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Functional Issues in Older Adults

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Title: Jordan bicher Author: bicherj Last modified by: Rebecca May-Cole Created Date: 2/21/2013 12:55:11 AM Document presentation format: On-screen Show (4:3) – PowerPoint PPT presentation

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Title: Functional Issues in Older Adults


1
Functional Issues in Older Adults
  • Jordan Bicher, D.P.T
  • Director of Rehabilitation Physical Therapist

2
What is Function?
  • The kind of action or activity proper to a
    person, thing, or institution the purpose for
    which something is designed or exists role
  • Everyones Functionality is different dependent
    on environment and support.
  • Ultimate goal for all people is to function at a
    SAFE level.
  • Safety is always the key.

3
Aging Process
  • Aging is inevitable, however the pace at which we
    age varies based on physiology and environmental
    factors.
  • Our Chronological Age is not the same as our
    Physiological Age.
  • You can be an old 55 or a young 80.

4
Current Aging Trends
  • Life expectancy in the U.S. went from age 47 to
    77 during the last century.
  • The fastest-growing age group is age 85 and
    older.
  • 35 million older Americans today will increase to
    70 million by 2030.

5
What Contributes to lack of function?
  • Immobility

6
Immobility
  • Aging of Muscles
  • Decrease in Muscle function of 30-50 by age 65.
  • Muscle fibers become smaller decreased number of
    myofibrils.
  • Reduction in size, strength, endurance.
  • Tendency to fatigue more rapidly.
  • Decreased cardiovascular function causes less
    blood flow during activity compared to younger
    person.

7
Immobility
  • Aging of Muscles (cont.)
  • Decreased muscle elasticity
  • Fibrosis occurs causing increased collagen tissue
    formation which restricts movement and
    circulation
  • Decreased Cardiovascular function
  • Decreased elasticity of arterial system
  • Decreased Cardiac Output (stroke volume x heart
    rate)
  • Decreased Ejection Fraction
  • Aortic Stenosis
  • Decrease in pacemaker cells
  • Decrease in regulated heart rate

8
Immobility
  • Decreased Cardiovascular function (cont.)
  • Increased incident of disease, to all systems,
    that stress the heart.
  • Resting heart rate does not decrease, but maximum
    heart rate does.
  • Limits ability to exercise
  • Hypertension

9
Immobility
  • Pain (see pain scale on next slide)
  • If it hurts, you dont use it.
  • Arthritis
  • If Immobility occurs, recovery time in elderly is
    longer.
  • Decline in Memory (will discuss in depth later)
  • If you dont remember what you need to do you are
    less likely to move.
  • Psychosocial
  • Depression
  • Isolation
  • Loss of ability to drive (Will discuss later)

10
Pain Assessment Scale A resident is asked to
rate their pain on a numerical scale from 0-10,
with 10 representing the worst pain
experience. Resident can be asked the
following Is the pain constant? Is the pain
intermittent? If pain is relieved what activities
or interventions relieve the pain? How long is
the pain relieved? What time of day is the pain
the greatest? When pain affects sleep, how much
sleep is obtained in a given period of
time? Describe the medication schedule and the
affect of medication on the pain type and
duration.
11
Rating Scale 0 No Pain 1 Mild Pain 2
Moderate Pain 3 Quite A lot of Pain 4 Very
Bad Pain 5 Worst Pain Pain Scale 0 1 2
3 4
5 Resident is asked to describe the pain
as Pain Descriptors S Sharp A Aching D
Dull B Burning C Cramping N Numbness TH
Throbbing T Tingling
12
Immobility
  • Decline in Respiratory Function
  • Not as prominent as cardiovascular function in
    the non-smoker.
  • Decline in oxygen exchange.
  • Decline in motility of cilia.
  • Decreased elasticity.
  • Decreased inflation/deflation
  • Lung tissue as well as decrease in rib cage
    movement.
  • On average one foot of membrane is lost every
    year after age of 30.

13
Immobility
  • 5 Senses (Decline in all five as we age)
  • Vision-3rd leading cause of disability in the
    elderly.
  • Poor vision can lead to a fear of moving.
  • Less motivated to get up since we cant see
    things.
  • Can greatly contribute to decline in memory.
  • Hearing-unaware of our surroundings.
  • Touch-Sensation
  • Peripheral neuropathy
  • DM

14
Immobility
  • 5 senses (cont.)
  • Taste and Smell
  • A decline in our taste and smell leads to a
    decrease in appetite.
  • Only 17 of adults over 60 have an appropriate
    diet.
  • Decreased Caloric intake
  • More processed food
  • Less energy
  • Less ability for our body to heal
  • Decline in Fluid/Water intake.
  • Decreases elasticity in tissue

15
A Decline in Mobility leads to a decline in
balance.
  • Balance is controlled by 3 main factors
  • Eyes/vision
  • Vestibular System
  • Contact with earth
  • Muscles
  • Sensation

16
How do we affect immobility?
17
How Do We Affect Immobility?
  • As we age we slow down
  • As caretakers, we dont allow people enough time
    to complete tasks.
  • Were in a hurry.
  • We confuse slow movement with struggling to
    complete a task.
  • We feel bad.
  • Its easier for us to do the task for them.
  • We dont appropriately modify home to allow for
    maximum function and safety.

