Transcript GERIATRIC FITNESS - The Nutrition Society of India (Mumbai),

GERIATRIC FITNESS
Dr. G. SUBBULAKSHMI,
PRESIDENT,
NSI, Mumbai Chapter
PURPOSE
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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?
FUNCTIONAL FITNESS
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PHYSICAL FITNESS
PHYSIOLOGICAL FITNESS
PSYCHOLOGICAL FITNESS
NEED FOR ASSESSMENT
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ENDURANCE LOWERS
COORDINATION DECLINES
SPEED DECREASES
MOTOR TASKS - POOR
COGNITIVE PERFORMANCE DECLINE
PHYSIOLOGICAL DETERIORATION
NEUROLOGICAL STATUS
PATHOLOGICAL CONDITIONS
Traditional, spiritual, religious
practices
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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
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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.
MERITS OF SELF ASSESSMENT
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SELF APPRAISAL
SATISFYING
PERIODIC ASSESSMENT
LOW COST
EARLY DIAGNOSIS
PRIDE
DISCOVER THEIR POTENTIALS
DETERMINANTS OF
INDEPENDENCE
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Flexibility - Leighton Flexometer.
Strength - modified sphygmomanometer. (This
is for Blood pressure measurement, not for blood pr.)
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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.
FRAILTY TEST
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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
FRAILTY SCALE
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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)
PHYSICAL ACTIVITY SCALE
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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).
PASE
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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).
OPTOELECTRONIC MOVEMENT
ANALYSIS
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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.
MEASUREMENTS
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Movement Time
The Postural Phase
The Locomotor Phase
The Manual Phase
The Simultaneity Index
ACTIVITIES OF DAILY LIVING
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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).
MENTAL HEALTH ASSESSMENT
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MEMORY
COORDINATION BETWEEN THOUGHT
AND SPEECH
CALCULATIONS
CONFUSION
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
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The health professional may evaluate the
nervous system by testing the reflexes,
balance, and senses (hearing, taste, sight,
smell, and touch).
MENTAL HEALTH ASSESSMENT
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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)
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Questionnaires generally contain 20 to 30
questions that can be answered quickly, often
in a "yes" or "no" format.
LABORATORY TESTS
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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).
SPECIFIC TESTS
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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.
COMPREHENSIVE GERIATRIC
ASSESSMENT
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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.