Transcript Old Adults perform ADLs closer to max than young adults

FIRST INTERNATIONAL SOCIETY FOR
GERONTECHNOLOGY
MASTERCLASS IN GERONTECHNOLOGY
TUE, EINDHOVEN, NL November 13-14 2007
TECHNOLOGY FOR EXTENDED HEALTH
James L. Fozard, Ph.D.
School of Aging Studies
University of South Florida
Tampa, FL 33260
For electronic copy of slides, send
me an e-mail request at
[email protected]
Extended Health—What’s that??
What is technology’s role in it??
• Extended health links the WHO definition of
health to the opportunities and challenges of
aging. WHO definition of health includes:
– Physical,
– Mental, and
– Social well being
• Technology’s roles include:
– Preventing or delaying age related limitations in
functioning
– Compensating for age related declines in functioning
– Care and support for elderly with illnesses and
limitations in function
– Enhancing quality of life for all 3 applications
Achieving Extended Health requires
us to change how we think about aging
• Negative stereotypes about old age and
aging are detrimental to the well being and
personal fulfillment of young and old alike
• Agism is apparent in many jokes:
– Pervasive negative stereotypes about aging
– Poor parental training about aging to the
young
– Poor appreciation of individual differences
Let’s change our way of thinking
about aging—starting here
• Pervasive negative stereotypes about
aging
– If I knew I was going to live this long, I would
have taken better care of myself
– One senior to another: “When does old age
begin?” Answer: “Later”
– Young adult’s most serious life decision?
Answer: “ When to begin middle age”
Let’s change our way of thinking
about aging—continuing here
• Poor parental training of the young about
aging
– Dennis the Menace to his father’s friend:
“What age are you in the middle of?”
– Child to grandmother: “If I’m only young once,
how many times do I have to be old?”
Let’s change our way of thinking
about aging-continuing here
• Poor appreciation of individual differences
– Old man answers question about his age: “What age
do you mean--My anatomical, physiological,
psychological, or chronological?
– This gentleman is both smart and wise, smart
because of the critical distinctions and wise because
chronological age is at the end of the list
• When asked what his doctor thought about his
lifestyle choices at age 100+, George Burns
replied, “I don’t know, my doctor’s dead.”
Technology can help education and
training activities related to aging
• Create simulations to educate people for
aging in various situations (BJ Fogg)
– Cause and effect simulations (social skills)
– Environmental simulations (treat phobias)
– Object simulations (drunk driver)
• Simulations of aging for young people can
reduce negative attitudes toward aging
Virtual simulations of aging and
healthy lifestyles
• Since the 1970s, many simulations of age
related sensory and mobility limitations have
been devised to educate the young
– Clouded lenses, ear plugs, gloves, weighted shoes
etc.
– Limitation is lack of linkage of these devices and
preventive and compensatory interventions
• Virtual reality simulations can improve
education by linking simulations of limitations
to effects of compensatory and preventive
measures
Gerontechnology Contributes in
many Ways to aging and health
• Education about and training for aging
• Enhancement of quality of life
• Prevention or delaying of age-associated losses
in sensory-perceptual and motor systems
– Technology to lower impact of long-term exposure to
environmental hazards and maintain cardiovascular
health and strength
• Compensation for age-associated losses
• Care for elderly persons with functional
limitations
High speed networking expands
scope of gerontechnologies
• Telemedicine and communication applications using
video over Internet
– Mobile-Health Toolkit wirelessly measures blood pressure, blood
glucose, etc. and relays information to patient records
• Ultra-wideband radio allows for precise location of
persons within a home and communication among
appliances
Common feature of examples is, “…enhanced
communication between people and people, people and
machines and among machines that themselves are
networked.”
•
Kearns WD, Fozard JL High-speed networking and embedded
gerontechnologies. Gerontechnology 2007;6:135-146
Preventing or delaying age-related
limitations in functioning
• Technology can contribute to motivating people
of any age adopt healthy life styles that prevent
or delay limitations in functioning
– Diet, weight control, exercise, substance abuse
• Idea rests on the capacity of technology for
monitoring physiological functioning and
changes in location of one or more persons
Prevention to delay age declines in
cardiovascular and strength
• Effects of cardiovascuclar training on preventing
heart disease and stroke as well as facilitating
rehabilitation are well known
• Positive effects of strength training on preventing
age related decline in physical functioning,
personal mobility, and physical frailty are being
demonstrated continuously in new research
• Technology can help promote motivation for
exercise and in setting targets for exercise
Background: Old Adults perform
ADLs closer to max strength than
young adults
Hortobagyi T, Mizelle C, Beam S,
DaVita P. J. Gerontology:Medical
Sciences, 2003, 58A,453-460.
