I. Development
A. Age related changes
1. Physiological
a) Prone to skin breakdown (loss of SQ)
b) Alt thermoreg, fluid req, loss of skin water, inc heat
stroke (atrophy of sweat glands, dec odor, dec heat loss,
dryness)
c) Red vent exchange, suscept to infect, inc atelectasis (dec
vital cap, change mucociliary transp, red handle sec & red effect
of foreign parts, part infltN of lungs
d) Dec Resp to stess, inc arrhythmias, loss of balance inc falls
(reduced SV/CO, slower HR, change in BP)
e) Inc risk constip & need fewer calories (alt motility and
dec storage cap-liver)
2. Lab results- Dunphy Table 77.2
a) Inc ESR (dehydration, malnutrition), reduced reserves (less
fat, thin skin,), mini nutritional assess: obesity.
b) Hbg- slight dec (men=13-18 to 10-17)/ WOMEN NONE
c) Dec HCT= norm hematopoiesis
d) WBC still valid for drugs or sepsis
e) Higher risk for infectN
f) Plt = norm
g) Dec protein= malnutrition, infection & liver dis
h) Dec GFR, dec CO
i) Creat inc to 1.9/100mL, clearance = dec 10%/decade after 40
y/o
j) Glucose- inc 10mg/dL/dec after 30 y/o (also from drugs
and DM)
k) Alk phos- Inc 8-10 or 20% from disease, bone abn, drugs,
fatty meals
, 3. Atypical disease presentations
4. Geriatric syndromes (SPICES)- prevent, early detection, maintaining
function, dignity & individual control to promote QOL
a) S- SLEEP DISTURBANCES
b) PROBLEMS WITH EATING OR FEEDING
c) INCONTINENCE
d) CONFUSION
(1) DELIRIUM-
(a) Drugs,
(b) electrolyte imbalance,
(c) lack of drugs,
(d) infection,
(e) reduced sensory input,
(f) intracranial,
(g) urinary retention/fecal impaction,
(h) myocardial/pulmonary
e) EVIDENCE OF FALLS- uses STEADI step-by-step instruction for
assessment. Keys to reduce= pt. edu, enhancing strength &
balance, mod meds, manage hypotension, vit D & CA supp,
footwear issues, vision & home safety.
(1) REVIEW self-assessment from older adults
(2) IDENTIFY risk factors (bars in bathroom, stairs, poor
home lighting, rugs)
(3) TEST gait and balance (yoga, tai chi, Zumba)
(4) UNDERTAKE multifactorial assessment
(5) APPLY interventions (fall prevention-canes, walkers,
bars in bathrooms)
, (6) LATER f/u
f) SKIN BREAKDOWN
5. Categories of aging- know age ranges for old, young old, old-old,
etc.
B. Exercise in older adults (Kennedy)
1. Recommended exercises for sleep and flexibilty
a) Sleep: tai chi, walking, aquatherapy, biking (assess balance
and fall risk)
b) Flexibility: osteoarthritis- walking, aquatic act, tai chi,
resistance exercises, cycling (vary type and intensity to AVOID
overstress; heated pool
2. Exercise recommendations for specific diagnoses (Kennedy)
a) CAD- walking, treadmill, cycle ergometry (supervised program
check BP & HR)
b) CHF- walking, treadmill, cycle (individualize & supervise)
c) DM2- resistive, aerobic, aquatic, recreational (proper shoe fit,
insulin red if insulin dependent
d) Anxiety- walking, biking & wx lifting (high-intensity ability)
e) Depression- walking, cycling & recreational (group part to
keep engaged)
f) Fibromyalgia- aerobic, aquatic, strengthening, tai chi,
pilates (heated pool, gentle stretches, counsel (pain)
g) COPD- cycle, treadmill, individualize )supervised
program- pulmon rehab)
h) CVI- walking & standing (supervised)
i) Osteoporosis- wx-bearing & training (assess balance & risk for
falls)
j) Parkinsons- walking, treadmill, bike, dancing, tai chi, pilates &
boxing (assess for falls 1st)
k) PAD- lower ext exercises, treadmill, walking (short intervals &
progress tolerated)
l) Dementia- walking & recreational (safe and fall risks)
3. Recommendations
A. Age related changes
1. Physiological
a) Prone to skin breakdown (loss of SQ)
b) Alt thermoreg, fluid req, loss of skin water, inc heat
stroke (atrophy of sweat glands, dec odor, dec heat loss,
dryness)
c) Red vent exchange, suscept to infect, inc atelectasis (dec
vital cap, change mucociliary transp, red handle sec & red effect
of foreign parts, part infltN of lungs
d) Dec Resp to stess, inc arrhythmias, loss of balance inc falls
(reduced SV/CO, slower HR, change in BP)
e) Inc risk constip & need fewer calories (alt motility and
dec storage cap-liver)
2. Lab results- Dunphy Table 77.2
a) Inc ESR (dehydration, malnutrition), reduced reserves (less
fat, thin skin,), mini nutritional assess: obesity.
