as age, gender, coping skills, social background, education, past and present life experiences, overall behavior patterns, and character – are what make up the person. In short, personal factors influence how the health condition is experienced by the individual. Environmental factors, on the other hand, make up the physical, social, and attitudinal place where people live and experience life. Examples of environmental factors include social attitudes, architectural characteristics, and legal and social structures, as well as the climate (WHO, 2002). Figure 5: International Classification of Function Model
Helen is an 80-year-old, recently widowed woman who has diabetes. Management of her blood glucose levels has recently become a problem because Helen is having difficulty maintaining a diabetic diet. There may be many reasons for Helen’s noncompliance. For example, depression resulting from her recent widowhood may be affecting her appetite, or she may be unable to: ● Remember to eat due to cognitive impairment (cognition). ● Measure insulin amounts correctly due to poor eyesight (sensory changes). ● Taste sugar content in foods due to gustatory sensory changes (sensory changes). ● Recognize proper dietary needs due to poor medical/ nutritional literacy (knowledge). ● Chew properly due to dental problems or poorly fitting dentures (oral health). ● Prepare meals adequately due to severe arthritis (pain, limited range of motion). ● Access the needed foods due to lack of transportation to shop (environmental support). ● Afford the costs of necessary foods or even the cost of gas to get to the grocery store (socioeconomic factors). The totality of an older adult’s health must be considered to best manage, not only the medical condition, but also the person’s quality of life. The World Health Organization (WHO) defines health as “a state of complete physical, mental and social well- being and not merely the absence of disease or infirmity” (WHO, 2013). This definition, in conjunction with the WHO International Classification of Functioning, Disability and Health (ICF), presents a framework for classifying function and disability based, not on medical diagnosis, but on a person’s ability to participate in life situations (WHO, 2013). The ICF model The ICF model shifts the focus of a person’s health status from disability or sickness to health and function. The APTA board of directors endorsed the ICF model in 2008 at the House of Delegates assembly as the accepted patient care model (APTA, 2008). ICF’s biopsychosocial (disablement) model is a dynamic classification system that integrates components of both medical and social models of health (Jette, 2009). Function and disability are represented on a continuum and uniquely determined for each individual based on whether he or she can perform the necessary and desired activities of daily life. The ICF model (Figure 5) presents a useful approach for rehabilitation professionals and other healthcare providers who work with older adults. Improvement in function is frequently cited as a primary goal in rehabilitation programs. However, function often has varying definitions, and these definitions result in broad interpretations by healthcare professionals, policymakers, and consumers. Outcomes commonly used to measure change in function of older adults have been criticized for examining only isolated components that contribute to performance rather than the person’s overall ability to engage in daily activities of life (Keysor & Brembs, 2011; Keysor & Jette, 2001). The ICF model aims to describe a person’s ability to engage in activities and participate in life. However, because this model crosses three domains – body function, activity, and participation – it is important to select an outcome measure that is appropriate for the targeted domain. For example, at the body function level, a dynamometer would be a suitable tool to measure muscle strength. At the activity level, an appropriate outcome tool would measure activity limitations, such as gait speed. For measurement at the participation level, a tool that takes into account the patient’s quality of life would be appropriate (Gilchrist, 2009). Such tools will be described in greater detail in the following sections. The model also indicates that there is an interplay among bodily structures, activity, participation, and the individual person, including his or her environment. In this context, personal factors are the expectations and demands that a person experiences in daily life. Personal factors – such
Note. From “Towards a Common Language for Functioning, Disability and Health: ICF,” by the World Health Organization, 2002, p. 9. Retrieved from http://www.who.int/classifications/icf/ icfbeginnersguide.pdf?ua=1. Reprinted with permission. Schwartz’s “slippery slope” continuum Aging older adults are a heterogeneous group. Older adults have varying challenges that can be identified using the ICF model. The ICF model takes into account the multifactorial nature of the health conditions of the older adult. The clinician must determine how various health conditions are affecting the patient’s life. The overall health conditions of aging adults are well recognized and have been classified by Dr. Robert S. Schwartz (Guccione, Wong, & Avers, 2012; Schwartz, 1997). Schwartz used the term slippery slope to describe the changes in physiologic reserve that accompany aging. He quantified these graded changes in abilities by expressing an individual’s health as a specific percentage of vigor, where vigor represents balance, strength, coordination, endurance, flexibility, and the interaction of all the other physiologic factors that play meaningful roles in function. Healthier people have greater amounts of vigor, within this continuum, extending from fun, the highest level of reserve, to failure, which is the most reduced level of ability. According to Schwartz’s theory, people can improve their levels of vigor despite their physiologic age. Conversely, engaging in poor lifestyle choices can reduce an individual’s level of vigor. Schwartz’s classification complements the ICF model because small changes in physiologic abilities result in changes in function, participation, and disability. Individuals who suffer a physiologic challenge and exhibit less vigor may move from a higher level to a lower one. On the other hand, individuals can also move from a lower to a higher level if the physiologic challenge has been remediated or if rehabilitation interventions have been successful in restoring function. There are four functional thresholds within the vigor process that Schwartz developed: fun, function, frailty, and failure . 1. Fun : A person classified in the Fun category has no limitations in terms of participation in work, home, and leisure. A competing senior athlete would exemplify a person in this highest category. 2. Function : A person in the Function category is able to complete most work and home activity but may need to modify his or her daily activities or self-restrict leisure activities because of declining physiologic capacity. An active
EliteLearning.com/Physical-Therapy
Page 40
Powered by FlippingBook