18
Effects of Immobility
19
Cardiovascular
  • 12 weeks of bedrest can cause a 15 decline in
    cardiac muscle mass
  • Orthostatic Hypotension
  • Decreased pressure sensors
  • Decreased Stroke Volume
  • Blood Clots

20
Respiratory
  • Decreased respirations cause decreased use of
    pulmonary tissue
  • Fluid build up
  • Pooling of secretions
  • Atelectasis
  • Pressure on certain areas of lungs

21
Digestive Genitourinary
  • Constipation
  • Anorexia
  • Pain
  • Diarrhea
  • Poor Gas/Nutrient exchange
  • Decreased Mobility
  • Fluid retention
  • Kidney infection
  • Limited bladder emptying
  • Incontinence

22
Nervous
  • Cognitive decline
  • Depression
  • Decreased Sensation
  • Decreased Pain Sensation
  • Decreased Coordination
  • Pressure Sores

23
Musculoskeletal
  • 50 muscle mass loss in 3 weeks
  • Osteoporosis
  • Calcium imbalance can affect cardiac function
  • Joint fusing
  • Decreased joint mobilitydecreased balance
  • Muscle wasting

24
Promoting Mobility
  • and Function

25
Mobility and Function
26
Mobility and Function
27
Mobility and Function
28
Mobility and Function
  • Dycem

29
Mobility and Function
30
Mobility and Function
  • Wheelchairs
  • Powerchairs
  • Power scooters
  • Stair Climbs
  • Life Lines
  • Ramps
  • Public Transportation
  • Church Organizations
  • Meals on Wheels
  • Adult Day Centers
  • Senior Centers
  • Area office of the aging
  • AARP
  • Association of the Deaf
  • Association of the Blind

31
Mobility and Function
  • Ramps
  • ADA says 112 Ratio really it needs to be at
    least 16.
  • Maximum rise for any Run should be 30 inches
  • Needs to be 36 inches wide.
  • Have at least a 2 inch railing.
  • Should have at least a 60 inch platform prior to
    entering structure
  • Standard step is 6 inches.

1in.
12 in.
2 in.
lt30 in.
gt 60 in.
32
Driving
  • Question When should someone talk to you about
    driving?
  • Health Change 74
  • General Safety Concerns 72
  • Forgetful/Getting Lost 71
  • Serious accident 50
  • Near miss 29
  • Minor accident 18
  • Older drivers said they were more likely to
    listen if the person talking to them had their
    best interests at heart focus on the older
    adult, his/her safety and mobility needs

33
Driving
  • Self-Regulation
  • Most healthy drivers make their own decisions to
    cut back on their driving to stay safe
  • Older drivers avoid driving
  • At night, or at dusk or dawn
  • In heavy traffic congestion
  • On highways or freeways
  • Long distances
  • In unfamiliar areas
  • In poor weather
  • Making left hand turns

34
Driving
  • Who should talk? Who would you be most likely to
    listen to?
  • Married drivers prefer to hear from their spouse,
    doctor, or adult child.
  • Single drivers prefer to hear from their doctor
    or adult child.
  • Who would you absolutely not want to hear from?
  • Married drivers would not want to hear from the
    police or DMV or, for some of them, a spouse.
  • Single drivers would not want to hear from the
    police or DMV.

35
Driving
  • www.AARP.ORG
  • www.thehartford.com/talkwitholderdrivers

36
Bladder Control
  • Check out this link
  • http//www.youtube.com/watch?vbhehwx2u0oE
  • Kegel Exercises
  • Strengthen the Plevic Floor (pubococcygeus)
    Muscle

The Best way to identify your Pelvic Floor
Muscles, is during urination. Once your flow
begins, try to stop it completely. The muscle
that you feel tightening is the pelvic floor
muscle.
37
Cognition
38
Cognitive Decline
  • Dependent on location of damage in brain
  • Attention and Concentration
  • Slowed Processing Speed
  • Decreased ability to learn
  • Word Finding/Naming difficulties
  • Poor Decision-Making
  • Difficulty Planning/Organizing
  • Memory Loss

39
Cognitive Decline
  • Irreversible Memory Loss
  • Alzheimers
  • Vascular Dementia
  • Lewey Body Dementia
  • Frontotemporal Dementia (Social)
  • Reversible Memory Loss
  • Meds/Drugs
  • Emotional/Depression
  • Metabloic (Deyhdration)
  • Sensory Loss
  • Tumor
  • Infection
  • Anemia/B12 Deficiency
  • NPH

