The 30-Second Sit-to-Stand (30SecSTS) and the 5-Times Sit-to-Stand (5XSTS) are tests that can be used to assess lower extremity muscle strength using a functional skill. The subject starts by sitting in the middle of the chair with back straight and feet flat on the floor, with upper extremities folded across the chest. He or she then stands up and sits down repeatedly for 30 seconds, while the completed number of stand-sit cycles is counted. Alternatively, the time needed to complete 5 sit-stand cycles is measured and recorded. The subject does not have to touch the seat back in between cycles. Some researchers consider the 30SecSTS to be more of a measure of endurance than strength. Norms have been published on community- dwelling adults for the 30-Second Sit-to-Stand (Rikli & Jones, 2001). The Timed Up and Go (TUG) test measures basic mobility. The subject is instructed to stand up from a chair, walk 3 meters, turn, and return to a sitting position. This activity is timed and repeated three times and the times are averaged. Age-specific norms are available. See Appendix A for an instruction and norms form. Adequate reaching, bending, and extending of the joints afford the body independence in a variety of obligatory and discretionary activities. Flexibility is defined as the available range of motion in a human joint and depends on the condition of the soft tissues of the joints, tendons, ligaments, and muscles (Dal Bello-Haas, 2009). Although change in maximum range of motion (ROM) in the joints of older adults is likely influenced by a multitude of factors, including dietary deficits, decreased activity, and osteoarthritis, there is evidence suggesting that specific age-related changes in collagen at the cellular level may result in decreased joint flexibility (Lewis, 2002; Robnett, 2008). The goal of flexibility programs is to improve range of motion in the major muscle tendon groups in accordance with the functional needs of the older adult (Garber et al., 2011). Although ROM and flexibility exercise is an important and integral component of physical therapy practice following orthopedic injuries or surgeries, few studies have investigated the benefit of flexibility exercise to improve functioning in older adults. The 2011 ACSM position statement on exercise prescription suggests performing flexibility exercise after cardiorespiratory endurance or resistance exercise for general fitness programs (Garber et al., 2011). However, consistent evidence regarding dosage is still lacking (Stathokostas, Little, Vandervoort, & Paterson, 2012). The 2009 ACSM position statement says that flexibility training may enhance postural stability and balance when combined with resistance training (ACSM et al., 2009). Frailty The term frailty , though not new, has taken on a more targeted clinical identity as healthcare practitioners and researchers attempt to better understand the enormous variations in health and functional performance in older adults. Frailty reflects a complex state of health, including a reduced reserve capacity that makes older adults more vulnerable to adverse events and outcomes such as acute illness, falls, and even death (Langlois et al., 2012). Frailty results in increased dependency in functional activities, more use of health care, and greater likelihood of placement in a long-term care facility. Frailty has been described as a biologic syndrome in which an individual has decreased reserve and resistance to physiologic stressors that results from cumulative declines across multiple bodily systems (Campbell & Buchner, 1997). A frail person faces greater challenges when attempting to address and recover from physical stressors. Frailty is commonly defined as a physical phenotype in the Fried Frailty Index and is deemed to exist when an older adult experiences three or more of the following conditions: ● Unintentional weight loss of greater than 10 pounds in the past year. ● Increased muscle weakness as reported by grip strength of
● Low physical activity levels (Collard, Boter, Schoevers, & Voshaar, 2012; Fried at al., 2001). Older adults who have fewer than three components are at an intermediate pre-frail stage, and those with none of the listed conditions are considered robust (Fried et al., 2001). Because factors other than physical performance may indicate a state of frailty, the Fried Frailty Index provides an alternate definition by considering impairments in a broader variety of areas, including social and psychological aspects (Collard et al., 2012; Rockwood et al., 1999). Limited research has been reported on the effectiveness of physical therapy for functional improvement of frail older adults, and physical therapy practitioners have been challenged to further investigate the efficacy of services for this specific, challenging population of older adults (Ottenbacher et al., 2009). Daniels, van Rossum, de Witte, Kempen, and van der Herwel (2008) found that some studies indicate that early involvement of occupational and physical therapy might be a crucial factor for the effectiveness of interventions in the management of frailty. The healthcare needs of older adults, especially those with frailty and chronic conditions, are often followed by an interdisciplinary team made up of physicians, physician assistants, nurses, and rehabilitation therapists who specialize in geriatrics. Sensory changes Changes in the sensory system are a natural consequence of aging. Sensory impairments are common among older adults. In 2010, close to one-half of older men and more than one-third of older women reported trouble hearing (Federal Interagency Forum on Aging-Related Statistics, 2012). The percentage of older adults with impaired hearing was higher for people age 85 and older (59%) than for people age 65 to 74 (31%). Auditory system changes related to aging include the need for more processing time, difficulty hearing higher frequencies, and decreased ability to locate sound. Men are more likely to be affected by age-related hearing loss (presbycusis) than women (Parham, McKinnon, Eibling, & Gates, 2011). In terms of impact on function, hearing loss can reduce a person’s ability to use the telephone, hear the doorbell, be aware of emergency situations, and participate socially. Often, others will mistake a person’s hearing loss for a cognitive impairment. In 2010, 14% of the older adult population in the U.S. reported a visual limitation, even with corrective lenses (Federal Interagency Forum on Aging-Related Statistics, 2012). Vision is the primary method of information gathering for most adults. With normal aging comes a need for increased lighting, a declining ability to distinguish color and contrast, and a declining visual focus (presbyopia; Robnett, 2008). Visual deficiencies are also independently associated with increased risk of falling, functional decline, and depression (Mitchell & Bradley, 2006). Among people age 85 and older, 27% reported trouble with their vision. The major causes of blindness and reduced vision in aging are age-related macular degeneration, glaucoma, cataracts, and diabetic retinopathy (Carlo, Cavallotti, & Cerulli, 2008). Age- related macular degeneration is the leading cause of blindness and visual disability in individuals over the age of 55 years in developed countries and is characterized by blurred vision and image distortion in the area of central vision where we see the finest details (Querques, Avellis, Querques, Bandello, & Souied, 2011). Glaucoma results in optic nerve damage, causing blurred vision and peripheral visual field loss. Cataracts may cause blurred vision, increased sensitivity to glare, and double vision. Diabetic retinopathy may cause blurred vision, floaters, visual field loss, and poor night vision. Older adults with visual impairments may express difficulty with a variety of daily tasks. Examples of difficulties might include: ● Reading prescription name and dosage on a pill bottle. ● Setting a thermostat or microwave. ● Selecting clothes that match. ● Determining if food is fully cooked or spoiled.
less than 30 kg for men and 18 kg for women. ● Reduced walking speed of less than 0.65 m/s. ● Self-reported exhaustion.
● Making a telephone call. ● Detecting fall hazards.
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