geriatrics week 1 summary.pdf

Parker: test of fxnal health literacy in adults (!995) 50 items on reading comp 17 numerical ability 22 min Updated shorter version decreased validity in numerical literacy 36 items 7 min REALM rapid estimate of adult literacy & medicine - asks individuals ro read...

Parker: test of fxnal health literacy in adults (!995) 50 items on reading comp 17 numerical ability 22 min Updated shorter version decreased validity in numerical literacy 36 items 7 min REALM rapid estimate of adult literacy & medicine - asks individuals ro read & correctly pronounce terms Newest Vital Sign (NVS) 6 questions based off fake nutrition label 2-3 min calories/allergies etc ask for non english speakers improving health literacy community based initiatives can help collaborative learning (share health info w/ family, community, healthcare prof) = increased social support = increased health literacy interactive learning opportunities & tailor to audience base in behavioral change framework helps promote health literacy - center: improve individual’s access & ability to understand/appraise/apply health info - can improve health care delivery, dx prevention, health promotion in society, affecting services, behaviors, costs & outcomes - leads to better participation/empowerment & long term sustainability Health literacy has significant + association w/ physical literacy BMI, healthy wt, grip strength, cardio respiratory fxn predicting physical literacy Physical literacy motivation, confidence, physical competence, knowledge/ understanding to value & take responsibility for engagement in PA for life  Physical literacy cont. promoting older adults being PA need safe environment education/promotion of PA intrapersonal motivation w/ social interaction/support for adaptions to enjoy PA sustained engagement in PA contributes to increased knowledge & awareness supported by environment/community changes culminates confidence & physical competence (refer to chart) PTS increase physical literacy and PA Summary increased health literacy & physical literacy can be linked to increased confidence, motivation, & self initiation  1.7 Communication Changes w/ Age W/ age normal decreases in What can impact communication comprehension physical word finding psychological naming mental cognitive health DO NOT anticipate significant changes in vocab grammatical judgement ability to repeat what heard Age can be predicted by voice tremor pitch Hoffman survey speaking rate 2005 42% hearing difficulties loudness 26% difficulties writing fluency of speech 7% telephone Communication impacts employment participation in social/leisure activities in community personal relationships (can create entry point of isolation, limited mob, impair mental/cognitive health & chronic dx) can impacts ability to complete basic ADLs & seeking assistance can lead to poor health literacy (poor health outcomes, lack of motivation, lack of self efficacy) Strategies for effective communication w/ older pt/caregivers know audience allow extra time avoid distractions sit face to face maintain eye contact listen - - doesn’t always depend on age speak slowly, clearly, loudly - don’t generalize ppl!! - use short simple words/sentences ~ - stick to one topic at time simplify/write instructions use charts/models/pics make things easy to read summarize most important points give pt opportunity to ask questions & express themselves summary of chart reiterates importance of non verbal demeanor include families minimize distractions  Digital Literacy & Communication fewer adults able to do so bc of limited finances, access, having hardware in place limited use of tech for both social & health interactions] - if do use they are passive and dont really interact w/ things 60-70s are starting to use more digital devices! Tech use increased after COVID lead to need for better e health literacy E Health Literacy ability to search for & understand relevant & reliable health care info for wellness, promotion & prevention requires literacy in all the petals on chart higher levels associated w/ - lower prevalence of chronic dx/disability w/ less healthcare visits Recommendations for UDL for OA adjustable font size, 16 point min have health workers help bridge gap and increase access to EMR sans serif fonts - roboto, arial, helvética, futura, avant garde, verdana high contract colors - avoid shades of green/red/yellow/blue (USE black/white) audio files should have subtitles large buttons on tablets/phones avoid acronyms avoid busy background Summary communication strategies must adapt to individuals own age changes  1.8 Behavioral Change Before facilitating behavioral change understand what stage in 5 stages to behavioral change precontemplation - not aware of a problem/change needed contemplation stage - increased awareness of issue/change needed but no intention preparation stage - acknowledge change needed & intends to and may have plan action stage - plan implemented & practice of desired behavior maintenance phase - plan implemented w/ consistency but continuous work to maintain Relapse prevention coping mechanisms problem solving to sustain changes Health behaviors impact physical, mental health, & QOL Poor health behaviors negative outcomes, chronic dx & poorer QOL Healthcare providers identify modifiable determinants of