Promoting Functional Mobility Independence and Activity in Mobility Older Adults Activity Function Falls Individual Anna H. Chodos, MD, MPH Assistant Professor Function Activity Division of Geriatrics UCSF Mobility Mobility is important for health What is mobility? “Optimal mobility , defined simply as being able Mobility is broadly defined as the ability to move to safely and reliably go where you want to go, oneself …within community environments that expand from one’s home, to the neighborhood, and when you want to go, and how you want to get to regions beyond . there, is a key component of healthy aging.” Am J Public Health. 2012 August; 102(8): 1508–1515. The Gerontologist (2010) 50 (4): 443-450. OPTIMIZING AGING COLLABORATIVE AT UCSF – GERIATRIC WORKFORCE ENHANCEMENT PROGRAM OPTIMIZING AGING COLLABORATIVE AT UCSF – GERIATRIC WORKFORCE ENHANCEMENT PROGRAM 1
Mobility Disability How do we measure Mobility? The gap between an individual’s For health or physical reasons, do you have difficulty climbing up 10 steps or walking one- physical ability and environmental quarter of a mile? challenges. ◦ Ability, examples: strength, balance, sensation Because of underlying health or physical ◦ Environment, examples: uneven surface, hill, reasons, have you modified the way you climb indoor vs. outdoor 10 steps or walk a quarter of a mile? JAMA. 2013;310(11):1168-1177. JAMA. 2013;310(11):1168-1177. OPTIMIZING AGING COLLABORATIVE AT UCSF – GERIATRIC WORKFORCE ENHANCEMENT PROGRAM OPTIMIZING AGING COLLABORATIVE AT UCSF – GERIATRIC WORKFORCE ENHANCEMENT PROGRAM Mobility Limitations are Measuring mobility Common Neurologic exam ◦ Gait speed = 10 feet at a comfortable pace ≤3 sec Of adults ≥65 NOT in long ◦ Balance term care, 27% have Short Physical Performance Battery “difficulty walking or climbing ◦ Chair stands stairs” ◦ Semitandem and tandem stand ◦ 8 ft. walk CDC report, July 31, 2015, 64(29);777-783. OPTIMIZING AGING COLLABORATIVE AT UCSF – GERIATRIC WORKFORCE ENHANCEMENT PROGRAM OPTIMIZING AGING COLLABORATIVE AT UCSF – GERIATRIC WORKFORCE ENHANCEMENT PROGRAM 2
Risk factors for Mobility Disability and Health Mobility Impairment Older age Physical: ◦ An early predictor of physical disability and mortality (2-3x risk) Low physical activity ◦ Linked to lower health status, quality of life Obesity Psychological and Social: Strength or balance impairment ◦ Linked to depression, isolation, loneliness Chronic disease burden (example, diabetes, heart failure, Increase risk of nursing home placement. arthritis) JAMA. 2013;310(11):1168-1177. JAGS 2000;48:493-498 J Gerontol A Biol Sci Med Sci. 2011;66(4):467-473. OPTIMIZING AGING COLLABORATIVE AT UCSF – GERIATRIC WORKFORCE ENHANCEMENT PROGRAM OPTIMIZING AGING COLLABORATIVE AT UCSF – GERIATRIC WORKFORCE ENHANCEMENT PROGRAM Requirements to maintain Early signs of mobility mobility disability Sensation Report of difficulty with walking ◦ Hearing, vision, feeling ◦ First signs typically walking longer distances or running Balance Strength Early: changes in method, frequency, or time Flexibility used in a mobility task J Prev Med Public Health. 2013 Jan; 46(Suppl 1): S50–S54. OPTIMIZING AGING COLLABORATIVE AT UCSF – GERIATRIC WORKFORCE ENHANCEMENT PROGRAM OPTIMIZING AGING COLLABORATIVE AT UCSF – GERIATRIC WORKFORCE ENHANCEMENT PROGRAM 3
Activity and Older Adults Mobility Mobility Activity Physical activity decrease with age Function Decreasing physiologic capacity in many organ Falls systems with age Individual Function Activity Arch Gerontol Geriatr. 2014 Jan-Feb; 58(1): 74–79. Prev Med. 2016 Aug;89:37-43. Br J Sports Med. 2009;43(1):28-31. OPTIMIZING AGING COLLABORATIVE AT UCSF – GERIATRIC WORKFORCE ENHANCEMENT PROGRAM OPTIMIZING AGING COLLABORATIVE AT UCSF – GERIATRIC WORKFORCE ENHANCEMENT PROGRAM Benefits of Activity in Older Activity is Possible and Beneficial Adults at Any Ability Level Improved disease management Improved brain health Prevention of disability and loss of independence Improved quality of life Lower mortality risk Age BMJ 2015; 350 :h100 Disease Arch Gerontol Geriatr. 2014 Jan-Feb; 58(1): 74–79. Br J Sports Med. 2009 Jan; 43(1): 28–31. Lancet. 2011, 378: 1244-1253. OPTIMIZE AGING COLLABORATIVE AT UCSF - GERIATRIC WORKFORCE ENHANCEMENT PROGRAM OPTIMIZING AGING COLLABORATIVE AT UCSF – GERIATRIC WORKFORCE ENHANCEMENT PROGRAM 4
