Prevent the risk of the elderly deconditioning

In 2031, those aged 65 and over will account for 55 to 72% of the working population, whereas today the dependent population accounts for only 22% of the working population. For human, social and economic reasons, now more than ever, it is important to learn about the best practices to optimize the health and independence of the elderly.

Risks of deconditioning in the elderly

Functional autonomy

It is well known that functional autonomy decreases in the elderly. These functional impairments affect mobility (29%), agility (25%), hearing (14%), intellectual activity (12%) and mental health (8%).

Osteoporosis

Osteoporosis affects, after 50 years, one in four women and one in eight men.

There are two types of osteoporosis.

• Type 1, primary, usually occurs in women between the ages of 51 and 75, after a decline in estrogen. Then, the trabecular bone is affected, putting them at greater risk of vertebral fractures by crushing, for example.
• Type 2, senile, occurs more in adults aged 70 years and older, secondary to immobilization and a decrease in the charge. This condition affects the trabecular and cortical bone most commonly causing hip, humerus and pelvis fractures.

Balance and Falls

Falls are the leading cause of fatal injuries in people over 65 years of age. Between 20 and 30% of them fall at least once a year. Falls, responsible for 84% of admissions to hospital, are an important predictor of institutional accommodation.

Physical activity – prevention and treatment

For osteoporosis

The bone is constantly remodeling thanks to muscle contractions. The calcium level of the muscle attachments is increased which, in turn, increases the level of calcium more globally in the bone.

Suggested activities for osteoporotic subjects:

• For people at risk of osteoporosis, exercises involving moderate to high ground contact (eg, step, running) as well as strengthening are advised. It is important to gradually increase the intensity to prevent any joint problems.
• For people with osteoporosis without an history of fracture, strengthening exercises with calcium supplements are advised. Again, it is essential to gradually increase the intensity and avoid extreme postures in order to prevent injuries.
• For people with osteoporosis with an history of fracture, pool exercises will be mostly recommended while respecting a progression in intensity.

For balance and risk of falls

A decrease in strength and muscle power is correlated with fallers. The most important muscle groups to prevent these falls are: hip flexors and extensors, quadriceps, as well as plantar and ankle dorsal flexors.

It is also important to increase joint range of motion and muscle flexibility. A decrease in joint amplitude at the ankles and hips is related to an increased risk of falls. Indeed, increasing the amplitude in extension of the hips improves walking pattern as well as the protective reactions if there is an imbalance.

Although possibly anxiety-provoking, learning to fall and get up is paramount in the population aged 65 and over. It must also be ensured that the person has, if necessary, appropriate and well-adjusted technical assistance.

One of the best predictors of fall risk is walking speed:

• The minimum distance required to walk in community is 300 m.
• A walking speed of less than 1 meter per second could cause difficulty in respecting traffic lights.
• The walking speed is strongly related to the strength of the legs why it is important to perform strengthening exercises.

General Exercise Recommendations – Issued by the American College of Sports Medicine

Aerobic Exercises :

Aerobic exercise: moderate intensity 30 minutes / day, 5 days / week. min.

Or

Aerobic exercise: high intensity 20 minutes / day, 3 days / week. min.

Strengthening exercises :

8-10 exercises (main muscle groups)

2 to 4 days per week non-consecutive

10-15 repetitions

Moderate intensity

For the following muscle groups:

• Hip and knee extensions
• Plantar and Dorsal Flexors
• Biceps, triceps
• Pectoral, deltoid
• Back and Abdominal Extensions

Flexibility exercises :

2 to 3 days / week for 10 minutes

30 seconds by stretching

≥ 4 repetitions / muscle

By Monica Windsor, physiotherapist

Références :

• Institut de la statistique du Québec, Démographie : Le bilan démographique du Québec,2011

• Institut canadien de la recherche sur la condition physique et le mode de vie. L’enquête Campbell sur le mieux-être au Canada, 1988

• Lefebvre, C. Un portrait de la santé des québécois de 65 ans et plus. Institut National de santé Publique du Québec, 2003

• Old, JL. Calvert, M. Vertebral compression fractures in the elderly. Am G, 2004

• Agence de la santé publique du Canada (2014). Chutes chez les aînés au Canada

• Sinaki, M. Exercise and osteoporosis. Archives of Physical Medicine and rehabilitation

• Smith, El, Raab, DM. Osteoporosis and physical activity, 1988

• Papaioannou A, Morin S, M Cheung A, Atkinson S, Lignes directrices de pratique clinique 2010 pour le diagnostic et le traitement de l’ostéoporose au Canada

• Arcand, M. Hébert, R. (1997). Précis pratique de gériatrie

• American College of Sports Medicine (2010) Guidelines for exercises testing and prescription

• American College of Sports Medicine (1998): American College of Sports Medicine Position Stand: Exercise and physical activity for older adults.

• American College of Sports Medicine (1990) : American College of Sports Medicine Position Stand : the recommended Quantity and Quality of Exercise for Developing and Maintaining cardiorespiratory and Muscular Fitness in Healthy Adults