40
Cognition Strategies
  • IF YOU DONT USE IT, YOU LOSE IT
  • Crosswords/Suduko/Word Finds
  • Puzzles
  • Reading (Adaptive equipment)
  • Appointment Calenders/Memo pads
  • Sticky Notes
  • Voice Recorders
  • Alarm Clocks/Timers
  • Pill Box/Automatic Pill Dispenser
  • Label Makers/Electronic Spellers

41
Cognitive Strategies
  • IF YOU DONT USE IT, YOU LOSE IT
  • Color Coding Files/Sorters
  • Key Finders
  • Written Instructions/Maps/Cue Cards
  • Senior Center
  • Church Groups
  • Coglink.com (Email Address)

42
Swallowing and Dysphagia
43
Swallowing
  • Normal swallowing involves a complex sequence of
    movements which occur rapidly and require precise
    muscle control.
  • It takes food/liquids about 2-3 seconds to pass
    from the back of the mouth to the stomach.
  • Difficulty with swallowing is known as Dysphagia.

44
Dysphagia
  • Neurological
  • CVA
  • Parkinsons Disease
  • Structural
  • Stricture
  • CA
  • Muscular (age-related)
  • Diverticulum
  • Psychological
  • Dementia
  • Fear

45
Dysphagia
  • Leads to Aspiration
  • Passage of foreign material into the lungs rather
    than the stomach.
  • Aspiration can lead to severe disease or death.
  • Approximately 60 of aspiration is silent
  • Everyone aspirates, however most are healthy
    enough to avoid illness.
  • Approximately 40,000 people die annually from
    Dysphagia complications.

46
Signs of Dysphagia
  • Coughing
  • Choking
  • Watery eyes
  • Wet, gurgly voice
  • Excess chewing
  • Residual food in mouth
  • Pocketing
  • Change in respiration rate
  • Change in lung sound/congestion
  • Difficulty breathing
  • Gagging
  • Chest pain
  • Pain
  • Temperature after eating
  • Report of something stuck in throat
  • Multiple swallows
  • Attempts to clear throat
  • Pneumonia or chronic URI

47
3 Ounce Water Test
  • Quick and easy test to check for dysphagia
  • Pour 3 ounces of water into a cup
  • Have patient drink the water taking normal sips,
    as many as needed, but they must be continual.
  • Look for any difficulty with swallowing or
    inability to drink the full glass in one attempt.

48
Diagnosing Dysphagia
  • Refer to a Physician
  • Refer to Speech and Language Pathologist
    (SLP)/Speech Therapist
  • Video Esophagram
  • Modified Barium Swallow
  • ENT to rule out Esophageal causes

49
Correct Swallowing chin tuck
Incorrect Swallowing Beyond head neutral
50
Aspiration Prevention Tips
  • Make sure patient is awake/alert.
  • Small Bites (1/2-1 Teaspoon).
  • Enourage coughing/clearing airways.
  • Allow time to swallow and re-swallow.
  • Relax!!!
  • Place Spoon on tongue, not in mouth
  • Watch for larynx to rise and fall
  • Ensure mouth is empty
  • Present liquids from midline or belowNot above.

51
Aspiration Prevention Tips (cont.)
  • Do not Dump liquids in mouth
  • Alternate liquids and solids. Drink after every
    2-3 bites.
  • Alternate hot and cold items.
  • END THE MEAL WITH A LIQUID.
  • Make sure patient remains upright 30 minutes
    after meal.
  • Do not drown a cough.
  • We should take each pill with 4 ozs. of water.

52
Feeding Posture
  • DOs
  • Sit upright with hips at 90 degrees of flexion
  • Head at 45 degrees of natural flexion.
  • Head should not be hyper-extended.
  • Make sure dentures are in
  • And glasses are on, with proper lighting.
  • DONTs
  • Extend head and neck forward
  • Sunken chest
  • Rounded shoulders
  • Leaning
  • Protruding abdomen
  • Slouching

53
Dysphonia
54
Dysphonia
  • Disorder of the voice inability to produce voice
    using voice organs.
  • A phonation problem
  • Different from dysarthria, which is a condition
    of the voice muscles.
  • Weakness
  • Breathiness
  • Hoarseness
  • Strained/struggled

55
Dysphonia Causes
  • Voice Misuse and Abuse
  • Yelling
  • Smoking
  • Trauma
  • Heat
  • Blunt
  • Nervous System
  • ALS
  • MS
  • PD
  • Huntingtons Chorea
  • Organic Disease
  • Granulomas
  • Cancer

56
Dysphonia Signs
  • Horseness
  • Breathiness
  • Tension
  • Tremor
  • Strained-Strangled
  • Pitch Breaks
  • Monopitch
  • Monoloudness
  • Glotial Fry

