assistive device. Gait assessment reveals a comfortable walking speed of 0.7 m/s, with decreased step length and limited gait variability.

Which of the following interventions is MOST appropriate to improve her ability to safely and independently participate in community activities?

A	Incorporate fast-paced walking and gait speed training into the plan of care
B	Facilitate static and anticipatory balance training on firm surfaces
C	Perform a home safety evaluation to reduce environmental hazards
D	Prescribe a standard cane to increase stability during community ambulation

Incorporate fast-paced walking and gait speed training into the plan of care

Which pharmacokinetic vanable is allected the most with aging, due to the decrease in renal mass, renal blood flow and glomerular filtration rate?

A Absorption

B Distribution

C Metabolism

D Elimination

D Elimination

A physical therapist is reviewing epidemiological data to anticipate future healthcare needs in the geriatric population. Which of the following statements most accurately reflects current demographic trends among older adults (265 years) in the United States?

A Racial and ethnic diversity diminishes with age due to uniformly lower life expectancy among all minority groups

B The older adult population is becoming more racially homogeneous over time

C The proportion of older adults identifying with racial and ethnic minority groups is increasing

D The racial composition of the older adult population has remained largely unchanged despite overall population growth

C The proportion of older adults identifying with racial and ethnic minority groups is increasing

A therapist receives a referral to see an elderly patient in the ICU recovering from COVID 19. The polient e contused and disoriented. What criteria would allow the therapist to determine if the disorientation is due to delirium rather than dementia?

A Hallucinations are present throughout the day

B Level of arousal is significantly depressed

C Persistent personality changes are evident

D Symptoms are intermittent

Symptoms are intermittent

Which of the following findings would MOST likely indicate pathology rather than normal age related changes?

16

	A Decreased nerve conduction velocity
	B Reduced proprioception in the distal lower extremities
	C Resting tremor and rigidity
	D Slower reaction time during balance testing

C Resting tremor and rigidity

An 89-year-old individual is being evaluated for home health physical therapy due to a recent history of three falls in the last three months. The evaluating physical therapist begins the initial visit by obtaining an accurate history including medications. Which of the following currently prescribed medications is strongly linked to increased falls in the elderly?

A Anticoagulants

B Antidepressants

C Insulin

D Thyroid medications

Antidepressants

Social determinants of health impact the aging population in which of the following ways?

A Common bamers to healthcare access include medical bills, transportation, and lack of responsiveness to patient concers

B Social engagement does not have an impact on the older adult's quality of life.

C The educational level of the older population has remained relatively the same over the last 50 years.

D The number of people 65 and older in theworkforce is decreasing

A Common bamers to healthcare access include medical bills, transportation, and lack of responsiveness to patient concers

Question 20

A PT receives a home care referral from the nurse care manager. An elderly man has lost functional independence after the recent death of his wife. His past medical history includes stroke with minimal residual disability. Currently, he no longer goes out of his house and rarely even gets out of his chair anymore. During the initial session, the therapist determines that depression may be the cause of his increasing inactivity. What clinical signs and symptoms would lead the therapist to reach this determination?

A Complaints of increasing dizziness and palpitations

B Low scores on the Geriatric Depression Scale

C Social withdrawal and difficulty concentrating

D Sleep apnea and weight gain

Social withdrawal and difficulty concentrating

A 76-yoar-old patient demonstrates increased postural sway and reports difficulty walking in dim lighting.

Which age related neurological change BEST explains this presentation?

increased proprioceptive acuity

decreased vestibular hair

enhanced cerebellar processing

increased motor excitability

decreased vestibular hair

A 76 year-old woman is referred to physical therapy due to progressive generalized weakness and decreased endurance. She reports difficulty rising from a chair, climbing stairs, and performing household tasks. She was recently hospitalized for pneumonia and has since been largely sedentary since she was discharged home.

