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Osteoporosis, Osteoarthritis and Residential Care (Osteoporosis:
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Osteoporosis, Osteoarthritis and Residential Care
General:
- the number of people aged 85 and older grew by 19.4% over the period from 2011 to 2016 (nearly four time the rate for the overall Canadian population)
- baby boomers are people born between 1946-1964
- aging population will continue to accelerate between 2010-2031 as the baby boomer will reach 65 years old
Seniors and Health Problems:
- MSK: osteoarthritis, osteoporosis (bone loss), gout, loss of muscle mass, fractures
- Hormonal: diabetes, menopause, thyroid dysfunction, high blood cholesterol, slower overall metabolism
- Neurological: dementia (Alzheimer's or other types), Parkinson's disease, cerebral vascular accident (strokes), ALS, post-polio syndrome
- Visual: macular degeneration, glaucoma, cataracts, diabetic and hypertension related eye disease
- CV: heart attacks, congestive heart failure, irregular heart rhythm (afib), HTN, atherosclerosis (hardening and narrowing of blood vessels), peripheral vascular disease (poor blood flow as a result of narrow blood vessels)
- Lungs: COPD, loss of lung volume
- Kidneys: poor kidney function (kidney or renal disease) from long standing diabetes and hypertension
- Auditory: hearing loss, tinnitus (ringing in ears)
- Cancers: prostate, colon, lung, breast, skin, bladder, ovary, brain, pancreas
- Bone Marrow and Immune System: inability to produce sufficient blood cells (anemia)
- GI: stomach ulcers, diverticulitis (small pockets forming in the wall of colon), colon inflammation swallowing difficulties (dysphagia), constipation, bowel incontinence, hemorrhoids
- Urinary: urinary incontinence, urinary urgency, difficulty urinating
- Psychiatric: depression, anxiety, sleep disturbance, insomnia
- General problems: fatigue, general deconditioning, forgetfulness, medication side effects, diminished appetite, weight loss, falls
Residential Care:
- Long-Term Care Facility: facility that provides rehabilitative, restorative and/or ongoing skilled nursing care to patients or residents in need of assistance with activities of daily living (ex. nursing homes, rehab facilities, inpatient behavioural health facilities, long-term chronic care facilities)
- Retirement Home: a residential complex, with one or more rental units of living accommodation (occupied primarily of people 65 or older)
- Residential Care Facility: long-term care given to adults or children who stay in a residential setting rather than their home
- Assisted Living for Seniors: offer housing, hospitality services, personal assistance to adults who can live independently but require regular help with ADLs; services include meals, housekeeping, laundry, social/recreational opportunities, 24 hour emerg response
Functional Disability:
- functional concept of disability, defines a disability as any long-term limitation in activity resulting from a condition or health problem
- a functional disability:
- typically limits a person's ability to perform physical or functional activities
- may have a significant sensory impairment
- may have involvement of mental illness
- may involve the use of assistive devices or technology
- may involve developmental delays or cognitive impairments
Cognitive Impairment:
- can be mild, moderate or severe:
- no anticipation of errors
- impaired organization and planning
- mild, moderate or severe problems related to attention span
- inability to comprehend/understand spoken/written instructions, visual images, diagrams, and drawings
- impaired motor response or actions
- inability to follow verbal instructions / demonstrated instructions
- inability to consider new information, imagine and reflect on possibilities
- cannot formulate original approaches to task performance
- poor judgement
- impaired problem solving
Osteoporosis (OP) VS. Osteoarthritis (OA):
- Osteoarthritis: (arth = joint and itis = inflammation) is a disease of the joints and surrounding tissues; OA commonly affects the knees, hips, hands, feet and back; a result of damage to cartiglage and usually occurs due to overuse, wear and tear and aging
- Osteoporosis: a skeletal disorder characterized by compromised bone strength predisposing a person to an increased risk of fracture; called the "silent thief" because it progresses without symptoms until a fracture occurs; fractures related to OP and joint damage related to OA can feel similar
- BOTH: cause pain and limited mobility; in spine OA and OP can co-exist causing pain and limited mobility
Bone:
- a framework of protein strengthened and hardened by calcium and phosphorus
- the amount of bone tissue is called bone mass, while density refers to how compact the bone is
The Remodelling Process:
- Cells called osteoclasts create a cavity on the bone surface
- Cells called osteoblasts fill in the cavity
