Functional Performance in Older Adults

Author: Bette R. Bonder
Published: October 2000
Publisher: Davis F A
ISBN: 0803605439
Hardcover Book
Number of Pages: 425

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Functional Performance in Older Adults, 2nd Edition, serves and the ideal resource of rehabilitation professionals who are working or preparing to work with older adults. This book describes the normal aging process and also shows how health and social factors can impede an aging individual's abilities. Review these key features:

Emphasizes intervention strategies that will maintain the older person's ability to perform the activities that give his or her life meaning.
Addresses self-care, work, and leisure from the perspective of aging—topics rarely addressed in gerontology textbooks
Coverage is from a multidisciplinary perspective and is equally balanced between theoretical and applied information
Chapters new to the second edition include theories of aging, sexuality, driving, wellness, and community-based care. Part 1 of this book describes the normal aging process in terms of the ""experience"" of growing old as well as the ""components"" of a performance (e.g., sensory, cognitive) that are compromised in normal aging. The second part describes factors that contribute to dysfunction in older adults and discusses intervention strategies to maintain and improve functional performance of older individuals. The book provides an understanding of ""what it is that older individuals want to do, need to do, what facilitates accomplishment of those tasks and what interferes."" This is accomplished by providing insight into the needs of older adults and their families and discussion of intervention that is effective and meaningful. Although written for health care providers, allied health care students and clinicians, particularly in the fields of occupational therapy, physical therapy, and recreational therapy, will find it most useful. The authors and multidisciplinary contributors are credible authorities in the subject of aging and function. Several tables, figures, and photographs of adequate quality illustrate and clarify text in each chapter. Extensive references provide resources that are pertinent and timely. A unique feature is the inclusion of introductory quotations that are insightful and relevant to each chapter. A list of objectives and review questions for each chapter and a glossary are extremely useful. Case examples are another means of translating theoretical concepts into real-world application. This book offers a blending of theoretical concepts, practical assessment, and intervention strategies for improving the functional performance and quality of life of older individuals andtheir families. Although chapters are introductory in nature, experienced clinicians in geriatric practice would benefit from this resource. Given the textbook format of this publication, students and faculty would especially benefit from its use in undergraduate gerontology courses, especially in the field of occupational therapy. The health-care industry is showing a growing interest in people's abilities to do everyday activities in their daily lives; research shows that older adults who can accomplish meaningful activities are relatively satisfied with their lives, regardless of their objective health. For these reasons, the work of therapists, social workers, psychologists, and other professionals whose focus is on quality of life has gained increasing importance. The editors (health sciences, Cleveland State U.) selected contributors from the US, Canada, and Australia who represent a variety of perspectives on the aging process, activities of older adults, factors contributing to dysfunction, intervention strategies, and special topics such as technology, driving, and the end of life. Chapters new to this edition include theories of aging, sexuality, wellness, and community-based care. Bette R. Bonder, PhD, OTR/L, FAOTA, Professor and Graduate Coordinator, Department of Health Sciences, Cleveland State University, Cleveland, Ohio
Marilyn B. Wagner, PhD, PT, Associate Professor, Department of Health Sciences, Cleveland State University, Cleveland, Ohio
Bonder, Bette R., PhD, OTR/L, FAOTA (Cleveland State Univ); Wagner, Marilyn B., MA, PT (Cleveland State Univ)The contributors represent the specialties of occupational therapy, nursing management, gerontology, anthropology, social work, speech and hearing science, physical therapy, psychiatry, epidemiology, and psychology.

