GERIATRIC FITNESSGERIATRIC FITNESS

Dr. G. SUBBULAKSHMI,Dr. G. SUBBULAKSHMI,PRESIDENT,PRESIDENT,

NSI, Mumbai ChapterNSI, Mumbai Chapter

PURPOSEPURPOSE Goals and elements of geriatric Goals and elements of geriatric

assessment? assessment? Comparative merits of different methods Comparative merits of different methods

in carrying out a geriatric assessment? in carrying out a geriatric assessment? Evidence that a geriatric assessment is Evidence that a geriatric assessment is

effective? If so, in what settings, for effective? If so, in what settings, for whom, and for which outcomes? whom, and for which outcomes?

Linkages to clinical management Linkages to clinical management systems are required? systems are required?

Priorities for future research in geriatric Priorities for future research in geriatric assessment? assessment?

  

FUNCTIONAL FITNESSFUNCTIONAL FITNESS

PHYSICAL FITNESS PHYSICAL FITNESS PHYSIOLOGICAL FITNESSPHYSIOLOGICAL FITNESS PSYCHOLOGICAL PSYCHOLOGICAL

FITNESSFITNESS

NEED FOR ASSESSMENTNEED FOR ASSESSMENT ENDURANCE LOWERSENDURANCE LOWERS COORDINATION DECLINESCOORDINATION DECLINES SPEED DECREASES SPEED DECREASES MOTOR TASKS - POORMOTOR TASKS - POOR COGNITIVE PERFORMANCE DECLINECOGNITIVE PERFORMANCE DECLINE PHYSIOLOGICAL DETERIORATIONPHYSIOLOGICAL DETERIORATION NEUROLOGICAL STATUSNEUROLOGICAL STATUS PATHOLOGICAL CONDITIONS PATHOLOGICAL CONDITIONS

Traditional, spiritual, religious Traditional, spiritual, religious practicespractices

• Surya NamaskarSurya Namaskar• Sit ups for Lord GaneshaSit ups for Lord Ganesha• “ “Japa” = pranayam?Japa” = pranayam?• Bow down to eldersBow down to elders• Balance water pots on the Balance water pots on the headhead• Pooja activitiesPooja activities

SELF ASSESSMENTSELF ASSESSMENT Postal questionnaires were associated Postal questionnaires were associated

with higher response rates but also with higher response rates but also higher proportions of missing values higher proportions of missing values than were interview methods. than were interview methods.

Lower estimates of self reported Lower estimates of self reported morbidity were obtained with the nurse morbidity were obtained with the nurse interview method and to a lesser extent interview method and to a lesser extent with the lay interview method than with with the lay interview method than with postal questionnaires. postal questionnaires.

Self assessment of health and fitness Self assessment of health and fitness with an intention of keeping fit and free with an intention of keeping fit and free from illness is very well accepted.from illness is very well accepted.

MERITS OF SELF ASSESSMENTMERITS OF SELF ASSESSMENT

SELF APPRAISALSELF APPRAISAL SATISFYINGSATISFYING PERIODIC ASSESSMENTPERIODIC ASSESSMENT LOW COSTLOW COST EARLY DIAGNOSISEARLY DIAGNOSIS PRIDEPRIDE DISCOVER THEIR POTENTIALSDISCOVER THEIR POTENTIALS

DETERMINANTS OF DETERMINANTS OF INDEPENDENCEINDEPENDENCE

Flexibility - Leighton Flexometer. Flexibility - Leighton Flexometer. Strength - modified Strength - modified sphygmomanometersphygmomanometer. .

((This is for Blood pressure measurement, not for This is for Blood pressure measurement, not for blood pr.)blood pr.)

Cardio respiratory fitness - self-paced Cardio respiratory fitness - self-paced walking test. walking test.

Body size factors - Std methods. Body size factors - Std methods. In capacity Index is associated with In capacity Index is associated with

participation in outdoor activities, greater participation in outdoor activities, greater shoulder flexibility, and a faster normal shoulder flexibility, and a faster normal walking speed.walking speed.

FRAILTY TESTFRAILTY TEST Frailty is a valid and clinically Frailty is a valid and clinically

important construct that is important construct that is recognizable by physicians. Clinical recognizable by physicians. Clinical judgments about frailty can yield judgments about frailty can yield useful predictive information.useful predictive information.

Clinical Frailty Scale performs better Clinical Frailty Scale performs better than measures of cognition, function or than measures of cognition, function or co morbidity in assessing risk for deathco morbidity in assessing risk for death

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

PHYSICAL ACTIVITY PHYSICAL ACTIVITY SCALESCALE

The PASE is a brief, easily scored, reliable and The PASE is a brief, easily scored, reliable and valid instrument for the assessment of physical valid instrument for the assessment of physical activity in epidemiologic studies of older activity in epidemiologic studies of older people.people.

PASE scores were positively associated with PASE scores were positively associated with grip strength (r = 0.37), grip strength (r = 0.37),

static balance (r = +0.33), static balance (r = +0.33), leg strength (r = 0.25) and leg strength (r = 0.25) and negatively correlated with resting heart rate (r negatively correlated with resting heart rate (r

= -0.13), = -0.13), age (r = -0.34)age (r = -0.34) perceived health status (r = -0.34); and perceived health status (r = -0.34); and overall Sickness Impact Profile score (r = -0.42). overall Sickness Impact Profile score (r = -0.42).

