Case Mgmt Test 1

(obj 1) It is estimated that about ___ of older adults fall each year, though only _-_% experience significant injury associated with the fall. falls are the most common cause of fatal accidents in the elderlay and are responsible for ___ of the 10,000 deaths due to accident. 

(obj 1) T or F: a cycle of fall, fear of falling, decreased strength, balance and reflexes leading to further falls probably contribute to gradual physical decline in many older persons.
True False

(obj 1.5) see guccione p.332-335 about the body systems that maintain static and dynamic postural control and enable coordinated response to perturbation. 

(obj 1.6) "a sudden, unintentional change in position causing an individual to land at a lower level, on an object, the floor, or ground other than as a consequence of sudden onset of paralysis, epileptic seizure, or overwhelming external force" --Definition:_____

(obj 2) Changes considered normal aging that contribute to falls:
-visual impairments (name 2)
-changes in ____ ____ receptors
-decreased ______ due to loss of muscle fibers
- increased ______ of connective tissue
-_______ ______ velocity does not slow very much, yet even the 10% decrease between age 20 and 80 may make the difference, as the elderly person is unable to take the one quick step that would normally avert a fall. 

(obj 3) Diseases that frequently occur with age and how they are associated with increased fall risk: 
-Nervous system disorders, such as ____ (central) or ____ ____ (peripheral), heighten fall risk significantly.
- Not counting the many medications prescribed for hypertension or heart rate or rhythm disorders, untreated _____ ____ may be associated with reduced cardiac output and dizziness or blackouts.
- ______ _____ or ______ are obvious contributors to falls. Various forms of _____ are associated with joint pain, muscle weakness, and decreased ability to maintian balance when challenged. 
-Any disease that leads to _____ ____ contributes to fall risk.
-Cognitive loss or ______

(obj 4) Extrinsic or environmental factors associated with falls- give examples

(obj 5) Home Assessments- OT's do them so they must not be that hard. 
-All stairs must have ____. 
-____ ____ must be put away
-all lights should be at least ____ watts
- ___ ____ should be in every room c ______ accessible
- there should be a ____ ____ between walls and floors, at thresholds, and on stairways, where top and bottom steps need to be marked. 
-bathroom _____ are a given.

(obj 7) meds commonly given that are associated c falls: 
________: especially diuretics and antiarrythmics
________: for angina
________: opioids
________: relaxants
________: for psychotic behaviors
________: for depression
________: for parkinsons

(obj 8) 
_______ can be associated with decreased judgment as well as hypokinesis that reduces an elderly person's level of fitness in a spiral fashion.
______ (chronic/unreversible) and _______ (acute and reversible) cause olderpersons to take unnecessary risks as they can't comprehend dangersous situations in the environment.

(Obj 9) risk factors for falls in older adults: name some

(Obj 10) recommend an exercise and activity program to lessen risk of falling: 

(obj 11) Describe the relationship between a fall and fear of falling: 

(Obj. 12) Instructions for getting down to the floor and getting back up:

(obj 13)
______=room spinning
*_____: otocoia from utircle escape into SCC: (canalithiasis or cupulolisthasis)
*____: causes unilateral peripheral hypofunction
other causes: unilateral central lesion CVA, CHI, MS, labyrinthitis
*other causes: MS, Meniere's, migraine HA, fistula

(obj13)
_______: going to faint or pass out: has many causes, name some

(obj 13) ________: "off balance, poor balance" 
may be caused by: 

(0bj 13) Duration of dizziness
________: BPPV, orthostatic hypotension
________: TIA, panic attack, migraine
_____-____: Meniere's 

(obj 13) Differentiation of peripheral and central Vertigo
Peripheral: Nausea (severe or moderate) Imbalance (mild or severe) Hearing Loss (common or rare) Neurologic Sysmptoms (rare or common) Compensation rate (rapid or slow) Gaze fixation causes (decreased nystagmus, or no change/increased nystagmus)

(obj 13) differentiation of peripheral and central Vertigo
Nausea (severe or moderate) Imbalance (mild or severe) Hearing Loss (common or rare) Neurologic symptoms (rare or common) Compensation rate (rapid or slow) Gaze fixation causes (decreased nystagmus or no change or increased nystagmus)

(Obj 15)
______: named for the direction of the quick phase
____/_____ ______: named by the direction that the superior pole of the iris moves: to the left or the right

(obj 16) List the 5 criteria in the diagnosis of BPPV using the Hallpike-Dix test: 

These criteria apply to the _____ and _____ canals but not the _____ canals

(obj 16)
< __sec nystagmus: likely caused by canalithiasis
>__ sec- likely cupuolithiasis
if nystagmus is persistent, it may indicate a ______ lesion rather than BPPV

(obj 17) Effects of aging on the Vestibular system
-loss of ___ ____
-loss of ____
- _____ in VOR gain
-also oscillopsia, visual and somatosensory input changes 
*all of these combined contribute to vestibular ________

(obj 17)
*if hypofunction is _______ there is dysequilibrium and gait ataxia= __ __ __
*if hypofunction is ______ there is dysequilibrium and vertigo= _ _ _

(obj 18) nOrmal and pathological changes to hearing
. ______: age related hearing loss c three origins
1. ______: outer and middle ear: excess wax, sclerotic tympanic membrane, or blocked eustachian tube; hearing aids most effective
2. ______: the inner ear; auditory nerve degeneration, ototoxic drugs, meniere's disease, brain tumor
3. _______: 
-(higher or lower) frequency sounds are lost
-(consonants or vowels) are more difficult to distinguish

(obj 19) Med Part B regulation promoting Screening for Future fall risks