57
Dysphonia Treatments
  • Always consult with ENT
  • Decrease amount of talking
  • Decrease loudness/Whisper
  • Limit Caffeine
  • Eliminate vocal abuse
  • Smoking
  • Throat clearing
  • Alcohol
  • Environment
  • Extra hydration
  • Speech Therapy
  • Humidify air
  • GERD management

58
HOME SAFETY
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Home Safety Tips
  • Good Lighting
  • Eliminate floor rugs
  • Eliminate clutter
  • Eliminate unneeded furniture
  • Elevate height of chairs/bed
  • Safety Rails/Grab bars
  • Non-skid mats on all non-carpeted floors
  • Non-skid shoes/socks
  • Avoid high heels
  • Avoid slippers
  • Avoid hard soled shoes
  • Avoid shoes without backs
  • Tub bench
  • Dry Floors
  • Skids in Shower
  • Place frequently used objects at most accessible
    locations

63
Home Safety Tips (cont.)
  • Dont ever stand on a chair or stool
  • Keep phone within reach
  • Emergency numbers handy
  • Pets!!!!!!!
  • Remove doorway thresholds or have them covered
  • Keep Electrical Cords out of the way

64
Energy Conservation
  • Remember we want to maximize function
  • Prioritize tasks that need to get done
  • Use planner to assist plan of day/week
  • Sit instead of stand to do activities
  • Dressing
  • Shower
  • Cooking
  • Folding laundry
  • Ironing
  • Use a lightweight cart to move objects

65
Energy Conservation (cont.)
  • Take breaks to preserve energy
  • Minimize trips up and down stairs
  • Use of energy saving tools
  • Reachers
  • Shower brushes
  • Electric can opener
  • Electric razor
  • Dishwasher

66
Energy Conservation (cont.)
  • USING PROPER BODY MECHANICS
  • Sit and stand with good posture
  • Lift with your legs, keeping your back straight
  • Keep your nose and toes pointed in the same
    direction do not twist your trunk
  • Push . . . dont pull
  • Slide . . . dont lift
  • When need be, use both hands to carry items and
    hold them close to your body

67
FALLS
  • In the U.S. one of every three people older than
    age 65 fall each year.
  • Falls are the most common cause of injuries and
    hospital admissions for trauma among the elderly,
    and are recognized as a leading cause of injury
    and death in the aged.
  • 50 of all fallers fall repeatedly.
  • 9,500 elderly deaths each year are related to
    falls.
  • Falls account for 87 of all fracture among
    people aged 65 or older and are the second
    leading cause of spinal cord and brain injury.
  • The economic cost of osteoporotic fracture will
    exceed 45.2 billion annually.

68
FALLS (cont.)
  • Half of all elderly adults hospitalized for hip
    fractures cannot return home or live
    independently after the facture.
  • For people aged 65 or older, 60 of fatal falls
    occur in the home, 30 occur in public places,
    and 10 occur in healthcare institutions.
  • Risks of falls increases proportionally with age.
  • Half of those over age 75 who fracture a hip as a
    result of a fall die within 1 year of the
    incident.
  • Between 50 to 90 of elders who report a fall
    admit to restricting their activities for fear of
    another fall.

69
Fall Risk Factors
70
Medications that Contribute to Falls
71
Balance Tests
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80
  • Center for Disease Control
  • www.cdc.gov/
  • Home Safety Council
  • www.homesafetycouncil.org/

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85
Rehabilitation Goals 1. Does your family
member plan to return home? ____________________
If so, will they live alone? ____________________
__________________ 2. Was your family member
walking before this recent hospitalization? ____
Used a cane? _____ Used a walker? ____ Used a
wheelchair? ____ Do they have their own
wheelchair? _______ How long has it been since
they last walked? ______________________ How far
where they able to walk? _____________ 3. Was
your family member able to bath and dress
independently? ________ How much help was
needed? ___________________________________ 4.
Did your family member use the bathroom for
toileting? ______________ Did they depend on
undergarment pads or briefs? __________________
5. Does your family member have difficulty
eating or swallowing? ________ __________________
_________________________________________ 6.
Have you noticed any increase in confusion or
memory problems? ______ _________________________
___________________________________ 7. What are
your goals for your family members
rehabilitation? __________________________________
__________________________
86
Exercise Program Adapted from Exercise and
Physical Activity, Your Everyday Guide from The
National Institute on Aging
  • Even very small changes in muscle strength can
    make a real difference in function, especially in
    people who have already lost a lot of muscle. An
    increase in muscle that you cant even see can
    make it easier to do everyday things like get up
    from a chair, climb stairs, carry groceries, open
    jars, and even play with your grandchildren.
    Lower body strength exercises also will improve
    your balance.
  • Depending on your condition, you might need to
    start out using 1-pound or 2-pound weights or no
    weight at all. Your body needs to get accustomed
    to strength exercises.

