Jacqueline's Blog

INNOVATIONS IN AGING recently published the article 'Implementing STEADI in Academic Primary Care (OHSU) to Address Older Adult Fall Risk'. 

The STEADI is an important falls screening tool that is recommended by the Center for Disease Control (CDC) to healthcare providers and is benefiial to fitness professionals in determining fall risk in senior clients and the outcome of the screening is essential in the development of an effective and beneficial exercise program that allow older adult clients to stay functionally healthy and independent.

Fitness & Function has been using the STEADI Fall Risk Screening as a major defense plan for their older adults clients who wish to remain independent while aging for at least 4 years or more. This article shows that timely intervention can prevent a lot of pain and despair in the aging population when used appropriately. 
 

Falls are the leading cause of injury-related deaths in older adults.Objectives include describing implementation of the Centers for Disease Control and Prevention’s Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative to help primary care providers (PCPs) identify and manage fall risk, and comparing a 12-item and a 3-item fall screening questionnaire. 

When any of our clients is identified as being at high fall risk, a falls Intervention program is designed specifically tailored to target the balance disorder. Our highly specialized personal trainers and physical therapists provide in-home fall risk intervention, balance and mobility training aimed to help our clients to achieve optimal function to remain independent to advanced 90+ years of age.

Read the complete article by following the link below. https://academic.oup.com/innovateage/article/1/2/igx028/4669728

Innovations in Aging, Volume 1, Issue 2, 1 September 2017, igx028, https://doi.org/10.1093/geroni/igx028 Published: 28 November 2017 Article history

I have incorporated the Senior Fitness Test as a functional fitness assessment with many of my personal training clients and class participants.

Most people do not like to get tested, however most like to stay independent.

As an older adult, this assessment when administered correctly is your TOOL TO LIFELONG INDEPENDENCE.

When your goal is to remain physically independent until ‘late in life’ (defined as 90+ years of age). The appropriate wellness goal to strive for is achieving the ‘FITNESS STANDARD’ which is the MINIMUM level of fitness needed to support functional mobility and physical independence. 

Achieving the Fitness Standard means having the ability to do common everyday activities such as simple housework, climbing steps, lifting and carrying objects, and walking far enough to do your own shopping and errands.

Going beyond the Fitness Standard is something that is achievable by many older adults, some are even OFF THE CHART!

Appropriate and timely assessments can identify areas of weakness that will need attention if declines leading to functional limitations are to be prevented or reduced. (Senior Fitness Test Manual 2nd edition Roberta E. Rikkli and C. Jessie Jones.)

BENEFITS of The Senior Fitness Test ASSESSMENT:

1 Can tell you whether your physical capacity on each item ranks in the Above Normal, Normal, or Below Normal categories compared with others of same age and gender.

2 Can tell you whether you have the recommended fitness level for your age to remain functionally independent until late in life - defined as 90+ years of age.

3 By taking the test on a regular basis you can track scores over time and monitor changes in performance.

4 Identify areas of weakness that will need attention if declines leading to functional limitations are to be prevented or reduced.

When you are experiencing changes in balance or having difficulty with balance and mobility the best place to practice skills and balance exercises is in the home. Since most falls happen in and around the home part of a targeted exercise program is learning to navigate safely through and around the home, build more confidence and prevent a falls or injuries.

The Center for Disease Control (CDC) states that one out of every four older adults 65 years and older fall annually and that falls are the main reason older adults lose their independence. Since falls and fall-related injuries happen in the home, older adults benefit more from bringing either the balance and mobility specialist or physical therapist to the home and receive targeted exercises that can be practiced on a daily basis.

Exercises at a fitness center or a physical therapy clinic do not often or always directly relate to the home. Additionally, older adults at high risk for falling or physically de-conditioned often do not have the stamina to fully benefit from an exercise or therapy session outside the home because by the time they get there they are already tired. Remembering the exercises for daily at home practice can also pose a problem and exercises are either not performed correctly or not done at all.

FALLS INTERVENTION is part of a Balance and Mobility Specialist and Physical Therapist's job. Restoring functional health, strenth, balance, mobility, adding years to our client's life and quality of life to our client's years with targeted exercise programs is our business.

When you are beginning to experience balance issues, had a near fall, a fall with or without injuries it is time to find out why you are having these problems. Just beginning an exercises program that includes balance exercises may or may not improve your balance or prevent falls from happening.  

