Chapter 4: Therapeutic Exercise and the Older Adult: An Evidence-Based Approach, 3rd Edition 2 Contact Hours
By: Heather Johnson, OTD, MS OTR/L, BSOT, CMhIMP Learning objectives After completing this course, the learner will be able to: Describe the changes that take place in the cardiovascular, respiratory, endocrine, interstitial and musculoskeletal systems with aging. Describe the benefits and explain an appropriate exercise intervention to mitigate age-related changes and support occupational performance for individuals, groups and populations. Implicit bias in healthcare Implicit bias significantly affects how healthcare professionals perceive and make treatment decisions, ultimately resulting in disparities in health outcomes. These biases, often unconscious and unintentional, can shape behavior and produce differences in medical care along various lines, including race, ethnicity, gender identity, sexual orientation, age, and socioeconomic status. Healthcare disparities stemming from implicit bias can manifest in several ways. For example, a healthcare provider might unconsciously give less attention to a patient or make assumptions about their medical needs based on race, gender, or age. The unconscious assumptions can lead to delayed or inadequate care, misdiagnoses, or inappropriate treatments, all of which can adversely impact health outcomes. Addressing
Explain common barriers to exercise in older adults. Compare and contrast appropriate tests for clinical use to measure change after an aerobic or resistance exercise intervention. Critique special considerations when prescribing exercise for older adults with comorbid conditions.
implicit bias in healthcare is crucial for achieving equity in medical treatment. Strategies to combat these biases involve education and awareness programs for healthcare professionals. These programs help individuals recognize and acknowledge their biases, fostering a more empathetic and unbiased approach to patient care. Additionally, implementing policies and procedures prioritizing equitable treatment for all patients can play a pivotal role in reducing healthcare disparities. Ultimately, confronting implicit bias in healthcare is essential to creating a more just and equitable healthcare system where everyone receives fair and equal treatment regardless of their background or characteristics.
INTRODUCTION
Healthy People 2020, in its mission to identify nationwide health improvement priorities, has made increasing older adults’ participation in routine physical activity a step in addressing the health-related quality of life social determinant of health (SDoH) (Office of Disease Prevention and Health Promotion, 2022). Physical therapy and occupational therapy clinicians are choice practitioners to address client barriers to movement, function, performance, and health—and both have visions to address routine physical activity within this SDoH. In its 2021–2022 Public Policy Priorities position paper, the American Physical Therapy Association (APTA) emphasized how more movement leads to better health, making a goal to support programs that increase physical activity and exercise among all individuals and thus aligning with the SDoH (2021). APTA’s vision statement for the physical therapy profession is “Transforming society by optimizing movement to improve the human experience” (American Physical Therapy Association, 2019). APTA (2019) further explains with their vision’s guiding principles that movement is a key to optimal living and quality of life for all people, and it extends beyond health to capability, participation, and societal contribution. In their position paper Evidence to Support the Distinct Value of Occupational Therapy for Older Adults (AOTA, 2017), the American Occupational Therapy Association (AOTA) defended occupational therapists’ key role as interdisciplinary providers in addressing the independence, performance, and participation of older adults. The paper contributes supporting evidence of occupational therapy’s use of exercise programs involving functional activities, resistance training, multicomponent patient education and training, habit formation training, problem-solving techniques, motivational interviewing, and individual tailoring of self-managed health programs (AOTA, 2017).
There are over 52 million adults over age 65 in the U.S., and more than 17 million identify as having a disability (U.S. Census Bureau, 2020a, 2020b). Another 42 million adults between the ages of 55 and 64 are headed toward becoming older Americans (U.S. Census Bureau, 2022a). Sedentary behavior in adults is linked to increased poor health outcomes related to diabetes and cardiovascular disease incidence, as well as cardiovascular, cancer, and all-cause mortality (World Health Organization [WHO], 2020). Most adults do not engage in the recommended amounts of physical activity (Liguori & American College of Sports Medicine, 2020). The cost of inactivity is high and is estimated to cause more than 5.3 million premature deaths worldwide per year (Murphy et al., 2021; Prabakaran et al., 2020). The leading causes of death in 2020 in the U.S. were heart disease, cancer, COVID-19, unintentional/accidents, stroke, chronic lower respiratory diseases, Alzheimer’s disease, diabetes, influenza, and pneumonia (Murphy et al., 2021). Aging is known to contribute to a multitude of systemic changes within the cardiovascular, respiratory, endocrine, and musculoskeletal systems that result in decreased health, mobility, and function in older adults. Many of these systemic changes are exacerbated by inactivity. Increased physical activity and exercise may mitigate epigenetic changes, conferring health benefits that include (Murach et al., 2022; WHO, 2020): ● Improved all-cause mortality. ● Improved cardiopulmonary and cardiovascular mortality. ● Reduction in incident diabetes. ● Reduction in incident site-specific cancers. ● Improved mental health (anxiety and depression). ● Improved cognition and physical function. ● Improved sleep. ● Reduction in adipose tissue. ● Fall and fall-related injury prevention.
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Book Code: PTNY1024
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