How to Markedly Reduce Your Risk of Going to a Nursing Home (Part II)
October 24, 2024 | Uncategorized
Part II: Functional Age the Solution
Steve and Stanley are identical twins who are now 76 years old. Steve has recently returned from a trip with his grandchildren exploring Iceland. For the past seven months, Stanley has been a resident in a nursing home. He and his wife, Carol, were unable to pay the $11,000 monthly cost of the facility. Stanley has been transferred to a Medicaid facility further away from Carol. He no longer has a private room, but the transfer to this facility will allow Carol to continue to live in and own the family home. The brothers have shared and been together in almost every aspect of their lives. Now their futures couldn’t be more different.
From a medical perspective they still both have hypertension, high cholesterol, and diabetes. With the exception that Stanley now requires insulin, their chronic conditions are controlled and well-managed. Due to falls in his home Stanley has been hospitalized twice. There is a reason for the difference in health and well-being in their 70s. Steve has routinely walked his dog several miles a day, and shortly after his retirement he began swimming two to three days a week. Stanley was generally sedentary and rarely walked a distance greater than two blocks.
The 70s is the decade of accelerated human disability. Disability is defined as the inability to perform basic daily activities independently. According to the Joint Center for Housing Studies of Harvard University, the most significant rise in disability occurs between 70 and 80 years old. Mobility disabilities such as walking, getting in and out of bed, and climbing stairs increase by 33%. By 80 years of age one out of three people will have a self-care disability in dressing, toileting, or bathing. Seven out of 10 people will have a limitation related to household activities and have a need for assistance preparing meals, shopping, working, or driving. As these disabilities increase in number and severity, people eventually are unable to care for themselves and live independently.
Functional disabilities are the primary cause and predictor of nursing home placement. A research meta-analysis of nursing home admissions in the United States by Dr. Robert L Kane and colleagues found that having three or more impairments in the ability to perform basic activities of daily living increased the odds of nursing home placement by 325%.
Unlike Alzheimer’s disease, which we have no effective treatment for or understanding of, we know the cause of functional disability, and we have a simple, readily available treatment to prevent, limit and even reverse it.
At the age of 30 you begin losing muscle mass and strength. This loss increases and may be more noticeable around the age of 60. By the age of 80 many people have lost over 50% of their muscle mass and strength. The medical term for this loss is sarcopenia. The name is of Greek origin and means “poverty of the flesh.”
Sarcopenia is a part of the aging process, with multiple causes including poor nutrition, inflammation, and changes in how muscle cells function and receive signals from nerve cells. However, the major risk factor for this loss of muscle mass and strength is sedentary behavior and inactivity. Conversely, regular physical activity and exercise can limit and even reverse the effects of sarcopenia.
The large impact of sarcopenia on functional decline and reduced quality of life in older adults is an important reason for physicians to understand, diagnose and treat this condition. Unfortunately, we are at a place similar to 40 years ago when physicians simply looked at memory loss as a normal part of aging before understanding that Alzheimer’s and other dementias were due to a disease. In a September 2022 article in the Journal of the American Geriatrics Society, it was reported that “Less than 20% of internist and family medicine physicians reported being familiar with the term sarcopenia.” They concluded that sarcopenia has not been fully incorporated into the knowledge base and practices of active physicians.
Physicians’ failure to understand and diagnose sarcopenia is very disturbing when you consider that the number of people over 65 with sarcopenia is four times greater than the number with Alzheimer’s disease.
In August 2023, the U.S. Department of Health and Human Services launched a national sarcopenia awareness campaign. The announcement stated, “Studies show that more than 45% of the older U.S. population is affected by sarcopenia, with millions of younger adults at risk for developing it later in life.”
Without the knowledge of or support from the medical community, how can a person get assessed and treated for sarcopenia? Sarcopenia reduces the ability for a person to function independently on a daily basis. Therefore, older adults need to test and determine their abilities in comparison to someone their age without sarcopenia. Ideally, a person’s functional age would be at or below their chronological age. If your functional age is greater than your chronologic age, now is the time to be motivated and act. The benefits of lowering functional age are particularly significant for those with chronic illness like diabetes, heart disease and hypertension.
Functional age is correlated with personal independence and reduces the risk of nursing home placement. The identical twins Steven and Stanley are 76. Steve’s functioning is like that of a 70 year old. Stanley’s functional age is 84. Stanley will spend the remainder of his life in the nursing home and Steve will likely never enter a nursing home.
Functional age Is within our control. It will increase or decrease based upon our physical activity and lifestyle. Multiple studies have shown that even simply walking for 30 minutes today can prevent and reduce functional disability by years.
The World Health Organization (WHO) defines healthy aging as “the process of developing and maintaining the functional ability that enables well-being in older age.” Now is the time to get and stay healthy. Begin by learning your functional age.
An accurate functional age can be obtained with the online Resilient 80s functional age test. The assessment is free and may be repeated to document changes in functional age. The site is secure and protects all information. Healthy life expectancy is also reported.