Successful Aging

1. Successful Aging Barbara Resnick, PhD, CRNP University of Maryland

2. Conceptualization • There are 29 different definitions of successful aging

3. Common themes • The definitions generally focus on either objective (# comorbidities; impaired function) or subjective (“I feel good!”; QOL) approach. • The central theme associated with successful aging tends to be one in which health is "good" and that the individual is free of physical and mental disability…or just feels successful and …”glad to be here!”

4. Conceptualization • Common themes are not always prevalent! • Resilience • Maintenance of an active life style • Good supportive relationships….more important in some studies • Montross et al., 2006

6. Conceptualization • Is successful aging: • A. A state of mind • B. Objective physical and cognitive function • C. Social engagement • D. All of the above?

7. Conceptualization • Physical and mental OPTIMIZATION of function not absolute function • Accepting changes and functioning at the highest level possible. • Physically • Mentally • Socially

8. So Who is Most Successful? • More educated more successful • Race/MS inconsistent • Younger • Volunteers • Those who adhere to healthy behaviors • RESILIENCE

9. Resilience • The capacity to spring back from a physical, emotional, financial, or social challenge • Adaptive behavior • Less likely to succumb to the challenge • Dynamic process and influenced by life over time

10. Resilience • Positive interpersonal relationships • Strong Self efficacy • Positive Self-esteem • A sense of purpose • Spirituality • Ability to use Humor • Creativity • Acceptance of changes (physical and mental) • Maintaining a positive attitude • Ability to identify and utilize resources • Self-determination • Optimism

11. Need MOTIVATION to be RESILIENT • Resilient reintegration for success requires increased energy/motivation to happen • Motivation=The inner urge that moves or prompts a person to action

12. Interventions to Facilitate Successful Aging • Healthy behaviors throughout lifespan • Cognitive stimulation • Maintaining a purpose in life

13. Benefits to Exercise • Meta-analytic reviews provide strong evidence that participation in either non-specific physical activity or specific aerobic or resistive exercise helps to: • decrease risk of coronary heart disease and stroke; • lower incidence of viral episodes; • decrease progression of degenerative joint disease; • prevent osteoporosis of the lumbar spine; • decrease incidences of falls; • increase gait speed and • improve mood, memory and quality of life.

14. New ACSM & AHA Guidelines • Do moderately intense aerobic exercise 30 minutes a day, five days a week OR • Do vigorously intense aerobic exercise 20 minutes a day, 3 days a week AND • Do eight to 10 strength-training exercises, 10-15 repetitions of each exercise twice to three times per week AND • If you are at risk of falling, perform balance exercises AND • Have a physical activity plan

15. Stretching Exercises: How Often? Minimum 3 times/week Do after muscles warm Example after endurance activities and resistance training Warm shower/bath, etc

16. Flexibility Training Flexibility-related activity results in greater range of motion around the joint. Flexibility exercises should be performed a minimum of 2 days a week.

17. Conversely….. Sedentary lifestyles exacerbate coronary heart disease, degenerative joint disease and osteoporosis, and likelihood of falls and other injuries. It is not just what you do…but what you don’t do!

18. Other Healthy Behaviors • Maintain ideal body weight • Don’t smoke • Drink moderate amounts of alcohol • Safe sex, seat belt use, and smart living (eg don’t go up the stairs carrying laundry and 12 packages!)

19. Benefits of Mind Stimulation? • Limited evidence that mental stimulation will prevent cognitive decline/dementia. • Cognitive remediation thru technology/gaming

20. Despite what we know … Only 30% engage in regular physical activity Obesity continues to be a major problem Approximately 9-11% of older adults smoke HIV continues to rise in older adults Preventable falls happen

21. OUR JOB…is to make successful aging happen!

22. Factors that Influence Motivation/ Resilience • Social supports • Beliefs (SEE; OE) • Unpleasant/pleasant sensations • Mood • Personality: Resilience • Goals • Environment • Policies

23. Function Focused Care • An exemplar of where we need to go in terms of care and optimizing successful aging.

24. Definition • Function focused care is a philosophy of care in which staff acknowledge older adults’ physical and cognitive capabilities and potential with regard to function and engage them in functional and physical activities (e.g., bathing, turning in bed or ambulating) by integrating these activities into routine care.

25. The Contrast to FFC • FFC contrasts with current care in which involves completing tasks for older patients or limiting the amount of activity they need to perform (e.g., giving a urinal or bedpan versus helping/encouraging individuals to stand and walk to the bathroom to urinate).

26. What are your thoughts????

27. Four Components • (I) Environment and Policy/Procedure Assessments; • (II) Education; • (III) Developing Function Focused Goals; and • (IV) Mentoring and Motivating.

28. I Environment/Policy • Person Environment Fit • Barriers to access of PA opportunities • Policy as relevant – restraint use; falls

29. II Education • Assessment skills • Philosophy • Goal development • Motivational tricks of the trade

30. III Developing the Goals

31. IV Mentoring and Motivating • Making it happen….

32. Safety • Promote ambulation and mobility • Gait belts • Sturdy equipment • Appropriate exercise equipment on the unit (weights, pedometers for fun) • Rest areas along the hallway and clear paths • Fun goals (walk to gift store/coffee bar/unit kitchen) • Increased patient visualization • Appropriate chair and bed height

34. Successful Aging Can Happen People who roll with the waves of life!