Slides for a class to Nursing College at UAH, Alabama on Sept 22nd 2022. - Importance of assessing physical function in older-adults - Integrated care for Older Adults - Multicomponent Physical Activity (ViviFrail)

1. Assessing Health in Older-adults
Angelo J. G Bós, MD PhD
Professor at School of Medicine
Researcher at Institute of Geriatrics and Gerontology
Pontifical Catholic University of Rio Grande do Sul
Porto Alegre, Brazil
angelo.bos@pucrs.br

2. What are the most important health problems in
older-adults and oldest-old people?
Go to www.menti.com and use the code: 87 95 84 1

3. Geriatric age-groups
Age-group
Countries
Developed |
Developing
Characteristics intervention
Young adults 18-39 Period of developing good and bad life styles Primary prevention
Middle aged 40-64 40-59 Identifiable asymptomatic chronic
conditions
Secondary prevention
Young older-adults 65-84 60-79 Clinical manifestation of chronic conditions,
light functional decline
Tertiary prevention
Oldest old 85 + 80 + Higher clinical and functional vulnerability
Quartenary prevention
(focus in the quality of life)
Centenarians 100+ Example of longevity
Supercentenarians 110+ Exceptional longevity

4. Example of a Supercentenarian (110 in 2018)

5. Frequency of Chronic Non-Communicable Diseases(CNCD)
in Older-adults and Oldest-old Brazilians
Has a doctor ever diagnosed you
with:
Age group*
Younger Older-adults Oldest-old Total
High blood pressure 10621(54.2%) 1807(60.4%) 12428(55.1%)
Diabetes 3766(19.7%) 539(18.5%) 4305(19.5%)
High cholesterol 5208(27.4%) 659(22.7%) 5867(26.8%)
Heart disease 2208(11.2%) 516(17.1%) 2724(12%)
Asthma 858(4.4%) 125(4.1%) 983(4.3%)
Arthritis 3407(17.3%) 618(20.5%) 4025(17.7%)
Chronic back pain 5811(29.5%) 806(26.7%) 6617(29.1%)
Depression 2122(10.8%) 244(8.1%) 2366(10.4%)
Chronic lung disease 474(2.4%) 113(3.7%) 587(2.6%)
Chronic kidney disease 437(2.2%) 92(3.1%) 529(2.3%)
* Age groups: younger older-adults: 60-79, Oldest-old: 80+

6. Frequency of Difficulties of preforming Basic Activities of
Daily Living (ADL) in Older-adults and Oldest-old Brazilians
Is it difficult for you to
Age group *
Younger Older-adults Oldest-old Total
Eat alone 695(3.5%) 420(13.9%) 1115(4.9%)
Bath or shower alone 995(5.0%) 672(22.3%) 1667(7.3%)
Go to the bathroom alone? 1378(7.0%) 669(22.2%) 2047(9.0%)
Dress yourself? 1840(9.3%) 836(27.7%) 2676(11.8%)
Walk around the house alone from room to
room?
1625(8.2%) 814(27.0%) 2439(10.7%)
Get into or out of bed by yourself? 2041(10.4%) 804(26.7%) 2845(12.5%)
Get into or out of a chair by yourself? 1901(9.6%) 812(26.9%) 2713(11.9%)
* Age groups: younger older-adults: 60-79, Oldest-old: 80+

7. Impact of CNCD on
Self Perception of Health

8. Impact of CNCD on
Self Perception of Health

9. Impact of CNCD on
Self Perception of Health

10. Impact of BADL on
Self Perception of Health

11. Impact of BADL on
Self Perception of Health

12. Functional Ability and Intrinsic Capacity (IC)
Functional ability Domains of Intrinsic Capacity
• WHO:
• “Health-related atributes that enable
people to be and to do what they have
a reason to value”
• Functional ability =
• Instrinsic capacity + environment
• Intrinsic capacity is the composite of
all the physical and mental capacities
that an individual can use.
• Enviroment (good or bad)

13. Add a Slide Title - 3
https://apps.who.int/iris/rest/bitstreams/1257934/retrieve

16. ICOPE App

18. SPPB more complete App - ViviFrail

21. Proposal
• In groups do SPPB in one or two students

22. VIVIFRAIL PROJECT (WWW.VIVIFRAIL.COM)
That is it
• A program for the Promotion of
Physical Exercise that is an
international reference for
community and hospital
intervention for the prevention of
frailty and falls in the elderly. It is
currently being used by more
than 5000 health professionals
reaching an impact on the
effective population of more than
15,000 people.
Aims
• This whole project is based on
the idea that health in older
people should be measured in
terms of its function and not as a
disease that determines life
expectancy, quality of life, and
resources or supports that need
each population. The objective is
to maintain a level of
functionality that maintains the
highest degree of autonomy
possible in each case.

