Functional Performance in Older Adults, 3rd Edition

700 Pages·2008·7.93 MB·English

by  Bette R. Bonder

1688_FM_i-xxii.qxd 9/12/08 5:43 PM Page i
Edition 3
FFuunnccttiioonnaall
PPeerrffoorrmmaannccee
iinn OOllddeerr AAdduullttss
Bette R. Bonder, Vanina Dal Bello-Haas,
PhD, OTR/L, FAOTA PhD, MEd, BSc(PT)
Professor,Depts.of Health Sciences and Psychology Associate Professor
Dean,College of Science School of Physical Therapy
Cleveland State University University of Saskatchewan
1688_FM_i-xxii.qxd 9/12/08 5:43 PM Page ii
F.A.Davis Company
1915 Arch Street
Philadelphia,PA 19103
www.fadavis.com
Copyright © 2009 by F.A.Davis Company
Copyright © 2009 by F.A.Davis Company.All rights reserved.This product is protected by copyright.No part
of it may be reproduced,stored in a retrieval system,or transmitted in any form or by any means,electronic,
mechanical,photocopying,recording,or otherwise,without written permission from the publisher.
Printed in the United States of America
Last digit indicates print number:10 9 8 7 6 5 4 3 2 1
Senior Acquisitions Editor:Christa Fratantoro
Manager of Content Development:George W.Lang
Developmental Editor:Peg Waltner
Art and Design Manager:Carolyn O’Brien
As new scientific information becomes available through basic and clinical research,recommended treatments and
drug therapies undergo changes.The author(s) and publisher have done everything possible to make this book
accurate,up to date,and in accord with accepted standards at the time of publication.The author(s),editors,and
publisher are not responsible for errors or omissions or for consequences from application of the book,and make
no warranty,expressed or implied,in regard to the contents of the book.Any practice described in this book
should be applied by the reader in accordance with professional standards of care used in regard to the unique
circumstances that may apply in each situation.The reader is advised always to check product information
(package inserts) for changes and new information regarding dose and contraindications before administering any
drug.Caution is especially urged when using new or infrequently ordered drugs.
Library of Congress Cataloging-in-Publication Data
Functional performance in older adults/[edited by] Bette R. Bonder, Vanina Dal Bello-Haas.—3rd ed.
p.;cm.
Includes bibliographical references and index.
ISBN-13:978-0-8036-1688-2
ISBN-10:0-8036-1688-0
1.Older people—Rehabilitation.2.Aging.I.Bonder,Bette.II.Dal Bello-Haas,Vanina.
[DNLM: 1. Aging—physiology. 2. Aged. 3. Health Promotion. 4. Health Services for the Aged.
5.Mental Disorders.WT 104 F9789 2009]
RC953.5.F86 2009
612.6’7—dc22
2008034206
Authorization to photocopy items for internal or personal use, or the internal or personal use of specific
clients,is granted by F.A.Davis Company for users registered with the Copyright Clearance Center (CCC)
Transactional Reporting Service, provided that the fee of $.10 per copy is paid directly to CCC,
222 Rosewood Drive,Danvers,MA 01923.For those organizations that have been granted a photocopy license
by CCC,a separate system of payment has been arranged.The fee code for users of the Transactional Reporting
Service is:8036-1688/09 0 + $.25.
1688_FM_i-xxii.qxd 9/12/08 5:43 PM Page iii
In loving memory of our friend and colleague,
Marilyn (Lynne) B.Wagner
B.R.B.and V.D.B.H.
1688_FM_i-xxii.qxd 9/12/08 5:43 PM Page iv
F O R E W O R D
In spite of illness,in spite even of the threaten performance (falls, dementia, and
archenemy sorrow,one can remain alive depression) are covered in essays that call our
long past the usual date of disintegration attention to critical points requiring prevention.