b) Hbg- slight dec (men=13-18 to 10-17)/ WOMEN NONE
c) Dec HCT= norm hematopoiesis
d) WBC still valid for drugs or sepsis
e) Higher risk for infectN
f) Plt = norm
g) Dec protein= malnutrition, infection & liver dis
h) Dec GFR, dec CO
i) Creat inc to 1.9/100mL, clearance = dec 10%/decade after 40
y/o
j) Glucose- inc 10mg/dL/dec after 30 y/o (also from drugs
and DM)
k) Alk phos- Inc 8-10 or 20% from disease, bone abn, drugs,
fatty meals
, 3. Atypical disease presentations
4. Geriatric syndromes (SPICES)- prevent, early detection, maintaining
function, dignity & individual control to promote QOL
a) S- SLEEP DISTURBANCES
b) PROBLEMS WITH EATING OR FEEDING
c) INCONTINENCE
d) CONFUSION
(1) DELIRIUM-
(a) Drugs,
(b) electrolyte imbalance,
(c) lack of drugs,
(d) infection,
(e) reduced sensory input,
(f) intracranial,
(g) urinary retention/fecal impaction,
(h) myocardial/pulmonary
e) EVIDENCE OF FALLS- uses STEADI step-by-step instruction for
assessment. Keys to reduce= pt. edu, enhancing strength &
balance, mod meds, manage hypotension, vit D & CA supp,
footwear issues, vision & home safety.
(1) REVIEW self-assessment from older adults
(2) IDENTIFY risk factors (bars in bathroom, stairs, poor
home lighting, rugs)
(3) TEST gait and balance (yoga, tai chi, Zumba)
(4) UNDERTAKE multifactorial assessment
(5) APPLY interventions (fall prevention-canes, walkers,
bars in bathrooms)
, (6) LATER f/u
f) SKIN BREAKDOWN
5. Categories of aging- know age ranges for old, young old, old-old,
etc.
B. Exercise in older adults (Kennedy)
1. Recommended exercises for sleep and flexibilty
a) Sleep: tai chi, walking, aquatherapy, biking (assess balance
and fall risk)
b) Flexibility: osteoarthritis- walking, aquatic act, tai chi,
resistance exercises, cycling (vary type and intensity to AVOID
overstress; heated pool
2. Exercise recommendations for specific diagnoses (Kennedy)
a) CAD- walking, treadmill, cycle ergometry (supervised program
check BP & HR)
b) CHF- walking, treadmill, cycle (individualize & supervise)
c) DM2- resistive, aerobic, aquatic, recreational (proper shoe fit,
insulin red if insulin dependent
d) Anxiety- walking, biking & wx lifting (high-intensity ability)
e) Depression- walking, cycling & recreational (group part to
keep engaged)
f) Fibromyalgia- aerobic, aquatic, strengthening, tai chi,
pilates (heated pool, gentle stretches, counsel (pain)
g) COPD- cycle, treadmill, individualize )supervised
program- pulmon rehab)
h) CVI- walking & standing (supervised)
i) Osteoporosis- wx-bearing & training (assess balance & risk for
falls)
j) Parkinsons- walking, treadmill, bike, dancing, tai chi, pilates &
boxing (assess for falls 1st)
k) PAD- lower ext exercises, treadmill, walking (short intervals &
progress tolerated)
l) Dementia- walking & recreational (safe and fall risks)
3. Recommendations
