Old Adults perform ADLs closer to max than young adults

1
FIRST INTERNATIONAL SOCIETY FOR
GERONTECHNOLOGY MASTERCLASS IN GERONTECHNOLOGY TUE
, EINDHOVEN, NL November 13-14 2007 TECHNOLOGY
FOR EXTENDED HEALTH
James L. Fozard, Ph.D. School of Aging
Studies University of South Florida Tampa, FL
33260 For electronic copy of slides, send me an
e-mail request at fozard_at_tampabay.rr.com
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Extended HealthWhats that??What is
technologys role in it??

• Extended health links the WHO definition of
  health to the opportunities and challenges of
  aging. WHO definition of health includes
• Physical,
• Mental, and
• Social well being
• Technologys roles include
• Preventing or delaying age related limitations in
  functioning
• Compensating for age related declines in
  functioning
• Care and support for elderly with illnesses and
  limitations in function
• Enhancing quality of life for all 3 applications

3
Achieving Extended Health requires us to change
how we think about aging

• Negative stereotypes about old age and aging are
  detrimental to the well being and personal
  fulfillment of young and old alike
• Agism is apparent in many jokes
• Pervasive negative stereotypes about aging
• Poor parental training about aging to the young
• Poor appreciation of individual differences

4
Lets change our way of thinking about
agingstarting here

• Pervasive negative stereotypes about aging
• If I knew I was going to live this long, I would
  have taken better care of myself
• One senior to another When does old age begin?
  Answer Later
• Young adults most serious life decision?
• Answer When to begin middle age

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Lets change our way of thinking about
agingcontinuing here

• Poor parental training of the young about aging
• Dennis the Menace to his fathers friend What
  age are you in the middle of?
• Child to grandmother If Im only young once,
  how many times do I have to be old?

6
Lets change our way of thinking about
aging-continuing here

• Poor appreciation of individual differences
• Old man answers question about his age What age
  do you mean--My anatomical, physiological,
  psychological, or chronological?
• This gentleman is both smart and wise, smart
  because of the critical distinctions and wise
  because chronological age is at the end of the
  list
• When asked what his doctor thought about his
  lifestyle choices at age 100, George Burns
  replied, I dont know, my doctors dead.

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Technology can help education and training
activities related to aging

• Create simulations to educate people for aging in
  various situations (BJ Fogg)
• Cause and effect simulations (social skills)
• Environmental simulations (treat phobias)
• Object simulations (drunk driver)
• Simulations of aging for young people can reduce
  negative attitudes toward aging

8
Virtual simulations of aging and healthy
lifestyles

• Since the 1970s, many simulations of age related
  sensory and mobility limitations have been
  devised to educate the young
• Clouded lenses, ear plugs, gloves, weighted shoes
  etc.
• Limitation is lack of linkage of these devices
  and preventive and compensatory interventions
• Virtual reality simulations can improve education
  by linking simulations of limitations to effects
  of compensatory and preventive measures

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Gerontechnology Contributes in many Ways to aging
and health

• Education about and training for aging
• Enhancement of quality of life
• Prevention or delaying of age-associated losses
  in sensory-perceptual and motor systems
• Technology to lower impact of long-term exposure
  to environmental hazards and maintain
  cardiovascular health and strength
• Compensation for age-associated losses
• Care for elderly persons with functional
  limitations

10
High speed networking expands scope of
gerontechnologies

• Telemedicine and communication applications using
  video over Internet
• Mobile-Health Toolkit wirelessly measures blood
  pressure, blood glucose, etc. and relays
  information to patient records
• Ultra-wideband radio allows for precise location
  of persons within a home and communication among
  appliances
• Common feature of examples is, enhanced
  communication between people and people, people
  and machines and among machines that themselves
  are networked.
• Kearns WD, Fozard JL High-speed networking and
  embedded gerontechnologies. Gerontechnology
  20076135-146

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Preventing or delaying age-related limitations in
functioning

• Technology can contribute to motivating people of
  any age adopt healthy life styles that prevent or
  delay limitations in functioning
• Diet, weight control, exercise, substance abuse
• Idea rests on the capacity of technology for
  monitoring physiological functioning and changes
  in location of one or more persons

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Prevention to delay age declines in
cardiovascular and strength

• Effects of cardiovascuclar training on preventing
  heart disease and stroke as well as facilitating
  rehabilitation are well known
• Positive effects of strength training on
  preventing age related decline in physical
  functioning, personal mobility, and physical
  frailty are being demonstrated continuously in
  new research
• Technology can help promote motivation for
  exercise and in setting targets for exercise

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Background Old Adults perform ADLs closer to max
strength than young adults

• Hortobagyi T, Mizelle C, Beam S, DaVita P. J.
  GerontologyMedical Sciences, 2003, 58A,453-460.

