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Samenvatting Theorie kine bij ouderen
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Dit is een samenvatting van alle theorie lessen kine bij ouderen, gevolgd in het jaar .
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KINE BIJ OUDEREN THEORIE,Healty aging (hoorcollege 1) ............................................................................................................................................................... 9
inleiding........................................................................................................................................................................................... 9
er is behoefte aan vertaling van wetenschappelijk onderzoek naar de praktijk ........................................................................ 9
Geriatrische fysiotherapie: noodzaak van juiste perceptie! ....................................................................................................... 9
case study ................................................................................................................................................................................... 9
wat is evidence based medicine? ................................................................................................................................................. 10
methodisch handelen ............................................................................................................................................................... 10
effectieve besluitvorming over behandeling vereist oordelijkundig klinisch redeneren .......................................................... 10
Klinisch redeneren is een denkproces om de PT tot 'verstandige' actie aan te zetten ............................................................ 10
Diagnose ....................................................................................................................................................................................... 11
gezond ouder worden ................................................................................................................................................................... 12
volgens de WHO omvat dit: ...................................................................................................................................................... 12
vroegtijdig ingrijpen ...................................................................................................................................................................... 13
WHO icope screening mechanisme .............................................................................................................................................. 13
doelen van de geriatrische fysiotherapeut zijn gerelateerd aan functie, activiteit & onafhankelijkheid ..................................... 14
medisch model .............................................................................................................................................................................. 15
synergetic morbidity model ...................................................................................................................................................... 15
attribution model ...................................................................................................................................................................... 15
causal chain model.................................................................................................................................................................... 15
unmasking event model ............................................................................................................................................................ 15
polyfarmacie ............................................................................................................................................................................. 16
kwetsbaarheid (hoorcollege 1) ......................................................................................................................................................... 16
frailty ......................................................................................................................................................................................... 17
er zijn verschillende modellen van frailty ................................................................................................................................. 17
FRIED model (fenotype model) ........................................................................................................................... 17
cumulatieve deficiet model (= Rockwood).......................................................................................................... 18
veerkracht ..................................................................................................................................................................................... 20
veerkracht en kwetsbaarheid worden negatief geassocieerd .................................................................................................. 20
vergelijking van kwetsbaarheid en veerkracht ......................................................................................................................... 20
interventies voor kwetsbaarheid .................................................................................................................................................. 21
slaapdisfunctie, diabetes en decubitus (hoorcollege 2) ................................................................................................................... 22
1
, slaap bij ouderen........................................................................................................................................................................... 22
slaappatroon ............................................................................................................................................................................. 22
aandoeningen van de slaap ...................................................................................................................................................... 24
slaapapneu .......................................................................................................................................................... 24
periodieke beenbewegingen ............................................................................................................................... 25
vervroegde slaapfase syndroom ......................................................................................................................... 25
Rem slaap gedragsstoornis.................................................................................................................................. 25
medische aandoeningen ..................................................................................................................................... 26
psychiatrische aandoeningen .............................................................................................................................. 26
organische hersensyndroom ............................................................................................................................... 26
Onderzoek ................................................................................................................................................................................. 26
behandeling .............................................................................................................................................................................. 27
diabetes ........................................................................................................................................................................................ 27
chronische verwikkelingen........................................................................................................................................................ 28
occulair = visusstoornissen.................................................................................................................................. 28
neurologisch ........................................................................................................................................................ 28
macrovasculair .................................................................................................................................................... 28
microvasculair ..................................................................................................................................................... 29
osteoarticulair ..................................................................................................................................................... 29
therapeutishe benadering ........................................................................................................................................................ 29
vasculaire pathologie .................................................................................................................................................................... 29
veneuze insufficiëntie ............................................................................................................................................................... 29
arteriële insufficientie: perifeer ................................................................................................................................................ 30
decubitus (doorligwonden) ........................................................................................................................................................... 31
psychogeriatrie (hoorcollege 3) ........................................................................................................................................................ 35
normale veroudering-cognitieve en gedragsmatige veranderingen ............................................................................................ 35
dementie ....................................................................................................................................................................................... 36
klinische kenmerken ................................................................................................................................................................. 38
verschillende vormen van dementie......................................................................................................................................... 39
ziekte van alzheimer ........................................................................................................................................... 40
lewy body dementie............................................................................................................................................ 41
ziekte van parkinson ........................................................................................................................................... 41
