Transcript Old Adults perform ADLs closer to max than young adults

FIRST INTERNATIONAL SOCIETY FOR
GERONTECHNOLOGY
MASTERCLASS IN GERONTECHNOLOGY
TUE, EINDHOVEN, NL MAY 22-23 2006
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]
Live long but don’t get old
• “If I knew 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?
“When to begin middle age.”
Extended health??
• Health means more than the absence of
disease
• Physical, mental and social well being
included in the WHO definition of health
• Aging brings challenges and opportunities
and technology addresses both
Everyone knows about the
challenges, but opportunities??
• Physical, Aging brings new opportunities
for:
– Adventurous and challenging activities
– New social opportunities and friendships
– Artistic expression
– Learning
– Work
• Technology can help make up for lost time!
Technology and New
Opportunities??
• Aging brings new opportunities for:
– Adventurous and challenging activities
• Perhaps we, but surely our children and
grandchildren enjoy video games
• There is a great potential for adult
adventure games; many current games
simply require slower actions speeds
Technology and New
Opportunities ??
• Aging brings new opportunities for:
– New social opportunities and friendships
• Retirement, relocation, empty nest,
widowhood—all create new opportunities
• Communication technology—internet, e-mail,
virtual neighborhoods—all are making a
significant impact on aged as well as young
persons.
Technology and New
Opportunities ??
• Aging brings new opportunities for:
– Artistic expression
• Group--Virtual jam sessions, group painting
• Bouma and Harrington (2000) describe a virtual
group painting activity in which all artists can see
and share in the others’ painting. Possible with
existing technology.
•
Bouma H, Harrington TL Information and communication. In TL Harrrington, MK
Harrington Gerontechnology: Why and How Maastricht NL: Shaker Publishing
2000 pp.156-159
Technology and New
Opportunities ??
• Aging brings new opportunities for:
– Artistic expression
• Individual
• Visual: making, copying and altering digital
images; drawing, animation and cartoons etc.
using existing software
• Auditory: create, arrange, add music to visual
scenes using contemporary software
•
Bouma H, Harrington TL Information and communication. In TL Harrrington, MK
Harrington Gerontechnology: Why and How Maastricht NL: Shaker Publishing
2000 pp.156-159
Technology and New
Opportunities ??
• Aging brings new opportunities for:
– Learning
– Work
• There are many existing examples of how
technology makes it possible to learn “on
line” and work at home or in a remote
setting. Japanese program of “Kaizen” is
recent example
•
www.seniornet.org;www.gerontechnology.org
Gerontechnology Contributes in
many Ways to aging and health
• Education and training for aging
• Prevention or delaying of age-associated losses
in sensory-perceptual systems
– Technology to lower impact of long-term exposure to
environmental hazards and maintain cardiovascular
health and strength
• Compensation for age-associated losses
• Enhancement of creativity and enjoyment of
artistic activities
Technology can help education and
training activities related to aging
• Three of life’s activities—education, work,
leisure—should be distributed evenly
across the lifespan
• Simulations can help educate people for
aging in various situations (BJ Fogg)
– Cause and effect simulations (social skills)
– Environmental simulations (treat phobias)
– Object simulations (drunk driver)
Preventing or delaying age-related
limitations in functioning
• Technology can contribute to the
monitoring of age-related changes 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
Hearing: Prevention 1
• Presbycusis:Age-related hearing loss. Recent
research indicates that aging alone cannot
explain hearing loss—etiology of presbycusis is
more complex.
• Together, hearing aid technology and
longitudinal data on presbycusis provide new
opportunity for research and intervention.
Hearing: Prevention 2
• Presbycusis: Noise exposure is best known risk
factor; but how much and how long exposure
must be is still poorly understood
• Existing data have two limitations:
– noise exposure usually measured at source rather
than at ear
– Most data from occupational groups with various ages
and varied histories of exposure
Hearing: Prevention 3
• Presbycusis and noise exposure guidelines:
• Starting with Corso (Arch Environ Health,
1963;6:350-3) age-specific HL data for
screened listeners are subtracted from total HL
loss to estimate HL attributable to noise
exposure.
• Corso’s age findings replicated and extended to
longitudinal data by Brant and Fozard (J Acoust
Soc Am 1990:88;813-820.