Purpose/Methods
• Walking, going up and down stairs and rising from chair
requires relatively higher percentage of maximum
reserve capacity in older than younger adults--True for
cardiovascular and muscle function
• Study measured relative effort to perform these tasks by
assessing maximal leg strength on a machine and by the
force used when going up or down stairs or standing up
from a chair. Force was measured by special recording
plate embedded in the floor or steps
• Participants were healthy women in two age groups
mean ages 22 and 74 years.
Relative effort (%) of maximum
strength required to perform ADLs
TASK
AGE
Ascending
Stairs
Descending Rising from
Stairs
Chair
22
55
35
35
74
80
88
80
Long-Term Consequences of
Age Differences in Strength
• Midlife strength predicts functioning 25 years
later
• Grip strength measured at age 45 to 68 in
Japanese-American men. 25 years later speed
of walking, ability to stand up from chair, and
self-reports of difficulty lifting 10 lbs, doing
housework, etc were measured.
•
Rantanen T, Guralnik JM, Masaki K et al Midlife hand grip strength as a predictor of
old age disability JAMA 1999;281:558-560
Proprioception, Balance and
Movement: Prevention 3
• Grip strength divided into thirds: <37, 3742, >42kg; outcome measures included
– Walking speed<0.4m/s (6.2%)
– Chair rise without using arms (2.2%)
– Difficulty doing housework (18.2%)
– Difficulty walking up 10 steps (14.1%)
•
Rantanen T, Guralnik JM, Masaki K et al Midlife hand grip strength as a
predictor of old age disability JAMA 1999;281:558-560
% with Limitations in Strength
Groups Measured 25 Yrs Ago
30
25
20
% 15
low 3rd
mid 3rd
high 3rd
10
5
0
House wk
10 steps
slow walk chair rise
Difficulty with Function
Data from Rantanen et al, JAMA 1999;281:559
Effects of strength training on
mobility—basic findings
• Strength training and physical activity
improve muscle mass, control of
movement, and balance
•
•
•
•
Fiaterone MA, Marks EC, Ryan ND et al. High-intensity strength training in
nonogernians:Effects of skeletal muscle. J Am Med Ass, 1990;263:3029.
Ivey FM, Tracy BL, Lemmer JT, NessAiver M, SM, Metter EJ, Fozard JL,
Hurley BH. The effects of strength training and detraining on muscle quality
: Age and gender comparisons J Gerontol:Biol Sci 2000;55A:B152-B157.
Miller ME, Rejeski WJ, Reboussin BA, Ten Have TR, Ettinger WH Physical
activity, funtional limitations and disability in older adults J Am Ger Soc
2000;48:1264-1272.
Since 2000, dozens of well designed studies extend these early
studies e.g., J. Gerontology: Med Sci 2007;62A;(June);2007; 62A(Aug)
Young Men
Young Women
Older Men
OlderWomen
Muscle Quality(MQ) is strength/volume. Strength training of
right leg occurred over 9 months; detraining over 31 weeks.
From Ivey et al 2000
Strength and Gait Speed
• Leg exension strength and leg power correlate
with gait speed. The distributions of leg power
associated with different speeds may provide the
basis for setting goals for strength needed for
walking.
•
Rantanen T, Avela J Leg extension power and walking speed in very old people
living independently. J Gerontol Med Sci 1997;52A:M225-M331.