Table of Contents
Introduction                                                             xxix
    PART I. NORMAL AGING 1
SECTION 1. INTRODUCTION AND OVERVIEW 5
1. Growing Old in the United States
Bette R. Bonder 7
Historical Definitions of Aging 9
Current Definitions 11
Current Attitudes 11
Cultural Factors 12
Place of Residence 19
Gender 20
Individual History 21
Public Policy and Aging 21
Summary and Implications for Service Providers 22
2. Biological Theories of Aging: Implications for Functional Performance
Wojtek J. Chodzko-Zajko 28
Definitions of Aging 29
Biological Theories of Aging 31
The Structural and Functional Consequences of Aging 33
Individual Differences and Aging 34
Lifestyle Interventions and Aging 37
Conclusion 39
3. The Psychosocial Meaning of Activity
Bette R. Bonder 42
Defining Meaning 44
Developing Meaning 44
Meaning of Activities; Theories 46
Toward and Integrated Model 51
Implications for Health-Care Providers 55
SECTION 2. THE AGING PROCESS 59
4. Mobility
Marilyn B. Wagner and Timothy L. Kauffman 61
Muscle Strength and Aging 62
The Skeletal System in the Older Adult 70
Balance, Coordination, and Movement and Aging 71
Summary 80
Appendix 4-1: Exercise for Persons 55 Years Old and Older 85
5. Cardiopulmonary Development
Elizabeth Dean 86
Age-Related Anatomic Changes in the Cardiopulmonary
System and Its Function 89
Age-Related Changes in the Cardiovascular System and Its Function 90
Other Factors that Affect Cardiopulmonary and Cardiovascular Function 92
Functional Consequences of Age-Related Cardiopulmonary and Cardiovascular Changes 96
Functional Consequences of Fitness in Older People 105
Implications for the Management of the Care of Older People 108
Customizing the Environment to Maximize Function 115
Summary 115
6. Sensory and Sensory Integrative Development
Celia Routh Hooper 121
Vision and Functional Performance 123
Hearing and Functional Performance 126
Taste and Smell: Physical Changes and Functional Performance 131
Somesthesis and Touch; Physical Changes and Functional Performance 132
Sensory Intergration: A conclusion 132
Appendix 6-1 137
7. Cognitive Development
Kathryn Perez Riley 138
Cognitive Changes in Normal Aging 139
Other Cognitive Abilities 141
Congnition and Activities in Normal Aging 144
Future Directions 149
SECTION 3. ACTIVITIES OF OLDER ADULTS 153
8. Self-Care
Charles H. Christiansen and Cindy Lynn Hammecker 155
Defining Self-Care 156
Person-Environment and Enablement Models 156
Importance of Self-Care 156
Functional Limitations Influencing the Performance of Self-Care 161
Measuring Self-Care Performance 163
Prevalence and Type of Limitations of Activities of Daily Living Among Elderly Persons 167
Activity of Daily Living Intervention 168
Summary 175
9. Work and Retirement
Harvey L. Sterns, M. Patricia Junkins and Janet G. Bayer 179
The Older Labor Force 180
Wellness Programs for Older Adults 183
Older Worker Performance 184
Obsolescence Versus Maintaining Competence 184
Retirement 189
Conclusion 192
10. Leisure
Anita C. Bundy 196
Leisure and Aging 198
Leisure as a Statement of Identity 200
Elements of Leisure 201
A Tentative Model 210
Promotion of Leisure: Application of the Model 211
Summary 214
11. Sexuality in Late Adulthood
Andrew W. Miracle and Tina S. Miracle 218
Sex and the Elderly Population 219
Age-Related Physical Changes and Sexual Functioning 224
Effects of Disease on Sexuality 227
Other Factors Affecting Sexuality 228
Summary and Implications for Health Professionals 230
Appendix 11-1: How to Obtain Additional Information 235
12. Assessment of Functional Performance
Seanne Wilkins, Mary Law and Lori Letts 236
The Meaning of Assessment 237
Assessment Philosophy 239
Assesment Realities 241
A Conceptual Framework for Assessment of Performance 242
A Decision-Making Process to Guide Assessment 244
Issues in the Assessment of Performance with Older Adults 244
Assessment Methods 248
Summary 250
Assessment Examples 251
   PART II. INTERRUPTIONS IN FUNCTIONAL PERFORMANCE 257
SECTION 4. FACTORS CONTRIBUTING TO DYSFUNCTION IN OLDER ADULTS 265
13. Falls
Rein Tideiksaar 267
Epidemiology 268
Causes of Falling 270
