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4605_FM_i-xxvi 02/11/17 10:49 AM Page i

Functional Performance
in Older Adults
FOURTH EDITION

Bette Bonder, PhD, OTR/L, FAOTA

Professor Emerita, School of Health Sciences
Cleveland State University
Cleveland, OH

Vanina Dal Bello-Haas, PhD, Med, BSc(PT)

Associate Professor
School of Rehabilitation Science
Assistant Dean, Physiotherapy
McMaster University
Hamilton University, Ontario, Canada
4605_FM_i-xxvi 02/11/17 10:49 AM Page ii

F. A. Davis Company
1915 Arch Street
Philadelphia, PA 19103
www.fadavis.com

Copyright © 2018 by F. A. Davis Company

Copyright © 2018 by F. A. Davis Company. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval
system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the
publisher.

Printed in the United States of America

Last digit indicates print number: 10 9 8 7 6 5 4 3 2 1

Senior Acquisitions Editor: Christa Fratantoro

Director of Content Development: George W. Lang
Developmental Editor: Rose Foltz
Art and Design Manager: Carolyn O’Brien

As new scientific information becomes available through basic and clinical research, recommended treatments and drug therapies undergo changes. The author(s)
and publisher have done everything possible to make this book accurate, up to date, and in accord with accepted standards at the time of publication. The
authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed
or implied, in regard to the contents of the book. Any practice described in this book should be applied by the reader in accordance with professional standards
of care used in regard to the unique circumstances that may apply in each situation. The reader is advised always to check product information (package inserts)
for changes and new information regarding dose and contraindications before administering any drug. Caution is especially urged when using new or infrequently
ordered drugs.

Library of Congress Cataloging-in-Publication Data

Names: Bonder, Bette, editor. | Dal Bello-Haas, Vanina, editor.

Title: Functional performance in older adults / [edited by] Bette R. Bonder,
Vanina Dal Bello-Haas.
Description: Fourth edition. | Philadelphia : F. A. Davis Company, [2018]
Identifiers: LCCN 2017043990 | ISBN 9780803646056 (hardcover)
Subjects: | MESH: Aging—physiology | Health Services for the Aged | Mental
Disorders | Health Promotion | Aged
Classification: LCC RC953.5 | NLM WT 104 | DDC 612.6/7—dc23
LC record available at https://lccn.loc.gov/2017043990

Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted by F. A. Davis Company for users
registered with the Copyright Clearance Center (CCC) Transactional Reporting Service, provided that the fee of $.25 per copy is paid directly to CCC,
222 Rosewood Drive, Danvers, MA 01923. For those organizations that have been granted a photocopy license by CCC, a separate system of payment has
been arranged. The fee code for users of the Transactional Reporting Service is 8036-4605-6/17 0 + $.25.
4605_FM_i-xxvi 02/11/17 10:49 AM Page iii

For our parents, older family, friends, and clients, who are wonderful role models for
aging gracefully.
—BRB and VDBH
4605_FM_i-xxvi 02/11/17 10:49 AM Page iv

PREFACE

It is hard to believe that more than 20 years have passed since and publishing a text of this scope takes time, and science
the first edition of this volume was published in 1994. It has and reality march on in the meantime. We hope readers will
been a fascinating process analyzing the situation in 2017 check the literature regularly to see what has happened since
and comparing it to years past. And it’s been heartening to this book was written.
see the many ways in which older adults around the world As one way to promote such exploration, we’ve added an
have seen improvements in their circumstances. At the same online site to provide elaboration, additional resources, items
time, the ongoing challenges are sobering for those of us in of interest, and materials you might find useful in working
health care. with clients. We hope you’ll find it helpful, and that you’ll
Updating and expanding the text has taken on personal visit it often.
immediacy over the years. We, the editors, and many of our We made a concerted effort to address interprofessional
longtime and excellent contributors are, ourselves, reaching care, particularly focused on physical and occupational ther-
old age. We have taken care of—and in some instances lost— apy. It is inevitable that there will be those who disagree with
older loved ones. We have adjusted to changes in our physical our delineation of the two disciplines and will wonder why
capacities, activities, social networks, and living situations. we didn’t more fully incorporate others. Those disagreements
As is true for all older adults, these changes have tested our and questions serve to highlight some of the very real chal-
adaptive capacities and required flexibility and, often, lenges of instituting truly interprofessional care. We believe
courage. Thus, the material in this book has increasing such care is in the best interests of clients, but we also know
salience in our own lives. This has encouraged us to be ever that professional boundary disputes and the realities of
more mindful of reflecting not only the facts associated with health-care systems and reimbursement make interprofes-
aging but also the emotional realities of the experience. sional care difficult in the real world. It is worth striving to-
Those of you who have read previous editions will note ward but not easy to enact.
that the content has been dramatically expanded. We have We hope you will find the new content and features of
tried to ensure a comprehensive picture of aging. We are well this book helpful and engaging, and that the updated material
aware that this is not really possible in a single volume. Even is worthy of your time and helpful in your professional and
if we could do so, it would be a snapshot in time. Writing personal lives.