Mobility and Activity are Recommendations: health.gov Linked Physical Activity Guidelines for ALL ADULTS Low levels of physical activity are linked to mobility limitations Avoid inactivity ◦ In 12 years, about ½ of adults over 70 developed walking At least 150 minutes of moderate-intensity/week disability in one study. OR 75 minutes of vigorous-intensity/week ◦ Lower physical activity was linked to ~40% increased Muscle-strengthening 2 days or more/week chance of walking disability. *walking disability= needing help walking ¼ mile Ann Intern Med. 2012;156(2):131-140. OPTIMIZING AGING COLLABORATIVE AT UCSF – GERIATRIC WORKFORCE ENHANCEMENT PROGRAM OPTIMIZING AGING COLLABORATIVE AT UCSF – GERIATRIC WORKFORCE ENHANCEMENT PROGRAM Recommendations: health.gov Physical Activity Guidelines for OLDER ADULTS Do it as abilities and conditions allow Exercises that maintain or improve balance if at risk of falling Determine level of effort based on level of fitness Understand how any chronic conditions might affect ability to do regular activity https://health.gov/paguidelines/guidelines/chapter5.aspx OPTIMIZING AGING COLLABORATIVE AT UCSF – GERIATRIC WORKFORCE ENHANCEMENT PROGRAM OPTIMIZING AGING COLLABORATIVE AT UCSF – GERIATRIC WORKFORCE ENHANCEMENT PROGRAM 5
Function Mobility Mobility Activity Function “The defining feature of geriatric medicine is Falls the intense focus on the preservation and Individual restoration of function.” Function Activity Gill TM, Assessment of Function and Disability in Longitudinal Studies. JAGS 2010;58(Suppl 2):S308-S312 OPTIMIZING AGING COLLABORATIVE AT UCSF – GERIATRIC WORKFORCE ENHANCEMENT PROGRAM OPTIMIZING AGING COLLABORATIVE AT UCSF – GERIATRIC WORKFORCE ENHANCEMENT PROGRAM Background: function Assessing Function •Physiologic age incorporates many factors –Age Instrumental Activities of Daily Activities of Daily Living –Genetics (family history) Living: ◦ Bathing ◦ Driving/transportation –Lifestyle factors (smoking, alcohol, diet, fitness) ◦ Dressing ◦ Using phone –Comorbidities ◦ Toileting ◦ Shopping for food –Functional loss ◦ Transferring ◦ Finances ◦ Feeding •Physiologic age is more important than chronologic ◦ Cooking age in determining health outcomes and prognosis ◦ Housework ◦ Taking meds Needs 24 hour care Needs help intermittently J Gerontol A Biol Sci Med Sci. 2005 Jul;60(7):888-93 Gerontologist 9:179-186, (1969) OPTIMIZING AGING COLLABORATIVE AT UCSF – GERIATRIC WORKFORCE ENHANCEMENT PROGRAM OPTIMIZING AGING COLLABORATIVE AT UCSF – GERIATRIC WORKFORCE ENHANCEMENT PROGRAM 6
Lower function associated with shorter life Risk Factors: Functional Decline expectancy Environment: Genes Social, Financial Life Expectancy (years) Living Supports Age Independent Mobility disabled ADL disabled Functional 70 16.7 15.7 11.5 Decline Hospitalizat Medications: ions, 85 8 6.9 4.6 Appropriate Medical Inappropriate Conditions, Falls *Mobility disabled = inability to walk half a mile and/or walk up and Age-related down stairs to the second floor without help. changes Keeler et al. J Gerontol A Biol Sci Med Sci. 2010 OPTIMIZING AGING COLLABORATIVE AT UCSF – GERIATRIC WORKFORCE ENHANCEMENT PROGRAM OPTIMIZING AGING COLLABORATIVE AT UCSF – GERIATRIC WORKFORCE ENHANCEMENT PROGRAM Hospitalization‐Associated Slippery slope Disability > 1/3 of older patients are discharged with worse functional status than baseline 1/2 of these patients acquire their deficits during their hospitalization Covinsky KE et al. JAGS 2003;51:451‐58 Covinsky KE et al. JAGS 2003;51:451-58 OPTIMIZE AGING COLLABORATIVE AT UCSF - GERIATRIC WORKFORCE ENHANCEMENT PROGRAM 7
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