Assessing Muscle Function and Balance Problems at Home, in the
Transcription
Assessing Muscle Function and Balance Problems at Home, in the
Assessing Muscle Function and Balance Problems at Home, in the Clinic, and in Research 25th IOA Colloquium on Aging September 17, 2013 Bjoern Buehring, M.D. University of Wisconsin School of Medicine and Public Health GRECC, William S. Middleton Memorial Veterans Hospital Madison, WI, USA y of I O. . O A e v i n U r s it M a W di s o n i s c o n s i n Disclosures/Conflicts of Interest None Outline How independent and active are older Americans? Muscle and Biomechanics 101 How do you know how well your muscles work? The impact of poor muscle function on health Activities of Daily Living are Parameters of Independence and Mobility Activity of Daily Living Instrumental Activities of Daily Living Personal hygiene and grooming Taking medications as prescribed Bowel and bladder management Managing money Self feeding Use of telephone or other technology Dressing and undressing Housework Functional transfers (getting into and Shopping for groceries or clothing out of bed or wheelchair, getting onto or off toilet, etc.) Ambulation (walking with or without use of an assistive device) Transportation within the community Impaired Function is Common in Older Adults Several governmental and non-governmental agencies collect survey and health data on older adults The “Older Americans 2012: Key Indicators of Well-Being” report by the Federal Interagency Forum on Aging-Related Statistics (Forum) summarizes several of these indicators Data presented here are based on: Centers for Medicare and Medicaid Services Medicare Current Beneficiary Survey Centers for Disease Control and Prevention National Center for Health Statistics National Health Interview Survey http://www.agingstats.gov/agingstatsdotnet/Main_Site/Data/ 2012_Documents/Docs/EntireChartbook.pdf#page=140 INDICATOR 20 Functional Limitations Impaired Function is Common in Older Adults INDICATOR 20 Functional Limitations Table 20a. Percentage of Medicare enrollees age 65 and over who have limitations in activities of daily living (ADLs) or instrumental activities of daily living (IADLs), or who are in a long-term care facility, selected years 1992–2009 1992 1997 2001 2005 2007 2009 Total 48.8 42.5 43.7 42.1 42.2 41.4 IADLs only 13.7 12.7 13.4 12.3 13.8 12.1 17.7 17.6 4.5 5.1 1–2 ADLs 19.6who have limitations 16.6 17.2of daily living 18.3 Table 20a. Percentage of Medicare enrollees age 65 and over in activities (ADLs) or instrumental activities of daily living (IADLs), or6.1 who are in a long-term care facility, 1992–2009 3–4 ADLs 4.9 5.3selected years4.7 5–6 ADLs Total 1992 1997 3.5 2001 3.2 2005 3.0 2007 2.5 2009 2.3 2.7 Long-term care facility 48.8 42.5 5.9 43.7 5.1 42.1 4.8 42.2 4.3 41.4 3.9 3.9 12.7 13.4 12.3 13.8 IADLs only 13.7 12.1 1–2 ADLs 18.3getting in/out of 17.7 17.6 inability to perform for a health19.6 reason) one or more 16.6 of the following tasks:17.2 bathing, dressing, eating, chairs, walking, or using the toilet. IADL limitations refer to 3–4 ADLs 6.1 are age-adjusted 4.9 5.3 population. shopping, or managing money. Rates using the 2000 standard 4.7 4.5 5.1 5–6 ADLs Reference population: These data 3.5refer to Medicare enrollees. 