“The tests that will be presented: Five-repetition Chair Stand, Timed Up and Go, One-leg Stand, Functional Reach, Tandem Stand Test, American Alliance for Health Physical Education Recreation and Dance (AAHPERD), BERG Balance Scale, Performance -Oriented of Mobility Assessment (POMA), Short Physical Performance Battery, WHODAS 2.0 (World Health Disability Assessment Schedule), and a few more.”
Prof. Dr. Wellington Lunz - Federal University of Espírito Santo
Today I will talk about several tests that evaluate different components of the lives of elderly people, with an emphasis on functional aspects, which obviously includes the physical aspect. So let's go!
Regarding physical assessment, the most important components are balance, strength, endurance, and functionality (functionality is the most important, but it depends on the items that precede it).
There are many validated tests to assess these components, and it is also possible to create other specific tests to test the functionality of the elderly person within their routine or family and community context.
For example, the elderly person’s ability to sit down and get up from a chair, sofa, or bed can be assessed. They can lie down on the floor without assistance and then stand up without assistance again. Their gait pattern can be assessed (a ‘shuffling’ gait is dangerous as it increases the risk of tripping and falling).
They can assess whether they have the strength to carry household objects, whether they can reach objects above their heads, or whether they can put on shoes or tie their laces. They can assess whether they can catch a ball thrown from different distances.
Test proprioception by asking the person to flex their hips (with their knees also flexed) and lift one leg off the ground. This test is basically the One Leg Stand, which I will mention shortly, and which is sometimes referred to in some scientific studies as the 'adapted Trendelenburg sign or test'.
You can also increase the challenge by asking the person to do this with their eyes closed. But be careful! Consider the person's level of fragility. We recently made this adaptation in a scientific study (not yet published), with eyes open and closed. We realized that it is not very challenging for trained young people, but for untrained adults, an association has been found between worse results in this test and younger biological age.
Since we have, through life and professional experience, an intuitive notion of what performance should be in these tasks that I mentioned, including the kinematic aspects, such initiatives will already help a lot in making decisions.
But there are also validated tests. The main importance of these tests is to allow comparison with reference values (when available), or with the values presented by one or more scientific articles that have used a sample similar to the elderly person you are evaluating. Among the many tests, I will highlight: Five-repetition Chair Stand, Timed Up and Go, One-leg Stand, Functional Reach, and the Tandem Stand Test.
In advance, I would like to take this opportunity to give a more concrete example of comparison: If the person being evaluated is a woman between 60 and 79 years old, you could compare the results obtained in these 5 tests above with those presented by Hauser et al. (2020).
They used a sample of 190 women in this age group. In other words, this allows you to get an idea of the expected value for the person being evaluated.
The tests I mentioned above (and others that I will mention later) are usually easy to conduct. These 5 tests are explained in the article by Hauser et al. (2020), but they can also be easily found on the internet. However, if you choose to search on the internet, be very careful with the source! Look for a reliable source. In any case, I will also now describe how they should be applied:
( 1 ) Five-repetition chair stand (standing up and sitting down 5 times from the chair): this is one of the most well-known tests. From a sitting position in a straight-backed, armless chair (for safety, the chair should be against a wall), the person must do five repetitions of standing up and sitting down in the chair.
The person's arms will be crossed in front of the body so that they cannot use their arms to assist in the movement. The person should be asked to do the test as quickly as possible. The result will be the total time. And, of course, the shorter the time, the better!
( 2 ) Timed Up and Go (Timed Task): from a seated position in a chair, give the person a command to stand up and walk a distance of 3 meters, turn around, go back, and sit down again. The person should perform the test once to familiarize themselves, then perform two more attempts.
The result will be the average time of the last two attempts. You should also pay attention to the kinematic characteristics (e.g., execution pattern) so that you can assess the autonomy of this task. NOTE: The person cannot run, and the shorter the time, the better!
It is interesting to note that worse results in this test are associated with a higher risk of falling. In a study conducted by Alexandre et al. (2012) with people over 60 years of age, the best cutoff point for predicting falls was 12.47 seconds (sensitivity = 74% and specificity = 66%).
There are other cutoff point recommendations for elderly people over 65 years of age, such as: <20 seconds = low risk of falling; 20–30 seconds = moderate risk of falling; ≥ 30 seconds = high risk of falling (see Costa et al., 2011).
Since falls are very debilitating and increase the risk of death in elderly people, while preventive interventions are relatively simple, it seems more sensible to use the lower cutoff point (e.g., 12.47 s proposed by Alexandre et al., 2012), and thus start interventions (e.g., physical training, restructuring of the domestic space) that can reduce the chance of falling.
( 3 ) One Leg Stand: the person is asked to lift one leg (hip flexion, with the knee also flexed) and remain in this position for 30 seconds or until they lose balance and place their foot on the floor. Three attempts are made, and the result will be the maximum time that the person can remain balanced on one leg. In this case, the longer the time, the better!
