BODYWORKS
A Disability Forecast : A Quick Screening Can Predict Whether
Independent Seniors Are Likely to Stay That Way
By Carol
Krucoff
The Washington Post, October
17, 2001
Johns Hopkins gerontologist Paulo Henrique M. Chaves times
Barbara Harris as she balances on one leg, one of three tests that
researchers say can predict the likelihood that a patient will soon face
impaired mobility. By Tom Allen
Riding up an escalator is easy for
Ethnea King, but don't ask her to ride down.
"It gives me a weird feeling to
look down," says King, a Baltimore grandmother who turns 78 this
month. "I had both knees replaced a few years back, and I'm afraid I
won't be able to move my legs forward."
A widow who lives alone, King has
become extremely cautious in her daily activities because she fears a fall
could mean loss of the independence she treasures. She walks backward down
the stairs to her laundry room, always holds onto handrails and uses a
cane whenever she leaves the house.
King's desire to stay independent
prompted her to volunteer for a Johns Hopkins University study designed to
predict whether older women will develop physical disabilities in the near
future. The study results, published recently in the Archives of Internal
Medicine, indicate that a series of simple tests can identify women at
highest risk of developing mobility disability within 18 months.
"People with this condition have
difficulty in mobility-related tasks, such as walking three blocks,
climbing steps and getting in and out of a car," says the study's
lead author, Paulo Henrique M. Chaves, a Johns Hopkins geriatrician who is
also an assistant professor at Brazil's University of Rio de Janeiro.
"It affects about 35 to 50 percent of women 70 and older, and is the
entry door to a series of changes that lead to further functional
deterioration, which will ultimately lead to moving to assisted living
settings or nursing homes."
The first test involves asking a
woman if health problems or physical conditions have prompted her to adapt
the ways she performs daily tasks. The other two tests measure the time it
takes her to walk one meter and determine how long she can balance on one
leg. By plugging the answers into a series of graphs, care providers can
quickly determine the likelihood that a woman will develop some degree of
disability in the near future.
For example, a woman who takes two
seconds to walk one meter, can balance on one leg for less than 10 seconds
and has substantially altered the way she does tasks has a 56 percent
probability of developing mobility disability within 18 months, Chaves
says. In contrast, a woman who takes one second to walk one meter, can
balance on one leg for 30 seconds and has not altered her activities of
daily life has a 3 percent probability of developing mobility disability
within the same time period.
"The idea is that it's much
easier to try and prevent disability instead of waiting for difficulty to
happen, then doing rehabilitation," notes Chaves, who says these
tests can identify declines in function before they are apparent.
While several tests exist to assess
mobility and predict subsequent loss, none was quick and easy enough to do
during a routine medical exam, says the study's coauthor, Linda P. Fried,
director of the Johns Hopkins Center on Aging and Health. "We wanted
to develop a simple, inexpensive tool doctors could use in clinical
decision-making," she says.
"Mobility disability is a highly
prevalent public health concern that is a major risk factor for difficulty
and dependency in other areas and for decreased quality of life in older
adults," Fried notes. "In the last 10 to 15 years, there's been
increasing recognition that disability can to a certain extent be
prevented or postponed. This screening tool can help target women who can
benefit most from preventive interventions."
Among the interventions that may be
prescribed for women at high risk are balance training and exercises to
increase strength, endurance and flexibility. Hopkins researchers are
working to determine which programs are most effective.
"The best prevention and
treatment we know of is physical activity," says Jack Guralnik, chief
of the epidemiology and demographics office at the National Institute on
Aging, adding that "simply having people increase the amount they
walk can be extremely helpful."
One of the best ways to help older
adults maintain function and avoid disability is to encourage them to
continue to do as much as possible in the community and at home, says C.
Jessie Jones, co-director of the Center for Successful Aging at California
State University, Fullerton.
"Things like taking the stairs,
playing with grandchildren and washing the car are all helpful because
they work many of the body's systems together," she says.
"Unfortunately, technology has taken away our need to do many
physical activities, so it's important to add as much movement as possible
back into our lifestyle. And it's never too late to start."
Just as lifestyle activities can help
maintain fitness and function, inactivity can lead to their loss. This can
become a vicious spiral, where sedentary habits lead to mobility
difficulty, which leads to further inactivity. The end stage of this
process can be muscles that are so weak that seniors are institutionalized
because they need help with tasks as simple as getting out of a chair.
While keeping active is beneficial
for everyone, Jones says, "the idea of moving more and sitting less
is particularly important for older adults, since the use-it-or-lose-it
phenomenon becomes increasingly more [significant] with age."
In addition to incorporating activity
into daily routines, she says, most older adults also can benefit from
setting aside time each day for specific strength, aerobic and flexibility
exercises. Those who want to exercise at home might consider seeking help
from a physical therapist or qualified senior fitness specialist in
setting up a program. Others might prefer participating in a structured
program at a senior center, YMCA or other facility.
"Older adults need to recognize
that avoiding functional problems will not make them go away," add
the Fullerton center's co-director Debra Rose. "In fact, becoming
less active will only make the problems worse."
RESOURCES
* "Exercise: A Guide from the
National Institute on Aging," is available free by calling
800-222-2225. A companion video is available for $7, payable to the
National Institute on Aging, by writing NIA Information Center, Dept. F,
PO Box 8057, Gaithersburg, MD 20898.
* The American Senior Fitness
Association will refer people to a qualified instructor in their area.
Call 800-243-1478 or visit the Web site www.seniorfitness.org
* Fifty-Plus Fitness Association
offers resources and activities for older adults who want to get and stay
fit. Call 650-323-6160 or visit Web site www.50plus.org
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