GERIATRIC FITNESS Dr. G. SUBBULAKSHMI, PRESIDENT, NSI, Mumbai Chapter

PURPOSE Goals and elements of geriatric assessment? Goals and elements of geriatric assessment? Comparative merits of different methods in carrying out a 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? 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? Linkages to clinical management systems are required? Priorities for future research in geriatric assessment? Priorities for future research in geriatric assessment?

FUNCTIONAL FITNESS PHYSICAL FITNESS PHYSICAL FITNESS PHYSIOLOGICAL FITNESS PHYSIOLOGICAL FITNESS PSYCHOLOGICAL FITNESS PSYCHOLOGICAL FITNESS

NEED FOR ASSESSMENT  ENDURANCE LOWERS  COORDINATION DECLINES  SPEED DECREASES  MOTOR TASKS - POOR  COGNITIVE PERFORMANCE DECLINE  PHYSIOLOGICAL DETERIORATION  NEUROLOGICAL STATUS  PATHOLOGICAL CONDITIONS

Traditional, spiritual, religious practices  Surya Namaskar Surya Namaskar Sit ups for Lord Ganesha Sit ups for Lord Ganesha “Japa” = pranayam? “Japa” = pranayam? Bow down to elders Bow down to elders Balance water pots on the head Balance water pots on the head Pooja activities Pooja activities

SELF ASSESSMENT Postal questionnaires were associated with higher response rates but also higher proportions of missing values than were interview methods. 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. 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. Self assessment of health and fitness with an intention of keeping fit and free from illness is very well accepted.

MERITS OF SELF ASSESSMENT SELF APPRAISAL SELF APPRAISAL SATISFYING SATISFYING PERIODIC ASSESSMENT PERIODIC ASSESSMENT LOW COST LOW COST EARLY DIAGNOSIS EARLY DIAGNOSIS PRIDE PRIDE DISCOVER THEIR POTENTIALS DISCOVER THEIR POTENTIALS

DETERMINANTS OF INDEPENDENCE Flexibility - Leighton Flexometer. Flexibility - Leighton Flexometer. Strength - modified sphygmomanometer. ( This is for Blood pressure measurement, not for blood pr.) Strength - modified sphygmomanometer. ( This is for Blood pressure measurement, not for blood pr.) Cardio respiratory fitness - self-paced walking test. Cardio respiratory fitness - self-paced walking test. Body size factors - Std methods. Body size factors - Std methods. In capacity Index is associated with participation in outdoor activities, greater shoulder flexibility, and a faster normal walking speed. In capacity Index is associated with participation in outdoor activities, greater shoulder flexibility, and a faster normal walking speed.

FRAILTY TEST Frailty is a valid and clinically important construct that is recognizable by physicians. Clinical judgments about frailty can yield useful predictive information. 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 Clinical Frailty Scale performs better than measures of cognition, function or co morbidity in assessing risk for death

FRAILTY SCALE 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 ) 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 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), 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), static balance (r = +0.33), leg strength (r = 0.25) and leg strength (r = 0.25) and negatively correlated with resting heart rate (r = ), negatively correlated with resting heart rate (r = ), age (r = -0.34) age (r = -0.34) perceived health status (r = -0.34); and perceived health status (r = -0.34); and overall Sickness Impact Profile score (r = -0.42). overall Sickness Impact Profile score (r = -0.42).

PASE Item weights for the PASE were derived by regressing a physical activity principal component score on responses to the PASE. 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. 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 = ). Reliability for mail administration (r = 0.84) was higher than for telephone administration (r = 0.68). Test-retest reliability, assessed over a 3-7 week interval, was 0.75 (95% CI = ). Reliability for mail administration (r = 0.84) was higher than for telephone administration (r = 0.68).

OPTOELECTRONIC MOVEMENT ANALYSIS PLM TEST – POSTURAL, LOCOMOTION, MANUAL 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 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. 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  Movement Time  The Postural Phase  The Locomotor Phase  The Manual Phase  The Simultaneity Index

ACTIVITIES OF DAILY LIVING I-ADL Instrumental Activities of Daily Living (cleaning, shopping, transporting and cooking). 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). P-ADL Personal Activities of Daily Living (bathing, dressing, going to the toilet, transfer, continence and feeding).

MENTAL HEALTH ASSESSMENT MEMORY MEMORY COORDINATION BETWEEN THOUGHT AND SPEECH COORDINATION BETWEEN THOUGHT AND SPEECH CALCULATIONS CALCULATIONS CONFUSION 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.

PHYSIOLOGICAL EXAMINATION The health professional may evaluate the nervous system by testing the reflexes, balance, and senses (hearing, taste, sight, smell, and touch). The health professional may evaluate the nervous system by testing the reflexes, balance, and senses (hearing, taste, sight, smell, and touch).

MENTAL HEALTH ASSESSMENT MENTAL HEALTH ASSESSMENT 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) 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) Questionnaires generally contain 20 to 30 questions that can be answered quickly, often in a "yes" or "no" format. Questionnaires generally contain 20 to 30 questions that can be answered quickly, often in a "yes" or "no" format.

LABORATORY TESTS 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). 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 Specific disorders, such as depression. These include the Hamilton Rating Scale for Depression, the Beck Depression Inventory, and the Geriatric Depression Scale. 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. General levels of functioning include the Mini Mental State Examination. The ability to carry out routine activities, such as eating, dressing, shopping, or banking. The ability to carry out routine activities, such as eating, dressing, shopping, or banking.

COMPREHENSIVE GERIATRIC ASSESSMENT This process is defined as a multidisciplinary evaluation in which the multiple problems of older persons are uncovered, described, and explained. 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. Has been used for many nonclinical purposes, including research, education, health policy, and administration.