Geriatric Assessment & Intervention. The Goal 5/9/2017. Current events. Student Conclave 2017 Fresno State goo.gl/slides/m5d6wm.

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1 Geriatric Assessment & Student Conclave 2017 Fresno State goo.gl/slides/m5d6wm Intervention The Goal Active Aging Current events Betty White s 95th birthday (Jan, 2017) Queen Elizabeth II s 91st birthday (April, 2017) Banana George (waterskiing at age 90!) Ed Whitlock - oldest person (85 years old) to complete a marathon in under 4 hours ( ) Former President George H. Bush (recently hospitalized) Married 72 years Sky dived for his birthday until 90 years old 1

2 Schwartz s Slippery Slope of Aging 1 Adapted from Schwartz RS: Sarcopenia and physical performance n old age: introduction. Muscle Nerve SuppI5: S10-S12, 1997) Pathway to Frailty 2 1 of multiple pathways Guccione, 2012 Concepts of Frailty 3 Clinical Syndrome ** NOT A NORMAL PROCESS OF AGING and NOT INEVITABLE** Fried, et al - Clinical Syndrome: Unintentional weight loss (> 10 lbs); self-reported exhaustion; weakness; slow walking speed; low physical activity Reversible!!! > 3 Frail 1-2 Pre-frail 2

3 4 Measuring Frailty Frailty Index 5 CSHA (Canadian Study of Health and Aging) items (disease, pathology, co-morbidities, age, genetics, etc) Number of deficits in an individual/total number of deficits measured 10 individual deficits/50 total deficits = 10/50 =.20 frailty index Higher number = more frail Clinical Frailty Scale 5 Based on clinical presentation of patients User friendly 9 different categories: mild, moderate, severe Different categories for dementia 3

4 6 7 Increased vulnerability to adverse outcomes Syndrome from decrease in multisystem reserve capacity 4

5 8 Frailty Prevention Goal Adapted from Schwartz RS: Sarcopenia and physical performance in old age: introduction. Muscle Nerve SuppI5: S10-S12, 1997) Exercise Statistics 5

6 EXERCISE STATISTICS 9 Regular physical activity (PA) = 21 % of persons over 65 years Percentage decreases with age <10% persons 85+ years regular PA Evidence & Exercise year old males had improved cardiovascular function (improved BP response) following lower limb strength training 10 LIFE-P Investigation 11 Health education compared to moderate intensity exercise Physical activity group: Improvements in Short Physical Performance Battery (SPPB) & 400 meter walk Berk et al. disability levels compared to exercise time 12 Less than 60 minutes per week Greater than 212 minutes per week Exercise decreases levels of disability equal to sedentary persons Benefits of Exercise in Older Adults Aerobic Resistive Training Slows physiologic changes that impair exercise capacity Decreased risk disability Manage chronic disease Increase longevity Optimize age related changes in body composition 12 Improves psychological well being (depression/anxiety) Improved aerobic capacity Improved ADLs & Independence Slows the decline muscle strength & lean body mass Prevent sedentary lifestyle related diseases IF dosed correctly (sufficient intensity) Improves cognition 6

7 Aerobic Exercise Types of Aerobic Exercise (1312ft) meter walk (20 meter walkway, mark every 1 meter, 2 min warm up- 60 rest-walk as fast as possible) 2. 2 minute step test 3. Interval Training (3X) 4. Walk/jog/run as fast possible 3 minutes Slow walk Peaking Threshold Same as above with harder push for 30 seconds Aerobic_Circuit Training 14 Warm up (3 laps with arms moving) All -2 laps Speed walk (fast) 14 heel rises Giant steps 15 push ups (wall) Side steps 15 squats Backward 15 toe raises 7

8 Resistive Exercise (Strengthening) Resistive Training Guidelines Type 8-10 exercises all major muscle groups Intensity Healthy Aging >60% 1 RM 9-11 RM 14 >8 repetitions BUT < 12 EQUIVALENT TO 70-80% 1 RM Work to muscle fatigue, Momentary Fatigue 8

