HLTB01H3F: Health, Aging and the Life Cycle
Functional Health and Social Support.
A&G: Chapter 8
Functional Health, Health Promotion and Quality of Life
• A person’s state of health is more than the simple sum of physical illness and problems.
• Functional health refers to the ability to take care of personal needs such as bathing, toileting, and
dressing, as well as being able to engage in everyday tasks, including shopping, paying bills, using the
telephone, and navigating the physical and social environment.
• Health promotion programs optimize health and health behaviours and intervene in illness, therefore
decelerating the effects of disease and functional losses
• Quality of life is an overarching construct that includes optimal health and maintence of independence,
but it also has affective and cognitive components.
• There is an increased chance of developing a disability in later life, especially among those over 85
years of age and older.
• In advanced stages, chronic diseases affect many of the everyday activities of the older person
• Sensory problems- make it difficult to hear or see, impairing mobility and social interactions
• Cognitive problems can limit people the ability to complete simple tasks [balancing a checkook]
• Congestive heart failure- can limit the person in making their beds or lifting heavy bags
• Arthritis and Osteoporosis- limit people when driving their cars
• Deterioration in balance and gait is a predictor of worsening health and decline of these abilities has a
major impact on the sensory, social, and mental functions of the older person.
• The loss of sense of balance is a major contributor to falls and fractured hips.
• Functional decline can also result from the cumulative effects of multiple organ dysfunctions; even
modest losses, if they occur in multiple sites, can add to the stress load on the body.
Assessing Functional Health
• Two of the most frequent ways of assessing functional health include: measures of daily living skills i.e.
activities of daily living (ADLs) and instrumental activities of daily living (IADLs).
• Gait, balance and cognitive function can be assessed as well.
Activities of Daily Living
• ADL six basic functions: bathing, dressing, toileting, transferring from bed to chair, continence, eating
• In general, ADLs are measured by asking either the person or the caregiver whether a task can be
completed i.e. “Can you dress yourself?” At other times, it is more appropriate to observe the person
completing a task.
• Answers can be categorized to three things:
o Ability to perform the task independently
o Ability to perform with some assistance
o Inability to perform the task even with assistance
• Best way is to observe them at home
• Although few older adults have ADL limitations, these numbers increase with age, especially for
• In general, older people are more likely to need assistance with bathing than any other ADL.
1 Instrumental Activities of Daily Living
• To complete IADLs, a person has to have the physical and mental abilities to perform a task, as well as
• Basic tasks involved: using the phone, shopping, food preparation, housekeeping, laundry, independent
travel, taking scheduled medications, being able to handle finances
• Questions related to IADLs are generally worded, “Can you go shopping for groceries?”
• Responses include: 1) without help 2) with some help 3) completely unable
• Reasons why they can’t perform the tasks: physical limitations, environmental barriers, social
constraints, and cognitive impairment or mental illnesses.
• There are age and gender difference in IADL performances.
• As with ADLs, IADL limitations increase with age.
• There are gender differences as well, with women having more impairment than men. By 85+ almost
half of all women and more than a quarter of men have some IADL limitation
• In general, there has been a decrease in the rate of impairment in ADLs and IADLs among older adults
in the past two decades.
• Women= chronic illness
• Men= mortal illnesses
• There has been a concomitant decrease in nursing home residency over the past two decades.
• From 4% in 1982 to 3% in 1999- those unable to perform ADLs decreased
• Reasons: better health care, more user-friendly environment, slowing of the of progression of chronic
degenerative diseases [ dementia, strokes, and heart disease]
• Older African Americans generally had greater rates of disability than non African Americans , their rate
of improvement over the time of the study was greater
• Decrease in nursing home residency – due to increased home health care & growth of assisted-living
Balance and Gait
• Another way to measure functional ability is to assess the balance and gait of the person.
• Loss of coordination is a risk factor, clinicians evaluate an older persons risk of falling
• Scale- developed by Tinneti in 1986- includes observing a person rising from a chair to a standing
position, walking & turning, and standing and leaning forward and backward = all these assess strength,
flexibility, and balance
• Another measure of functional health is cognitive ability, in particular, ability to care for oneself
• Evaluate memory, functional limitations, judgment, and social appropriateness with cognitive losses
• Commonly used tool: Short Portable Mental Status Questionnaire developed in 1975 by Pfeiffer.
o 10-item scale
o Measures recent and remote memory
• Measuring the functional status of those with dementia requires a different sort of tool than the usual
ADL and IADL scales.
• Loewenstein et al. (1989) discovered the tool: Direct Assessment of Functional Status (DAFS)
o Directly observe a persons ability to complete a functionol
• There are other challenges in measuring the functional ability of those with dementia, such as how to
assess their environment for safety and their need for supervision, or management of behaviour.
• Functional losses are closely entwined with the psychological, social, and physical h