December 13, 2013
News Review From Harvard Medical School -- Most People over 65 Need Help in Daily Life
Two-thirds of people over 65 need some kind of help with activities of daily living such as bathing and dressing, a new study finds. The study included more than 8,000 people over 65. All but 500 lived in their own homes. Researchers interviewed them. About 25% said they got help with daily activities from changes in the home, such as grab bars, or devices such as a cane. Another 18% used such devices but still had problems with some activities. About 6% cut back on daily activities because of such problems. And 21% needed help from another person. Only 31% were able to do all activities of daily living with no help. Age made a difference. About 45% of those ages 65 to 69 got by without help, compared with only 4% of those in their 90s. Nearly 90% could feed themselves without help, but half needed help with bathing. Researchers said the study could help public health officials figure out who needs help and what kind of help. The Journal of Public Health published the study. HealthDay News wrote about it December 12.
By Howard LeWine, M.D.
Harvard Medical School
What Is the Doctor's Reaction?
A longer life span can be a double-edged sword. You stick around longer, but every year past age 65 means your risk of complete independence declines.
Independence can be defined as the ability to perform activities of daily living (ADLs) without help. The basic ADLs are:
- Bathing or showering
- Getting in and out of bed or a chair
- Using a toilet
It's difficult to study how many Americans over 65 can't do these activities of daily living. There's also no consensus on how best to define independence. Does it mean you can do all your ADLs without any device such as grab bars in the bathroom or a walker? Or does it mean that you have these devices in your home but don't need help from another person?
For this study, the researchers defined 5 new categories of mobility and self-care in older adults. The study included more than 8,000 Medicare enrollees, age 65 and over. Interviews found that:
- 31% were able to be as mobile as they desired and perform all ADLs without any type of device
- 25% were able to be mobile and perform all ADLs with one or more devices for mobility and/or changes in the home, such as bathroom grab bars
- 6% limited their activities and mobility, despite devices and changes in the home
- 18% reported problems with movement or performing ADLs, even with assistive devices and home changes
- 21% needed a person to help them get around and perform ADLs
The key to remaining independent is to stay as free of disability as possible. In other words, you want to avoid becoming frail.
There are no standard definitions of frailty. It's a general decline in physical function that makes you more vulnerable to sickness and death. Signs of frailty might include a shuffling and unsteady gait, weight loss, fatigue and physical weakness.
It's complex. Neither old age nor disability alone makes a person frail. But clearly the changes that all of us will have as we age are heavy contributors, even without any chronic condition or illness. And, of course, the risk of chronic or severe illness also rises with age. Heart disease, arthritis, diabetes, depression or cancer can promote frailty because of physical or mental effects.
What Changes Can I Make Now?
You can help prevent frailty or help keep it from getting worse:
- Stay active. You're never too old or frail to exercise.
- Maintain a healthy weight and diet. Eat a variety of healthy foods, and don't skip meals. If you don't feel like eating or if you lose weight unexpectedly, see your doctor. The culprit could be illness, medications, depression or possibly dental problems. Your doctor or a nutritionist may recommend a high-calorie supplement.
- Practice fall prevention. Frailty can result from a fall as well as cause one. If your medicines affect your balance or alertness, ask your doctor about getting a lower dose or a different medicine. Have your vision checked regularly. Clear your home of clutter and loose rugs or wires. Good lighting is essential. Use night-lights in bathrooms, hallways and, if needed, your bedroom. Wear flat-soled shoes or boots that grip. In bad weather, exercise indoors.
- Make connections. Relationships can keep you active and help ward off depression. Dining with others may encourage better eating. An exercise or walking partner also can help you stick to your program.
- See your primary care doctor, eye doctor and dentist regularly. They can identify conditions that contribute to frailty. The list includes heart disease as well as problems with vision, teeth and gums.
What Can I Expect Looking to the Future?
Now we have a better estimate of how many people over age 65 need some form of help to maintain independence. New studies will be needed to figure out the best things we can do to prevent or postpone frailty.