Assessing health of older adults

The care of older adults is a major component in the health-care world, and two experts recently presented insights on the challenge and an approach to assessing the health of older Americans at the CIMIT Forum at Simches Research Center at Massachusetts General Hospital.

Presenters were Alan M. Jette, PT, PhD, FAPTA, professor of health policy and management, Boston University School of Public Health; director, Health and Disability Research Institute, BU; research director, New England Regional Spinal Cord Center, BUMC; director, post doctoral research fellowship in rehabilitation outcomes and effectiveness research, BU; and Jonathan Bean, MD, MS, MPH, assistant professor, director, Research Training and Education, Department PM&R, Harvard Medical School; medical director, Spaulding Cambridge Outpatient Center.

Dr. Jette's address was titled, “How Are You Really Doing? Innovations in Functional Outcomes Measurement in Rehabilitation.”

He talked about his plans for contemporary techniques for innovative functional outcome assessment instrument in rehabilitation. He has helped develop the Boston University Activity Measure for Post Acute Care (AM-PAC). It compiles and calibrates a set of 269 functional tasks (washing face, walking indoors) likely to be encountered within the context of a day.

The AM-PAC test is designed to be used across patient diagnoses, conditions and rehabilitation sessions. Dr. Jette discussed the promise and challenges of this approach to functional outcome assessment.

Dr. Bean outlined “Three Big Risks for Older Adults: Walking, Climbing Stairs and Rising from a Chair – Evidence-based Rehabilitative Care for Older Adults.”

Dr. Bean said as many as 25 percent of older adults are at increased risk for disability. He discussed the relative importance of rehabilitative impairments in limb power, limb velocity and trunk integrity.

He said that certain capabilities are important for seniors. One of his slides showed a woman about to cross a wide, busy street, and the light indicated she had 54 seconds to traverse it. He said that if the time comes when her propulsion and speed could not get her across, she would have to find a new part of the neighborhood at which to cross the street.

Dr. Bean suggested that older adults should be screened to find out if there is potential to be impaired. If so, there could be a need to change living arrangements.

Impaired mobility is a major health concern for older adults, affecting fifty percent of people over 85 and at least a quarter of those over 75.  As adults lose the ability to walk, to climb stairs, and to rise from a chair, they become completely disabled. The problem cannot be ignored because people over 65 constitute the fastest growing segment of the U.S. population. 

Therapy designed to improve mobility in elderly patients is usually built around diagnosing and treating specific impairments, such as reduced strength or poor balance.  It is appropriate to compare older adults seeking to improve their mobility to athletes seeking to improve their split times.  People in both groups perform best when they measure their progress and work toward specific goals related to strength, aerobic capacity, and other physical qualities.  Someone attempting to improve an older adult’s mobility must decide what impairments to focus on, and in many cases, there is little scientific evidence to justify any of the options.   

Today, many caregivers choose to focus on leg strength and balance.  Growing evidence, however, supports the view that limb velocity and core strength are also important factors in mobility.  Power, after all, is the product of force (strength) and velocity, and exercise physiologists have long stressed that strong abdominal and back muscles are important to athletic performance.

It is still relatively difficult to measure limb velocity and core strength.  Ideally, measures of these factors should be inexpensive, reliable, broadly applicable, and easy for the one being tested to perform.  A newly thought-up stair-climbing test of power is slightly less reliable than more expensive tests, but so far, it has worked relatively well.  Measures of core strength, too, are being developed.  As clinically feasible ways of measuring limb velocity and core strength are found, these considerations may become a more important part of the care received by patients with impaired mobility.

   

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