3.2 3.0 2.5 2.3 2.7 4.8 4.3 3.9 3.9 Long-term care facility 5.9 5.1 Table 20b. Percentage of Medicare enrollees age 65 and over who have limitations in activities of daily living (ADLs) or instrumental activities of daily living (IADLs), or who are in a long-term care facility, by sex, 2009 inability to perform for a health reason) one or more of the following tasks: bathing, dressing, eating, getting in/out of chairs, walking, or using the toilet. IADL limitations refer to shopping, or managing money. Rates are age-adjusted using the 2000 standard population. Reference population: These data refer to Medicare enrollees. Total Both Sexes Men Women 41.4 35.5 45.8 IADLs only 12.1 9.5 Table 20b. Percentage of Medicare enrollees age 65 and over who have limitations in activities of daily living (ADLs) or 1–2 ADLs 17.6 instrumental activities of daily living (IADLs), or who are in a long-term care facility, by sex, 200916.1 3–4 ADLs 5.1 4.3 Both Sexes Men Women 5–6 ADLs 2.7 2.7 Total 41.4 35.5 45.8 Long-term care facility 3.9 2.9 IADLs only 12.1 9.5 14.2 1–2 ADLs 3–4 ADLs 5–6 ADLs 14.2 18.8 5.8 2.6 4.4 17.6 16.1 18.8 http://www.agingstats.gov/agingstatsdotnet/Main_Site/Data/ 5.1 4.3 5.8 2012_Documents/Docs/EntireChartbook.pdf#page=140 shopping, or managing money. Rates are age-adjusted using the 2000 standard population. inability to perform for a health reason) one or more of the following tasks: bathing, dressing, eating, getting in/out of chairs, walking, or using the toilet. IADL limitations refer to 2.7 Reference population: These data refer to Medicare enrollees. 2.7 2.6 Impaired Function is Common in Older Limitations INDICATOR 20 Functional Adults Table 20c. Percentage of Medicare enrollees age 65 and over who are unable to perform certain physical functions, by sex, 1991 and 2009 Function 1991 2009 Stoop/kneel 8.0 10.2 Reach over head 3.1 3.1 Write/grasp small objects 2.3 1.5 14.2 14.5 9.4 7.1 19.1 19.0 15.2 17.9 Reach over head 6.2 4.1 Write/grasp small objects 2.6 1.8 Walk 2–3 blocks 23.1 21.4 Lift 10 lbs. 18.4 13.5 32.0 29.7 Men Walk 2–3 blocks Lift 10 lbs. Women Stoop/kneel NOTES: Rates for 1991 are age-adjusted to the 2009 population. Reference population: These data refer to Medicare enrollees. http://www.agingstats.gov/agingstatsdotnet/Main_Site/Data/ 2012_Documents/Docs/EntireChartbook.pdf#page=140 Walk 2–3 blocks 23.1 21.4 Impaired Function is Common in Older Adults Lift 10 lbs. 18.4 13.5 32.0 29.7 Men Women 65–74 12.9 18.7 75–84 22.1 33.7 85 and over 39.6 53.0 White, not Hispanic or Latino 18.4 28.6 Black, not Hispanic or Latino 23.1 33.4 Hispanic or Latino (any race) 20.4 33.6 NOTES: Rates for 1991 are age-adjusted to the 2009 population. Reference population: These data refer to Medicare enrollees. functions, by selected characteristics 2009 Selected characteristic Age Race Reference population: These data refer to Medicare enrollees. http://www.agingstats.gov/agingstatsdotnet/Main_Site/Data/ 2012_Documents/Docs/EntireChartbook.pdf#page=140 Purchasing goods and services 0.8 3.5 0.9 3.9 0.7 3.1 Grooming 0.7 2.7 0.6 2.7 0.6 2.6 Other activities 1.2 4.8 1.4 5.9 1.4 5.9 Watching TV is THE Leisure Activity of Older Adults NOTE: “Other activities” includes activities such as educational activities; organizational, civic and religious activities; and telephone calls. Table includes people who did not work at all. Reference population: These data refer to the civilian noninstitutionalized population. SOURCE: Bureau of Labor Statistics, American Time Use Survey. Table 28b. Average number of hours and percentage of total leisure time that people age 55 and over spent doing selected leisure activities on an average day, by age group, 2010 55–64 Average hours per day Socializing and communicating 65–74 Percent of leisure time Average hours per day 0.6 11.3 Watching TV 3.0 Participation in sports, exercise, and recreation 75 and over Percent of leisure time Average hours per day Percent of leisure time 0.7 10.3 0.6 8.0 57.8 3.8 55.6 4.4 57.7 0.3 4.9 0.3 4.3 0.2 3.0 Relaxing and thinking 0.3 5.2 0.5 7.8 0.7 8.6 Reading 0.4 7.1 0.6 9.5 0.9 12.2 Other leisure activities 0.7 13.7 0.8 12.2 0.8 10.6 Selected leisure activities NOTE: “Other leisure activities” includes activities such as playing games, using the computer for leisure, arts and