23. Scientific evidences for ViviFrail
• Cadore EL, Millor N, Gomez M, Rodriguez-Manas L, Izquierdo M (2013) Multicomponent exercises
including muscle power training enhance muscle mass, power output, and functional outcomes in
institutionalized frail nonagenarians." Age 36: 773-785. https://DOI.org/10.1007/s11357-013-
9586-z
• Martínez-Velilla N, Casas-Herrero A, Zambom-Ferraresi F, Sáez de Asteasu ML, Lucia A, Galbete A,
García-Baztán A, et al. (2019) Exercise Intervention on Functional Decline in Very Elderly Patients
During Acute Hospitalization: A Randomized Clinical Trial. JAMA Intern Med. 179(1):28-36.
https://doi.org/ 10.1001/jamainternmed.2018.4869.
• Saez de Asteasu ML, Martinez-Velilla N, Zambom-Ferraresi F, Casas-Herrero A, Cadore EL, Galbete
A, et al. (2019) Assessing the impact of physical exercise on cognitive function in older medical
patients during acute hospitalization: Secondary analysis of a randomized trial. PLoS Med 16(7):
e1002852. https://doi.org/10.1371/ journal.pmed.1002852
• Casas-Herrero, Á., de Asteasu, M. L. S., Antón-Rodrigo, I., Sánchez-Sánchez, J. L., Montero-Odasso,
M., Marín-Epelde, I., ... & Izquierdo, M. (2022). Effects of Vivifrail multicomponent intervention on
functional capacity: a multicentre, randomized controlled trial. Journal of cachexia, sarcopenia and
muscle, 13(2), 884-893. htps://doi.org/10.1002/jcsm.12925

25. Establish the weight of the bottle
Exercise Lift a bottle is a strength exercise for which it is
necessary to establish an adequate weight for each person:
• Fill 2 500 ml (16.9on) water bottles.
• Check whether the person is able to perform about 30 repetitions
with the 500 ml bottle.
• Adjust the amount of water in the bottle until the person is able to
do about 30 repetitions with some effort.
• Make a note of the amount of water on page 4 and on the exercise
page of the passport.
• It is recommended that this weight is recalculated after 6 weeks
and the new quantity of water in the bottle adjusted accordingly.

26. PRESCRIPTION OF PASSPORT TYPE A
• PASSPORT DELIVERY
• Let the person know that passport type A is for an elderly person who cannot
rise from a chair or a bed. Explain that by carrying out the program, they may be
able to get up again or, at least, gain safety and autonomy and decrease their risk
of falls. Let them know that the program lasts 12 weeks and that they must do a
daily round of approximately 30–45 minutes.
• The walking exercise will start only when the elderly person has improved their
muscle strength.
• Check the passport with the elderly person, section by section, and complete the
personal data section.
• Encourage them to make an effort to stay on the program until the end, and make
an appointment for that moment.

27. PRESCRIPTION OF PASSPORT
TYPE B and B+
• PASSPORT DELIVERY
• Let the person know that passport type B (frail) is for an elderly people who can
walk with difficulty or help. Explain that by carrying out the program they may
be able to walk again without help or, at least, gain autonomy and balance.
• Let them know that the program lasts 12 weeks and that they must do a daily
round of approximately 45–60 minutes.
• For passport type B+, it is recommended to review the recommendations for people
at risk of falls.
• Check the passport, section by section, with the elderly person and complete the
personal data section.
• Encourage them to make an effort to stay on the program until the end, and make
an appointment for that moment.

28. PRESCRIPTION OF PASSPORT
TYPE C and C+
• PASSPORT DELIVERY
• Let the person know that passport type C (pre-frail) is for an elderly person who
has slight difficulties when walking and also has difficulty getting up or with
balance. It is very important that they exercise to continue enjoying their walks.
Let them know that the program lasts 12 weeks and that they must do a daily
round of approximately 45–60 minutes.
• For passport type C+, it is recommended to review the recommendations for people
at risk of falls.
• Check the passport with the elderly person, section by section, and complete the
personal data section.
• Encourage them to make an effort to stay on the program until the end, and make
an appointment for that moment.

29. PRESCRIPTION OF PASSPORT TYPE D
• PASSPORT DELIVERY
• Let the person know that the passport type D (robust) is for elderly
person who has minimal physical limitations or no limitations. It is very
important that they perform physical exercise so that they are able to
preserve their autonomy for many years. Let them know that the program
lasts 12 weeks and that they must do a daily round of approximately 45–
60 minutes.
• Check the passport with the elderly person, section by section, and
complete the personal data section.
• Encourage them to make an effort to stay on the program until the end,
and make an appointment for that moment.

30. TIPS AND RECOMMENDATIONS FOR PEOPLE AT
RISK OF FALLS
• If there is a vitamin D deficiency (<20 ng / ml), its supplementation with at least 800 IU should be assessed if there are no
contraindications. It is necessary to ensure an adequate oral intake of calcium.
• In patients with diabetes it will be necessary to readjust the treatment of low blood sugar.
• If there are symptoms compatible with postural hypotension, review the number and doses of antihypotensive drugs.
• Overmedication should be reviewed and minimized with special attention to psychotropic drugs.
• A nutritional assessment should be carried out in frail patients.
• Protein-calorie supplements should be taken after the training session to optimize their benefits.
• It is essential to assess the risk of falls in patients with cognitive problems, as they have a high risk of falling and fractures.
• Patients with a previous fracture must be treated for osteoporosis. The main objectives in a patient with a previous fracture
should be preventing any deterioration of functional capacity and preventing new falls and fractures.
• Concerning patients with recurrent falls, it is essential to evaluate and intervene on environmental risks at home (adaptation of
bathrooms, carpets, footwear, etc.).
• All older adults should undergo a comprehensive geriatric assessment, especially those who are frail, since it is the main tool to
detect problems and make decisions.

31. All QR-codes