• Correlations between power and speed ranged
from .4 to.7 in old people
•
Kwon I, Oldaker S, Schrager MA, Talbot LA, Fozard JL, Metter EJ. Relationship
between muscle strength and self-paced gait speed: Age and sex effects. J
Gerontol Biol Sci 2001;56B:B398-B404
Cumulative
distributions of
leg power for 5
groups of walking
speed from <1m/s
to>2m/s
Cum
%
Data from
Rantanen
andAvela 1997
Leg power is expressed as Watts/kg
Note that the cumulative % of leg power at 1m/s ranged from 1-3 W/kg
The cumulative % of leg power at 2m/s ranged from 8-15.5 W/kg
Technology and setting goals for
strength training
• Prevention requires that we set standards for
reserve strength needed for adequate
functioning at a later age
• Early estimates--we need 40% of our strength at
age 25 to function well at age70
• Wearable transducers provide information on
quality and required number of maneuvers
– New technology development at University of Pisa by
Dr. E. Piaggio allows for Kinesthetic sensing by use of
smart fabrics in gloves, socks and leotards
– http://www.piaggio.ccii.unipi.it/kine.htm
Development of health monitoring systems: Early work
Health Monitoring in the Home of the Future
Infrastructure and Usage Models for Wearable
Sensors That Measure Health Data in the
Daily Environments of the Users
ILKKA KORHONEN, JUHA PÄRKKÄ, AND MARK VAN GILS
IEEE ENGINEERING IN MEDICINE AND BIOLOGY MAGAZINE MAY/JUNE 2003 71
Korhonen et al
The sensors are integrated into the
everyday life of the users. They should
either fit by their look to the individual’s
preferences or they should be as
unobtrusive as possible.
Automatic processing of the sensor
data becomes essential when health
monitoring is applied in long-term
conditions; i.e., over months or years.
While the main application domain
of health monitoring is often the
home, the research is closely related
to the concepts of smart home
and home networking
Health monitoring seems a very
promising application for the
smart home. First of all, there is
a clear need to provide tools to
support independent living.
Personal Mobile Hub
Dirk Husemann, Chandra Narayanaswami, Michael Nidd IBM Research Division
[email protected], [email protected], [email protected]
Proceedings of the Eighth International Symposium on Wearable Computers
(ISWC’04) 1530-0811/04 $ 20.00 IEEE
Abstract
•As advances are made in wearable computing, there is a
need for a personal mobile hub that can manage
interactions between the wearable devices and act as a
proxy for these devices.
•Our personal mobile hub supports multiple wireless protocols, some
short range and some wide area so that the power of the internet is
available even
to body worn sensors.
•We describe custom hardware that we built for this purpose and also
the software necessary to make this concept work.
•We have tested out thisarchitecture with an end to end application.The
workingsystem was demonstrated at the annual IBM Stockholders
meeting in 2004 and is also available for customers to see
at the IBM Industry Solutions Lab in Zurich.
Localization via Ultra-Wideband Radiosation via Ultra-Wideband Radios
[A look at positioning aspects of future sensor networks]
Sinan Gezici, Zhi Tian, Georgios B. Giannakis,Hisashi Kobayashi, Andreas F.
Molisch,H. Vincent Poor, and Zafer Sahinoglu]
IEEE SIGNAL PROCESSING MAGAZINE [70] JULY 2005
POSITIONING SYSTEMS CAN BE DIVIDED
INTO THREE MAIN CATEGORIES: TIMEOFARRIVAL,DIRECTION-OF-ARRIVAL, AND
SIGNAL-STRENGTH BASED SYSTEMS.
LOCATING A NODE IN A WIRELESS
SYSTEM INVOLVES THE COLLECTION OF
LOCATION INFORMATION FROM RADIO
SIGNALS TRAVELING BETWEEN THE
TARGET NODE AND A NUMBER OF
REFERENCE NODES.
TIME-BASED POSITIONING
TECHNIQUES RELY ON
MEASUREMENTS OF TRAVEL TIMES
OF SIGNALS BETWEEN NODES
Localization via Ultra-Wideband Radiosation via Ultra-Wideband Radios
[A look at positioning aspects of future sensor networks]
Sinan Gezici, Zhi Tian, Georgios B. Giannakis,Hisashi Kobayashi, Andreas F.
Molisch,H. Vincent Poor, and Zafer Sahinoglu]
IEEE SIGNAL PROCESSING MAGAZINE [70] JULY 2005
TIME-BASED POSITIONING
TECHNIQUES RELY ON
MEASUREMENTS OF TRAVEL TIMES
OF SIGNALS BETWEEN NODES
UWB TECHNOLOGY PROVIDES AN
EXCELLENT MEANS FOR WIRELESS
POSITIONING DUE TO ITS HIGH
RESOLUTION CAPABILITY
IN THE TIME DOMAIN.