Medications Increasing Fall Risk

One of the risk factors for falling we look at during the initial assessment and evaluation is the number of medications prescribed; according to CDC- Center of Disease Control, taking four or more medications daily increases fall risk among the elderly. We often notice that the type of medications prescribed to older adults are also associated with falls and fall related injuries. Medications such as Metformin for diabetes, Citalopram, Lamotridine, and Loratafine for depression, Simvastatin for cholesterol, Nadalol and Valsartan for blood pressure, and many more are prescribed to older adults. Some medications need to be taken to sustain life, however with targeted exercise many of these medications maybe reduced in dosage or can be completely eliminated, thus reducing and eliminating medication side effects and dramatically lower the fall and injury risk.

Reducing Fall Risk Factors
When we also are able to improve muscle strength, posture, joint range of motion and stability, we reduce the number of balance disorders and fall risk factors for falling which often leads to huge improvements in quality of life and even restore someone's ability to live independently.

There are many reasons why people fall, however the risk for falling seems to increase with age. Falls are not a normal part of aging, an inevitable part of aging and the aging process by itself does not cause falls to happen. Unfortunately many older adults wait too long and falls with or without injuries happen. Falls are the number one reason older adults lose their independence and one out of every four older adults falls annually. About 40 percent of all assisted living admissions are relegated to falls and fall related injuries.

The Good News
Many seniors hire us to receive intervention and exercise training for improving balance, mobility, strength aimed to prevent falls and fall related injuries. Even at advanced age (90+ years), older adults can make improvements in strength, balance and mobility and improve functional health to the level that they can remain independent living in their own home. Reducing and eliminating risk factors for falling that are within your control can bring years to your life and quality of life to your years.

Nordic Walking allows people with fibromyalgia a safe exercise intervention that allows them to walk outdoors without having to avoid hills and increasing fall risk. 

Persons with fibromyalgia can enjoy the same improvement in strength, flexibility, aerobic capacity and perhaps postural control as can healthy persons according to Arthritis Research Therapy.

Symptom flares are commonly exacerbated by exercise that is not modified for fibromyalgia. Specific aerobic activities that involve fast cycling, running, jumping, quick turns and certain dance moves may result in symptom flares, as can higher intensity exercise compared to lower intensity exercise.

Clinician often recommend exercise program for fibromyalgia patients 'start low and go slow', exercise should provide significant fitness improvements without a symptom flare, improve fatigue, pain, sleep, mood/distress and quality of life.

Research shows that moderate to high intensity (Rating of Perceived Exertion 13-15) outdoors Nordic Walking with nordic walking poles can activate muscles in the trunk and upper and lower body while adding balance.

The poles also allowed participants to increase their stride length and employ a faster gait or walking speed.

Learn the technique of Nordic walking in one of our clinics and and join the group outdoor Nordic Walking events offered in your community.

Feet, Forks, and Fingers are the Master Levers of Medical Destiny have the knowledge to eliminate fully 80 percent of all chronic disease and premature death. The leading causes of death are heart disease, cancer, chronic lower respiratory diseases, unintentional injuries, stroke, Alzheimer’s disease, diabetes, influenza and pneumonia, kidney disease. David Katz explains that most of these diseases are immediately responsible for an enormous loss of years from life, and an even greater loss of life from years. In that context, heart disease is indeed the most common immediate precipitant of early death among women and men alike. Cancer, stroke, and diabetes do indeed follow close behind. It’s just that these diseases aren’t really causes. They are effects.” 

In the United States, people age 65 can expect to live an average of 19.4 years. 

How are we going to live the 19.4 years after age 65 depends on many variables. We cannot “prevent” death. But what makes death tragic is not that it happens — we are all mortal — but that it happens too soon. And even worse, that it happens after a long period of illness drains away vitality, capacity, and the pleasure of living. Chronic disease can produce a long, lingering twilight of quasi-living, before adding to that injury the insult of a premature death. And that, we can prevent. We can preserve vitality, and we can postpone death to its rightful time, at the end of our full life expectancy.

In other words, the actual, underlying “cause” of premature death in our country fully 8 times in 10 comes down to bad use of our feet (lack of physical activity), our forks (poor dietary choices), and/or our fingers (holding cigarettes).

Flip the switch on any of these factors from bad to good, and the lifetime risk of serious chronic disease was reduced by nearly 50 percent. By changing what we eat and how we live, we can alter the expression of our very genes in a way that immunizes us against chronic disease occurrence, recurrence, or progression.

In his book Disease-Proof: The Remarkable Truth About What Makes Us Well Dr. David Katz provides information on how our behavior has tremendous effects on our health, well-being, and even gene expression. 

