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
• 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
• 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
• 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.
• Although few older adults have ADL limitations, these numbers increase with age,
especially for women.
• In general, older people are more likely to need assistance with bathing than any other
• 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 motivation.
• Questions related to IADLs are generally worded, “Can you go shopping for groceries?”
• 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
1 more impairment than men. In general, there has been a decrease in the rate of
impairment in ADLs and IADLs among older adults in the past two decades.
• There has been a concomitant decrease in nursing home residency over the past two
Balance and Gait
• Another way to measure functional ability is to assess the balance and gait of the person.
• Another measure of functional health is cognitive ability, in particular, ability to care for
• Measuring the functional status of those with dementia requires a different sort of tool
than the usual ADL and IADL scales.
• 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 health
of the older adult.
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. Losses can also foreshadow future
physical and mental problems.
• Functional limitations can impact the lifestyle of the older person.
• Functional losses can affect mental health.
Promoting Optimal Functional Health
• Positive and negative health behaviours have a major impact on functional health.
• Mental health also has an impact on functional health. Another indicator and predictor of
one’s health is the personal attitude of the person. Self-rated health is a major predictor
of health status as well as mortality, over and above physicians’ ratings or other objective
indicators of poor health.
Health Promotion in Older Adults
2 • 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