Muscle strength: 3+/5 in major lower extremity muscle groups

• Gait speed: 0.7 m/s

• 5x Sit-to-Stand: 18 seconds

• Patient reports fatigue with minimal activity

The patient's goal is to "get stronger and walk longer distances without getting so tired."

A Single-leg stance on the affected limb for 30 seconds without hand support

B Standing marching in place with light upper extremity support, progressing to reduced hand support

C Static standing on a foam surface with eyes closed and no upper extremity support

B Standing marching in place with light upper extremity support, progressing to reduced hand support

A 76 year-old woman is referred to physical therapy due to progressive generalized weakness and decreased endurance. She reports difficulty rising from a chair, climbing stairs, and performing household tasks. She was recently hospitalized for pneumonia and has since been largely sedentary since she was discharged home.

Muscle strength: 3+/5 in major lower extremity muscle groups

• Gait speed: 0.7 m/s

• 5x Sit-to-Stand: 18 seconds

• Patient reports fatigue with minimal activity

The patient's goal is to "get stronger and walk longer distances without getting so tired."

A RPE 0-1 (rest to extremely light)

B RPE 2-3 (light activity)

C RPE 4-6 (moderate to somewhat hard)

RPE 4-6 (moderate to somewhat hard)

A 76 year-old woman is referred to physical therapy due to progressive generalized weakness and decreased endurance. She reports difficulty rising from a chair, climbing stairs, and performing household tasks. She was recently hospitalized for pneumonia and has since been largely sedentary since she was discharged home.

Muscle strength: 3+/5 in major lower extremity muscle groups

• Gait speed: 0.7 m/s

• 5x Sit-to-Stand: 18 seconds

• Patient reports fatigue with minimal activity

The patient's goal is to "get stronger and walk longer distances without getting so tired."

85% of 1RM, 3 sets of 6 repetitions, 4x/week

60-70% of 1RM, 2-3 sets of 8-12 repetitions, 2-3x/week

40% of 1RM, 1 set of 20 repetitions, daily

60-70% of 1RM, 2-3 sets of 8-12 repetitions, 2-3x/week

An 82-year-old patient with age-related motor unit remodeling and fiber-type grouping, presents to physical therapy with decreased gait speed, impaired coordination, and difficulty with sit-to-stand transfers. The therapist notes reduced lower extremity strength and poor motor control.

Low intensity passive range of motion exercises

High-repetition, low-resistance endurance training

Task-specific functional training combined with progressive resistance exercise

Task-specific functional training combined with progressive resistance exercise

An 82-year-old patient with age-related motor unit remodeling and fiber-type grouping, presents to physical therapy with decreased gait speed, impaired coordination, and difficulty with sit-to-stand transfers. The therapist notes reduced lower extremity strength and poor motor control.

A Enhanced distribution of muscle fiber types allowing endurance

B Increased motor Unit precision leading to improved coordination during gait

C Reinnervation of denervated muscle fibers resulting in larger, less efficient motor units

C Reinnervation of denervated muscle fibers resulting in larger, less efficient motor units

An 84 year-old woman is referred to physical therapy due to progressive decline in function. The patient has unintentionally lost 12 pounds over 4 months, demonstrates decreased appetite, and reports fatigue She requires assistance with basic ADLs. On examination, she also presents with generalized weakness, slowed gail speed, and decreased physical activity levels.

Which of the following BEST differentiates failure to thrive from frailty in this patient?

A	Failure to thrive is characterized primarily by decreased physiologic reserve, whereas frailty is defined by unintentional weight loss and malnutrition.
B	Frailty is defined by a multidimensional syndrome of decreased reserve and resistance to stressors, whereas failure to thrive is primarily associated with weight loss and functional decline.
C	Failure to thrive requires the presence of slow gait speed and weakness, whereas frailty does not.
D	Frailty is an acute condition, whereas failure to thrive develops only in patients hospitalized long

Frailty is defined by a multidimensional syndrome of decreased reserve and resistance to stressors, whereas failure to thrive is primarily associated with weight loss and functional decline.

