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HLTB01H3Y: Health, Aging and the Life Cycle
Department of Health Studies
University of Toronto at Scarborough
Instructor: Anna Walsh.
Term: Summer 2010 Mondays 10 a.m.-12 p.m.
Lecture Room: SW 319.
Functional Health and Social Support.
A&G: Chapter 8
Functional Health, Health Promotion and Quality of Life
x A person’s state of health is more than the simple sum of physical illness and problems.
x After age 65, rare to find someone that doesn’t have some aches or pains and they have
some form of chronic illness
x 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
x Normative aging changes do not interfere with everyday functioning of the older adult
x There is an increased chance of developing a disability in later life, especially among
those over 85 years of age and older.
x In advanced stages, chronic diseases affect many of the everyday activities of the older
Assessing Functional Health
x 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
x First ADL scale to measure persons ability to complete 6 basic functions: bathing,
dressing, toileting, transferring from bed to chair, continence and eating
x 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.
x More limitations in this increase with age, especially among women
x Older people will need most help with bathing
o Gov’ts initiative in providing homecare services, they get on average one bath or
shower a week
x Occupational therapist looks at the patient’s ability to do this
o Do they need assistance? Safe for them to be left alone?
o Do assessment of functional ability
Instrumental Activities of Daily Living
x To complete IADLs, a person has to have the physical and mental abilities to perform a
task, as well as motivation.
x First IADL instrument: using the telephone, shopping, food prep, housekeeping, laundry,
independent travel, taking scheduled medications, being able to handle finances
x Many elderly people retain their ability to engage in ADL but have trouble with IADL
x Questions related to IADLs are generally worded, “Can you go shopping for groceries?”
x If elderly loses ability to prepare food, go shopping, handling finances, making calls –
many things are compromised (don’t eat properly)
x Few older adults have problems with IADL until 70s or 80s. However by 85+ almost half
of all women and more than a quarter of men have some IADL limitation
o Differences may be due to men having mortal illnesses and women having
x Most frequently lost function is the ability to shop, relatively few lose ability to use the
x Older African Americans have greater rates of disability than non African Americans but
their rate of improvement over time was greater
o May be due to an increase in educational level
x There’s a decrease in nursing home residency
o Older African Americans less likely to be residents
o May be due to increase in home care, assisted living, decrease in functional
Balance and Gait
x Another way to measure functional ability is to assess the balance and gait of the person.
x Gait: ability to walk, climb stairs, mobility
x Balance: ability to stand, walk
x People with neurological conditions > cause more pressure on spinal cord and will affect
their balance (ataxia)
x Gait assessment: checking if you can walk independently
x Used to determine the risk of falling
x Another measure of functional health is cognitive ability, in particular, ability to care for
x Direct assessment of functional status: first tool to measure functional status of those with
x OT does cognitive assessments
o Cognitive losses that affect ability to manage on their own?
o Difficulty with ST memory?
o They retain LT memory longer than ST memory
o Physicians don’t remember to ask pertinent questions (write prescription, tell
them to take it 3 times a day > doesn’t realize patients ST memory problems and
that they becomes disoriented to time)
x Need to look at things holistically > limitations placed on doctors, people not given
treatment they need
Functional Losses, Morbidity, and Mortality
- The consequences of functional losses can be severe, affecting the person’s perception of
self and the ability to maintain normal daily life.
- Need to advocate for them and refer them to occupational or physical therapist for an
assessment because a doctor wont do that
- Functional Limitations can impact lifestyle of the elderly
o Fear of falling can cause further muscle weakness and instability
- Receiving help for one ADL was predictive of needing even more help including LT care
in the home
- It is disease processes that is predictive of functional losses and death, not age
- Increase in ADL impairment = precursor to nursing home placement
Promoting Optimal Functional Health
x Positive and negative health behaviours have a major impact on functional health.
x Mental health also has an impact on functional health.
x Self rated health is a major predictor of health status as wells as mortality over and above
physicians ratings or other objective indicators of poor health
x Elderly may maintain positive health beliefs by minimizing their problems or using
Health Promotion in Older Adults
x Promoting good health behaviour habits is critical to decelerating the rate of aging, but
changing unhealthy habits (such as smoking, drinking, poor diet, and being sedentary) is
often extremely difficult.
x Try to assess quality of life: how are they functioning? How can see if they are suffering?
How can we make things easier for them?
o OT will make recommendations for different assistive devices that can be used
Ex. difficulty bending > long handled reachers
o Need home assessments
See if they can manage to cook by themselves, safety with stove, unable
to lift pots and pans
Can they sit on a toilet by themselves > need rail around the toilet
x Assess individuals to see if they are engaging in positive or negative HC behaviour
o Need to enlist the help of family members
x Elderly can be embarrassed about functional lossess > fear being a burden, being sent to a
nursing home, learnt about ageism and discrimination, fear it could be worse if they
o Fear going to doctors, telling loved ones
Models of Health Behaviour Change
x Early models of behaviour change tended to emphasize behavioural or cognitive
o Behavioural = reward and punishments
o Cognitive = focus on education