Prolonging Independent Living Among Older Adults Via Functional Assessments
A major goal among older adults is to maintain their independence and ability to perform activities of daily living (ADLs). Once daily tasks cannot be performed on one’s own, quality of life often begins to drastically fall. No one wants to rely on others to be dressed, bathed, get out of one’s favorite chair and get around town – so maintaining key elements of physical fitness such as muscular strength, power and endurance as well as balance, flexibility and coordination is crucial.
Cardiorespiratory capacity is important for functional capacity and combatting disease, but the fitness components tied into the neuromuscular system appear to be the most correlated with being able to perform ADLs. An overall lack of physical activity which challenges these components during the 4th-6th decades of life significantly contributes to the estimated 10-30% loss of function during these years.
This lack of physical activity and other issues combined with gradual sarcopenia (loss of muscle mass, strength and power) as well as neural factors and structural changes in joints/connective tissue provide the fitness professional with a lot to work on among older adults fighting the pains of aging. To recognize what and older adult needs most to maintain independence, they should undergo functional and task-specific assessments. After these procedures, specific and appropriate functional training can be prescribed for:
- Increased bone density, muscle mass, muscular strength and endurance and flexibility
- Improved circulation, digestion, performance of ADLs, sleep patterns, balance/coordination, reaction time, and walking/stair climbing ability (gait efficiency)
- Decreased body fat, resting heart rate, blood pressure, and risk for falling or injuries
Various techniques exist to evaluate function in a testing battery for older adults. For example, self-reported scales of function can be obtained by interviewing the client and recording his/her self-ratings on how they perform ADL. There are several established scales, such as the Short Form-36 from the Medical Outcomes Study (also known as a Health Status Questionnaire), which asks subjects to rate their ability to perform household tasks, get dressed, or go shopping.
Even general questions from other forms such as Behavioral Questionnaire can help assess the client’s quality of life and greatest needs. An initial interview process between the fitness professional and the older client can greatly help develop a level of familiarity, trust and rapport which can enhance the client/trainer relationship over the course of an exercise program.
Physical testing should be functionally-specific. A common battery of assessment will include balance, coordination, mobility, power, and lower/upper body functional strength. Some may consider power training unsuitable for older adults, but indeed power production in the hips is critical for improving gait and being able to perform simple tasks such as getting out of a chair without assistance.
Resistance training in general demonstrates the greatest capacity to slow age-related functional decline by combatting sarcopenia, reducing the risk for osteoporotic fractures and falls as well as maintaining physical confidence.
Timed tasks of walking speed over a 15ft. distance can provide information on mobility and lower body power. The sit-to-stand test from a chair with the arms crossed for 5, 10, or 30 seconds will provide information on lower body functional power and strength. Balance tests can include walking on a straight line taped to the floor and counting the number of steps off the line as a simple test of dynamic balance, while a timed single-leg balance stance is a good test of static balance and a predictor of falling risk.
Lateral movement is often impaired with age, so timed-tests of change of direction can be used, such as walking a figure 8 around two-cones placed on the floor or the Edgren side-step test. Modified upper-body assessments can be used such as “push-ups” off a wall across gravity or the Senior Arm Curl test which includes dumbbell curling for 30 seconds instead of a basic hand grip strength test.
The Apley Back Scratch test is a useful flexibility assessment as shoulder mobility is often impaired among older adults. A modified chair sit-and-reach assessment can be used for lower-body mobility if appropriate. If desired, the 6-minute walk test or 2-minute Step-in-Place test can be used to get a picture of aerobic capacity. The fitness professional can devise various tests of coordination and fine motor skills based on ADLs the client wants to improve, or used a pre-devised assessment such as the Soda Pop Test used by Shape America (formerly AAHPERD).
Developing a good battery of tests for older adults can help a fitness professional increase the success rate of their programs and business overall - but more importantly, help combat the increase in age-associated disability and the decline on quality of life that affects many seniors worldwide.
It is vital when incorporating these tests that all possible safety measures are put in place to reduce the risk of injury and falls; including knowledge of all stop-test indicators and paying close attention to client feedback. Collecting valid data will identify true capability and can dramatically increase the rate of improvement in addition to effectively guiding activity progressions.