vasculaire dementie ............................................................................................................................................ 42
frontotemporale dementie ................................................................................................................................. 43
2
, risicofactoren dementie ............................................................................................................................................................ 43
verloop volgens etiologie .......................................................................................................................................................... 43
corticale en subcorticale vormen van dementie....................................................................................................................... 44
stadia van dementie.................................................................................................................................................................. 44
differentiaal diagnose dementie ............................................................................................................................................... 46
mild cognitive impairment (MCI) = geeft geen probleem in het dagelijkse leven .............................................. 46
delirium = plotseling optreden van ernstige verwardheid die een lichamelijke oorzaak heeft .......................... 46
depressie bij ouderen ............................................................................................................................................................... 48
motoriek en dementie .............................................................................................................................................................. 49
pijn en dementie ....................................................................................................................................................................... 49
behandeling .............................................................................................................................................................................. 50
omgaan met personen met dementie ...................................................................................................................................... 52
sarcopenie-fysieke activiteit (hoorcollege 4) .................................................................................................................................... 52
active aging ................................................................................................................................................................................... 52
sarcopenie: fysieke kwetsbaarheid ........................................................................................................................................... 54
de belgische vereniging voor gerontologie en geriatrie ontwikkelde een richtlijn sarcopenie ................................................ 55
spierkracht .......................................................................................................................................................... 56
fysieke performance............................................................................................................................................ 57
exercise................................................................................................................................................................ 58
farmacologie (minder belangrijk)........................................................................................................................ 61
Farmacotherapie en revaki bij ouderen (Hoorcollege 5) .................................................................................................................. 62
aandoeningen & medicatie: artrose ............................................................................................................................................. 64
paracetamol .............................................................................................................................................................................. 64
paracetamol & revaki ................................................................................................................................................................ 64
niet-narcotische analgetica (NSAID) ......................................................................................................................................... 64
NSAID en revaki......................................................................................................................................................................... 64
aandoeningen & medicatie: beroerte ........................................................................................................................................... 65
medicatie ter secundaire preventie van atherosclerose A. carotis .......................................................................................... 65
beroerte medicatie & revaki ..................................................................................................................................................... 65
aandoeningen & medicatie: osteoporose ..................................................................................................................................... 65
botontkalking kan ontstaan door de menopauze en/of medicatiegebruik .............................................................................. 65
botontkalking wordt vermeden en behandeld met beweging en medicatie ........................................................................... 65
3
, osteoporose medicatie en revaki.............................................................................................................................................. 65
aandoeningen & medicatie: cataract & glaucoom ....................................................................................................................... 66
cataract en glaucoom zijn verschillende oogaandoeningen ..................................................................................................... 66
glaucoom medicatie en revaki .................................................................................................................................................. 66
aandoeningen & medicatie: herpes zoster ................................................................................................................................... 66
bij ouderen neemt de immunologische afeer tegen varicellazostervirus af............................................................................. 66
postherpeszosterinfectie .......................................................................................................................................................... 66
herpes zoster medicatie & revaki ............................................................................................................................................. 67
aandoeningen & medicatie: prostaathyperplasie ......................................................................................................................... 67
postaathyperplasie komt veel voor bij oudere mannen ........................................................................................................... 67
prostaathyperplasie medicatie & revaki ................................................................................................................................... 67
aandoeningen & medicatie: urine-incontinentie .......................................................................................................................... 67
urine-incontinentie komt vaker voor bij oudere vrouwen dan bij mannen ............................................................................. 67
urine-incontinentie medicatie & revaki .................................................................................................................................... 67
aandoeningen & medicatie: ziekte van parkinson ........................................................................................................................ 67
levodopa is het meest werkzame middel tegen symptomen van de ziekte van parkinson ..................................................... 67
ziekte van parkinson medicatie & revaki .................................................................................................................................. 68
aandoeningen en medicatie: pijn (acute pijn → medicatie voorgeschreven) .............................................................................. 68
de who pijnladder werd opgesteld met het oog op pijnstelling bij acute pijn ......................................................................... 68
codeïne (wordt veel minder gebruikt) is nauw verwant aan morfine ...................................................................................... 68
de pijnstillende werking van tramadol is ongeveer even sterk als codeïne ............................................................................. 68
er bestaan verschillende soorten opoïden ............................................................................................................................... 68
pijn medicatie & revaki ............................................................................................................................................................. 68
Overzicht bijwerkingen ................................................................................................................................................................. 69
artrose en oefenen (hoorcollege 6) .................................................................................................................................................. 70
osteoarthritis (OA) ........................................................................................................................................................................ 70
epidemiologie ........................................................................................................................................................................... 70
definitie knie osteoartritis ......................................................................................................................................................... 70
pathologie – kraakbeen ............................................................................................................................................................ 71
Oa-gerelateerde weefselafwijkingen (remodellering) .............................................................................................................. 71
belangrijk! ................................................................................................................................................................................. 75
4
, mechanismen die het effeect van lichaamsbeweging verklaren .................................................................................................. 75
