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Physical Therapists Review Tests of Physical Ability in Seniors
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Posted on: 11/30/1999
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Physical therapists are often called upon to help determine when an older adult is ready to go home after being in the hospital. Or when it's time to move from an independent living situation to an assisted living or skilled nursing care facility. These judgments are made with the assistance of standardized tests that measure physical performance.
In this study, a group of therapists from the Department of Human Movement Sciences at the University of Wisconsin in Milwaukee asked the question: are the results of physical performance tests really a reliable way to predict function at home?
They tested a group of adults (ages 55 and older) who were living in a continuing care retirement community (CCRC). Only adults in the independent living and assisted living sections of the CCRCs were included. They had to be able to walk to participate in the study. Tests used included the Mini-Mental State Examination (MMSE), Physical Activity Scale for the Elderly (PASE), and the Six-Minute Walk Test (6MWT).
The PASE is a self-reported survey. It is usually filled out by people still living at home. The person taking the test answers questions about him or herself regarding exercise activity, work or volunteer activities, and daily household-related activity. The 6MWT was done inside the retirement facility. Each adult was asked to walk for six-minutes. Distance covered in that amount of time is recorded. Blood pressure, heart rate, and ratings of perceived exertion (e.g., no fatigue, moderate fatigue, most fatigue ever experienced) were collected.
After completing these tests, a special device called the StepWatch Activity Monitor (SAM) was attached to the ankle. The SAM was used to count the total number of steps each person took each day for a period of seven days. The device is designed to be used with people who have different walking patterns, speeds, and limps. It can be used by anyone with an assistive device such as a walker or cane. And the SAM can be used in water for those who participate in a pool-exercise program of any kind.
The authors report that the tests used did not really measure actual functioning of older adults living in a senior community. Most of the people tested had much higher physical function than was reflected by the formal testing. It appears that people living in continuing care retirement communities (CCRC) are more active than seniors living independently but not in a CCRC.
That was a surprise because the seniors in the CCRC appeared more physically limited than those living home on their own. The difference may be in the level of activity that goes on in the senior-designed environments. The facilities are set up so that the residents have to walk short distances many times during the day to get their meals, pick up the mail, or participate in any of the many activities available each day.
Several suggestions were made for physical therapists using these common clinical tests. First, be aware that the 6MWT and the PASE tests may not be good predictors of daily physical activity in this population/environment. Caution must be used in looking at the test results and predicting what a senior can or can't do at home (home including a CCRC type setting).
The SAM device may be a better tool to use when measuring daily physical activity. It is easy to use and gives both objective and accurate information about daily physical activity. The only disadvantage in using the SAM is that it may overcount the number of steps taken. That could make it look like the person is engaged in more activity than is really the case.
The results of this study may be a true testimony as to the benefit of living in a retirement community. The environment is designed to meet the needs of older adults with some physical limitations. Short bouts of walking activity at the person's own pace carried out daily and consistently over time seem to be the key to achieving higher physical function. The result is to minimize the impact of physical limitations on daily function for these seniors. That could mean improved quality of life with fewer health problems and greater independence.
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References:
Kathryn R. Zalewski, PhD, PT, et al. Measures of Physical Ability Are Unrelated to Objectively Measured Physical Activity Behavior in Older Adults Residing in Continuing Care Retirement Communities. In Archives of Physical Medicine and Rehabilitation. June 2009. Vol. 90. No. 6. Pp. 982-986.
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*Disclaimer:*The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic. |
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