if one is unafraid of change,insatiable in The activities central to self maintenance and
intellectual curiosity,interested in big plasticity (self-care, leisure, work and retire-
things,and happy in a small way. ment, community mobility, interactions and
—Edith Wharton,American Poet,1862–1937 relationships, and sexuality) are carefully put
into a contemporary context. The section on
Question:How do health professionals help service delivery stresses evaluation, wellness
older adults live long past the “usual date of dis- and health promotion,and community-based as
integration”so that they can retain the activities well as home health, rehabilitation, and long-
and roles that support their interests, curiosity, term care; all written to foster care to maximize
and happiness? the performance and the experiences of older
Answer: By understanding the process of adults who need services. The last section gives
aging, the theories that guide our interventions, context that can be enabling (culture and aging,
how disease and injury can threaten the daily and products and technology), that can help
experiences of life,how to support the activities practitioners recognize and manage an issue
that make participation possible, how to build that requires our attention (elder abuse), and
services, and context that supports the older that highlights a very important aspect to
individuals as they seek to live lives with mean- our care and the needs of people and their
ing,purpose,and growth. families—end-of-life care. Each of these chap-
In the 3rd Edition of Functional Performance ters has been written by scientists and clinicians
in Older Adults,Drs. Bonder and Dal Bello-Haas that dedicate their work to enabling participa-
have authored and edited a volume that will pro- tion in the elderly. They are superbly written,
vide the health professional with the concepts, conceptually linked, and strongly referenced,
theories,knowledge,and tools to use best prac- which makes this an excellent book to use with
tices and evidence as they design and provide students who will be providing care to the
services for our nations aging population. Con- largest population of older adults in the history
gratulations to them for gaining the commit- of the world.
ment for this project from people who are Our nations’ elderly deserve care from
leaders in the field of aging. Each chapter is an knowledgeable practitioners. The body of
elegant essay that offers a contemporary knowledge exists to support excellence in the
review of the literature and engages the reader in delivery of services. It is our individual and col-
a greater understanding of the importance of lective responsibility to shape the care that our
employing this knowledge to address the needs elderly will receive. Policy makers and a dmin-
of individuals,communities,and society. istrators of health and community services are
The chapters reviewing the impact of looking for ways to meet the needs of a growing
normal aging give context to our increased population of older adults. Let’s help them
understanding of the intrinsic determinants design the services and systems. This wonderful
(cardiovascular, pulmonary, sensory, neuro- book gives us the tools.
musculoskeletal, and mental function) that Carolyn Baum,PhD,OTR/L,FAOTA
must be considered in determining the capabil- St. Louis,Missouri
ities of the older adult. The major issues that June,2007
iv
1688_FM_i-xxii.qxd 9/12/08 5:43 PM Page v
P R E F A C E
For age is opportunity no less aging. However, as will be seen in the pages of
Than youth itself,though in another dress, this volume,critics contend that the factors Rowe
And as the evening twilight fades away and Kahn identified as the main elements for suc-
The sky is filled with stars,invisible by day. cessful aging are incomplete or even inaccurate.
—Henry Wadsworth Longfellow After all,while there are strategies that elders can
pursue to avoid disease, most will at some point
This book considers what it means to grow develop one or more chronic or acute diseases.
old. Specifically,it examines what it is that older And clearly many elders who have various health
individuals want to do, need to do, what facili- or functional problems find ways to pursue the
tates accomplishment of those tasks, and what meaningful occupations that promote positive
interferes. These are not simple matters. quality of life. Occupational therapists would
Philosophers,scientists,novelists,and religious argue that regardless of physical status,the ability
leaders have examined them for generations and to pursue these occupations would be a measure
debate continues to this day about what consti- of success at any stage of life.
tutes a satisfying later life. Every health profession that provides care to
Perhaps a reason for the continuing discus- elders has its own focus in the broader context
sion is the fact that aging is such a complex of promoting successful aging and quality of
phenomenon. Personal experience and charac- life. Some, medical professionals, for example,
teristics, biological factors, culture, historical emphasize preventing or treating biological
events, and context all influence later life for a disease; others, like physical therapists, empha-
particular individual. Theory and research have size enhancing physical capacity. Occupational
typically focused on describing groups, an therapists focus on promoting engagement in
approach that explains a great deal about aging meaningful occupation. For all these professions,
in general but little about the experience for adequate care for the individual requires an under-
a particular person. Recent advances in our standing of the societal and physical environment
understanding of individuals’ unique develop- in which care is provided,and the characteristics
ment in later life can be attributed to the and needs of the service recipient from a histori-
growing interest in qualitative research that cal,cultural,biological,and social perspective. In
emphasizes description of perceptions and addition, health-care providers must understand
experiences in depth and detail. the unique combination of these factors that make
While researchers struggle to find the best up the individual person.