iv
4605_FM_i-xxvi 02/11/17 10:49 AM Page v

ACKNOWLEDGMENTS

This edition is a significantly expanded version of Functional We appreciate the input from our students over the years,
Performance. It has been a labor of love for many people and we are deeply grateful to the many clients who have
who’ve been instrumental in making it the best book it could enabled us to learn from their experiences. We also appreciate
possibly be. the students who helped us refine the content of the book,
We thank our many excellent authors for their thoughtful responding to material, checking references, and otherwise
contributions and patience during a lengthy revision process. helping us enhance the product. We are grateful to the many
We also thank our reviewers, who offered helpful observa- people who have read the book, and especially those who
tions that have greatly improved the final product. We thank contacted us with suggestions or posted reviews that helped
Melissa Spor, who provided technical writing assistance, and us continue to improve it.
Rebecca and Jordan Bray who were instrumental in develop- And, as always, we thank our families. The process of
ing the online materials. bringing this book to completion has been a very long term,
We thank F. A. Davis for its continuing support and con- and at times intensive, effort, and they’ve not only provided
fidence in this project. In particular, Christa Fratantoro, Rose helpful input, but have also cooked meals, handled household
Foltz, George Lang, Amelia Bevins, Nicole Liccio, Megan chores, and been cheerleaders during the process. Patrick Bray,
Chandler, Carolyn O’Brien, and Bob Butler. Our sincere Lisa Gomersall and Aaron Bray, Rebecca and Jordan Bray,
apologies if we left anyone off this list; many F. A. Davis staff and Tom Haas have our profound gratitude.
work hard and effectively behind the scenes.

v
4605_FM_i-xxvi 02/11/17 10:49 AM Page vi

CONTRIBUTORS

Georgia J. Anetzberger, PhD, ACSW, LISW Lindy M. Clemson, PhD, MAppSc, OT, DipOT
Adjunct Assistant Professor Professor
Department of Medicine Occupational Therapy
Case Western Reserve University University of Sydney
Cleveland, OH Sydney, Australia

Julie D. Bass, PhD, OTR/L, FAOTA Nicole T. Dawson, PT, PhD, MA, GSC
Professor Assistant Professor
Occupational Therapy Department of Physical Therapy
St. Catherine University University of Central Florida
St. Paul, MN Orlando, FL

Susana Villasana Benítez, PhD Elizabeth Dean, PhD, PT

Maestría en Antropología Social Professor
Instituto de Estudios Indígenas Department of Physical Therapy
Universidad Autónoma de Chiapas Faculty of Medicine
San Cristobal de las Casas, Chiapas, Mexico University of British Columbia
Vancouver, British Columbia, Canada
Patricia Bowyer, EdD, OTR, FAOTA
Associate Director and Professor Sanetta H. J. Du Toit, PhD, MSc (OT), BOccTh
School of Occupational Therapy Lecturer, University of Sydney
Texas Women’s University Affiliated Lecturer, University of the Free State
Houston, TX Sydney, Australia

Brent Braveman, PhD, OTR/L, FAOTA Beth A. Ekelman, PhD, JD, OTR/L
Director Professor and Director
Rehabilitation Services Program in Occupational Therapy
M. D. Anderson Cancer Center Cleveland State University
Houston, TX Cleveland, OH

Patrick Bray, MD, MPH R. Elaine Fogerty, OTR/L

Medical Consultant Occupational Therapist
Shaker Heights, OH Clovis, NM

Jenny Brodsky Laureano Reyes Gómez, PhD

Director Vocal Titular de Investigación
Center for Research on Aging Instituto de Estudios Indígenas
Jerusalem, Israel Universidad Autónoma de Chiapas
San Cristobal de las Casas, Chiapas, Mexico
Anita C. Bundy, ScD, OT, FAOTA
Professor and Department Head Joshua Greene, OTD, OTR/L
Department of Occupational Therapy Adjunct Faculty
Colorado State University Occupational Therapy
Fort Collins, CO Quinnipiac College
Hamden, CT
Faculty of Health Sciences
University of Sydney
Sydney, Australia

vi
4605_FM_i-xxvi 02/11/17 10:49 AM Page vii

CONTRIBUTORS vii

Kristine Haertl, PhD, OTR/L, FAOTA Norma J. MacIntyre, PhD, PT

Professor Associate Professor
Department of Occupational Science and Therapy Physical Therapy
Saint Catherine University McMaster University
St. Paul, MN Hamilton, Ontario, Canada