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Purpose/Methods

• Walking, going up and down stairs and rising from
  chair requires relatively higher percentage of
  maximum reserve capacity in older than younger
  adults--True for cardiovascular and muscle
  function
• Study measured relative effort to perform these
  tasks by assessing maximal leg strength on a
  machine and by the force used when going up or
  down stairs or standing up from a chair. Force
  was measured by special recording plate embedded
  in the floor or steps
• Participants were healthy women in two age groups
  mean ages 22 and 74 years.

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Relative effort () of maximum strength required
to perform ADLs
TASK AGE Ascending Stairs Descending Stairs Rising from Chair
22 55 35 35
74 80 88 80
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Long-Term Consequences of Age Differences in
Strength

• Midlife strength predicts functioning 25 years
  later
• Grip strength measured at age 45 to 68 in
  Japanese-American men. 25 years later speed of
  walking, ability to stand up from chair, and
  self-reports of difficulty lifting 10 lbs, doing
  housework, etc were measured.
• Rantanen T, Guralnik JM, Masaki K et al Midlife
  hand grip strength as a predictor of old age
  disability JAMA 1999281558-560

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Proprioception, Balance and Movement Prevention 3

• Grip strength divided into thirds lt37, 37-42,
  gt42kg outcome measures included
• Walking speedlt0.4m/s (6.2)
• Chair rise without using arms (2.2)
• Difficulty doing housework (18.2)
• Difficulty walking up 10 steps (14.1)
• Rantanen T, Guralnik JM, Masaki K et al Midlife
  hand grip strength as a predictor of old age
  disability JAMA 1999281558-560

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with Limitations in Strength Groups Measured 25
Yrs Ago
Data from Rantanen et al, JAMA 1999281559
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Effects of strength training on mobilitybasic
findings

• Strength training and physical activity improve
  muscle mass, control of movement, and balance
• Fiaterone MA, Marks EC, Ryan ND et al.
  High-intensity strength training in
  nonogerniansEffects of skeletal muscle. J Am Med
  Ass, 19902633029.
• Ivey FM, Tracy BL, Lemmer JT, NessAiver M, SM,
  Metter EJ, Fozard JL, Hurley BH. The effects of
  strength training and detraining on muscle
  quality Age and gender comparisons J
  GerontolBiol Sci 200055AB152-B157.
• Miller ME, Rejeski WJ, Reboussin BA, Ten Have TR,
  Ettinger WH Physical activity, funtional
  limitations and disability in older adults J Am
  Ger Soc 2000481264-1272.
• Since 2000, dozens of well designed studies
  extend these early studies e.g., J. Gerontology
  Med Sci 200762A(June)2007 62A(Aug)

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Young Men Young Women Older Men
OlderWomen
Muscle Quality(MQ) is strength/volume. Strength
training of right leg occurred over 9 months
detraining over 31 weeks. From Ivey et al 2000
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Strength and Gait Speed

• Leg exension strength and leg power correlate
  with gait speed. The distributions of leg power
  associated with different speeds may provide the
  basis for setting goals for strength needed for
  walking.
• Rantanen T, Avela J Leg extension power and
  walking speed in very old people living
  independently. J Gerontol Med Sci
  199752AM225-M331.
• Correlations between power and speed ranged from
  .4 to.7 in old people
• Kwon I, Oldaker S, Schrager MA, Talbot LA, Fozard
  JL, Metter EJ. Relationship between muscle
  strength and self-paced gait speed Age and sex
  effects. J Gerontol Biol Sci 200156BB398-B404

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Cumulative distributions of leg power for 5
groups of walking speed from lt1m/s togt2m/s Data
from Rantanen andAvela 1997
Cum
Leg power is expressed as Watts/kg
Note that the cumulative of leg power at 1m/s
ranged from 1-3 W/kg The cumulative of leg
power at 2m/s ranged from 8-15.5 W/kg
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Technology and setting goals for strength
training