crafts as a hobby, arts and entertainment (other than sports), and related travel. Reference population: These data refer to the civilian noninstitutionalized population. SOURCE: Bureau of Labor Statistics, American Time Use Survey. http://www.agingstats.gov/agingstatsdotnet/Main_Site/Data/ 2012_Documents/Docs/EntireChartbook.pdf#page=140 Aerobic and Strength Training is INDICATORUncommon 24 Physical Activity in Older Adults Table 24a. Percentage of people age 45 and over who reported participating in leisure-time aerobic and musclestrengthening activities that meet the 2008 Federal physical activity guidelines, by age group, 1998–2010 Year 45–64 65 and over 65–74 75–84 85 and over 1998 11.4 5.5 7.0 3.9 2.0 1999 11.9 5.9 7.7 4.5 0.9 2000 12.8 6.9 8.4 5.7 1.9 2001 13.1 6.7 7.7 6.1 3.1 2002 14.2 7.1 8.8 5.8 2.1 2003 14.6 7.6 9.2 6.7 2.9 2004 14.0 7.8 9.7 6.4 3.5 2005 14.4 7.9 10.5 5.7 3.0 2006 13.8 7.5 9.1 6.5 3.0 2007 15.0 7.9 9.5 6.6 4.1 2008 16.3 9.5 11.3 9.3 2.3 2009 16.9 10.0 12.8 7.9 2.8 2010 17.8 10.5 13.6 7.3 4.0 NOTE: This measure of physical activity differs from previous editions of Older Americans. (available from: http://www.agingstats.gov/agingstatsdotnet/Main_Site/Data/ of moderate- and vigorous-intensity aerobic activity. Aerobic activity should be performed in episodes of at least 10 minutes, and preferably, it should be spread throughout the 2012_Documents/Docs/EntireChartbook.pdf#page=140 2010 17.8 10.5 13.6 7.3 4.0 Aerobic and Strength Training is Uncommon in Older Adults NOTE: This measure of physical activity differs from previous editions of Older Americans. (available from: of moderate- and vigorous-intensity aerobic activity. Aerobic activity should be performed in episodes of at least 10 minutes, and preferably, it should be spread throughout the activity and muscle-strengthening guidelines. Table 24b. Percentage of people age 65 and over who reported participating in leisure-time aerobic and musclestrengthening activities that meet the 2008 Federal physical activity guidelines, by sex and race and ethnicity, 2010 Aerobic activity only Both sexes Men Women All White, not Hispanic or Latino Black, not Hispanic or Latino Hispanic or Latino 10.5 11.5 5.2 5.6 13.6 14.6 7.8 9.0 8.0 9.0 3.6 3.0 NOTE: This measure of physical activity differs from previous editions of Older Americans. (available from: of moderate- and vigorous-intensity aerobic activity. Aerobic activity should be performed in episodes of at least 10 minutes, and preferably, it should be spread throughout the activity and muscle-strengthening guidelines. http://www.agingstats.gov/agingstatsdotnet/Main_Site/Data/ 2012_Documents/Docs/EntireChartbook.pdf#page=140 Muscle 101 The musculoskeletal system is needed for locomotion and posture It consists of several tissues including bone, muscle, joints, ligaments and tendons Muscle is attached to bone through tendons Muscle contractions lead to body movement www.orthoinfo.aaos.org, www.predatornutrition.com Muscle 101 Muscle cells (or fibers) are long and are grouped into fascicles Several fascicles make up a muscle Muscle cells contain proteins that move within the cell and shorten their length The nervous system is responsible for initiating, controlling and coordinating contractions http://www.sciencelearn.org.nz Biomechanics 101 There are different types of muscle contractions Concentric = muscle shortens as it contracts Eccentric = muscle lengthens as it contracts Isometric = muscle remains at the same length Biomechanics 101 Force (F, Newton) = Mass (m, kilogram) x Acceleration (a, meters/second2) Velocity (v, meters/second) = Distance (d, meters) / Time (t, seconds) Power (P, Watts) = Force (F, Newton) x Velocity (v, meters/second) = Work (W, Joule) / Time (t, seconds) Sway can be measured in “Path