Mobility Chap 15
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- narrower standing base
- temporary or permanent consequences of illness
- immobilized by the fear of falling
DISORDERS AFFECTING MOBILITY
FALLS: CAUSES AND CONSEQUENCES
- near falls not usually reported important in assessing fall risk.
- must be reported to the Centers for Medicare & Medicaid Services (CMS).
- Falls are a symptom of a problem
- iatrogenic factors such as limited staffing, lack of toileting programs, and restraints andside rails
sudden and unexpected fall to the ground without loss of consciousness in an otherwise healthy individual
can cause hip trochanter cracks, femur fractures
primary causes of most falls found to be cardiovascular (vasovagal syncope, orthostatic hypotension, carotid sinus hypersensitivity)
- followed by neurological causes (primarily vestibular disorders), gait and balance disturbances, and
- drug-related causes.
Fall risk factors that increase proportionally as one ages
- visual acuity, cognitive impairment, postural
- hypotension, cardiac arrhythmias,
- uncontrolled diabetes, depressive symptom
- four or more prescription medications
Balance and Gait
- Muscle weakness experienced in hyperthyroidism, hypothyroidism, hypokalemia, hyperparathyroidism,
- osteomalacia, and hypophosphatemia
- The swing phase of gait ivulnerable because only one
- foot is in contact with ground
The get-up-and-go test
- The client is asked to rise from a straight-back chair, stand briefly, walk
- forward about 10 feet, turn, walk back
- to the chair, turn around, and sit down. Performance
- is graded on a 5-point scale from 1 (normal) to 5 (severely abnormal). The quality of the movement is assessed for impaired balance
- Wide-based gait with frequent side-stepping
- defective muscular coordination when voluntary muscular movements are attempted
- Associated with stooped posture;
- hip and knee flexion; diminished arm swing; stiffness in turning; broad-based,
- small steps with poor gait intention
- Poor arm and leg swing, affected
- limb does not bend at knee; ankle fixed and
- inverted as leg swings in wide circle; foot tends to drag
- Ill-defined skeletal
- pain; pain on weight bearing; unstable, waddling gait
- porous bone characterized by low bone mass (or bone
- mineral density) and subsequent deterioration of the
- bone structure.
- Primary osteoporosis is associated with the normal changes of aging
- Secondary osteoporosis, accounting for 15% of cases, is
- caused by another disease state or medications
- (hyperthyroidism, hyperparathyroidism,
- gastrointestinal [GI] disorders, neoplasms,
- health consequence of OP is the fall- related morbidity
- and mortality
Causation and Pathophysiology Risk Factors for Osteoporosis
- fastest overall loss of BMD is in the 5 to 7 years
- immediately after menopause
- Low calcium intake
- Estrogen deficiency
- Low testosterone
- Inadequate exercise or activity Use of steroids or
- anticonvulsants Excess coffee or alcohol intake Current cigarette smoking
- Osteoporoticrelated hip fractures have the most serious
- Vertebral fractures are the most common
- osteoporoticrelated fracture.
RHEUMATIC DISEASES OF OLDER ADULTS
- disorders of joints and connective tissue
- rheumatic disorders bursitis, polymyalgia rheumatica, gout,rotator cuff tears, tendinitis, frozen shoulder, low back pain, acute disk herniation, chronic disk
- generation, lumbar
- spinal stenosis, rheumatoid arthritis,
- degenerative joint disorder (DJD)
- including increased age, genetic predisposition, obesity, cellular and biochemical processes, and
- repetitive use or trauma to the joint.cartilaginous lining becomes thin and damaged
- crepitus may be heard an indication of the deterioration of the synovial covering of the joints.
- Spinal involvement common 5, T8, and L3, areas of greatest flexibility.
- Osteophytes (bony outgrowths) in the lumbar
- region can become spinal
- stenosis if encroaching in the foramina and spinal cord and can result in radiating low back pain
Medical / Pharmacological Interventions for
- acetaminophen (Tylenol) remains the drug of choice
- the next choice is one of the NSAIDs, such as aspirin or ibuprofen;with significant risk for GI problems such as bleeding
- Other pharmacological agents often used in OA
- management include topical
- capsaicin made from pepper plants and available over the counter in two strengths
- surgical replacement of the joint (arthroplasty)
- chronic, systemic inflammatory joint disorder.
- autoimmune disease in which an inflamed synovium (lining
- of the joint)
- normally affects the small joints of the wrist, knee, ankle, and hand, although it affects large joints as well.
Systemic Manifestations RA
- affects many organ systems in addition to the joints
- Rheumatoid nodules mayarise within tendons or ligaments and can cause rupture or joint dysfunction
- lungs, the sclera, and the vocal cords
- RA can develop Sjogren's syndrome,
- stiffness and pain in the muscles of the neck, shoulders, lower back, buttocks, and thighs
- also may have coexistent OA
- Although it is sometimes difficult to differentiate PMR from OA,
- important since PMR isreversible and requires different treatment.
Bursitis and Tendinitis
- soft tissue rheumatic syndromes
- in the tissues and structures such as ligaments, tendons, bursae, and muscles. Because the problem is so near a joint, it is often confused with arthritis.
- inflammation of the tissues or synovial sheaths around a
- It usually occurs from overuse, unaccustomed activity, or exercise
- occurs with repetitive physical stresses.
- occurs mainly in subacromial bursae (shoulder) and olecranon bursae (elbow). In the lower extremity, it
- occurs in the trochanteric, prepatellar,
- inflammatory arthritis that results from accumulation of
- uric acid crystals (tophi) in a joint
- one-time acute illness, or chronic condition with acute attacks
- the great toe is the most typical site
- exquisite pain in the affected joint, often starting in the middle of the night during sleep
- avoiding drugs or foods that are high in purine and alcohol,
- both of which increase uric acid levels
- is a progressive disease of the basal ganglia corpus striatum) and involves the dopaminergic nigrostriatal
- disorder produces a syndrome of abnormal movement called parkinsonisrn that leads to difficulty with mobility
- bradykinesia (slow movement);resting tremor; rigidity; abnormalities of posture, balance and gait; and deficiency of the neurotransmitter dopamine.
- Parkinson's disease is called
- primary parkinsonism or idiopathic.
- Idiopathic (for which no cause been found)
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