• Prevention requires that we set standards for
  reserve strength needed for adequate functioning
  at a later age
• Early estimates--we need 40 of our strength at
  age 25 to function well at age70
• Wearable transducers provide information on
  quality and required number of maneuvers
• New technology development at University of Pisa
  by Dr. E. Piaggio allows for Kinesthetic sensing
  by use of smart fabrics in gloves, socks and
  leotards
• http//www.piaggio.ccii.unipi.it/kine.htm

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Development of health monitoring systems Early
work
Health Monitoring in the Home of the
Future Infrastructure and Usage Models for
Wearable Sensors That Measure Health Data in
the Daily Environments of the Users ILKKA
KORHONEN, JUHA PÄRKKÄ, AND MARK VAN GILS
IEEE ENGINEERING IN MEDICINE AND BIOLOGY MAGAZINE
MAY/JUNE 2003 71
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Korhonen et al
The sensors are integrated into the everyday life
of the users. They should either fit by their
look to the individuals preferences or they
should be as unobtrusive as possible.
Health monitoring seems a very promising
application for the smart home. First of all,
there is a clear need to provide tools to support
independent living.
Automatic processing of the sensor data becomes
essential when health monitoring is applied in
long-term conditions i.e., over months or years.
While the main application domain of health
monitoring is often the home, the research is
closely related to the concepts of smart home and
home networking
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• Personal Mobile Hub
• Dirk Husemann, Chandra Narayanaswami, Michael
  Nidd IBM Research Division
• hud_at_zurich.ibm.com, chandras_at_us.ibm.com,
  mni_at_zurich.ibm.com
• Proceedings of the Eighth International Symposium
  on Wearable Computers (ISWC04) 1530-0811/04
  20.00 IEEE
• Abstract
• As advances are made in wearable computing, there
  is a
• need for a personal mobile hub that can manage
• interactions between the wearable devices and act
  as a
• proxy for these devices.
• Our personal mobile hub supports multiple
  wireless protocols, some short range and some
  wide area so that the power of the internet is
  available even
• to body worn sensors.
• We describe custom hardware that we built for
  this purpose and also the software necessary to
  make this concept work.
• We have tested out thisarchitecture with an end
  to end application.The workingsystem was
  demonstrated at the annual IBM Stockholders
• meeting in 2004 and is also available for
  customers to see
• at the IBM Industry Solutions Lab in Zurich.

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Localization via Ultra-Wideband Radiosation via
Ultra-Wideband Radios A look at positioning
aspects of future sensor networks
Sinan Gezici, Zhi Tian, Georgios B.
Giannakis,Hisashi Kobayashi, Andreas F.
Molisch,H. Vincent Poor, and Zafer Sahinoglu
IEEE SIGNAL PROCESSING MAGAZINE 70 JULY 2005
POSITIONING SYSTEMS CAN BE DIVIDED INTO THREE
MAIN CATEGORIES TIME-OFARRIVAL,DIRECTION-OF-ARRIV
AL, AND SIGNAL-STRENGTH BASED SYSTEMS.
LOCATING A NODE IN A WIRELESS SYSTEM INVOLVES THE
COLLECTION OF LOCATION INFORMATION FROM
RADIO SIGNALS TRAVELING BETWEEN THE TARGET NODE
AND A NUMBER OF REFERENCE NODES.
TIME-BASED POSITIONING TECHNIQUES RELY
ON MEASUREMENTS OF TRAVEL TIMES OF SIGNALS
BETWEEN NODES
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Localization via Ultra-Wideband Radiosation via
Ultra-Wideband Radios A look at positioning
aspects of future sensor networks
Sinan Gezici, Zhi Tian, Georgios B.
Giannakis,Hisashi Kobayashi, Andreas F.
Molisch,H. Vincent Poor, and Zafer Sahinoglu
IEEE SIGNAL PROCESSING MAGAZINE 70 JULY 2005
TIME-BASED POSITIONING TECHNIQUES RELY
ON MEASUREMENTS OF TRAVEL TIMES OF SIGNALS
BETWEEN NODES
UWB TECHNOLOGY PROVIDES AN EXCELLENT MEANS FOR
WIRELESS POSITIONING DUE TO ITS HIGH RESOLUTION
CAPABILITY IN THE TIME DOMAIN.
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Networking improves coaching in strength training

• Motivation is major issue for utilizing strength
  trainingmachines can have motivational
  properties
• Networking can improve motivation and quality of
  feedback from strength training
• Reinforcement from sharing information by peers
  doing similar workouts

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Boston Red Sox Deploy
Activity-Monitoring Technology
FitSense's ActiHealth wireless system seamlessly
collects, transports, and presents information on
physical activity, weight, body fat, blood
pressure, heart rate, peak flow, and blood
glucose.

