FUNCTIONAL Cognitive functions Social function CAPACITY ij M, - PDF document

7.2.2016 Content Functional ability of • When we are old? – Age definitions older people • What is functional ability? – Different dimensions – What is the evidence from the research? Marja Äijö PhD, Principal • Disablement process lecturer • Measurements, some Savonia University of Applied examples Sciences, Kuopio Finland Äijö M, Savonia UAS 2 Four dimensions DIMENSONS OF • Physical function • Psychological functions FUNCTIONAL • Cognitive functions • Social function CAPACITY Äijö M, Savonia UAS 4 Intervention. STUDIES IN SPORT, PHYSICAL EDUCATION AND HEALTH 177 . University of Jyväskylä. 2012. Mean center of pressure velocity moments and standard errors in four different stance positions by pain groups. * p<0.017 for comparison https://jyx.jyu.fi/dspace/bitstream/handle/123456789/37330/9789513946203.pdf?sequence=1 between those with moderate/severe pain and no pain determined Physical function from least significant test. (Lihavainen K. Mobility limitations, balance impairments and musculoskeletal pain among people age > 75 years. A Study with a Comprehensive Geriatric • Physiological basic functions – For example: muscles strength, balance, aerobic capacity, joint mobility, body composition, status of health Äijö M, Savonia UAS 5 Äijö M, Savonia UAS 6 1

7.2.2016 Coimpairments: strength and balance as (Anton SD. 2015. Successful ageing: Advancing the sience of physical independence in older adults. Ageing Reseach Reviews predictors of severe walking disability. (Rantanen et al. 1999. Midlife hand grip strength as a predictor of old age disability. JAMA 10;281(6): 558-60) -25 years prospective study, The conceptual model illustrates important factors that can affect Functional impairments 6089 healthy men physical function during aging and ultimately maintenance of health 10 steps climb and independence in older adults 800 m walk raise the weight 4.5 kg heavy housework 24 (part B), 304-327, doi: 10.1016/j.arr.2015.09.005. Epub 2015 Oct 14.) Use of toilet Eating Dressing Hand grip strength Wash Highest Functional difficulties Medium Lowest Chair raise Walking speed <0.4 m/s Äijö M, Savonia UAS 7 Äijö M, Savonia UAS 8 % 0 10 20 30 Risk factors for social isolation and loneliness among older adults Psychological functions • Mental health • Life satisfaction • Psychological well- being • Self-evaluation • Mood • Own resources • Coping strategies (Valtorta N. & Hanratty B. 2012. Loneliness, isolation and the health of older adults: do we need a new research agenda? JRSM 105(12): 518-522, doi: 10.1258/jrsm.2012.120128) Äijö M, Savonia UAS 9 Äijö M, Savonia UAS 10 What are the causes of late-life Psychological approach to depression? successful ageing Rehan A & Steffens, D. Psychiatric Clin North Am. 2013, 36(4): 497- 516, doi:10.1016/j.psc.2013.08.001 • Psychological approach • Increasing use of preventive care, better medical independently predicted Depressive symptoms in elders have been associated with • management of morbidity, and quality of life (QoL) impairment similar to that of major depressive disorder. changing lifestyles in older • Successful ageing: people may have beneficial • Late-onset depression has been prominently linked to effects on health and longevity, cerebrovascular compromise. – Not only maintenance of but may not improve their • Depression likely serves as both a risk factor and potentially health QoL. an early sign of dementia. – Maximizing one’s • Follow-up health status, • The most significant psychosocial factors leading to psychological resources number of supporters and depression are bereavement; social activities, and self-rated • Self-efficacy active ageing also significantly – perceived social support; neuroticism; personality disorders; • Resilience predicted QoL at follow-up. loneliness; disability; total number of life events; total number of daily hassles; and impaired social support, including lack of a confidante. (Bowling A, Iliffe S. 2011. Psychological approach to successful ageing predicts future queslity of life in older adults. Äijö M, Savonia UAS 11 Äijö M, Savonia UAS 12 Health Qual Life Outcomes. 2011 Mar 9;9:13. doi: 10.1186/1477-7525-9-13. ) 2