A 78 year-old female patient presents to outpatient physical therapy for knee pain. During the visit, she mentions feeling a bit unsteady lately. Which of the following options best represents the core elements of the CDC's STEADI (Stopping Elderly Accidents, Deaths, & Injuries) initiative that her physical therapist should incorporate into her care to assess and address her risk of future falls?

A Medication review, home safety assessment, and exercise intervention.

B Falls and vision screening, musculoskeletal and neurological examination, and environmental modifications

C Asking about fall history, assessing gait and balance, reviewing medications, and intervene to reduce risk.

D Assessing functional limitations, cognitive screening, and nutritional counseling.

C Asking about fall history, assessing gait and balance, reviewing medications, and intervene to reduce risk.

An aging adult patient is screened at risk for falls. Subsequently, the CDC's STEADI recommends use of which three outcome measures to assess gait, strength, and balance

A Tined Up and Go, 30-Second Chair Stand test, 4 Stage Balance lest

B Tinetti, 5-Time Sit to Stand, 4-Stage Balance test

C Timed Up and Go, 5-Time Sit to Stand, Berg Balance Scale

D 6-Minute Walk test, 30-Second Chair Stand test, 4-Stage Balance test

A Tined Up and Go, 30-Second Chair Stand test, 4 Stage Balance lest

An elderty person has lost significant functional vision over the past 4 years and compiains of tuted vein and difficulty reading. The patient frequently mistakes images directly in front of them, espotiatly in bright light. The patient is able to locate items in the environment using peripheral vision. Based on those findings, what is the visual condition this patient is MOST likely experiencing?

A Glaucoma

B Homonymous hemianopsia

C Macular degeneration

D Presbyopia

C Macular degeneration

Which of the following is true regarding the aging adult population?

A Biological females have a shorter life expectancy relative to biological males.

B It is very difficult for older adults to leam new things.

C Most older adults live in nursing homes.

D Most older drivers are quite capable of safely operating a motor vehicle.

D Most older drivers are quite capable of safely operating a motor vehicle.

Which of the following is true regarding biomechanical age related gail changes?

A Increased excursion of movement

B Increased gait speed

C Increased step length

D Increased variability

Increased variability

An 82-year-old man is referred to physical therapy with a diagnosis of trailty. He presents with slow gai speed, decreased grip strength, low physical activity, and reports feeling easily fatigued Which of the following intervention strategies is MOST appropriate for this patient?

A	Emphasize nutritional counseling and caloric supplementation
B	Focus exclusively on passive range of motion exercises to maintain joint mobility
C	Initiate progressive resistance training combined with balance and endurance exercises
D	Limit activity to prevent further fatigue and reduce risk of injury

Initiate progressive resistance training combined with balance and endurance exercises

Gerontology

the study of aging

Geriatrics

refers to medical care for older adults

Older Adults

: > 65 years old is the age most often used*

Aging

refers to the inevitable, irreversible decline in organ function that occurs over time even in the absence of injury, illness, environmental risks, or poor lifestyle choices

Demographic Changes

In 2022, people 65 and older represent 17% of the US population and by 2040 will be 22%

Successful Aging

• Characterized by absence of disease and disability, maintenance of high cognitive and physical functioning, and continued capacity for active engagement in life.

Healthy/Optimal Aging

• The capacity to function across multiple domains to one's satisfaction and despite one's medical conditions.

Typical Aging

• Described as having one or more medical conditions that become prevalent in later life, which may compromise function, independence, and quality of life.