What really kills us prematurely, and all too often imposes years of misery beforehand, isn’t a list of chronic diseases, but the factors that cause those diseases. What really takes years from life and life from years is a willingness to know WHAT, yet neglect the opportunity to know HOW. 

What really kills us is the failure to turn what we know and have long known into what we do.

Enlist health fitness professionals such as a personal trainer, medical exercise specialist, health coach and exercise physiologist lifestyle modification to boost vitality, capacity, and the pleasure of living. We are specialist in exercise training and modifying behavior in the prevention and better management of chronic medical conditions and illness, optimize function, health fitness and physical performance.

Redirecting Aging is choosing an aging path that is different than that often portrait by advertisements you see on tv and social media where aging adults are needy, having multiple chronic medical conditions and taking medications and drugs, incontinence pads, assistive devices, scooters, etc. that just flood the tv channels distrupting your viewing pleasure and other media. All these things maybe needed at one point in our life, however many  may also be avoided until very late in life.

Aging by itself does not cause a decline in function

Aging by itself does not cause development of most chronic disease that a large percentage of Americans face.

Aging by itself does not cause falls and injuries to happen.

Aging by itself does not cause bladder problems

These are merely as a result of lifestyle choices, physical inactivity, eating too much and choosing unhealthy foods and beverages.

REDIRECT THE WAY WE AGE:

I often hear that aging is not fun and is not for sissies. Yes, aging comes with change, we have been aging since we were born. Poor lifestyle choices combined with age-related declines accumulate over the years, and catches up with us as we get older, unless we stop it, reverse and redirect it at a time when we are still able to make that choice. Redirecting the way you age is choosing a different path, a path that helps you maintain and improve your quality of life, a path to long-term and extended independence, a path where you are able to make choices.

WHAT IS THE ALTERNATIVE?

The alternative is being led along a path that makes you choose an unhealthy lifestyle; by consuming healthy food and beverage choices, physical inactivity, and/ or exercise that is simply insufficient to balance out your lifestyle. Avoid a path that causes you to take increasingly number of unnecessary medications and other drugs that just fatten the bank accounts of the drug companies and others. When we wait too long to make changes in lifestyle the number of choices that we can make disappear, choices are reduced to the point that there are no more choices, or others must make the choice for us.

STAYING INDEPENDENT AND VIBRANT AS YOU AGE:

Be pro-active in aging and take an active interest into your own aging process by optimizing function, health and fitness, to live a lifestyle that reduces the risk and prevents development of chronic medical conditions, and for those of us with significant medical conditions, to actively slow down the progression and optimize function where possible.

LIFE WELL SPEND?

Today over 86% of healthcare dollars are send treating chronic medical conditions. These conditions directly affect quality of life, affect length of life, they also cause financial struggles by patients and their families, and cause insurances rates to skyrocket thus making it another financial burden for all citizens who are forced to spend thousands of dollars each year on health insurance that no one really can afford to live without, money we all prefer to spend on things that bring us joy and fulfillment in life.

ACHIEVING ENJOYMENT, FULFILLMENT AND HAPPINESS:

Redirecting Aging is about taking charge of your life care, achieving enjoyment, fulfillment and happiness. Redirecting Aging is about being your own Heath Care Provider first by taking on the responsibility realizing that we create our health and well being. Choosing foods, lifestyle choices , activities and products that are truly healthy and protect our being and questioning everything that that is placed before us.

Redirecting how we age is also about choosing and hold accountable our health care provider(s), health insurance company and our fitness professional, and to make sure they truly have our best interest in mind and not their pocket book.

Redirecting how we age is being part of our life plan, taking charge and not taking things for granted, to ask questions and to educate ourselves constantly.

BE THE CEO OF YOUR OWN PERSONAL HEALTHCARE TEAM:

Redirecting Aging and how we age is about being the CEO of your own personal healthcare and life wellness team.

Redirecting Aging is about signing our own personal Declaration of Independence, a life lived by you and not directed or limited by the current healthcare system and the poor lifestyle choices in the media portrait as normal everyday life.
It is well known that most chronic medical conditions are preventable, and seniors falling and losing their independence is something we become accept as normal when in fact these are NOT NORMAL.

The fact is that all these things I just mentioned contributed to the over 86% of healthcare dollars spend. One out of every four older adults over the age of 65 falls annually and those falls are the main reason older adults lose Independence. Fourty percent of assisted living residents lost their independence because of a fall, most if not all of those falls were preventable.