Networking improves coaching
in strength training
• Motivation is major issue for utilizing
strength training—machines can have
motivational properties
• Networking can improve motivation
and quality of feedback from strength
training
– Reinforcement from sharing information by peers
doing similar workouts
Boston Red Sox Deploy
Activity-Monitoring Technology
FitSense's ActiHealth wireless system seamlessly collects,
transports, and presents information on physical activity, weight,
body fat, blood pressure, heart rate, peak flow, and blood glucose.
SOUTHBOROUGH, MA /BUSINESS WIRE/ -- It's hardly noticeable, but if you
look closely enough, the Boston Red Sox players are all wearing something
new at spring training. It's a small, wireless, intelligent pedometer called the
ActiPed, from Massachusetts-based FitSense Technology. This isn't any
ordinary pedometer; in fact, it's an activity monitor that accurately tracks
your every step, the calories you burn, how much time you've been active,
and how far you went in miles.
The ActiHealth network provides physiological information and feedback
tools for health and wellness program providers that engage and motivate
their members, changing their behaviors and improving health. The
network seamlessly collects, transports, and presents information on
physical activity, weight, body fat, blood pressure, heart rate, peak flow,
and blood glucose, for anyone, anytime, anywhere.
Technology and motivation:
Computerized coaching
• FitLinxx is a computerized system that attaches directly
to existing fitness equipment
– FitLinxx “learns” users' programs, “coaches” them individually
through their workout for better form, safety and confidence
during every exercise, and “tracks” their progress over time.
• On strength equipment, FitLinxx appears as an easy-toread touch-screen display that's attached to the
machine. For cardiovascular equipment, each machine's
existing console is simply networked to FitLinxx
– Users simply tap in their PIN to display their targets - FitLinxx
then coaches them on speed, form, heart rate, etc., and tracks
the workout session - every rep, set and step.
• http://www.fitlinxx.com/Article.htm?ID=976
Kressig, R. W., & Echt, K. V. (2002). Exercise prescribing: computer application
in older adults. The Gerontologist, 42(2), 273-7.
Abstract: PURPOSE: The purpose of this study was to determine if older
adults are capable and willing to interact with a computerized exercise
promotion interface and to determine to what extent they accept
computer-generated exercise recommendations. DESIGN AND METHODS:
Time and requests for assistance were recorded while 34 collegeeducated volunteers, equal numbers of men and women, ranging in age
from 60 to 87, interfaced with a health promotion tool. The computerized
exercise promotion tool's ease of use and the acceptability of the exercise
recommendations made were rated by the participants. RESULTS: On
average, completion of the items on the computer took 33 min and each
participant made 3 requests for assistance, of which only 22% were
mouse related. The system's ease of use and the exercise prescription
acceptability ratings were high and independent of prior experience with
computers. IMPLICATIONS: User friendliness of computerized health
promotion tools will determine if, and how, health providers integrate
these new technologies into daily practice. The participants in the study
were able to complete the computerized items within a reasonable
amount of time and with minimal assistance from the provider. These data
support the potential of interactive technology in health promotion among
the expanding older population.
Development of an exercise expert system for older adults
Lisa Wynn Boyette, MEd; Adrienne Lloyd, MEd; Stephanie Manuel, MS; James
Edward Boyette, MSICS; Katharina V. Echt, PhD
Allanta VA Medical Center, Rehab R&D Center, Decatur, GA 30033; Emory University
School of Medicine, Division of Geriatric Medicine & Gerontology. Atlanta, GA 30033;
Veterans Affairs, Health Eligibility Center, Atlanta, GA 30033
Abstract—The purpose of this study was to develop a cotnputerized
exercise expert system (CEES) that creates tailored
exereise plans for older adults. A panel of experts was selected
in the areas of medicine, exercise physiology, health promotion,
exercise psychology, and gerontology. The experts communicated
with the principal investigator and the project
members by mail, email, telephone, and expert meetings. A
two-day workshop was held during the second year for the project
metnhers as well as local and national experts to review the
CEES. The CEES demonstrated adequate inter-rater reliability
(0.80) and criterion validity (0.70). Content validity was
achieved by literature review and expert opitiion. The CEES
gathers information on the elder's health status, clinical factors,
and exercise determinants that characterize specific barriers
or incentives to exercise. The software program then
develops individualized exercise prescriptions that are customized to
older adults.
Summary: Technology and
Extended health
• Physical, mental and social well being
included in the WHO definition of health
• The role of technology in extended health
is to create what former UN Secretary
General Kofi Anan called “enabling
environments” that support human
endeavors for all regardless of age