Gerontology

Question 1

What is the definition of physical activity?

Answer 1

Any force exerted by skeletal muscle that results in energy expenditure above resting level

This includes:
“The full range of human movement, from competitive sport and exercise to active hobbies, walking and cycling or activities of daily living”

Question 2

What is the definition of being sedentary?

Answer 2

Sedentary refers to a person taking less than 30 minutes of activity per week

Question 3

What conditions are physical inactivity associated with? 9

Answer 3

1. CHD
2. Stroke
3. Obesity
4. T2DM
5. HTN
6. Colorectal cancer
7. Stress/anxiety
8. Osteoarthritis/osteoporosis
9. Lower back pain

Question 4

What is sarcopenia?

Answer 4

Sarcopenia is the degenerative loss of skeletal muscle mass and strength associated with ageing.

Question 5

Globally, what is the prevalence of physical inactivity among adults?

Answer 5

17%

Question 6

What % of disease burden and number of deaths in developed countries are caused by physical inactivity according to WHO?

Answer 6

3% of disease burden and 1.9 million deaths in developed countries are caused by physical inactivity

Question 7

What are the benefits of exercise (4)?

Answer 7

1. Prevention of disease
   - Diet and exercise significantly reduce the incidence of development of diabetes
   - Endurance predominant activity can prevent both the development of hypertension and reduce blood pressure in hypertensive individuals
   - Physical activity leads to reduced obesity and improved lipid profiles, insulin resistance and endothelial function
   - Lower risk of cancer, especially colon cancer, and breast cancer in females
   - Lower incidence of stroke, MI, and used in treatment of heart failure and intermittent claudication
2. Prevention of disability
3. Prevention of complications of immobility and isolation
4. Improves life expectancy

Question 8

What are the health benefits of exercise specific to older people?

Answer 8

1. Disease prevention, mortality reduction
2. Improve strength, balance and coordination in older age helping to prevent falls, reducing complications of immobility and helping to maintain independence for activities of daily living
3. Active lifestyles provide opportunities for recreation and social activity. This can increase social participation, improve quality of life and prevent depression
4. Regular physical activity can also slow cognitive decline

Question 9

What is the estimated cost of physical inactivity in England a year?

Answer 9

£8.2 billion including direct costs of treatment for the major lifestyle-related diseases, and the indirect costs caused through sickness absence

Question 10

What % of women do not have the aerobic capacity to walk comfortably at 3mph?

Answer 10

50%

and a significant proportion of men

Question 11

Among adults older than 65, what % cannot walk outside independently and what % cannot manage stairs?

Answer 11

12% cannot walk outside independently and 9% cannot manage stairs

Question 12

What proportion of care home residents are classed as inactive?

Answer 12

Majority

Question 13

What areas of functional capacity do older people lose (8)?

Answer 13

1. Kinesthetic awareness
   - an individual’s conscious awareness of body and joint position in space
2. Thermoregulation
3. Aerobic capacity
   - max amount of oxygen the body can use during a specified period, usually during intense exercise
4. Muscle strength
5. Flexibility
   - absolute range of movement in a joint or series of joints.
   - loss of flexibility can lead to balance problems
6. Muscle power
   - efficiency of muscle contraction (the ability to produce force quickly)
7. Bone density
8. Proprioception
   - the unconscious perception of movement and spatial orientation arising from stimuli within the body itself

Question 14

What is the Heidelberg guideline?

Answer 14

Framework to classify older people into 3 groups according to their physical activity needs

Question 15

What are the 3 groups in the Heidelberg guideline?

Answer 15

Group 1: Physically unfit frail - unhealthy dependent

• These individuals are no longer able to function independently in society due to a variety of physical and/or psychological reasons.
• Appropriate physical activity can significantly enhance their quality of life and restore independence in some areas of functioning

Group 2: Physically unfit – unhealthy independent

• These individuals are not engaged in adequate physical activity.
• While they are still living independently they are at high risk of developing chronic medical conditions which may threaten their independence.
• Regular physical activity can improve functional capacity and prevent loss of independence.

Group 3: Physically fit – healthy

• These individuals regularly engage in appropriate physical activity.
• They can be described as physically fit and can participate in all activities of daily living.

Question 16

What are the 5 components of the hierarchy of physical function in older adults?

