Question

Gerontologists have identified 4 dimensions of health—chronological, social, functional and subjective health. Many older adults believe the dimension which most affects quality of life is functional health. Functional health is measured by ADLs and IADLs and is perceived by older adults as being the most important to quality of life. Which ADLs do you believe is the most important to maintaining quality of life in later life? IADL? Why? What measures can be taken to help older adults who need assistance with this ADL or IADL to maintain quality of life? What factors (behaviors) place individuals at greatest risk for functional loss and the need for assistance with ADLs. Explain. Which chronic illness do you believe has the greatest negative effect on functional health? Why? How is functional loss related to disability? Do you think compression of morbidity is possible for future older adult cohorts. Discuss one health promotion program which you believe has the most potential for maintaining good health and quality of life for older adults, keeping in mind that quality of life includes both physical and psychological health? Explain.

Answer 1

Functional Health in Old age

Functional health is the most important quality to have a good life in old age. It is measured by ADLs and IADLs to detect the disability of people to perform the basic tasks of life.

ADLs (Activities of Daily Living) means the basic activities of daily life such as eating, dressing, grooming, toileting, bathing and transferring; which are the core tasks of life. The commonly used measure of functional ability is the Katz Activities of Daily Living Scale. The tasks assessed in this scale are bathing, dressing, transferring, using the toilet, continence, and eating.

IADLs (instrumental activities of daily living) include more complicated tasks such as cooking, using telephone, managing finances, shopping, doing housework, traveling, ability to take correct dosage of medicine etc. IADL is the most important function to maintain good quality of life in old age because it determines the ability of a person to have an independant life in community.

Measures to help Older Adults:

Nobody likes to be dependant on others for the activities of daily living. Everyone wants to feel control over their life and be independent. Always respect their feelings and be empathetic while helping them with ADLs. The following measures can improve the quality of care;

1. Keep a Routine: Make a routine plan for performing activities like eating, bathing, sleeping etc. and stick with it so that the biological clock within the body will get adjusted with the routines easily. Adhering to toilet schedule is important to maintain continence and to avoid accidental incontinence.

2. Perform tasks slowly and be patient: Never rush for completing the tasks. Always allow them to perform slowly and to take as much time as they needed. Encourage them to take part in activities.

3. Limit full baths to 2 - 3 times a week to prevent dryness and other skin complications. Daily partial baths and back rubs are enough to maintain hygiene and circulation.

4. Allow to choose their own grooming. They will have clothing preferences. Choosing own grooming is self satisfactory.

5. Maintain compassion and empathy. If the caregiver is uncomfortable during accidental incontinence or bathing an old person, the client may feel ashamed or embarrassed. So, always be calm and passionate.

6. Exercises: Encourage to do active and passive exercises routinely.

7. Social interactions: Help to interact with others in the same age group and to develop some hobbies.

Risks for Functional Loss

Falls and fractures are the most important risk factors for losing functional ability in old age. Old people are prone to falls because of their instability in gait, impairment of sensory organs and weakness of muscles and joints. Stroke and arthritis also may cause weakness and disability. Diseases like parkinsonism and alzheimier's also may contribute to falls and functional disability at old age. Many medications taking for heart diseases, hypertension, diabetes etc. also may contribute to weakness and subsequent risk of falls.

Chronic illness causing functional disability

Alzheimier's disease is the chronic illness causing functional disability in older people. In Alzheimer's disease, the person will have dementia that causes problems with memory, thinking and behavior. It develop slowly and thus not very noticeable at the beginning stages and get worse over time, and later the patient will be unable to do even daily tasks.

Functional Loss and Disability

Functional loss can occur as a result of disability due to pain, weakened movement, excess fatigability, and lack of coordination. Patient will be reluctant to perform ADLs because of pain and weakness. Excessive fatigability also may prevent the person to do the necessary core tasks of life. Lack of coordination in the movement is another disability which causes functional loss.

Compression of morbidity hypotheses means the age of onset of chronic illness may be postponed more than the age at death and squeezing most of the morbidity in life into a shorter period with less lifetime disability. Increase in life expectancy also increased the disability period through out the world. By promoting early detection of diseases and preventive measures to avoid chronic illnesses, we can reduce the disability period in life.

Home Care Program which includes various group activities to engage old people and help them to have a hobby and fullfiling social life will help to maintain good health and quality of life for older adults.