Hearing: Prevention 4
• Presbycusis and noise: Longitudinal
data from carefully screened men and
women used to predict age related HL
changes over 8-14 years in persons with
different initial HL levels. Predictions
available for cohorts with initial ages from
20s through 80s.
• Morrell CH, Gordon-Salant S, Pearson JD, Brant LJ, Fozard JL
Percentiles for cross-sectional and longitudinal changes in hearing
level. J Acoust Soc Am 1996;100:1949-1967.
HL (db)
HL Changes in 424 men with
Initial Ages from 30s to 70s
16
14
12
10
8
6
4
2
0
30s
40s
50s
60s
70s
2
4
6
8
Years
From Morrell, et al. J Acoust Soc Am 1996; 100;1959
10
12
14
Hearing: Prevention 6
• Propose a clinical intervention trial that uses
data from Morrell et al study to identify men and
women at risk, and hearing aid technology to
measure noise level at ear.
• Need controlled clinical trial to determine if
control of ‘usual’ noise over long period of time
will delay or lessen risk of noise exposure.
• The data from the Morrell et al study could be
used to identify men and women at risk for
hearing loss
Hearing: Prevention 7
• Clinical trial in natural setting could use noise
suppression feature of contemporary hearing
aids to limit noise exposure and to monitor noise
levels at ear.
• In the intervention phase of the trial, the noise
suppression feature would control the noise
level in the intervention group
Hearing: Prevention 8
• Presbycusis--tobacco and alcohol use
• Positive relationship between tobacco use
and hearing loss found in population study
•
Cruickshanks KJ, Wiley TL Tweed TS et al Prevalence of hearing loss in older adults
in Bearver Dam WI Am J Epid 1998;148:879-886.
• Less loss with moderate alcohol use
•
Popelka MM, Cruickshanks KJ Wiley TL et al Moderate alcohol consumption and
hearing loss: A protective effect J Am Ger Soc 2000;48:1723-1278
Hearing: Prevention 9
• Presbycusis--elevated blood pressure
• Longitudinal data from men with initially
normal hearing established relationship
between hearing loss (>25db for
.5,1,2,4 kHz) for three levels of systolic
blood pressure (120, 140, 160 mmHg)
•
Brant, LF, Gordon-Salant S, Pearson JD, Klein LL, Morrell CH, Metter, EJ,
Fozard JL. Risk factors related to age associated hearing loss in the
speech frequencies. J Am Acad Audiol 1996;7;152-160.
% with normal
hearing:
a:SBP 120
b:SBP 140
c:SBP 160
From Brant,et al 1996
Hearing: Prevention 10
• Brant et al findings come from observational
study, need clinical trial
• Other measures of circulation would probably
be better for study, e.g., computed
tomography imaging of arteries to detect
coronary calcification, doppler techniques for
assessing loss of flexibility of the arteries or
possible imaging of cerebral or aural blood
flow.
•
•
Clay RA Research to the heart of the matter Monitor on Psychol 2001;32:42
Grady CL, et al Age-related changes in cortical blood flow activation
during visual processing of faces and location J Neurosci 1994;14:14501462
Vision: Prevention
• Conclusions: inconclusive data
• Best evidence is that control of elevated
blood pressure will reduce visual problems
that are secondary to diseases for which
high blood pressure is a primary risk factor
Proprioception, Balance and
Movement: Prevention 1
• Strength training and physical activity
improve muscle mass, control of
movement, and balance
•
•
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, funcional limitations and disability in older adults J
Am Ger Soc 2000;48:1264-1272.
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
Proprioception, Balance and
Movement: Prevention 2
• 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
Strength and Gait Speed 2
• 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
Cum
%
Cumulative
distributions of
leg power for 5
groups of walking
speed from <1m/s
to>2m/s
Data from
Rantanen
andAvela 1997
Prevention:Strength and Gait
• There is considerable work relating
contemporary strength to gait speed and
balance, e.g., Rantanen and Avela
• Prevention requires that we set standards for
reserve strength needed for adequate
functioning at a later age
• Rough estimates are that we need 40% of our
strength at age 25 to function well at age70
Old Adults perform ADLs closer
to max 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
Conclusions
• Prevention possibilities discussed include
– Hearing
– Gait, balance
– Simulations for anticipating age changes in
function