Burden of Chronic Diseases

• Leading Causes of Death

• Diminished Quality of Life and Loss of Independence

• Major Contributor to Health Care Costs

• Ways to Promote and Preserve the Health of Older

• Adults and Reduce Costs

• Addressing Challenges for People with Multiple Chronic Conditions

what is the current sex ratio

90 males per 100 females

as age increases, there are less males

women have a higher life expectancy

Leading Causes of Death in indivuals over 65 or older

1. heart diease

2. cancer

3. Resp diease

There is a decrease in the ____ population over 65 than other races because the increase

white

more women are ___

widowed

more men are ____

married

women that live with a partner vs men

71 - man

49 women

Health Care Costs

Among health care costs for older Americans, _____% are for chronic diseases.

95

The cost of providing health care for one person aged 65 or older is______ higher than the cost for someone younger than 65.

three to five times

By 2030, health care spending will increase by ___%

25

Preservation of Health

The risk of chronic diease increases with age, but growing older does not have to mean becoming disabled.

Diminished Quality of Life and Loss of Independence

long period of decline and problems doing IADLS and ADLs

• loss in vision

• hearing

• ambulatory

• cognitive

• self care

• independent living

as a persons age increases these decline more

in older adults:

• how many people have no leisure time physical activity within the past month

• how many fruits and vegetables daily

• are obese

• fall with injury within the past year

31.4

41.8

24.3

31.7

---

percent of adults have issues with mobility and self care

21 and 7

The declines that occur with aging may be due at _____

least partly to lifestyle, behavior, diet, and environment

Benefits of Physical Activity for the Aging Adult

Reduced mortality rates, even for smokers and the obese

• Preservation of skeletal muscle strength, aerobic capacity, and bone density, contributing to greater mobility and

independence

• Reduced risk of obesity

• Prevention and treatment of cardiovascular disorders (including rehabilitation after myocardial infarction),

diabetes, osteoporosis, colon cancer, and psychiatric disorders (especially mood disorders)

• Prevention of falls and fall-related injuries by improving muscle strength, balance, coordination, joint function,

and endurance

• Improved functional ability

• Opportunities for social interaction

• Enhanced sense of well-being

• Possibly improved sleep quality

Screening the Aging Adult

____ older patients starting an exercise program should be screened to identify those with chronic disorders and to determine appropriate activities

All

Physical activity is inappropriate for _____

only a few older people (eg, those with unstable medical conditions

Some experts recommend an examination, possibly with an exercise stress test, for patients who have______ ) and who plan on starting an activity more strenuous than walking

≥ 2 cardiac risk factors (eg, hypertension, obesity

moderate and vigorous intensity exercise

strength training

guidlines for ages 18-64

Moderate intensity: 150–300 minutes

Vigorous intensity: 75–150 minutes

Strength training all major muscle groups ≥ 2x/week

Physical Activity Guidelines for older adults (65 and older)

same as 18-64 with some additions

• focus on muticomponet PA

• flexibility and balance training

• relative to their level of fitness

• people with chronic conditions should understand how their condition affects them

• when they cant do 150 mins bc of chronic conditions should do as much as their abilities and conditions allow them too

Talk test

• to gauge exercise intensity based on ability to carry a conversation

• steady conversation is associated with moderate intensity aerobic exercise

• Vigorous intensity is an exercise intensity where only a few words are sustainable

Heart Rate

• can be monitored by using a wrist watch or chest strap

• Moderate intensity exercise is 65-75% HR max

• Vigorous is 76-96% HR max

• Target HR = 220-age x HRmax

RPE

perceived effort is a subjecteive effort of how exercise feels

• 3 - mod

• 5 is hard

• 10 max

Calculating Heart Rate for the Aging Adult

HR max = 208 - 0.7 x age

moderate and vigorous intensity step amount

• moderate is 100 per min

• greater than 100 steps

Relative Contraindications for Exercise

• Resting HR <50 bpm or >100 bpm

• Resting systolic blood pressure <90 mmHg or >200 mmHg

• Resting diastolic blood pressure >100 mmHg

• SpO2 ≤ 90%

• Signs and Symptoms: SOB, angina, DVT, cyanosis, increase edema, HA, abnormal heart rate or breath sounds