- Repair complete
Bone Mass Changes with Age:
- start losing bone at the rate of ~1% per year in our mid 30's
- at menopause bone loss increases to 2-3% per year
- in men bone loss is slower until after age 65
- bone loss can reach a point where fracture risk increases
Osteoporosis:
- a skeletal disorder characterized by compromised bone strength predisposing a person to an increased risk of fracture
- Primary: bone loss related to menopause, age or unknown causes
- Secondary: conditions or medications can cause bone loss
- perceived as a "women's disease" - so men are often not diagnosed
- mostly affects: spine, hip, ribs, wrists
Primary Signs:
- low bone mass
- loss of height
- loss of postural alignment
- suffering of fragility fractures (fractures occurring spontaneously or following minor trauma such as a fall from standing height or less - excludes fractures of skull, hands, ankles, feet)
Osteoarthritis:
- most common form of arthritis, especially among the elderly
- one of the most frequent causes of physical disability among older adults
- can also occur in younger ages with injury
- joint disease
- mostly affects the cartilage
- degenerative Joint Disease or Osteoarthrosis
- causes are unknown; but suspected factors include overweight, aging process, joint injury, stress on joints from certain jobs or sports, heredity
- stats: younger than 45 - more common in men; older than 45 - more common in women
- affects people differently - it can progress slowly over time or present with severe symptoms
- related disorders: range from mild (tendonitis, bursitis) to severe (gout, lupus, rheumatoid arthritis); common denominator is joint and muscle pain (inflammation)
- most often affects: fingertips, thumbs, neck, lower back, knees, hips
- Heberden's Nodes: begin after age 45, affect women 10x more than men; heredity may play a role in women, not always painful, cause limited
Warning Signs:
- steady or intermittent pain in a joint
- stiffness in a joint after getting out of bed or sitting for prolonged periods
- swelling or tenderness in one or more joints
- a crunching feeling or the sound of bone rubbing on bone
Joints: two moving bones come together to allow smooth movement and absorb shock
- components: cartilage, joint capsule, synovial membrane, synovial fluid, ligaments, tendons, muscles
Osteoarthritic Cartilage:
- surface layer of cartilage breaks down and wears away
- bone under cartilage rubs together
- causes: pain, swelling, loss of motion
- over time, joint may lose its normal shape
- bone spurs (osteophytes) may grow on the edges of the joint
- bits of bone/cartilage can break off and float
Impact of Spinal Fractures:
- back pain, depression, fear of future fracture and falling, reduced quality of life
- height loss, protuberant abdomen, reduced lung function, weight loss, sleep disturbances
- impaired ADLs
Bone Mineral Density Test (BMD):
- who should get tested?
- all women and men 65 years or older
- postmenopausal women and men 50-64 at risk of fracture
- younger men or women (under 50) with a disease or condition associated with low bone mass or bone loss
Prescribing Medication:
- based on comprehensive fracture risk assessment --> combines BMD results, age, sex, previous fragility fracture and other risk factors
- assessment gives more accurate prediction of fracture risk than BDM alone
- medications are available to treat osteoporosis and reduce risk of osteoporotic fractures
- people respond differently to medications
- all medications reduce risk of vertebral fractures from 30-70%
- for high-risk individuals, the benefits of drug therapy far outweigh potential risks
Treatment Plans:
- OA:
- pain management (heat/ice, wax bath, whirlpool, gentle range, ultrasound, TENS)
- improve level of function
- exercise – increase flexibility and strength
- education – combination of rest & exercise
- use of assistive devices (canes, walkers, splints/braces as necessary)
- rest versus Exercises
- referral to physician for medication (NSAIDS, topical pain-relieving creams, painkillers, corticosteroids)
- OP:
- postural management
- improve level of function
- exercise – increase strength, balance and postural stability
- nutrition
- calcium & Vitamin D
- education – ADLs and exercise
Nutrition:
- Calcium: found in cells, blood, skeleton, and teeth; if not enough in diet the body takes calcium from bone (so bones become fragile); at 50+ you should take 1200mg of calcium (higher then when you are 19-50)
- rich foods include: all dairy products, dark green leafy vegetables, fortified foods, sardines and canned salmon
- Vitamin D: helps to build stronger bones by increasing absorption of calcium; few natural sources (the sun is one but we don't get much in Canada so a supplement is recommended); improves function of muscles (which will improve balance and help prevent falls)
- supplement: 19-50 = 400-1000IU; 50+ = 800-2000IU; pregnant/lactating = 400-1000IU