( 4 ) Tandem stand test: the person must place one foot exactly in front of the other, where the heel of one foot is positioned in front of the other foot, so that the heel touches the toes of the second foot.
The examiner helps the person to assume the position. The test begins when the examiner allows the person to maintain this position on their own. The time will end if the person moves their foot (loses the position), or if they need to lean on the examiner, or if they reach the maximum time for the test, which is 10 seconds.
The result will be the time, and obviously the longer the time, the better! Note: up to 3 attempts can be allowed, and the average time will be used as the result.
( 5 ) Functional reach: The person is positioned next to a wall, without touching it. Feet parallel, shoulders flexed at 90º, and elbows extended. The starting position should be marked on the wall. The person is then asked to lean their torso forward, keeping their arm extended, without lifting their heel off the floor and without losing their balance.
The distance between the first and second marks will be the result. Three attempts are allowed, and the average of the three measurements should be considered. Although the description may seem difficult, it is quite simple. Search the internet for videos that can help you if you have any questions. In this test, reaching greater distances will mean better results.
There are many other tests in the literature designed to assess different aspects (e.g., risk of falls, functionality, disability, sociability, etc.). Among these many, I will highlight the most common ones.
One of them is the American Alliance for Health, Physical Education, Recreation and Dance (AAHPERD) test battery. This battery assesses the functional fitness of elderly individuals through five physical tests. It is a test that also has normative values (Benedetti et al., 2013).
Another is the BERG Balance Scale. In fact, it is one of the most widely used tests in the clinical/hospital environment. Although it is not free from criticism, there are cutoff points for the risk of falls.
Another test used to predict falls is the Performance-Oriented Mobility Assessment (POMA), also known as the Tinetti Scale. In addition to balance tasks, this test assesses gait kinematics (height, length, and symmetry of steps), which is quite interesting.
There is also the Short Physical Performance Battery, which assesses balance, gait speed, and lower limb strength (for strength, they use the Five-repetition chair stand test, which I mentioned earlier).
There is also the Modified Physical Performance Test and the Fugl-Meyer Balance Subscale. An article that discusses these last tests that I just mentioned (from the BERG Scale to here) is by Costa et al. (2011). This article is exciting for anyone who wants an introduction to the subject.
Finally, it is worth highlighting another instrument: WHODAS 2.0 (World Health Disability Assessment Schedule). It is an instrument proposed by the World Health Organization for ‘assessing disability in activities and participation’.
By 2019, WHODAS 2.0 had already been translated into 47 languages and dialects. The tool is presented in three versions: one with 36 items, a summarized version containing 12 items, and a combined version (12+24 items) (Ferrer et al., 2019).
Some very positive aspects of WHODAS 2.0 are:
1) It is a question-and-answer questionnaire. In other words, it is very easy to apply and can be applied in any environment;
2) It analyzes different dimensions of activities and social participation and how much these influence the well-being and functionality of the elderly;
3) In 2019, normative values were published with a Brazilian sample, which facilitates comparison and expands the applicability of the instrument (Ferrer et al., 2019);
4) There is an association between the worst scores on the WHODAS and the worst scores on the Timed up and go test (Ferrer et al., 2019). This suggests that the WHODAS can also predict falls.
Finally, there is nothing stopping you from associating this questionnaire with other tests, such as the Timed Up and Go itself. This could give you more information about the disabilities and capabilities of the elderly.
Now, to conclude… There are several other possible tests. Some are more challenging, such as the FMS (functional movement screen) and the Y-balance. These are not specific tests for the elderly, but I would recommend them to less fragile people, whose motor skills you want to monitor over the years.
The FMS involves 7 movements, but there is nothing stopping you from using just some of these movements. The Y-balance is simpler and is also widely used by many groups.
Anyway, all of this can be easily found in scientific papers, but if you have any difficulty, you can contact me via the ‘Contact’ section on the website (www.wellingtonlunz.com.br) or by email (welunz@gmail.com).
Also, get in touch to share any other interesting tests that you may know. And in the next post, I will complement the subject with ‘anamnesis and prescription of strength training’ for older people. See you in the next post!
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Author: Wellington Lunz is the owner of this blog and the website www.wellingtonlunz.com.br. He also has a YouTube channel: (youtube.com/@prof.wellingtonlunz) where he shares evidence-based knowledge from different areas (e.g. muscle hypertrophy, strength training, bodybuilding, exercise physiology, flexibility). He has a bachelor's degree in physical education, a Master's degree in nutrition science, and a PhD in Physiological Sciences. Furthermore, he is currently an Associate Professor at the Federal University of Espírito Santo (UFES). Contact via the website or email: welunz@gmail.com.br
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