Cynthia Hovland-Scafe, PhD, MSSW Mary Ann McColl, PhD, MTS

Assistant Professor Associate Director
School of Social Work Centre for Health Services & Policy Research
Cleveland State University
Professor
Cleveland, OH
Rehab Therapy/Community Health
Queen’s University, Abramsky Hall
Linda A. Hunt, PhD, OTR/L, FAOTA
Kingston, Ontario, Canada
Professor, School of Occupational Therapy
Director, Graduate Program in Gerontology
Bobby Nijjar, BSc, MSc, EdD, RD
Pacific University
Assistant Professor
Hillsboro, OR
Simon Fraser University
Vancouver, British Columbia, Canada
Katherine S. Judge, PhD
Associate Professor
Megan E. O’Connell, BA Hon, MA, PhD, RD Psych
Department of Psychology
Associate Professor
Cleveland State University
Psychology
Cleveland, OH
University of Saskatchewan
Saskatchewan, Canada
Maayan Katz, PhD, OT
Deputy Director of Occupational Therapy
Evguenia S. Popova, MS, OTR/L
National Service
Graduate Research Assistant
Director of Geriatric Occupational Therapy
University of Illinois at Chicago
Ministry of Health
Chicago, IL
Jerusalem, Israel
Iris Rasoolu, MD, MPM
Karen la Cour, PhD, MSc, OT
Head, Community Services Department
Associate Professor
Geriatric Division
Head of the Research Initiative of Activity Studies and
Israel Ministry of Health
Occupational Therapy Institute of Public Health
Jerusalem, Israel
University of Southern Denmark
Odense, Denmark
Julie Richardson, PT, PhD
Associate Dean
Lori Letts, PhD, OT Reg (Ont)
School of Rehabilitation Science
Assistant Dean, Occupational Therapy Program
McMaster University
Professor
Hamilton, Ontario, Canada
School of Rehabilitation Science
McMaster University
Nancy Richman, OTR/L, FAOTA
Hamilton, Ontario, Canada
Occupational Therapist
Rehabilitation Associates
Kim Lewitte, BOT
Chicago, IL
Occupational Therapist, Private Practice
Johannesburg, South Africa
Sergio Romero, PhD
Research Assistant Professor
Line Lindahl-Jacobsen, PhD, MPH, OT
Department of Occupational Therapy
Associate Professor
University of Florida
Department of Public Health, General Practice
University of Southern Denmark Research Health Scientist
Odense, Denmark Center of Innovation on Disability and Rehabilitation
Research
North Florida/South Georgia Veterans Health System
Gainesville, FL
4605_FM_i-xxvi 02/11/17 10:49 AM Page viii

viii CONTRIBUTORS

Sirirat Seng-Iad, PhD(C) Joyce Tryssenaar, PhD, OT Reg (Ont)

Doctoral Candidate Associate Professor
School of Rehabilitation Science McMaster University
McMaster University Hamilton, Ontario, Canada
Hamilton, Ontario, Canada
Sarah Wojkowski, PhD, PT
Anupa Singh, BOT Assistant Professor
Occupational Therapist, Private Practice School of Rehabilitation Science
Johannesburg, South Africa McMaster University
Hamilton, Ontario, Canada
Wendy Stav, PhD, OTR/L, SCDCM, FAOTA
Chair and Professor Missi Zahoransky, MS, OTR/L
Occupational Therapy Department Adjunct Faculty
Nova Southeastern University School of Health Sciences
Ft. Lauderdale, FL Cleveland State University
Cleveland, OH
Amanda Stead, PhD, CCC, SLP Integrity Home Care
Assistant Professor Cleveland, OH
College of Education, School of Communication Sciences
and Disorders Yael Zilberslag
Pacific University Occupational Therapist
Forest Grove, OR Jerusalem, Israel

Renée R. Taylor, PhD

Professor
Department of Occupational Therapy
University of Illinois at Chicago
Chicago, IL
4605_FM_i-xxvi 02/11/17 10:49 AM Page ix

REVIEWERS

Ron Carson, OTD, MHS, OT David Greene, PhD, OTR

Assistant Professor Associate Professor Occupational Therapy
Occupational Therapy Occupational Therapy
Adventist University of Health Sciences Colorado State University
Orlando, FL Fort Collins, CO