87
Exercise Program Adapted from Exercise and
Physical Activity, Your Everyday Guide from The
National Institute on Aging
  • Use a light weight the first week then gradually
    add more weight. Starting out with weights that
    are too heavy can cause injuries.
  • Gradually add more weight in order to benefit
    from strength exercises. You need to challenge
    your muscles to get the most benefit from
    strength exercises. (The Progressing section will
    tell you how).
  • It should feel somewhere between hard and very
    hard for you to lift or push the weight. It
    shouldnt feel very, very hard. If you cant lift
    or push a weight 8 times in a row, its too heavy
    for you. Reduce the amount of weight.
  • Take 3 seconds to lift or push a weight into
    place, hold the position for 1 second, and take
    another 3 seconds to return to your starting
    position. Dont let the weight drop returning it
    slowly is very important.
  • Try to do 10 to 15 repetitions for each exercise.
    Think of this as a goal. If you cant do that
    many at first, do as many as you can. You may be
    able to build up to this goal over time.

88
Exercise Program Adapted from Exercise and
Physical Activity, Your Everyday Guide from The
National Institute on Aging
  • Safety
  • Talk with your doctor if you are unsure about
    doing a particular exercise. For example, if
    youve had hip or back surgery, talk about which
    exercises might be best for you.
  • Dont hold your breath during strength exercises.
    Holding your breath while straining can cause
    changes in blood pressure. This is especially
    true for people with heart disease.
  • Breathe regularly. Breathe in slowly through your
    nose and breathe out slowly through your mouth.
    If this is not comfortable or possible, breathe
    in and out through either your nose or mouth.
  • Breathe out as you lift or push, and breathe in
    as you relax. For example, if youre doing leg
    lifts, breathe out as you lift your leg, and
    breathe in as you lower it. This may not feel
    natural at first and you probably will have to
    think about it for a while as you do it.

89
Exercise Program Adapted from Exercise and
Physical Activity, Your Everyday Guide from The
National Institute on Aging
  • Safety (cont.)
  • Proper form and safety go hand in hand. For some
    exercises, you may want to start alternating arms
    and work your way up to using both arms at the
    same time. If it is difficult for you to hold
    hand weights, try using wrist weights.
  • To prevent injury, dont jerk or thrust weights
    into position. Use smooth, steady movements.
  • Avoid locking your arm and leg joints in a
    tightly straightened position. To straighten your
    knees, tighten your thigh muscles this will lift
    your kneecaps and protect them.
  • Muscle soreness lasting a few days and slight
    fatigue are normal after muscle-building
    exercises, at least at first. After doing these
    exercises for a few weeks, you will probably not
    be sore after your workout.

90
Exercise Program Adapted from Exercise and
Physical Activity, Your Everyday Guide from The
National Institute on Aging
  • Progressing Muscle strength is progressive over
    time.
  • Gradually increase the amount of weight you use
    to build strength. When you can do 2 sets of 10
    to 15 repetitions easily, increase the amount of
    weight at your next session.
  • Here is an example of how to progress gradually
    Start out with a weight that you can lift only 8
    times. Keep using that weight until you become
    strong enough to lift it easily 10 to 15 times.
  • When you do 2 sets of 10 to 15 repetitions
    easily, add more weight so that, again, you can
    lift it only 8 times.
  • Keep repeating until you reach your goal, and
    then maintain that level as long as you can.

91
Exercise Program Adapted from Exercise and
Physical Activity, Your Everyday Guide from The
National Institute on Aging
  • Working with a Resistance Band Resistance bands
    are stretchy elastic bands that come in several
    strengths, from light to heavy. You can use them
    in some strength exercises instead of weights.
  • 1. Lay the band flat in your hand with the end
    toward your pinky finger.
  • 2. Wrap the long end of the band around the back
    of your hand.
  • 3. Grasp firmly.
  • If you are a beginner, try exercising without the
    band until you are comfortable then add the
    band.
  • Choose a light band if you are just starting to
    exercise, and move on to a stronger band when you
    can do 2 sets of 10 to 15 repetitions easily.
  • Hold on to the band tightly (some bands have
    handles), or wrap it around your hand or foot to
    keep it from slipping and causing possible
    injury.
  • Do the exercises in a slow, controlled manner,
    and dont let the band snap back.

92
Exercises
  • Hand Grip This simple exercise should help if
    you have trouble picking things up or holding on
    to them. It also will help you open things like
    that pickle jar more easily. You can even do this
    exercise while reading or watching TV.
  • 1. Hold a tennis ball or other small rubber or
    foam ball in one hand.
  • 2. Slowly squeeze the ball as hard as you can
    and hold it for 3-5 seconds.
  • 3. Relax the squeeze slowly.
  • 4. Repeat 10-15 times.
  • 5. Repeat 10-15 times with other hand.
  • 6. Repeat 10-15 times more with each hand.

