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 Physical Decline Begins Earlier Than Expected: Study

Physical decline is common in frail elders, but a new study suggests that this downward slide actually begins sooner in life—when people are in their 50s. According to researchers at Duke University, efforts to maintain basic strength and endurance should begin in middle age, when it is still possible to preserve the skills that keep people mobile and independent. This should begin with functional tests.

“Typically, functional tests are conducted on people in their 70s and 80s, and by then you’ve missed 40 years of opportunities to remedy problems,” said Miriam Morey, PhD, senior fellow in the Center for the Study of Aging and Human Development at Duke University School of Medicine. Morey and her colleagues studied 775 participants—ranging in age from 30 to over 100--enrolled in the Measurement to Understand the Reclassification of Disease of Cabarrus/Kannapolis (MURDOCK) Study. All participants performed the same simple tasks to demonstrate strength, endurance or balance, rising from a chair repeatedly for 30 seconds, standing on one leg for a minute, and walking for six minutes.

The researchers found that men generally performed better than women on the tasks; not surprisingly, younger people outperformed older participants. However, the age at which physical declines began to appear were consistent regardless of gender or other demographic features. Both men and women in their 50s began to lose their ability to stand on one leg and rise from a chair. Decline continued through the next decades, and researchers observed further differences in aerobic endurance and gait speed for individuals in their 60s and 70s.

“These five tests were selected not only for their superior measurement properties, but because they can be easily conducted in the field, with minimal equipment and instruction,” said Katherine Hall, PhD, assistant professor in the Duke University Department of Medicine-Geriatrics, and a study co-author. She added, “We did these assessments in cafeterias, community centers, and clinics.” She stressed that a clinician such as a registered nurse or physician isn’t necessary to administer these tests; they just require someone who is adequately trained.

While the authors urge that functional testing be conducted on younger adults, they stress the value of physical activity at any age. “It’s never too late to start. Physical activity can play a role in preventing or postponing decline and limitations,” said Hall. She added, “It is a great way for older adults experiencing deficits to keep further decline at bay. Rebounding and improvement with exercise at any age is possible.”

Morey noted that long term care center staff and family members are sometimes hesitant to encourage physical activity among elders. “They are afraid to recommend or allow activity that might result in a fall or injury. While it is true that someone lying in bed is less likely to fall than someone who is active, there is a preponderance of evidence showing that the benefits of being active far outweigh the potential risks. Being sedentary leads to accelerated functional decline, and even people at high risk for falls can be active, with activities tailored to their functional status,” she said.

Functional tests can help centers customize exercise programs, said Morey, and deliver “personalized medicine instead of applying activity recommendations with a broad stroke.” Part of this, she stressed, means understanding patients’ personal goals regarding functioning activity. A healthy person in their 80s who wants to get back on the golf course after an illness will have different goals than a counterpart with heart disease who just wants to be able to walk down the aisle at her granddaughter’s wedding.
 
Morey and her team recommend including functional testing as part of admission to a long term care center. It creates an opportunity to address each person’s abilities and level of physical decline and disclose exercise goals and wishes. At the same time, this presents a chance to educate adult children about the benefits of pursuing functional testing for themselves so that they can stay active, independent, and healthy longer. “We need to get the word out about this. Our study is the very first step in determining factors associated with physical decline and looking at means of preventing it whenever possible.”
 
For more information, visit the MURDOCK study website.
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