Functional Assessment of the Elderly Chapter 3

Assessment of Physiological Age in Humans Physiological age depends on Physiologic competence: good to optimal function of all body systems & Health status: absence of disease Physiological age may or may not coincide with chronological age

Laboratory Values in Old Age: 1.Most values unchanged (e.g. hepatic, coagulation, electrolytes, renal, thyroid, blood count, etc.) 2.Some values decreased (e.g. HDL in women) 3.Some values increased (e.g. LDL in men, glucose) **See Table 3.2**

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Geriatric Assessment Involves a multi-dimensional diagnostic process designed to qualify an elderly individual in terms of: Functional capabilities Disabilities Medical & Psychological characteristics A list of typical assessments is summarized in Table 3.3 For our discussion, we will consider particularly: Activities of Daily Living (ADL) Instrumental Activities of Daily Living (IADL) **See Table 3.4**

Multi-Factorial Aspects of Aging Assessment criteria for measurements: Variables must be indicative of a function important for the general health of the individual Must correlate with chronological age Must change sufficiently, and with regularity, over time to show differences over 3-5 year intervals Must be easily measured without discomfort for the individual (without great expense & excessive labor) Page 31

Assessment Programs include tests that are grouped into three categories: 1.Tests examining general physical health 2.Tests measuring ability to perform basic self care (ADLs) 3.Tests measuring ability to perform more complex activities (IADLs), reflecting the ability to live independently in the community

The severity of the disability may be measured in terms of whether a person: Does not perform the activity at all Can only perform the activity with the help of another person Can perform the activity with the help of special equipment

Figure 3. 6: % of persons 70 years & older having difficulty/inability to perform ADLs & IADLs With advancing age, 1) disability intensity increases in men & women; 2) disability intensity is higher in women than in men at the same age (esp. at later ages); 3) females live a longer average life span but live longer with disability

Why do women have more disability? Women have more chronic disabling diseases than men but less life threatening Examples of conditioning limiting ADL (% indicate number of people affected in a given population): Arthritis (10.6%) Heart disease (4.0%) Stroke (2.6%) Respiratory (2.5%) Diabetes (1.5%)

Some disabilities of aging resemble with those of physical inactivity (disuse) **The following table shows some examples of physiological changes in aging, physical inactivity, and weightlessness**

Table 3-6 Physiologic Parameters in Aging, Physical Inactivity Weightlessness (In Space) ReducedIncreased Maximum oxygen consumptionSystolic blood pressure and peripheral resistance Restingandmaximum cardiac outputVestibularsensitivity StrokevolumeSerum total cholesterol Sense of balanceUrinary nitrogen andcreatinine Bodywater and sodium Blood cell mass Leanbody mass Glucose tolerance testVariable Sympathetic activity and neurotransmissionEndocrine changes ThermoregulationAlteredEEG Immune responsesAlteredsleep Changes in specific senses Maximum Oxygen Consumption Systolic blood pressure and peripheral resistance Urinary and Fecal Calcium

Table 3.7: Holistic view of the Elderly In geriatrics, it is necessary: 1.To differentiate the aging process from disease 2.To correlate physical state with psychological environment

Aging is associated with increased incidence of: Diseases Accidents Stress The increased susceptibility to stress and disease in old age may be related to cell senescence.

Table 3.3 “Simple” Functional Assesment of Ambulatory Elderly PHYSICAL EXAMINATION including: neurologic and musculoskeletal evaluation of arm and leg, evaluation of vision, hearing and speech NUTRITION dental evaluation body weight laboratory tests depending on nutritional status and diet HISTORY

INCONTINENCE (eventually fecal incontinence) presence and degree of severity MENTAL STATUS Number of tests are available DEPRESSION If Geriatric Depression scale is positive: - check for adverse medications - initiate appropriate treatment ADL and IADL (see Table 3-4) HOME ENVIRONMENT AND SOCIAL SUPPORT Evaluation of home safety and family and community resources Table 3.3 “Simple” Functional Assesment of Ambulatory Elderly (Cont)