93
Exercises
  • Wrist Curl This exercise will strengthen your
    wrists. It also will help ensure good form and
    prevent injury when you do upper body strength
    exercises.
  • 1. Rest your forearm on the arm of a sturdy
    chair with your hand over the edge.
  • 2. Hold weight with palm facing upward.
  • 3. Slowly bend your wrist up and down.
  • 4. Repeat 10-15 times.
  • 5. Repeat 10-15 times with other hand.
  • 6. Repeat 10-15 more times with each hand.

94
Exercises
  • Overhead Arm Raise This exercise will
    strengthen your shoulders and arms. It should
    make swimming and other activities such as
    lifting and carrying grandchildren easier.
  • 1. You can do this exercise while sitting in a
    sturdy, armless chair of standing.
  • 2. Keep your feet flat on the floor, shoulder
    width apart.
  • 3. Hold weights at your sides at shoulder height
    with palms facing forward. Breathe in slowly.
  • 4. Slowly breathe out as you raise both arms up
    over your head keeping your elbows slightly bent.
  • 5. Hold the position for 1 second.
  • 6. Breathe in as you slowly lower your arms.
  • 7. Repeat 10-15 times.
  • 8. Rest then repeat 10-15 more times.
  • As you progress, use a heavier weight and
    alternate arms until you can lift the weight
    comfortably with both arms.

95
Exercises
  • Front Arm Raise This exercise for your
    shoulders can help you put things up on a shelf
    or take them down more easily.
  • 1. Stand with your feet shoulder width apart.
  • 2. Hold weights straight down at your sides with
    palms facing backward.
  • 3. Keeping them straight, breathe out as you
    raise both arms in front of you to shoulder
    height.
  • 4. Hold the position for 1 second.
  • 5. Breathe in as you slowly lower arms.
  • 6. Repeat 10-15 times.
  • 7. Rest then repeat 10-15 more times.
  • As you progress, use a heavier weight and
    alternate arms until you can lift the weight
    comfortably with both arms.

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Exercises
  • Side Arm Raise This exercise will strengthen
    your shoulders and make lifting groceries easier.
  • 1. You can do this exercise while sitting in a
    sturdy, armless chair or standing.
  • 2. Keep your feet flat on the floor shoulder
    width apart.
  • 3. Hold hand weights straight down at your sides
    with palms facing inward. Breathe in slowly.
  • 4. Slowly breathe out as you raise both arms to
    the side, shoulder height.
  • 5. Hold the position for 1 second.
  • 6. Breathe in as you slowly lower your arms.
  • 7. Repeat 10-15 times.
  • 8. Rest then repeat 10-15 more times.
  • As you progress, use a heavier weight and
    alternate arms until you can lift the weight
    comfortably with both arms.

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Exercises
  • Arm Curl After a few weeks of doing this
    exercise for your upper arm muscles, lifting that
    gallon of milk will be much easier.
  • 1. Stand with your feet shoulder width apart.
  • 2. Hold weights straight down at your sides with
    palms facing forward. Breathe in slowly.
  • 3. Breathe out as you slowly bend your elbows
    and lift weights toward chest. Keep elbows at
    your sides.
  • 4. Hold the position for 1 second.
  • 5. Breathe in as you slowly lower your arms.
  • 6. Repeat 10-15 times.
  • 7. Rest then repeat 10-15 more times.
  • As you progress, use a heavier weight and
    alternate arms until you can lift the weight
    comfortably with both arms.

98
Exercises
  • Arm Curl with Resistance Band This variation of
    the Arm Curl uses a resistance band instead of
    weights. (See Working with a Resistance Band.)
  • 1. Sit in a sturdy, armless chair with your feet
    flat on the floor shoulder width apart.
  • 2. Place the center of the resistance band under
    both feet. Hold each end of the band with palms
    facing inward. Keep elbows at your sides. Breathe
    in slowly.
  • 3. Keep wrists straight and slowly breathe out
    as you bend your elbows and bring your hands
    toward your shoulders.
  • 4. Hold the position for 1 second.
  • 5. Breathe in as you slowly lower your arms.
  • 6. Repeat 10-15 times.
  • 7. Rest then repeat 10-15 more times.
  • As you progress, use a heavier strength band.

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Exercises
  • Seated Row with Resistance Band This exercise
    to strengthen upper back, shoulder and neck
    muscles should make everyday activities such as
    raking and vacuuming easier. (See Working with a
    Resistance Band.)
  • 1. Sit in a sturdy, armless chair with your feet
    flat on the floor shoulder width apart.
  • 2. Place the center of the resistance band under
    both feet. Hold each end of the band with palms
    facing inward.
  • 3. Relax your shoulders and extend your arms
    beside your legs. Breathe in slowly.
  • 4. Breathe out slowly and pull both elbows back
    until your hands are at your hips.
  • 5. Hold the position for 1 second.
  • 6. Breathe in as you slowly return your hands to
    the starting position.
  • 7. Repeat 10-15 times.
  • 8. Rest then repeat 10-15 more times.
  • As you progress, use a heavier Strength band.