PASEPASE Item weights for the PASE were derived by Item weights for the PASE were derived by

regressing a physical activity principal regressing a physical activity principal component score on responses to the PASE. component score on responses to the PASE.

The component score was based on 3-day The component score was based on 3-day motion sensor counts, a 3-day physical activity motion sensor counts, a 3-day physical activity dairy and a global activity self-assessment. dairy and a global activity self-assessment.

Test-retest reliability, assessed over a 3-7 week Test-retest reliability, assessed over a 3-7 week interval, was 0.75 (95% CI = 0.69-0.80). interval, was 0.75 (95% CI = 0.69-0.80). Reliability for mail administration (r = 0.84) was Reliability for mail administration (r = 0.84) was higher than for telephone administration (r = higher than for telephone administration (r = 0.68). 0.68).

OPTOELECTRONIC OPTOELECTRONIC MOVEMENT ANALYSISMOVEMENT ANALYSIS

PLM TEST – POSTURAL, LOCOMOTION, MANUALPLM TEST – POSTURAL, LOCOMOTION, MANUAL

The subject is asked to move an object The subject is asked to move an object repetitively between the floor and a shelf repetitively between the floor and a shelf thereby forcing their body through postural thereby forcing their body through postural changes, locomotion and goal directed arm changes, locomotion and goal directed arm movement. movement.

The PLM phase duration is automatically The PLM phase duration is automatically calculated by the computer from the vertical calculated by the computer from the vertical velocity of the head, displacement of the feet velocity of the head, displacement of the feet and angular velocity of the upper arm.and angular velocity of the upper arm.

MEASUREMENTSMEASUREMENTS Movement TimeMovement Time The Postural PhaseThe Postural Phase The Locomotor PhaseThe Locomotor Phase The Manual PhaseThe Manual Phase The Simultaneity IndexThe Simultaneity Index

ACTIVITIES OF DAILY LIVINGACTIVITIES OF DAILY LIVING I-ADL Instrumental Activities of I-ADL Instrumental Activities of

Daily Living (cleaning, shopping, Daily Living (cleaning, shopping, transporting and cooking).transporting and cooking).

P-ADL Personal Activities of Daily P-ADL Personal Activities of Daily Living (bathing, dressing, going to Living (bathing, dressing, going to the toilet, transfer, continence and the toilet, transfer, continence and feeding).feeding).

MENTAL HEALTH MENTAL HEALTH ASSESSMENTASSESSMENT

MEMORY MEMORY COORDINATION BETWEEN THOUGHT COORDINATION BETWEEN THOUGHT

AND SPEECHAND SPEECH CALCULATIONS CALCULATIONS CONFUSIONCONFUSION

INTERVIEWINTERVIEW Questions to assess thinking, Questions to assess thinking,

Reasoning, and memory (your Reasoning, and memory (your cognitive functioning). cognitive functioning).

Questions that assess thought Questions that assess thought processes, logical thinking, processes, logical thinking, perceptions, and potential for suicide perceptions, and potential for suicide may also be included in the may also be included in the interview. interview.

PHYSIOLOGICAL PHYSIOLOGICAL EXAMINATIONEXAMINATION

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

MENTAL HEALTH MENTAL HEALTH ASSESSMENTASSESSMENT

A A mental health assessment may involve mental health assessment may involve one or more verbal or written tests, often one or more verbal or written tests, often in the form of questionnaires and rating in the form of questionnaires and rating scales. The answers are then rated and scales. The answers are then rated and scored by the health professional. scored by the health professional. (We want (We want to teach the participant how to score, they will be the to teach the participant how to score, they will be the health professionals)health professionals)

Questionnaires generally contain 20 to 30 Questionnaires generally contain 20 to 30 questions that can be answered quickly, questions that can be answered quickly, often in a "yes" or "no" format. often in a "yes" or "no" format.

LABORATORY TESTSLABORATORY TESTS Laboratory tests on a blood or urine sample Laboratory tests on a blood or urine sample

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

SPECIFIC TESTSSPECIFIC TESTS Specific disorders, such as depression. Specific disorders, such as depression.

These include the Hamilton Rating Scale These include the Hamilton Rating Scale for Depression, the Beck Depression for Depression, the Beck Depression Inventory, and the Geriatric Depression Inventory, and the Geriatric Depression Scale. Scale.

General levels of functioning include the General levels of functioning include the Mini Mental State Examination. Mini Mental State Examination.

The ability to carry out routine activities, The ability to carry out routine activities, such as eating, dressing, shopping, or such as eating, dressing, shopping, or banking.banking.

COMPREHENSIVE GERIATRIC COMPREHENSIVE GERIATRIC ASSESSMENTASSESSMENT

This process is defined as a This process is defined as a multidisciplinary evaluation in which multidisciplinary evaluation in which the multiple problems of older persons the multiple problems of older persons are uncovered, described, and are uncovered, described, and explained.explained.

Has been used for many nonclinical Has been used for many nonclinical purposes, including research, purposes, including research, education, health policy, and education, health policy, and administration. administration.