Answer 16

1. Physically Elite
   - These people may participate in sports competitions for senior adults, high risk sports and power exercises
2. Physically Fit
   - These people may participate in moderate intensity physical work, take part in endurance sports and engage in most hobbies
3. Physically Independent
   - These people may engage in very light physical work, some hobbies (such as walking or gardening), low physical demand activities (such as golf, social dance, hand crafts) and pass all instrumental ADLs
4. Physically Frail
   - These people may engage in light housework, food preparation, grocery shopping, and can pass some instrumental ADLs and all basic ADLs, though they may be housebound.
5. Physically Dependent
   -These people cannot pass some or all basic ADLs such as walking, bathing, dressing, eating or transferring.
   They may need home or institutional care

Question 17

What are the most common risks of exercise in older adults?

Answer 17

MSK injury - most common

and falls

Question 18

What is the International Classification of Functioning, Disability and Health?

Answer 18

WHO framework for measuring health and disability at both individual and population levels. It is based on the rationale that when considering physical functioning it is important to not confuse activity limitation (inability to perform a task) or impairment (absence or loss of body structure or function) with fitness.
This system is widely used in rehabilitation research and practice to describe impairments of body structure and function and how these impact on activities and participation

Question 19

According to HEA figures, what proportion of men and women aged 55-74 years participate in the recommended levels of physical activity?

Answer 19

29% men and 21% women

Question 20

What is the current recommended adult guideline for physical activity?

Answer 20

30 minutes of at least moderate intensity physical activity on at least 5 days a week

The WHO has published guidelines for adults > 60 that recommend building up to at least 30 minutes of aerobic exercise on most if not all days

The recommended 30 minutes can be achieved by doing all the activity in one session or through several shorter bouts of activity of 10 minutes or more

Question 21

How can you tell you are doing moderate intensity exercise?

Answer 21

Moderate intensity implies the heart rate and work of breathing are increased so a person will feel an increased warmth but should still be able to maintain a conversation.

Question 22

What are the 5 types of physical activity?

Answer 22

1. Endurance (aerobic) activities
   - Cardiorespiratory or ‘aerobic’ endurance exercises increase the heart rate and improve the health of the heart and lungs and improve the circulation.
   - These activities may include cycling, swimming, brisk walking, heavy housework or gardening.
   - The recommendation is for adults to undertake moderate intensity aerobic physical activity for a minimum of 30 minutes on five days a week.
2. Muscular strength and power exercises
   - These activities can help to offset bone loss and assist older people in performing activities of daily living such as climbing stairs, rising from a chair and moving household objects.
   - should be performed on 2-3 days per week, with a day of rest between work-outs
3. Bone building exercises
   - These exercises help to stimulate bone activity by working against gravity, and may be specific exercises targeted at the main fracture sites such as the spine, hip and wrists e.g. squeezing tennis balls daily for 10 mins
4. Balance exercises
   - Help to prevent falls e.g. tai-chi and aqua-aerobics
   - the general consensus is that older adults with substantial risk of falls should perform exercises that maintain or improve balance and three occasions per week
5. Flexibility exercises
   - Stretching is important since it helps to keep the body supple and flexible.
   - This helps older people to keep a wider range of movement and maintain their ability to perform everyday tasks. Stretching of all the major muscle groups should always be done before and after strengthening or aerobic exercise
   - The recommendation is that stretching should be carried out before and after any endurance or strengthening activities or if such exercises are not possible an individual should perform activities that maintain or increase flexibility on at least two days a week for at least 10 minutes a day

Question 23

What are different ways older people can achieve physical activity, depending on limitations and impairments?

Answer 23

1. Continued or renewed sports participation and active recreation including fitness, exercise and dance activities and groups.
2. ‘Active Living’ including walking, cycling, swimming and gardening. This may include playing with grandchildren, posting a letter or walking in shopping centres
3. Assisted corridor and ward walking, or activities in the hydropool.
4. Chair-based activities.

Question 24

Promoting physical activity with older people is an important factor which is considered in the implementation of a wide range of both local and national policies. What are the other policies?

Answer 24

1. Active ageing - such as non-governmental agencies and the voluntary and independent sector.
2. Physical activity such as sport, leisure and recreation
3. Health promotion - such as health promotion services for older people, primary healthcare and hospitals
4. Local government services such as health and social care services, environment and planning

Question 25

What are the intrinsic or extrinsic barriers that older people have to physical activity?

Answer 25

Intrinsic: include negative previous experiences, concerns about the possibility of harm or over-exertion, concerns about facilities or a lack of confidence

Extrinsic: relate to the environment, available opportunities and attitudes of other people. These may include skills and attitudes of advisors, the facilities or opportunities available and access to them, concerns over cost, transport or personal safety and sport or recreation policies.

Question 26

What are solutions to intrinsic barriers to exercise in older people (6)?