100
Exercises
  • Wall Push-Up These push-ups will strengthen
    your arms, shoulders, and chest. Try this
    exercise during a TV commercial break.
  • 1. Face a wall, standing a little farther than
    arms length away, feet shoulder-width apart.
  • 2. Lean your body forward and put your palms
    flat against the wall at shoulder height and
    shoulder width apart.
  • 3. Slowly breathe in as you bend your elbows and
    lower your upper body toward the wall in a slow,
    controlled motion. Keep your feet flat on the
    floor.
  • 4. Hold the position for 1 second.
  • 5. Breathe out and slowly push yourself back
    until your arms are straight.
  • 6. Repeat 10-15 times.
  • 7. Rest then repeat 10-15 more times.

101
Exercises
  • Elbow Extension This exercise will strengthen
    your upper arms. If your shoulders arent
    flexible enough to do this exercise, try the
    Chair Dip.
  • 1. You can do this exercise while sitting in a
    sturdy, armless chair or standing.
  • 2. Keep your feet flat on the floor shoulder
    width apart.
  • 3. Hold weight in one hand with palm facing
    inward. Raise that arm toward ceiling.
  • 4. Support this arm below elbow with other hand.
    Breathe in slowly.
  • 5. Slowly bend raised arm at elbow and bring
    weight toward shoulder.
  • 6. Hold the position for 1 second.
  • 7. Breathe out and slowly straighten your arm
    over your head. Be careful not to lock your
    elbow.
  • 8. Repeat 10-15 times.
  • 9. Repeat 10-15 times with other arm.
  • 10.Repeat 10-15 more times with each arm.
  • If it is difficult for you to hold hand weights,
    try using wrist weights.

102
Exercises
  • Chair Dip This pushing motion will strengthen
    your arm muscles even if you are not able to lift
    yourself up off the chair.
  • 1. Sit in a sturdy chair with armrests with your
    feet flat on the floor, shoulder width apart.
  • 2. Lean slightly forward keep your back and
    shoulders straight.
  • 3. Grasp arms of chair with your hands next to
    you. Breathe in slowly.
  • 4. Breathe out and use your arms to push your
    body slowly off the chair.
  • 5. Hold position of 1 second.
  • 6. Breathe in as you slowly lower yourself back
    down.
  • 7. Repeat 10-15 times.
  • 8. Rest then repeat 10-15 more times.

103
Exercises
  • Back Leg Raise This exercise strengthens your
    buttocks and lower back. For an added challenge,
    you can modify the exercise to improve your
    balance. (See Progressing to Improve Balance)
  • 1. Stand behind a sturdy chair, holding on for
    balance. Breathe in slowly.
  • 2. Breathe out and slowly lift one leg straight
    back without bending your knee or pointing your
    toes. Try not to lean forward. The leg you are
    standing on should be slightly bent.
  • 3. Hold the position for 1 second.
  • 4. Breathe in as you slowly lower your leg.
  • 5. Repeat 10-15 times.
  • 6. Repeat 10-15 times with other leg.
  • 7. Repeat 10-15 more times with each leg.
  • As you progress, you may want to add ankle
    weights.

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Exercises
  • Side Leg Raise This exercise strengthens your
    hips, thighs, and buttocks. For an added
    challenge, you can modify the exercise to improve
    your balance. (See Progressing to Improve
    Balance.)
  • 1. Stand behind a sturdy chair with feet
    slightly apart, holding on for balance. Breathe
    in slowly.
  • 2. Breathe out and slowly lift one leg out to
    the side. Keep your back straight and your toes
    facing forward. The leg you are standing on
    should be slightly bent.
  • 3. Hold the position for 1 second.
  • 4. Breathe in as you slowly lower your leg.
  • 5. Repeat 10-15 times.
  • 6. Repeat 10-15 times with other leg.
  • 7. Repeat 10-15 more times with each leg.
  • As you progress, you may want to add ankle
    weights.

105
Exercise
  • Knee Curl Walking and climbing stairs are
    easier when you do both the Knee Curl and Leg
    Straightening exercises. For an added challenge,
    you can modify the exercise to improve your
    balance. (See Progressing to Improve Balance.)
  • 1. Stand behind a sturdy chair, holding on for
    balance. Lift one leg straight back without
    bending your knee or pointing your toes. Breathe
    in slowly.
  • 2. Breathe out and slowly bring your heel up
    toward your buttocks as far as possible. Bend
    only from your knee, and keep your hips still.
    The leg you are standing on should be slightly
    bent.
  • 3. Hold the position for 1 second.
  • 4. Breathe in as you slowly lower your foot to
    the floor.
  • 5. Repeat 10-15 times.
  • 6. Repeat 10-15 times with other leg.
  • 7. Repeat 10-15 more times with each leg.
  • As you progress, you may want to add ankle
    weights.

