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					GERIATRIC FITNESS


  Dr. G. SUBBULAKSHMI,
         PRESIDENT,
     NSI, Mumbai Chapter
             PURPOSE
   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

   PHYSICAL FITNESS
   PHYSIOLOGICAL 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
   •   Sit ups for Lord Ganesha
   •   “Japa” = pranayam?
   •   Bow down to elders
   •   Balance water pots on the head
                  




   •   Pooja activities
         SELF ASSESSMENT
   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

   SELF APPRAISAL
   SATISFYING
   PERIODIC ASSESSMENT
   LOW COST
   EARLY DIAGNOSIS
   PRIDE
   DISCOVER THEIR POTENTIALS
              DETERMINANTS OF
               INDEPENDENCE
   Flexibility - Leighton Flexometer.
   Strength - modified sphygmomanometer. (This
    is for Blood pressure measurement, not for blood pr.)
   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
   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
   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),
   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
   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
   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

   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).
   P-ADL Personal Activities of Daily Living
    (bathing, dressing, going to the toilet,
    transfer, continence and feeding).
MENTAL HEALTH ASSESSMENT

   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.
PHYSIOLOGICAL EXAMINATION

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

				
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