Answer 26

These barriers are best addressed by individuals working directly with older people to provide education, motivation or programme planning. This might be a nurse, GP, health visitor, peer mentor or health champion:

1. Emphasise non-health benefits
   - social aspects, personal goals e.g. playing with grand children
2. Provide info around life events
   - e.g. work pre-retirement programmes, guidance at the onset of illness or disease
3. Provide reassurance
   - about injury etc and that it is never too late to start
4. Enhance self-efficacy and confidence
5. Provide education, advice and information
   - i.e. how to get started, what is available etc
6. Change perceptions of what active means
   - even small changes can make a difference

Question 27

What are solutions to extrinsic barriers to exercise in older people (5)?

Answer 27

These concerns are more likely to be addressed by those responsible for policy and strategic developments relating to older people

1. Media and communications
   - Provide info on local opportunities and exercise in diff languages, formats etc. Create info cues in public places e.g. use the starts
2. Physical environment
   - increase no. exercise classes and groups for older people
   - improve physical environment to encourage walking or cycling.
   - improve transport options and safety of neighbourhood
3. Organisations and institutions
   - encourage GPs and nurses to assess physical activity levels and promote active lifestyles.
   - Give healthcare providers access to materials to assess and counsel patients over 50 about activity.
   - Raise awareness amongst staff in older people’s services.
4. Create positive images of older people
   - Promote positive non-stereotypical images of older people.
   - Use activity ‘ambassadors’ or physical activity role models from same population.
5. Social and cultural environment
   - Community events promoting activity for older people.
   - Public education to change perceptions of older people.
   - Establish walking groups and buddy systems

Question 28

What is an ageing population?

Answer 28

An ageing population is one in which there is an increase in the proportion of older people with a corresponding decline in the proportion of children and young adults

Question 29

What is the definition of total fertility rate?

Answer 29

The expected number of children born per woman in her child-bearing years

Question 30

What is the definition of replacement level?

Answer 30

The number of children required to join the population to replace each couple

Question 31

What is the definition of perinatal mortality rate?

Answer 31

The number of stillbirths and deaths of infants under 1 week of age per 1,000 live and stillbirths

Question 32

What is the definition of birth rate?

Answer 32

The number of live births per 1,000 women in the age group 15-44 years

Question 33

What is the definition of expectation of life at birth?

Answer 33

The average number of years which a new born baby can be expected to survive if current mortality rates continue

Question 34

What are the 2 improvements in survival over the past few decades that have led to an ageing population?

Answer 34

1. Reductions in childhood and infant mortality so they were more likely to survive childhood and reach adulthood
2. Reductions in mortality during adulthood
   - improvements in living standards and other social/economic determinants of health

Question 35

What are the main determinants of health (look at picture) from inside to out?

Answer 35

1. Age, sex and hereditary factors
2. Individual lifestyle factors
3. Social and community networks
4. Living and working conditions
5. General socio-economic, cultural and environmental conditions

Question 36

What are the components of the living and working conditions sector of the main determinants of health model?

Answer 36

1. Agriculture and food production
   - the 20th century saw considerable improvements in the nation’s diet
2. Education
   - The Fisher Act of 1916 made education compulsory up to the age of 14. This was increased to 16 in the 1960s.. Better education allowed citizens to make lifestyle choices which would benefit their health
3. Work environment
   - Health and safety legislation has improved safety in the workplace
4. Unemployment
   - The impact on health of poverty and low income as a result of unemployment are well known
5. Water sanitation
   - Presently 100% of UK households have access to clean water and 94% are connected to networked sewerage (with the remainder using septic tanks)
6. Healthcare services
   - The National Health Service, providing universally healthcare free at the point of access, did not emerge until 1948
7. Housing
   - In the 20th century steps were taken to improve the amount and quality of housing. This included slum clearance schemes.

Question 37

How has fertility rates changed since 1900 and why?

What is its overall impact?

Answer 37

1. High birth rates at 1900 but decline from 1900-1930
   - Poor methods of contraception led to high birth rates
   - Decline due to: war and death of men, economic crisis
2. Rise from 1930-1960s
   - Post war baby boom
3. Decline from 1960s to now
   - Better contraception
   - Abortion legal
   - Oil crisis in 1973
   - Women working

The lower birth rates at the end of the 20th century meant that fewer children were coming into the population, leading to the older people already in the population becoming a larger proportion of the whole population

Question 38

What services are important in helping people who wish to live in their own homes even when they are in poor health or have physical or mental health needs?

Answer 38

Community health and social care services
Respite care for carers

(many are cared for at home by family)

Question 39

How has the expectation of life at birth changed over the years?

Answer 39

Life expectancy has increased

Question 40

What % of older people live in a long stay care facility?

Answer 40

20%

The rest live at home