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Exercises
  • Leg Straightening This exercise strengthens
    your thighs and may reduce symptoms of arthritis
    of the knee.
  • 1. Sit in a sturdy chair with your back
    supported by the chair. Only the balls of your
    feet and your toes should rest on the floor. Put
    a rolled bath towel at the edge of the chair
    under thighs for support. Breathe in slowly.
  • 2. Breathe out and slowly extend one leg in
    front of you as straight as possible, but dont
    lock your knee.
  • 3. Flex foot to point toes toward the ceiling.
    Hold position for 1 second.
  • 4. Breathe in as you slowly lower your leg back
    down.
  • 5. Repeat 10-15 times.
  • 6. Repeat 10-15 times with other leg.
  • 7. Repeat 10-15 more times with each leg.
  • As you progress, you may want to add ankle
    weights.

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Exercises
  • Chair Stand This exercise strengthens your
    abdomen and thighs, will make it easier to get in
    and out of the car. If you have knee or back
    problems, talk with your doctor before trying
    this exercise.
  • 1. Sit toward the front of a sturdy, armless
    chair with knees bent and feet flat on the floor,
    shoulder width apart.
  • 2. Lean back with your hands crossed over your
    chest. Keep your back and shoulders straight
    throughout the exercise. Breathe in slowly.
  • 3. Breathe out and bring your upper body forward
    until sitting upright.
  • 4. Extend your arms so they are parallel to the
    floor and slowly stand up.
  • 5. Hold the position for 1 second.
  • 6. Breathe in as you slowly sit down.
  • 7. Repeat 10-15 times.
  • 8. Rest then repeat 10-15 more times.
  • People with back problems should start the
    exercise from the sitting upright position.

108
Exercises
  • Toe Stand This exercise will help make walking
    easier by strengthening your calves and ankles.
    For an added challenge, you can modify the
    exercise to improve your balance. (See
    Progressing to Improve Balance.)
  • 1. Stand behind a sturdy chair, feet shoulder
    width apart, holding on for balance. Breathe in
    slowly.
  • 2. Breathe out and slowly stand on tiptoes as
    high as possible.
  • 3. Hold the position for 1 second.
  • 4. Breathe in as you slowly lower your heels to
    the floor.
  • 5. Repeat 10-15 times.
  • 6. Rest repeat 10-15 more times.
  • As you progress, try doing the exercise standing
    on one leg at a time for a total of 10-15 times
    on each leg.

109
Exercise Program Adapted from Exercise and
Physical Activity, Your Everyday Guide from The
National Institute on Aging
  • How to Improve Your Flexibility
  • Stretching or flexibility exercises are an
    important part of your physical activity program.
  • They give you more freedom of movement for your
    physical activities and for everyday activities
    such as getting dressed and reaching objects on a
    shelf.
  • Stretching exercises can improve your
    flexibility, but will not improve your endurance
    or strength.
  • How Much, How Often
  • Do each stretching exercise 3 to 5 times at each
    session.
  • Slowly stretch into the desired position, as far
    as possible without pain, and hold the stretch
    for 10 to 30 seconds. Relax, breathe, then
    repeat, trying to stretch farther.

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Exercise Program Adapted from Exercise and
Physical Activity, Your Everyday Guide from The
National Institute on Aging
  • Safety
  • Talk with your doctor if you are unsure about a
    particular exercise. For example, if youve had
    hip or back surgery, talk with your doctor before
    doing lower-body exercises.
  • Always warm-up before stretching exercises.
    Stretch after endurance or strength exercises. If
    you are doing only stretching exercises, warm up
    with a few minutes of easy walking first.
    Stretching your muscles before they are warmed up
    may result in injury.
  • Always remember to breathe normally while holding
    a stretch.
  • Stretching may feel slightly uncomfortable for
    example, a mild pulling feeling is normal.
  • You are stretching too far if you feel sharp or
    stabbing pain, or joint pain while doing the
    stretch or even the next day. Reduce the stretch
    so that it doesnt hurt.
  • Never bounce into a stretch. Make slow, steady
    movements instead. Jerking into position can
    cause muscles to tighten, possibly causing
    injury.
  • Avoid locking your joints. Straighten your arms
    and legs when you stretch them, but dont hold
    them tightly in a straight position. Your joints
    should always be slightly bent while stretching.
  • Progressing
  • You can progress in your stretching exercises.
    For example, as you become more flexible, try
    reaching farther, but not so far that it hurts.

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Special Thanks
  • RehabCare A Division of Kindred HealthCare
  • Melanie Heck
  • Susan Bolash
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