SOUTHBOROUGH, MA /BUSINESS WIRE/ -- It's hardly
noticeable, but if you look closely enough, the
Boston Red Sox players are all wearing something
new at spring training. It's a small, wireless,
intelligent pedometer called the ActiPed, from
Massachusetts-based FitSense Technology. This
isn't any ordinary pedometer in fact, it's an
activity monitor that accurately tracks your
every step, the calories you burn, how much time
you've been active, and how far you went in miles.


Mar 7, 2007
Sensors

The ActiHealth network provides physiological
information and feedback tools for health and
wellness program providers that engage and
motivate their members, changing their behaviors
and improving health. The network seamlessly
collects, transports, and presents information on
physical activity, weight, body fat, blood
pressure, heart rate, peak flow, and blood
glucose, for anyone, anytime, anywhere.
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Technology and motivation Computerized coaching

• FitLinxx is a computerized system that attaches
  directly to existing fitness equipment
• FitLinxx learns users' programs, coaches them
  individually through their workout for better
  form, safety and confidence during every
  exercise, and tracks their progress over time.
• On strength equipment, FitLinxx appears as an
  easy-to-read touch-screen display that's attached
  to the machine. For cardiovascular equipment,
  each machine's existing console is simply
  networked to FitLinxx
• Users simply tap in their PIN to display their
  targets - FitLinxx then coaches them on speed,
  form, heart rate, etc., and tracks the workout
  session - every rep, set and step.
• http//www.fitlinxx.com/Article.htm?ID976

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Kressig, R. W., Echt, K. V. (2002). Exercise
prescribing computer application in older
adults. The Gerontologist, 42(2),
273-7. Abstract PURPOSE The purpose of this
study was to determine if older adults are
capable and willing to interact with a
computerized exercise promotion interface and to
determine to what extent they accept
computer-generated exercise recommendations.
DESIGN AND METHODS Time and requests for
assistance were recorded while 34
college-educated volunteers, equal numbers of men
and women, ranging in age from 60 to 87,
interfaced with a health promotion tool. The
computerized exercise promotion tool's ease of
use and the acceptability of the exercise
recommendations made were rated by the
participants. RESULTS On average, completion of
the items on the computer took 33 min and each
participant made 3 requests for assistance, of
which only 22 were mouse related. The system's
ease of use and the exercise prescription
acceptability ratings were high and independent
of prior experience with computers. IMPLICATIONS
User friendliness of computerized health
promotion tools will determine if, and how,
health providers integrate these new technologies
into daily practice. The participants in the
study were able to complete the computerized
items within a reasonable amount of time and with
minimal assistance from the provider. These data
support the potential of interactive technology
in health promotion among the expanding older
population.
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Development of an exercise expert system for
older adults Lisa Wynn Boyette, MEd Adrienne
Lloyd, MEd Stephanie Manuel, MS James Edward
Boyette, MSICS Katharina V. Echt, PhD Allanta VA
Medical Center, Rehab RD Center, Decatur, GA
30033 Emory University School of Medicine,
Division of Geriatric Medicine Gerontology.
Atlanta, GA 30033 Veterans Affairs, Health
Eligibility Center, Atlanta, GA
30033 AbstractThe purpose of this study was to
develop a cotnputerized exercise expert system
(CEES) that creates tailored exereise plans for
older adults. A panel of experts was selected in
the areas of medicine, exercise physiology,
health promotion, exercise psychology, and
gerontology. The experts communicated with the
principal investigator and the project members by
mail, email, telephone, and expert meetings.
A two-day workshop was held during the second
year for the project metnhers as well as local
and national experts to review the CEES. The CEES
demonstrated adequate inter-rater
reliability (0.80) and criterion validity (0.70).
Content validity was achieved by literature
review and expert opitiion. The CEES gathers
information on the elder's health status,
clinical factors, and exercise determinants that
characterize specific barriers or incentives to
exercise. The software program then develops
individualized exercise prescriptions that are
customized to older adults.
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Summary Technology and Extended health

• Physical, mental and social well being included
  in the WHO definition of health
• The role of technology in extended health is to
  create what former UN Secretary General Kofi Anan
  called enabling environments that support human
  endeavors for all regardless of age