strategies for explaining later life, health-care This book is designed to provide both foun-
providers are concerned primarily with individu- dational information about aging and concrete
als; thus, they focus on research that can guide strategies for supporting successful aging. It
their practice and describe the best possible inter- describes optimal aging, the normal aging
vention strategies. Although there is increasing process, and the factors that can interfere with
attention being paid to population-based interven- normal aging. The material is presented from
tions such as careful community planning,and to the perspective of functional performance of
public policy that affects older adults and their everyday activities, taking the stance that it is
families,for most care professionals,the focus is accomplishment of these activities that defines
on maximizing well-being for each client. well-being and life satisfaction for older adults,
Of course,well-being is also a complex phe- and that “we who are interested in reducing the
nomenon. Rowe and Kahn (1998) popularized the risk to elders of unproductive aging need to con-
concept of successful aging, which they distin- centrate our attention and our efforts on enhanc-
guish from usual (or typical) and unsuccessful ing the opportunities for older persons”(Grams
aging. They suggested that avoiding disease, & Albee,1995,p. 13). It is inevitable that every
maintaining health, and engaging in meaningful older adult will experience some degree of
activities are the three main elements of successful physical or cognitive decline, but it is not a
v
1688_FM_i-xxii.qxd 9/12/08 5:43 PM Page vi
vi Preface
given that this will lead to a commensurate disabilities that affect younger individuals, and
decline in function. Further, if function does that they may also have to deal with the long-term
decline in a particular area, substitution of new consequences of such disorders as diabetes that
occupations may serve to ensure satisfaction of may have emerged in earlier life. These issues are
personal meanings and values in life. addressed in subsequent chapters.
The book is divided into five main parts. Part 3, Chapters 11 through 16, considers
The first provides a demographic, historical, activities and participation,with an emphasis on
and theoretical context for understanding the how typical elders engage in various kinds of
aging process. In doing so, it reviews biologi- occupations and the normal developmental chal-
cal theories as well as psychosocial theories of lenges occupations can present as people age.
aging, and emphasizes understanding of the There is also discussion about what health-care
importance of occupational engagement in providers, particularly occupational therapists,
later life. can do to prevent or minimize dysfunction. It
Part 2 focuses on normal aging and inter- reviews theoretical issues related to aging, the
ruptions in normal aging that can impede meaning of activity, and our current under-
engagement in occupation. The chapters are standing of the biological and psychosocial
organized based on the American Occupational processes that influence various aspects of
Therapy Association’s Practice Framework participation.
(2002), a model that is based on a hierarchy of Part 4, Chapters 17 through 22, focuses
factors contributing to occupational performance. on provision of care from the perspective of
Section 1, Chapters 4 through 7, focuses on various health-care systems. Because most
normal age-related change in body functions and health care in the United States is paid by
body structures. These changes occur to some third-parties, therapists must understand the
degree for every elder,although as these chapters systems in which they work to ensure they
make clear,there is considerable individual varia- provide the best possible care in the specific
tion. In spite of these individual differences, the environment,and work to change systems that
aging process does have a somewhat predictable are unfair or inadequate. In these chapters, in-
sequence,with some decrements in function more formation is presented about the kinds of func-
likely to occur earlier than others and some func- tional problems most often seen in each set-
tions more likely to remain intact, or even to ting, strategies for assessing functional
improve over time. These chapters also consider abilities and deficits, and for intervening to
the ways in which the aging process can,at some maximize older adults’ability to engage in the
point almost certainly will,lead to some deterio- occupations that matter most to them.
ration of function. Most elders experience The last part of the book, Chapters 23
periodic abrupt or severe personal,social,or envi- through 26, presents several special issues.
ronmental losses. These include the interaction of culture with
There are some predictable factors that can individual and community experiences of later
lead to sudden major performance decrements. life; the impact of emerging technologies on
Loss of a spouse can precipitate a debilitating functional performance for older adults; and the
depression that might interfere with accomplish- issue, all too common in the United States, of
ment or even identification of desired activities. elder abuse. Finally, the unavoidable issue of
Ice on the sidewalk can cause a fall that might loss is addressed. Occupational therapists and
have devastating effects for an older adult. Section other health professionals are increasingly
2, Chapters 8 through 10, describes common involved in supporting elders and their families
kinds of dysfunction that may signal the begin- at the very end of life. Effective intervention
ning of a downward spiral of functional loss. can assist individuals as they cope with this final
These three chapters are not meant to be an life task.
exhaustive survey of medical conditions; rather, More and more individuals are spending
they have been chosen to typify common muscu- longer and longer periods in the later stages
loskeletal (falls/fractures), psychosocial (depres- of life. Quality of life and functional ability
sion), and cognitive (dementia) problems that are crucial considerations. It is in everyone’s
interfere with function. It is important to recog- best interests to understand the process and
nize that elders are affected by all the diseases and develop effective mechanisms for maximizing
1688_FM_i-xxii.qxd 9/12/08 5:43 PM Page vii
Preface vii
well-being. Our ability to accomplish this is, References
of course,a “work in progress.”As the elderly American Occupational Therapy Association (AOTA)
population increases, more attention is being (2002). Occupational therapy practice framework:
paid to its circumstances. New information Domain and process. American Journal of Occupa-
tional Therapy,56,609–639.
emerges daily that increases our ability to pro-
Grams,A.,& Albee,G. W. (1995). Primary prevention
vide high-quality service. It is our hope that
in the service of aging (pp. 5–33). In L. A. Bond,
this volume will generate new questions, the S. J. Cutler,& A. Grams (Eds.),Promoting successful
answers to which may further enhance our and productive aging.Thousand Oaks,CA:Sage.
ability to assist older adults in leading mean- Rowe,J. W.,& Kahn,R. L. (1998). Successful aging.
ingful and satisfying lives. New York:Random House.