9 Academy of Geriatric Physical Therapy Exercise Recommendations 16 Academy of Geriatric Physical Therapy 16 Resistive Training (RT) Guidelines 15 Frequency 2x per week (minimum) 48 hour rest Duration minutes RT longer than 60 minutes - detrimental effects 9

10 Technique for 9-11RM 15 Maintain good form & technique Observe every repetition closely Provide ongoing instruction Good stabilization No substitution No significant postural deviations Strict adherence reduces risk of injury Establish Correct Speed 15 Slow Movements Stop on a dime Full, painfree ROM Good form and technique (no compensatory movement) 10

11 Momentary Fatigue when exercise form deteriorates & client unable to complete repetitions when prompted to maintain form 15 Failure to exercise through full ROM (even when prompted) Exercise speed increases If exercise form deteriorates Unable to complete repetitions if prompted to move slowly Evidence: Resistance Training Dosing 15 Research support is lacking that 3 sets of exercise is better than 1 (Berger 1963 & 2003) Once an optimal stimulus is given (one set), it does not need to be given again IF working to FATIGUE, 1 set is sufficient Research demonstrates that a single set of exercise provides equal strength gains to exercise performed using 2 or 3 sets of exercise & significantly enhances physical performance (Starkey 1996, Feigenbaum 1999, Hass 2000, Galvao 2005) Benefits: Momentary Fatigue (1 set) 15 Quality not quantity focus Effective use of time Increased compliance Less risk of injury Certified Exercise Expert for the Aging Adult Course II. Academy of Geriatric Physical Therapy. 2015:

12 References 1. Guccione AA, Wong RA, Avers D. Geriatric Physical Therapy. 3 rd ed. St. Louis, MO: Elsevier; 2012: Guccione AA, Wong RA, Avers D. Geriatric Physical Therapy. 3 rd ed. St. Louis, MO: Elsevier; 2012: Fried LP 1, Tangen CM, Walston J, Newman AB, et al. J Gerontol A Biol Med Sci. 6(3):M Frailty in older adults: evidence for a phenotype. 4. Guccione AA, Wong RA, Avers D. Geriatric Physical Therapy. 3 rd ed. St. Louis, MO: Elsevier; 2012: Rockwood K, Xiaowei S, MacKnight C, et al. CMAJ (2005;172[13]:1700-2) Accessed Guccione AA, Wong RA, Avers D. Geriatric Physical Therapy. 3 rd ed. St. Louis, MO: Elsevier; 2012: Colby SL, Ortman JM. Projections of the Size and Composition of the U.S. Population: 2014 to 2060, P , U.S. Census Bureau, Washington, DC, ACSM Position Stand, Exercise and Physical Activity for Older Adults. Med Sci. SportsExerc. 2009;Jul;41(7): doi: /MSS.0b013e3181a0c95c. 10. Lovell DI, Cuneo R, Gass GC. Strength Training Improves Submaximum Cardiovascular Performance in Older Men. J Geriatric Phys Ther. 2009; 32(3): The LIFE Study Investigators. Lifestyle Interventions and Independence for Elders Pilot (LIFE-P) Study. J Gerontology. 2006; 61A(11): Berk DR, Hubert HB, Fries JF. Associations of Changes in Exercise Level With Subsequent Disability Among Seniors: A 16-Year Longitudinal Study. J Gerontol: 2006;61A(1): Guo S, Zeller C, Chumlea W, Siervogel R. Aging, Body Composition, and Lifestyle: The Fels Longitudinal Study. Am J Clin Nutr. 1999;70:

13 Additional Resources Geriatric Assessment Toolkit: geriatricphysio.yolasite.com/resources/geriatric_assessment_tool_kit.pdf Who We Are. Deborah Walker PT, DPT, OCS, GCS, CEEAA Fresno State Assistant Professor Leslie Zarrinkhameh PT, DPT, GCS Fresno State Director of Clinical Education Lecturer 13