GERIATRIC FITNESS

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GERIATRIC FITNESS

• Dr. G. SUBBULAKSHMI,
• PRESIDENT,
• NSI, Mumbai Chapter

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PURPOSE

• Goals and elements of geriatric assessment?
• Comparative merits of different methods in
  carrying out a geriatric assessment?
• Evidence that a geriatric assessment is
  effective? If so, in what settings, for whom, and
  for which outcomes?
• Linkages to clinical management systems are
  required?
• Priorities for future research in geriatric
  assessment?
•  

What
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FUNCTIONAL FITNESS

• PHYSICAL FITNESS
• PHYSIOLOGICAL FITNESS
• PSYCHOLOGICAL FITNESS

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NEED FOR ASSESSMENT

• ENDURANCE LOWERS
• COORDINATION DECLINES
• SPEED DECREASES
• MOTOR TASKS - POOR
• COGNITIVE PERFORMANCE DECLINE
• PHYSIOLOGICAL DETERIORATION
• NEUROLOGICAL STATUS
• PATHOLOGICAL CONDITIONS

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Traditional, spiritual, religious practices

• Surya Namaskar
• Sit ups for Lord Ganesha
• Japa pranayam?
• Bow down to elders
• Balance water pots on the head
• Pooja activities

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SELF ASSESSMENT

• Postal questionnaires were associated with higher
  response rates but also higher proportions of
  missing values than were interview methods.
• Lower estimates of self reported morbidity were
  obtained with the nurse interview method and to a
  lesser extent with the lay interview method than
  with postal questionnaires.
• Self assessment of health and fitness with an
  intention of keeping fit and free from illness is
  very well accepted.

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MERITS OF SELF ASSESSMENT

• SELF APPRAISAL
• SATISFYING
• PERIODIC ASSESSMENT
• LOW COST
• EARLY DIAGNOSIS
• PRIDE
• DISCOVER THEIR POTENTIALS

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DETERMINANTS OF INDEPENDENCE

• Flexibility - Leighton Flexometer.
• Strength - modified sphygmomanometer. (This is
  for Blood pressure measurement, not for blood
  pr.)
• Cardio respiratory fitness - self-paced walking
  test.
• Body size factors - Std methods.
• In capacity Index is associated with
  participation in outdoor activities, greater
  shoulder flexibility, and a faster normal walking
  speed.

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FRAILTY TEST

• Frailty is a valid and clinically important
  construct that is recognizable by physicians.
  Clinical judgments about frailty can yield useful
  predictive information.
• Clinical Frailty Scale performs better than
  measures of cognition, function or co morbidity
  in assessing risk for death

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FRAILTY SCALE

• 7-point Clinical Frailty Scale applied to measure
  frailty on 2305 elderly patients who participated
  in the second stage of the Canadian Study of
  Health and Aging (CSHA) and were followed
  prospectively after 5 years, determined the
  ability of the Clinical Frailty Scale to predict
  death or need for institutional care, and
  correlated the results with those obtained from
  other established tools. (I feel How one does the
  Frailty test is more important that the study
  description)

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PHYSICAL ACTIVITY SCALE

• The PASE is a brief, easily scored, reliable and
  valid instrument for the assessment of physical
  activity in epidemiologic studies of older
  people.PASE scores were positively associated
  with grip strength (r 0.37),
• static balance (r 0.33),
• leg strength (r 0.25) and
• negatively correlated with resting heart rate (r
  -0.13),
• age (r -0.34)
• perceived health status (r -0.34) and
• overall Sickness Impact Profile score (r
  -0.42).

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PASE

• Item weights for the PASE were derived by
  regressing a physical activity principal
  component score on responses to the PASE.
• The component score was based on 3-day motion
  sensor counts, a 3-day physical activity dairy
  and a global activity self-assessment.
• Test-retest reliability, assessed over a 3-7 week
  interval, was 0.75 (95 CI 0.69-0.80).
  Reliability for mail administration (r 0.84)
  was higher than for telephone administration (r
  0.68).

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OPTOELECTRONIC MOVEMENT ANALYSIS

• PLM TEST POSTURAL, LOCOMOTION, MANUAL
• The subject is asked to move an object
  repetitively between the floor and a shelf
  thereby forcing their body through postural
  changes, locomotion and goal directed arm
  movement.
• The PLM phase duration is automatically
  calculated by the computer from the vertical
  velocity of the head, displacement of the feet
  and angular velocity of the upper arm.

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MEASUREMENTS

• Movement Time
• The Postural Phase
• The Locomotor Phase
• The Manual Phase
• The Simultaneity Index

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ACTIVITIES OF DAILY LIVING

• I-ADL Instrumental Activities of Daily Living
  (cleaning, shopping, transporting and cooking).
• P-ADL Personal Activities of Daily Living
  (bathing, dressing, going to the toilet,
  transfer, continence and feeding).

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MENTAL HEALTH ASSESSMENT

• MEMORY
• COORDINATION BETWEEN THOUGHT AND SPEECH
• CALCULATIONS
• CONFUSION

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INTERVIEW

• Questions to assess thinking, Reasoning,
  and memory (your cognitive functioning).
• Questions that assess thought processes,
  logical thinking, perceptions, and potential for
  suicide may also be included in the interview.

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PHYSIOLOGICAL EXAMINATION

• The health professional may evaluate the nervous
  system by testing the reflexes, balance, and
  senses (hearing, taste, sight, smell, and touch).

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MENTAL HEALTH ASSESSMENT

• A mental health assessment may involve one or
  more verbal or written tests, often in the form
  of questionnaires and rating scales. The answers
  are then rated and scored by the health
  professional. (We want to teach the participant
  how to score, they will be the health
  professionals)
• Questionnaires generally contain 20 to 30
  questions that can be answered quickly, often in
  a "yes" or "no" format.

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LABORATORY TESTS

• Laboratory tests on a blood or urine sample may
  be part of the mental health assessment. If a
  nervous system problem is suspected, tests such
  as magnetic resonance imaging (MRI),
  electroencephalography (EEG), or a computed
  tomography (CT) scan may be done. Laboratory
  tests to detect physical ( Physiological??)
  problems may include thyroid function tests,
  electrolyte levels, or toxicology screening (to
  detect drug or alcohol problems).

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SPECIFIC TESTS

• Specific disorders, such as depression. These
  include the Hamilton Rating Scale for Depression,
  the Beck Depression Inventory, and the Geriatric
  Depression Scale.
• General levels of functioning include the Mini
  Mental State Examination.
• The ability to carry out routine activities, such
  as eating, dressing, shopping, or banking.

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COMPREHENSIVE GERIATRIC ASSESSMENT

• This process is defined as a multidisciplinary
  evaluation in which the multiple problems of
  older persons are uncovered, described, and
  explained.
• Has been used for many nonclinical purposes,
  including research, education, health policy, and
  administration.