Assessment and Exercise Prescription for Geriatric Population PDF

Assessment and exercise prescription of geriatric population BPT17 : Physiotherapy through the life course Lecture outline ▪Challenges and consequences of falls in the elderly ▪Physiological reminders of ageing ▪Risk factors for falls ▪ Intrinsic factors ▪ Extrinsic factors ▪Strategies f...

Assessment and exercise prescription of geriatric population BPT17 : Physiotherapy through the life course Lecture outline ▪Challenges and consequences of falls in the elderly ▪Physiological reminders of ageing ▪Risk factors for falls ▪ Intrinsic factors ▪ Extrinsic factors ▪Strategies for preventing falls ▪ Prevention axis ▪ "Scientific validity” ▪ Lifestyle advice ▪ Exercise Therapy 2 Introduction When are we ”old” ? What is ageing ? 3 “What is ageing?” Accumulation of molecular and cellular damage over time No difference between the process of "ageing" and degenerative processes Age is a poor indicator of these changes Associated with life transitions Retirement Housing adaptations Death of relatives 4 “What is ageing?” Reduced reaction time Gait impairment Reduced adaptive strategies Difficulties in double tasks Reduced perception of obstacles and adaptation to light Balance impairment Sarcopenia Hormonal changes : sleep, Growth Factor, osteoporosis 5 Be part of it. Sarcopenia Loss of muscle mass, quality and strength link with ageing 4 to 6% per decade Women starting 40y.o ; men starting 60 y.o Strictly correlate with physical impairment, quality of life, death 6 Sarcopenia Precipitated by : Poor diet Physical inactivity Comorbidities (more than two diseases at the same time) Genetics Hormones Neuromuscular dysfunction Trauma 7 Frailty The risk of falling is not strictly related to age ! Relates more to ”frailty” No consensus Conjunction of multiple interacting conditions Inescapable process Consequences of sub-clinical elements that are difficult to observe on clinical examination Assessed by functional scales 8 Frailty 4 major components Muscle function Balance and walking function Cognitive function Nutritional status 9 Frailty Operational definition using 5 areas Mobility Physical impairments Sensory ability Memory Energy 10 Frailty Dependency is not the only expression of frailty < 20% of "frail" people are dependent Not correlated with gender, region of residence, marital status, age Correlated with socio-economic level "Energy" is the most frequently affected area 11 Frailty No 'typical’ elderly Inequalities in health Stereotypes Rapidly changing world 12 What is falling? "An event in which a person inadvertently lands on the ground or other surface at a lower level than previously.” Excludes loss of consciousness, stroke, major extrinsic accidents 13 Consequences of falling Leads to significant and lasting functional decline even in the absence of severe physical trauma Revealing frailty Decreased ability to respond to minor external disturbances Aggravated frailty process Relapses > 50% within a year Reflects maladjustment to the environment Can be influenced by multiple factors About 20% result in medical intervention About 10% result in fracture Hip Vertebrae Wrist 14 Post-falls syndrome Fear of falling may predate the fall Psychomotor maladjustment Spontaneous reduction in activity Decreased functional abilities Postural disorders Gait disorders Increased risk of further falls 15 Predictive factors Multifactorial Aging Pathology affecting the equilibrium function Medication Environment Behaviour Intrinsic factors Do not identify a priori those at high risk of serious injury Extrinsic factors Environments Behaviour Activities 16 Extrinsic factors Behavioural Alcohol Sedentary lifestyle Nutrition Risk-taking Vigorous" older people 20-40% fall 22% (vigorous) vs. 6% (frail) of serious injury 17 Extrinsic factors Environmental (30-50% of falls) Object on the ground Poor lighting Slippery or uneven ground Steps Chairs Bed height Risk of falling not generally associated with the "number" of hazards but with the relevance of the hazard to the elder 18 Example 19 Intrinsic factors Type Measure Level of evidence Demographics > 80 y.o. High Health & function Reduction in ADL, reduction in mobility High Pathology Parkinson high Dementia Incontinence MSK Reduction in knee/hip/ankle/grip strength High Sensory Reduced visual acuity High Gait / balance / physical Gait dysfunction High capacity Reduced walking speed Altered dynamic balance Sit to stand difficulty Cognitive Mini Mental State High Depression Medication sedative, hypnotic, anxiolytic High Polymedication (> 4 medication) 20 Recurrence factors History of falls > 2 Time spent on the ground > 3 hours. Tinetti test score less than 20 points. Timed up and go test performance greater than 20 seconds. Unipodal hold less than 5 seconds. Impaired postural adaptation reactions. Stopping walking when the examiner asks the person to speak. 21 Prevention Medical appointment without prior Medical appointment because of a fall: ask if there was a fall during the previous year fall Risk factor assessment History Previous fall Intrinsic risk factor Extrinsic risk factor No problems / problems resolved Gait and balance : quick test Risks or persistent problem Neurological assessment Cardio-vascular assessment Personalized multifactorial intervention Primary prevention including education Exercise prescription: gait + balance Yearly assessment Medication prescription adaptation Intrinsic risk factors adaptation Environmental adaptation 22 Strategies Stage Assessment Specific strat Common strat Good health, living Fall assessment - Promote physical - Neurosensory at home + Risk factors activities correction - Specific rehab if - Shoeing impairments - Nutritional advice Frail, living at home Same as above - Household - Preventive or in institution + standardise adaptation measures against geriatic assessment - Specific rehab osteoporosis (cognitive, nutrition, including how to - Assessment of gait and balance) get back up after iatrogenic factors + assessment of a fall - Reduce household if medication necessary Dependent, living in Same as above - Address institution + polypathology polypathology assessment - Restraint measure 23 Assessing frailty Fried’s criteria 1) Physical inactivity 1) less than 150 minutes of moderate activity per week 2) Low muscle strength 1) can be measured by grip strength -