length” (Length, meters) or “Area of Sway” (Area, meter2) Grip Strength Can you open a jar? Power grip (232.8 N), Precision grip (248.6 N) Kuo, Proc Inst Mech Eng H, 2009 http://bobonews.tumblr.com/ Grip Strength Grip strength is measured with a dynamometer It is an isometric contraction It measures maximal force http://www.physicalcompany.co.uk Leg Power Can you get up from a chair? out of bed? out of a car? http://www.avin.ca/ Leg Power Leg power can be measured with the repeated chair rise test the get up and go test Power assesses muscle force and speed (velocity) http://tle.tafevc.com.au Leg Power Repeated chair rises can be measured with a stop watch or force platform http://www.galileotraining.com Gait speed How long does it take you to cross the street? Distance: 28 meters (91.9 feet) Time the light is green: 20 seconds (plus 10 seconds of flashing) Although walking requires muscle power it is largely dependent on velocity (not force) Gait speed How long does it take you to cross the street? If gait speed is: 1.3 m/s à 21.5 seconds 1.0 m/s à 28 seconds 0.8 m/s à 35 seconds 0.5 m/s à 56 seconds Gait speed Balance / Sway Do you have difficulties getting out of a bathtub? http://i.ytimg.com/vi/9afRaaNXpbY/0.jpg Balance / Sway Balance The and Sway can be measured with Romberg stance test The semi-tandem and tandem stance test The functional reach test On a force platform Balance / Sway The Romberg and Tandem Stance tests These tests examine static balance http://www.osceskills.com/ http://drxuacupuncture.wordpress.com Balance / Sway The functional reach test This test examines dynamic balance Individuals are asked to lean forward as far as they can without taking a step forward Pérennou, 2005 Balance / Sway Sway can be quantified with a force platform http://www.galileotraining.com How Do you Measure Muscle Mass and Function? Muscle mass is often measured by dual energy x-ray absorptiometry (DXA) http:// info.blockimaging.com Measuring Muscle and Fat with DXA • • Individuals with the same body mass index can have different body composition Older individuals have more fat mass and lower muscle mass Cut-off values for muscle function tests Muscle function test Cut-off Grip strength (dynamometer) Females: <20kg; Males: <30kg Chair rise (5 chair rises) > 11.5 – 15 seconds (depending on age and gender) Get up and go Females and Males > 12 seconds (get up from chair walk 10 feet, turn around, walk back and sit down) Walking speed (20 feet) Females and males < 0.8 – 1.0 m/s Romberg, (semi-) tandem stance Able to stand for 60 (or 30) seconds Functional reach (leaning forward) < 6-7 inches Muscle mass (DXA appendicular lean mass, arms + legs) Females: <5.45 kg/m2 Males < 7.45 kg/m2 Grip Strength is Associated with ADLs / IADLs § 6089 45 to 68year-old healthy men had grip strength measured 1965 through 1970 § 3218 surviving participants had disability assessment 25 years later Rantanen, JAMA, 1999, 10;281(6):558-60 Impaired Physical Performance Increases Hip Fracture Risk Data from the MrOS study, which included 5995 men age 65+ Adapted from Cawthon, et. al., J Bone Miner Res, 2008, 23:1037-1044 Slow Walking Speed is Associated with Increased Mortality Relationship of walking speed and mortality InChianti Study (Aging in the Chianti area study), started 1998, ~1,150 participants, between ages 65 and 102 Cesari, J Gerontol A Biol Sci Med Sci, 2009, 64:377-84 Summary Impaired physical function is common in older adults The (Neuro-) Musculoskeletal system consists of many tissues including bones, muscles, joints and the nervous system Muscle contractions are the origin of movement Muscle functions include force, power, speed and balance Poor muscle function is associated with decreased physical function, hospitalizations and death Thank You