healthy aging behavioral interventions need to be adapted to stage Healthy aging fxnal ability wellbeing that allows ppl to do what they value Fred chart understand ppls perspective on themselves aging motivating/demotivating factors to pursue foals there must be motivation and support to set goals/ pursue them (if not = disengagement) - culture, social, tech, physical, organizational, life course/hx can affect motivation/pursuit/disengagment Barek all 3 of these influence improving diet/exercise health concerns - new dx, worsening labs, decrease in fxn, not wanting medication anticipated benefit - better appearance/fxn for events, controlling dx, success w/ prior change (demotivator = no success prior) confidence that’s measurable.attainable Social motivation strong motivator for behavioral change community/population standpoint - health behavior change is more successful if no social approval of positive health behaviors - increasing visibility of + health bebaiots in social environment w/ peers/role models Use behavioral contracts (PT) share plans/goals w/ others - builds accountability maintain changes - increased attn to & by social influences helpful - forming social relationships supporting these changes - group exercise for rapport Lockman summary chart consider background factors - age - economic status - personality - fragility - dx - work status - social/political determine best type of motivation can increase healthy behaviors everything is personalized!! PT interventions should have broad reach available and inclusive of those of lowest physical fxn by increasing accessibility w/in community challenge those w/ higher fxn interventions should lead to long term changes by monitoring progress, providing support, and have structured follow up, maybe introducing digital tech to keep teach no more paper exercises want to improve self efficacy Summary behavioral change in older adults for exercise relies on health concerns, confidence & anticipated benefits may require focus on social motivation  1.9 Aging Changes in Multiple Systems Physiology of Aging & Exercise - Various anticipated changes that occur w/ aging - Looking at integumentary, immune, endocrine, digestive, urinary - Exercise & diet fxn as only true anti-aging agents we know of Integumentary System - Expected to be thinner epithelium & fatty layers - Shrinking of collagen & elastic by about 1% each yr - Decreased sweat glands, skin vascularity, thinner blood vessel walls - Results in skin rigidity & decreased elasticity - Importance - Touching or handling older patients to prevent wounds - With existing injuries, older adults require increased time to recover - Have delayed healing - Susceptible to infection Immune System - Overall reduction of immune response w/ age (immunosenescence) - Characterized by decreased blood stem cells, decreased humoral & cellular immunity - Increased inflammation & oxidative damage - Increased autoantibodies - Decline in antibody protection in response to pathogens - Creates inflammatory environment (inflammaging) Neuroendocrine System - AKA hormonal release - Hormone release & production decreased typically around 30 - At a rate of 1%/yr, increased irregularity of release pattern - Specifically melatonin - Thyroid atrophies increase risk of developing hypo/hyper thyroidism - Increase in parathyroid hormone release - Leads to vitamin D deficiencies - Decreased bone mineral density - Adrenal gland increases cortisol levels w/ age - Decreased clearance can cause muscle atrophy, frailty, obesity, insulin resistance - Gonads (men) - Decreased androgen levels resulting in decreased testosterone - Decrease in abnormal sperm production w/ age - Decreased strength, cognitive functioning, sex desire, bone density - Women (gonads) - Result in menopause Menopause - Altered timing of release of luteinizing hormone - Decreased estrogen, leads to ineffective release of follicle stimulating hormones - Overall loss of ovarian function - Progressing from anovulatory cycles towards loss of menstrual cycles - Tend to have systemic changes in skin/mucosal fxn, cardiovascular, weight gain, increased waist -Decreased sex desire/fxn, vaginal dryness, urinary urgency/frequency - Altered central nervous system fxns - Anxiety, sleep disruption, cognitive changes, migraines Urinary System - Decrease in kidney & bladder size & number of nephrons - Bladder muscle weakens, decreased renal blood flow & glomerular filtration rate - Overall reduced renal filtration & bladder capacity - Increased urinary tract infections - Decreased control of urinary sphincter - Urinary incontinence is NOT part of normal aging - Expected changes - Results in decreased excretion of drugs & toxins - Increased risk of fluid & electrolyte abnormalities & vitamin D deficiency Gastrointestinal System - Normal Changes - Decreased smooth muscle tone, enteric system signaling, liver fxn, esophageal sphincter, immunity to mucosal lvls - Results in slower peristalsis - Slow peristalsis & dietary changes can increase overall inflammation - Less nutrient absorption, altered drug absorption - Increased susceptibility to infection - Impaired nutrient absorption (Vitamin D & Calcium) - Predispose impairments in bone structure & formation Summary - Human body ages at different physiological rates, resulted in altered fxn & performance