Functional Assessment of the Elderly

Chapter 3

Assessment of Physiological Age in Humans

Physiological age depends onPhysiologic 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**

Secrets to Long Life

Geriatric AssessmentInvolves 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

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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

Table 3-4 Categories of Physical Health Index MeasuringPhysical Competence

ACTIVTIES INSTRUMENTAL ACTIVITIESOF DAILY LIVING OF DAILY LIVING

Feeding CookingBathing CleaningTo ileting Using telephoneDressing WritingAmbulation ReadingTransfer from toilet LaundryVisual acuity Driving a carOthers Others

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 threateningExamples 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)

Reduced Increased

Maximum oxygen consumption Systolic blood pressure andperipheral resistance

Resting and maximum cardiac output Vestibular sensitivityStroke volume Serum total cholesterolSense of balance Urinary nitrogen and creatinineBody water and sodium Blood cell massLean body massGlucose tolerance test VariableSympathetic activity and neurotransmission Endocrine changesThermoregulation Altered EEGImmu ne responses Altered sleep

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

NUTRITIONdental evaluation body weight laboratory tests depending on nutritional status and diet

HISTORY

INCONTINENCE (eventually fecal incontinence)presence and degree of severity

MENTAL STATUSNumber of tests are available

DEPRESSIONIf Geriatric Depression scale is positive:- check for adverse medications - initiate appropriate treatment

ADL and IADL (see Table 3-4)

HOME ENVIRONMENT AND SOCIAL SUPPORTEvaluation of home safety and family and community resources

Table 3.3 “Simple” Functional Assesment of Ambulatory Elderly (Cont)