Clinical Assessment and Intervention 273
Interventions 278
Common Environmental Hazards 278
Fear of Falling 279
Alternatives to Physical Restraints 280
Intervention Trials 281
Summary 284
14. Dementia
Mary A. Corcoran 287
Irreversible Conditions Resulting in Dementia 289
The Notion of Excess Disability 290
Assessing Functional Performance in Individuals with Dementia 293
Managing Dementia-It takes a Team 296
Summary and Future Directions 302
15. Depression
Kathryn Perez Riley 305
Overview of Depressive Disorders in Older Adults 306
Depression and Functional Status: An Interactive Relationship 310
Treatment of Depression 313
Cultural Factors in Depression 315
Summary and Future Directions 315
SECTION 5. INTERVENTION STRATEGIES 319
16. Wellness
Bette R. Bonder 321
Defining Wellness 322
Factors That Promote Wellness 323
Theories of Behavior Change 330
Designing and Funding Programming 332
Model Programs 336
Conclusion 336
17. Community-Based Services
Georgia J. Anetzberger 339
Service Classifications 340
Service Utilization 341
Something to Do 344
Someone to Care 353
Someplace to Live 355
Summary and Future Directions 358
18. Home Health Care
Ben J. Atchison 363
Historical Development of Home Health Care 364
Cost-Effectiveness of Home Care 365
Qualifications for the Medicare Home Health Benefit 366
Common Conditions Treated in Home Care 367
Age and Functional Status of Home-Care Clients 367
Caregiver Issues 368
Core Competencies of Occupational Therapy Practice in Home Health Care 368
The Therpeutic Process in Home Health Care 372
Conclusion 378
Appendix 18-1: Home Health Care 382
19. Rehabilitation
Lynnda J. Emery 390
Geriatric Rehabilitation Priorities 391
Evaluation in Geriatric Rehabilitation 391
Factors to Consider in Treatment of Older Persons 394
Conditions Frequently Treated In Rehabilitation 396
Common Problems of Older Adults 398
Rehabilitation Delivery Systems for Older Persons 399
Reimbursement and Practice Management 400
Summary 403
20. Activities as Agents for Intervention and Rehabilitation in Long-Term Care
Ruth E. Plautz and Cameron J. Camp 405
Evolution of the "Modern" Nursing Home 406
OBRA '87 Philosophy and Occupational Therapy 408
Activities in Long-Term Care 411
Interdisciplinary Teams in Long-Term Care 412
Therapies and Total Environment 414
Regulatory and Reimbursement Issues 415
Innovative Trends 415
Summary and Challenges 420
Appendix 20-1: Coding Sheet for Montessori Activities 423
SECTION 6. SPECIAL TOPICS 427
21. Technology
William C. Mann 429
Definitions and Concepts 430
Aging and Functional Performance 431
Assistive Technology for Older Adults 432
Disability Impact Continuum: Difference in Assistive Technology Needs 441
Appendix 21-1: Resources 447
22. Driving and Older Adults
Beth A. Ekelman, Steven Mitchell and Pam 0'Dell-Rossi 448
Overview of National Statistics on Violations, Crashes, and Fatalities 449
Neurosensory Model of Driving 449
Age-Related Physiological and Disease-Related Changes Affecting Driving Performance 455
Clinical Assessment and Intervention 459
Suggestions for the Geriatric Clinician 470
Losing the Ability to Drive-A Psychosocial Perspective 471
Conclusions 474
Appendix 22-1: Occupational Therapy Driving Evaluation 478
23. Families and Professionals: Therapeutic Considerations
Bette R. Bonder and Betty R. Hasselkus 487
Factors Affecting Family Relationships 489
Therapeutic Relationshops 490
Techniques for Practice 493
Addressing Family Issues in the Current Health-Care Environment 496
Summary 497
24. The End of Life
Rosalind A. Bye, Gwynnyth M. Llewellyn and Karl E. Christl 500
Understanding Terminal Illness 501
Individuals' Experience of Terminal Illness 502
Terminal Illness and the Older Person 503
A Good Death 504
Palliative Care 504
Occupational Therapy and Physical Therapy-Our Role in Palliative Care 506
Reframing Occupational Therapy and Physical Therapy for Palliative Care 507
Therapy That Affirms Life and Helps Prepare for Death 508
Reframing the Processes of Therapy 509
Support Strategies for Therapists 516
Conclusions 518

Glossary 521

Index 533

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