7.2.2016 Cognitive function and physical disability Cognitive functions • Cognitive function significantly contribute to functional decline and eventual development of physical disability • Cognition = the – Age-related (e.g. memory and attention) (Atkinson et cognitive functions of al. 2005) information processing – Transient decline (e.g. delirium) (Brummel et al. – perception 2014) – attention – decision – Increased rates of injury, hospitalization, dependence – awareness on assistive living and mortality (Boockvar et al. 2013, – linguistic functions Brummel et al. 2014) – learning – problem solving (H.H. Atkinson, M. Cesari, S.B. Kritchevsky, B.W. Penninx, L.P. Fried, J.M. Guralnik, J.D. Williamson. Predictors of combined cognitive and physical decline J. Am. Geriatr. Soc., 53 (2005), pp. 1197 – 1202 – thinking K. Boockvar, D. Signor, R. Ramaswamy, W. Hung Delirium during acute illness in nursing home residents J. Am. Med. Dir. Assoc., 14 (2013), pp. 656 – 660 N.E. Brummel, J.C. Jackson, P.P. Pandharipande, J.L. Thompson, A.K. Shintani, R.S. Dittus, T.M. Gill, G.R. Bernard, E.W. Ely, T.D. Girard Delirium in the ICU and subsequent long-term disability among survivors of mechanical ventilation Crit. Care Med., 42 (2014), pp. 369 – 377) Äijö M, Savonia UAS 13 Äijö M, Savonia UAS 14 Social functions Potential functional ability • Relations with family members and friends • What is possible to do? • Responsibility for the • The potential consists of an individual's social functioning and various individual factors (e.g. family members and social skills, temperament, motives, goals, values) friends and the social network • Quality of social • It is dynamic interaction between environment and relationship older person • The sense of life • It is dynamic interaction with the provision of services within the framework of opportunities and • Roles constraints. (Jyrkämä 2003; TOIMIA asiantuntijaverkosto 2011: http://www.thl.fi/toimia/tietokanta/suositus/18/) Äijö M, Savonia UAS 15 Äijö M, Savonia UAS 16 Actual functional ability • What is possible to do this environment? The disablement • Emphasizes the context: department performance • The ability to respond to the physical and social process setting • For example: – Experiencing inclusion – Performance of the roles: e.g. patient – Experiences: good / bad (Jyrkämä 2003; TOIMIA asiantuntijaverkosto 2011: http://www.thl.fi/toimia/tietokanta/suositus/18/) Äijö M, Savonia UAS 17 3

7.2.2016 The model of the disablement process Verbrugge and Jette (1994) Diseases Cardiac infarction, stroke Impairment Strength and endurance EXTRA-INDIVIDUAL FACTORS decrease , balance decline The main pathway: Functional limitation Slow walking ability PATHOLOGY IMPAIRMENT FUNCTIONAL LIMITATION Disability ADL and IADL problems DISABILITY Problems in social interaction RISK FACTORS INTRA-INDIVIDUAL FACTORS (Verbrugge L & Jette A. 1994. The disablement process. Soc.Sci.Med. 38(1): 1-14) (Verbrugge & Jette 1994) Äijö M, Savonia UAS 19 Äijö M, Savonia UAS 20 Preclinical mobility limitations How to measure? (Mänty 2010; Early signs of mobility decline and physical activity counseling as a preventive intervention in older people. Studies in sport, physical education and health 147. University of Jyväskylä https://jyx.jyu.fi/dspace/bitstream/handle/123456789/23586/9789513938826.pdf?sequence=1) Äijö M, Savonia UAS 21 Basic activity of daily living How to measure? • The ability to perform physically: ADL Physical function – ADL functions – IADL functions • Rivermead mobility index – AADL – functions • Katz index • Short Physical Performance (meaningful leisure • IADL-index Battery (SPPB) time, physical activity) • The timed Up and Go (TUG) • The Barthel index Test • Chair stand, 5 or 10 times • The 30-Second Chair Stand Test Äijö M, Savonia UAS 23 Äijö M, Savonia UAS 24 4

7.2.2016 How to measure? How to measure? Psychological function Social function Cognitive function • The Center for • The Social Provisions • Mini-Mental State Epidemiologic Studies Scale Examination (MMSE) Depression Scale • Perceived loneliness • Geriatric Depression Scale, GDS-15 Äijö M, Savonia UAS 25 Äijö M, Savonia UAS 26 Different frameworks, some examples FUNCTIONAL ABLITY / • Optimal functionality optimal functionality • ICF - The International classification of functioning, disability and health • Active ageing Marja Äijö 1 • Healthy ageing 1 Principal lectures, Gerontology, Savonia, University of Applied Sciences, • Successful ageing Unit of Health Care, Kuopio, Finland Äijö M, Savonia UAS 28 How to support optimal functionality in different environments? Äijö M, Savonia UAS 30 ( JAMA. 2011;306(16):1782-1793) 5

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