1688_FM_i-xxii.qxd 9/12/08 5:43 PM Page viii
A C K N O W L E D G M E N T S
A project like this one is complex and challeng- editor, ably aided by Elizabeth Zygarewicz.
ing and requires help from a vast array of indi- Peg Waltner, developmental editor, spent many
viduals. We would like to thank the many older hours getting the chapters formatted and making
adults and their families who have shared their sure the materials were user-friendly. The pro-
lives and their stories with us. We also thank the duction team included: David Orzechowski,
many professionals from whom we have learned managing editor, Bob Butler, production man-
about strategies for improving quality of life ager,Carolyn O’Brien,art and design manager,
for elders. and Linda Kern at PPA.
Many of the chapter authors in this book Special thanks to our “on the scene”
have been with us from the beginning, and we assistants: Tasha Thornhill, School of Physical
greatly appreciate their contributions. Thank you Therapy (Class of 2008), University of
to the authors who are new to this edition. The Saskatchewan.
reviewers have provided invaluable insight and And last, but certainly not least, we thank
advice as this book was developed. We appreciate our families. Tom Haas and Pat, Aaron, and
their thoughtfulness and thoroughness. Jordan Bray were patient when we weren’t
A large team was assembled at F.A. Davis. available for other tasks, and were supportive
Christa Fratantoro served as senior acquisitions during the lengthy writing and editing process.
viii
1688_FM_i-xxii.qxd 9/12/08 5:43 PM Page ix
C O N T R I B U T O R S
Georgia J. Anetzberger,PhD,ACSW Lindy M. Clemson,PhD
Assistant Professor Sesquicentenary Senior Research Fellow
Health Care Administration Program and Senior Lecturer
Cleveland State University Faculty of Health Sciences
Cleveland,OH The University of Sydney
Lidcombe,Australia
Ben Atchison,PhD,OTR,FAOTA
Professor Elizabeth Dean,PhD,PT
Department of Occupational Therapy Professor
Western Michigan University Department of Physical Therapy
Kalamazoo,MI Faculty of Medicine
University of British Columbia
Patrick Baker,MSHS,CDRS,OTR/L
Vancouver,Canada
Clinical Specialist
The Cleveland Clinic Armele D. De Andrade
Cleveland,OH Universidad Federal de Pernambuco
Recife,PE,Brazil
Vern Bengtson,PhD
Chair and Professor Vanina Dal Bello-Haas,PhD,PT
University of Southern California Associate Professor
Davis School of Gerontology School of Physical Therapy
Ethel Percy Andrus Gerontology Center University of Saskatchewan
Los Angeles,CA Saskatoon,Canada
Anita Bundy,ScD,OTR,FAOTA Karl Christl,BAppSc(PT),LLB(Hons)
Professor and Chair of Occupational Therapy Consultant Aged Care Physiotherapist
Faculty of Health Sciences Company Director
The University of Sydney Christl,Bye & Associates Pty Ltd
Lidcombe,Australia Aged Care Physiotherapy Services
Rosalind Bye,PhD,MAppSc(OT), Susan E. Doble,PhD,OTReg (NS)
BAppSc(OT) Associate Professor
Senior Lecturer in Occupational Therapy School of Occupational Therapy
School of Biomedical and Health Sciences Dalhousie University
College of Health and Science Halifax,Nova Scotia,Canada
University of Western Sydney
Beth A. Ekelman,JD,OTR/L
Penrith South,Australia
Director and Associate Professor
Cameron Camp Department of Health Sciences
Director of Research and Product Development Cleveland State University
Hearthstone Alzheimer Care Cleveland,OH
Woburn,MA
Kristine Haertl,PhD,OTR/L
Boin Chang,M.A. Associate Professor
Doctoral Candidate Occupational Science and Occupational
Industrial/Organizational Psychology Therapy
The University of Akron College of St. Catherine
Akron,OH St. Paul,MN
Charles Christiansen,EdD/L
College of Health Sciences
University of Texas Medical Branch
Galveston,TX
ix