bewegen wordt aanbevolen door internationale richtlijnen .................................................................................................... 75
Geen specifieke aanbevelingen met betrekking tot de oefenmodaliteiten ............................................................................. 76
Bewegen heeft een matig effect op artrose kniepijn ............................................................................................................... 76
Patiënten onderverdelen in subgroepen is de basis van gepersonaliseerde gezondheidszorg ............................................... 76
Inzicht in de mechanismen die ten grondslag liggen aan de effecten van lichaamsbeweging kan helpen om behandelingen
te optimaliseren ........................................................................................................................................................................ 76
Belangrijk! ................................................................................................................................................................................. 77
behandeling van OA pijn ............................................................................................................................................................... 77
Een grote verschuiving in het begrijpen van artrosepijn... maar nog geen verschuiving in de huidige behandelingen voor OA-
pijn ............................................................................................................................................................................................ 77
Pijneducatie + Mulligan manuele therapie voor knieartrose ................................................................................................... 77
Gegradueerde activiteit = oefening aangepast aan de behoeften van de patiënt ................................................................... 77
houding (hoorcollege 7) .................................................................................................................................................................... 78
houding ......................................................................................................................................................................................... 78
anatomische en fysiologische veranderingen ........................................................................................................................... 78
gewrichtsstijfheid ...................................................................................................................................................................... 78
momentwerking heup .............................................................................................................................................................. 79
voornaamste veranderingen in houding ................................................................................................................................... 79
parkinson .................................................................................................................................................................................. 79
hyperkyfose................................................................................................................................................................................... 80
definitie en prevalentie ............................................................................................................................................................. 80
oorzaak en pathologie .............................................................................................................................................................. 80
geassocieerde gezondheidsrisico’s ........................................................................................................................................... 81
evaluatie.................................................................................................................................................................................... 81
observatie............................................................................................................................................................ 81
röntgen ................................................................................................................................................................ 82
cobb angle ........................................................................................................................................................... 82
debrunner kyphometer ....................................................................................................................................... 82
flexicurve ruler .................................................................................................................................................... 82
spinal mouse ....................................................................................................................................................... 82
inclinometer ........................................................................................................................................................ 82
occiput – to – wall ............................................................................................................................................... 83
5
, evaluatie .............................................................................................................................................................. 83
functionele testing .............................................................................................................................................. 83
behandeling .............................................................................................................................................................................. 83
manuele mobilisatie/mobilisaties ....................................................................................................................... 84
stretching ............................................................................................................................................................ 85
progressieve weerstandstraining ........................................................................................................................ 85
stabilisatietraining ............................................................................................................................................... 85
oefentherapie ...................................................................................................................................................... 85
proprioceptie/postural alignment....................................................................................................................... 86
postural taping .................................................................................................................................................... 86
spinale orthese “corset”...................................................................................................................................... 86
uithouding (hoorcollege 8) ............................................................................................................................................................... 86
deel 1: uithoudingsvermogen ....................................................................................................................................................... 86
centrale circulatie ..................................................................................................................................................................... 88
Hart ..................................................................................................................................................................... 88
Perifere circulatie ...................................................................................................................................................................... 89
Bloedvaten .......................................................................................................................................................... 89
Respiratoir systeem .................................................................................................................................................................. 89
Longfunctie ......................................................................................................................................................... 89
Spiermetabolisme ..................................................................................................................................................................... 90
Deel 2: Uithoudingsvermogen meten ........................................................................................................................................... 90
6 minuten wandeltest ............................................................................................................................................................... 90
2 minuten wandeltest ............................................................................................................................................................... 90
10m incremental schuttle walk test.......................................................................................................................................... 90
Åstrand-test .............................................................................................................................................................................. 91
Steep Ramp Test ....................................................................................................................................................................... 91
Deel3: Uithoudingsvermogen trainen ........................................................................................................................................... 91
Aerobe en anaerobe energiewinning ....................................................................................................................................... 91
GlYcolyse en oxidatieve fosforylering ....................................................................................................................................... 92
ATP-CP-systeem ........................................................................................................................................................................ 92
Oefenadviezen .......................................................................................................................................................................... 92
valpreventie (hoorcollege 9) ............................................................................................................................................................. 94
definitie van een valincident ......................................................................................................................................................... 94
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