Assessment of Functional Status in Older Adults

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Assessment of Functional Status in Older Adults

• Performance Based Tests of Physiological Capacity
  and Functional Limitations

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Pathway to Disability

• Physiological/Pathological Deficit
• Functional Limitation
• Disability

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Pathway to Disability

• Physiological/Pathological Deficit
• Muscle strength, power
• Aerobic capacity
• Balance
• Flexibility
• Metabolic abnormality
• Disease

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Pathway to Disability

• Functional Limitations
• Chair rising
• Gait speed
• Stair climbing
• Simulated dressing, reaching, etc.

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Pathway to Disability

• Disability
• Activities of daily living
• Instrumental activities of daily living
• Recreation
• Work
• Social roles

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Pathway to Disability

• Disability
• Activities of daily living
• Eating
• Transferring
• Toileting, continence
• Bathing, grooming
• Dressing
• Walking

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Pathway to Disability

• Disability
• Instrumental activities of daily living
• Housekeeping
• Laundry
• Cooking
• Shopping
• Management of finances
• Use of telephone
• Transportation
• Leisure activities

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Gait speed

• Functional limitation
• Predictive of mortality, need for
  institutionalization, health care resources,
  falls, hip fracture, rehabilitation outcomes
  after stroke

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Measurement of gait speed

• Habitual gait speed
• Normal 1.0-1.5 m/s
• Use habitual assistive devices
• Short distance (2-20 meters)
• Average of 2 trials
• Control environmental conditions, flooring,
  footwear, visual aids

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Measurement of gait speed

• Maximal gait speed
• Not allowed to run
• Normal 1.5-2.0 times habitual
• Use habitual assistive devices
• Short distance (2-20 meters)
• Best of 2 trials
• Control environmental conditions, flooring,
  footwear, visual aids

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Factors related to Gait Speed

• Muscle strength
• Aerobic capacity
• Balance
• Neurological disease
• Visual impairment
• Acuity
• Contrast sensitivity
• Depth perception

• Cognition
• Depression
• Self-efficacy

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StrengthGait Speed Relationship
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Chair Rise

• Functional limitation
• Related to disability in transfers
• Predictive of need for mechanical or human
  assistance for ADLs

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Measurement of Chair Rising

• Single or multiple (5 or 10) chair rise test
• Standardize height and type of chair
• Measure time to perform, use of arms, number of
  rises completed
• Start without arms, allow use of arms if
  necessary
• Normal single rise in 1-2 sec 5 chair rise in
  10-12 seconds

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Factors related to Chair Rise time

• Lower extremity muscle strength
• Leg extensor power
• Balance
• Osteoarthritis in knees

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Effect of PRT on Chair Rise time
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Effect of PRT on ability to transfer out of bed
and chair
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Stair climbing

• Functional limitation
• Field test for leg extensor power, similar to
  stair-running in younger cohort

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Measurement of stair climbing power

• Estimate power as body weight x vertical height
  of staircase/time (FORCE/time) Watts
• Use standard staircase with rails
• Hold on only if necessary
• Ascend as fast as possible
• Best of 2 trials

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Balance testing

• Physiological capacity
• Predictive of recurrent falls, hip fracture, need
  for assistive devices

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Balance testing

• Field tests necessary due to limited access to
  balance platorms and unclear relationship with
  fall risk

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Measurement of balance

• Static balance Maintain postures of increasing
  difficulty-
• Narrow base of support
• Decrease vision, proprioception, concentration
• Measure sway, limits of stability, time,
  stepping, falling

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Hip and Knee Strength Predict Static Balance
Performance in Older Women
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Balance Capacity and Falls Risk
Lord, 1999

• Need to take a step during a static balance test
  predicts number of falls in elderly cohort

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Effect of PRT on Static Balance
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Measurement of balance

• Dynamic balance
• Ability to move through space despite narrowed
  base of support, withdrawal of vision, placement
  of obstacles, reduction in proprioception,
  disturbance of center of mass

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Measurement of balance

• Dynamic balance
• Tandem walk
• Heel walk
• Toe walk
• Obstacle course, stepping over objects
• Moving platform
• Balance beam walk

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Tandem walk

• Instructions
• Walk heel to toe for 20 feet, turn and repeat
• Complete as quickly as possible with as few
  errors as possible
• Toes of rear foot must be touching heel of front
  foot
• Remove hand support and vision to make test more
  difficult
• Count errors and time may be summed for a single
  measure of performance (low score is best)

one hand support
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Balance improves when the body is on the brink of
disaster
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The Balance Training Prescription

• Equipment
• Chairs and free weights
• Obstacles to step over
• Bars
• Mirrors

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Balance Training Improves Balance, Confidence,
Mobility, and Reduces Falls in Combination with
Strength Training
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Six Minute Walk Distance

• Physiological capacity
• Originally field test for aerobic capacity
• Predictive of mortality, rehabilitation success,
  need for resources

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Measurement of Six Minute Walk Distance

• Choose standard path, environmental conditions
• Instruct to walk as fast as possible and cover
  as much ground as possible
• Encourage every 30 seconds, time check every 2
  minutes
• Clock keeps running even if stops
• Record distance walked to nearest cm.
• Performance 10-15 better on second trial take
  the best of 2 trials on separate days

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Factors related to 6 minute walk distance

• Aerobic capacity
• Muscle strength
• Muscle power
• Muscle endurance
• Balance
• Cognition
• Arthritis pain
• Neurological abnormality
• Other diseases

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PRT using Leg Press machine
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Increased Six-minute Walk Distance After PRT in
Older Women With CHF
Distance (m)
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Effect of PRT on 6 min walk distance in older
adults
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Muscle strength and disability
What was once heavy or impossible to lift...
becomes easier and easier!
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Effect of PRT on Self-reported Disability