Normal and Abnormal Heart Rate during and after exercise

• HR returns to within 10 bpm to pre-exercise value at 5 minutes stopping exercise

• Remains elevated 5 minutes post activity

normal and abnormal Blood Pressure during and after Exercise

• Rise in SBP 20-30 mmHg

• BP returns to within 10 mmHg to pre-exercise value at 5 minutes stopping exercise

abnormal

Systolic rises slightly

Fall in systolic with rise of HR

Diastolic drops 10-20mmHg below baseline

Changes Associated with Aging that Impact Nutrition

Changes in body composition

2. Decline in immune system

3. Changes in gastrointestinal tract

4. Dental Problems

5. Sensory losses

Sarcopenia

The progressive loss of skeletal muscle mass and strength with aging

decreased insulin sensitivity and decreased energy needs

increased risk of mortaility

Nutrition’s Role in Sarcopenia (reverse effects)

Goal: to prevent loss of muscle mass

• Increase protein

• Increase creatine

• Increase Vitamin D

• Exercise - build muscle mass

Obesity

Aging adults are at increased risk of both malnutrition and obesity

are often malnurished from empty cals and leads to diability

Immune System

Decreased immuno-responsiveness with age

*** Malnutrition is the most common cause of immunodeficiency

*** Obesity also reduces immuno-responsiveness

increase susectibility to cancer and dieases

Nutrition’s Role in the Immune System

Goal: to improve/promote the immune response

• Increase protein

• Well balanced diet - macros like iron and copper

Gastrointestinal Tract

Decreased smooth muscle tone - reduces motiity

Decreased production of hydrochloric and peptic acid - dgests protein

Constipation

Weakening of esophageal sphincter - heartburn

Diarrhea

Dry mouth

Pharmacology

Dental Problems

Poor nutrition diminishes oral health

Tooth and gum pain

Dentures

Tooth loss

Difficulty with oral hygiene

Sensory Losses

Taste bud atrophy

Loss of olfactory bulb cells - loss of taste and smells causing loss of appetite

Vision

Loss of sense of thirst and/or hunger

Environmental Risk Factors for Altered Nutrition

Social isolation

• Decreased ability to feed self

• Insufficient availability of food

Effects of Poor Nutrition

Increased medical costs

• Increased hospital length of stay

• Deep vein thrombosis

• Weaking of the immune system

• Fatigue

• Frailty

• Confusion

• Low RBC count

• Weakness

• Falls

• Depression

• Dependence

• Increased mortality

Nutrition Take Home Message

• Nutrition is a critical component of health and wellness

• Moderation and variety are recommended

• Some individuals may have additional nutritional needs

• Fruits and vegetables are critical

Your Role as a PT in regards to nutrition

Recommendation: Oral supplemental nutrition with dietary advice should be recommended for older people affected by undernutrition.

• Assessment of muscle mass and muscle strength.

• Refer older people with evidence of potentially serious underlying physical illness for medical review by a physician or specialist.

• Mealtime interventions

• Food insecurity screening

• Anthropometric measurements

for moderate level intensity what should you be able to do

talk but not sing

should you use 220 minus age for HR max for older adults

no

for vigorous intensity what should the RPE be

5-7 // 15-17

the 220 minus age equation ____ the max HR for older adults

underestimates

the educaton of the older popultion completing education ___

rose recently

The most common barriers to seeing a physician were______

the doctor’s lack of responsiveness to patient concerns, medical bills, transportation, and street safety.

almost all people aged 65 and older obtained their insurance via

medicare (94)

covers mostly acute services

only covers about half

health literacy

the degree to which the indivuals have the capacity to obtain process and understand basic health information and services needed to make appropriate health decisions

Among adult age groups, those aged 65 or older have the smallest percentage of people with proficient health literacy skills and the largest percentage with ___ health literacy skills.

“below basic”

causes skipping medical things because they dont understand why it is imprortant and have a harder time managing chronic diseases