Redirecting age is not picking it anymore and to say; "No, hold on there is another way, and I want to make that choice while I am still able to make choices." Lifestyle changes through increased physical activity, using portion control, truly healthy and more plant based nutrition, and exercise targeted to live well, strong, prevent and/or better manage and control chronic medical conditions with lifestyle medicine first and supplement this with medication only when needed.

Chose to live life redirected and be open to the idea that you have a large control over your health and how you age in your lifetime.

Jacqueline Sinke - business owner - and aging apprentice

Our ability to perceive where we are and how we should respond to changing sensory conditions during our daily lives is heavily dependent on (a) the amount and quality of information we receive from our peripheral sensory receptors and (b) how the brain organizes and integrates that information once it has reached the central nervous system (CNS).

Each of the three sensory systems (visual, vestibular, and somatosensory) contribute to balance and mobility experiences significant changes as a function of the aging process.

·    Decline in visual acuity, contrast sensitivity, and depth perception

·    The threshold for detecting vibration and joint movement increases- may not detect changes in time to respond

·    The number of sensory receptors (hair cells) within the inner ear’s vestibular apparatus drops

·    A reduction in the gain of the vestibular-ocular reflex (VOR)

Although older adults generally are able to compensate for small age-related changes occurring in each of these systems, impairments associated with particular medical diagnosis (e.g. macular degeneration, peripheral neuropathy, Meniere’s disease) combined with severe deconditioning (loss of muscle strength, joint flexibility and range of motion, and  reduced stamina) will negatively affect the postural control system which limit both the types of activities older adults can perform successfully and the environments in which they can function successfully. This causes the older adult to lose balance easily and falls begin occur.

In balance and mobility training we focus on optimizing functioning of the unimpaired sensory systems while compensating for the systems that are known to be permanently impaired.

Careful review of our clients' medical history, and balance and mobility assessments helps us determine which sensory system is permanently impaired or becoming progressively more impaired over time (e.g. macular degeneration, peripheral neuropathy). Your trainer or therapist will then select exercises that would force the use of other, non-impaired sensory systems, so that the older adult can compensate for the loss in one sensory system by maximizing the function of another sensory system.

Balance and mobility exercises will benefit the older adult when exercises are targeted to the impairment. Just signing up for a balance class may or may not provide the results that you are looking for.

Our senior clients enjoy a holistic approach in restoring balance with multisensory balance and mobility training two to three times per week in combination with (two to three times per week) muscle strengthening exercises and daily cardiovascular exercise (e.g. walking, cycling or recumbent cycle, recumbent/seated stepper-NuStep, or recumbent elliptical, swimming), a home and environmental fall safety check. We may also request your healthcare provider to perform a medication review and annual eye exam. This holistic intensive intervention can make dramatic improvements in functional fitness, overall health, and quality of life of our older adult client.

Information from FallProof balance and Mobility Training professional training manual

One of the main priorities of your cardiovascular system is to maintain an adequate blood pressure to ensure sufficient blood flow to your brain.

HYPERTENSION is a blood pressure of >140/90mmHg or being on blood pressure medication (140 is the systolic and 90 is the diastolic blood pressure). High blood pressure increases with age, after age 50 it steadily increases.

• 70% of Americans over the age of 75 have high blood pressure or are on blood pressure medication, with two thirds of those on medication not achieving appropriate blood pressure control, and
• 30% are unaware they have high blood pressure

High blood pressure is an independent risk factor for coronary artery disease, stroke and renal failure (kidney cannot filter waste from the blood). The higher your blood pressure the greater the chance of a heart attack, heart failure, stroke and kidney disease. Long-term high blood pressure thickens the heart muscle and becomes less efficient as a pump.

CHECK YOUR BLOOD PRESSURE on a regular basis and take a reading on both your left and right arm. Sit for about 5 minutes with both feet on the floor before you take your blood pressure. When you experience a difference of 15 mmHg between blood pressure on your left or right arm (either systolic or diastolic you need report this to your healthcare provider.

Your fitness professional often works in collaboration with clinicians and nutritionists to optimize blood pressure lowering potential through lifestyle modifications with pharmacotherapy. Remember that all medications have side effects, are costly and that your first defense for preventing and managing high blood pressure is lifestyle modification.

THE BENEFIT of a targeted and purposeful exercise program that you can prevent and manage your blood pressure, and that you will also see improvements in functional health and fitness. All these are essential for maintaining a high quality of life as you age and long-term independence. Your fitness professional follows the exercise guidelines from the American College of Sports Medicine and the American Heart Association to help you prevent, lower and maintain your blood pressure that includes cardiorespiratory training and resistance training.

Non-medication treatment for high blood pressure includes the following:

 Source: ACE CMES manual