Susan M. Cleghorn, MS, OTRL, TRS, CAPS Ashley Halle, OTD, OTR/L
Assistant Professor Assistant Professor
Occupational Science & Therapy Chan Division of Occupational Science & Occupational
Grand Valley State University Therapy
Allendale, MI University of Southern California
Los Angeles, CA
Erica DeFrancesco, MS, OTR/L
Clinical Assistant Professor Margaret D. Hart, PhD, OTR/L
Occupational Therapy Professor Emeritus
Quinnipiac University Occupational Therapy
North Haven, CT Worcester State University
Worcester, MA
Susan P. Denham, EdD, OTR/L, CHT
Occupational Therapy Nathan B. Herz, OTD, MBA, OTR/L CEAS
Alabama State University Founding Director
Montgomery, AL Occupational Therapy
Murphy Deming College of Health Sciences
Mary Lou Donovan, PhD, OTR/L Fishersville, VA
Assistant Professor
Occupational Therapy Sandra Hobson, BSc(OT), MAEd, LLD, FCAOT
College of St. Scholastica Professor Emerita
Duluth, MN School of Occupational Therapy
The University of Western Ontario
Ruth Ford, EdD, MSBS, OTR/L London, Ontario, Canada
OTD Program Director
Occupational Therapy, Doctorate Brenda Kennell, OTR/L
Huntington University Program Chair
Fort Wayne, IN Occupational Therapy Assistant
Central Piedmont Community College
Susan Friguglietti, DHA, MA, OTR/L Charlotte, NC
Associate Professor of Occupational Therapy
College of Health Sciences Cindy Koehn, OTR/L
Lenoir-Rhyne University Academic Fieldwork Coordinator
Hickory, NC Occupational Therapy Assistant Program
Hawkeye Community College
Lynn Gitlow, OTR/L, PhD, ATP Waterloo, IA
Associate Professor
Occupational Therapy Susan Kristoff, LMT, PTA
Ithaca College President/Owner of a private practice: Homecare PT
Ithaca, NY Massage Therapy, Physical Therapy
Nuebody Therapy
Willow Grove, PA
ix
4605_FM_i-xxvi 02/11/17 10:49 AM Page x

x REVIEWERS

Danielle N. Naumann, BA(H), MSc(OT), PhD(c), OT Stacey L. Schepens Niemiec, PhD OTR/L
Reg(Ont) Research Assistant Professor
Occupational Therapist; PhD Candidate Rehabilitation Chan Division of Occupational Science and Occupational
Science Therapy
School of Rehabilitation, Faculty of Health Sciences University of Southern California
Queen’s University Los Angeles, CA
Kingston, Ontario, Canada
Nancy Schneider Smith, PT, DPT, GCS
Terry Peralta-Catipon, PhD, OTR/L Clinical Associate Professor
Department Chair Physical Therapy
Occupational Therapy Winston Salem State University
California State University Dominguez Hills Winston Salem, NC
Carson, CA
Steven Wheeler, PhD, OTR/L
Ann Marie Potter, MA, OTR/L Associate Professor
Lecturer Occupational Therapy
Occupational Therapy West Virginia University School of Medicine
Elizabethtown College Morgantown, WV
Elizabethtown, PA
Caryn Young, BA, BSc, PgDIP, MBAOT, MCOTSS-NP,
Samia H. Rafeedie, OTD, OTR/L, CBIS HCPC Registered OT
Assistant Professor Lecturer in Occupational Therapy
Division of Occupational Science & Occupational Therapy School of Health Sciences
at the Herman Ostrow School of Dentistry Ulster University
University of Southern California Newtownabbey, Northern Ireland
Los Angeles, CA

Patricia Louise Schaber, PhD, OTR/L, FAOTA

Associate Professor
Program in Occupational Therapy
University of Minnesota
Minneapolis, MN
4605_FM_i-xxvi 02/11/17 10:50 AM Page xi

CONTENTS

PREFACE iv
ACKNOWLEDGMENTS v
CONTRIBUTORS vi
REVIEWERS ix
INTRODUCTION TO THE FOURTH EDITION xxv

PART I Global Health and Aging: Implications for Health and Participation 1
1 Growing Old in Today’s World 3
Bette Bonder
History of Aging 4
Life Expectancy 4
Impact of Economic Circumstances and Gender Throughout History 4
Attitudes About Aging From a Historical Perspective 5
Historical Roles of Older Adults 6
Cohort Effects 6
Aging Today: Factors Affecting the Experience of Aging 7
Physical Environment 7
Sociocultural Factors 8
Individual Characteristics 10
The Impact of Gender in Modern Times 11
Socioeconomic Factors 11
Positive Aging 12
2 Theories of Aging: A Multidisciplinary Review for Occupational and Physical
Therapists 19
Bette Bonder, Renée R. Taylor, and Evguenia S. Popova
Challenges of Societal Aging 19
What Do Gerontologists Want to Explain? 19
Sociodemographic Changes 20
The Current State of Theory in Gerontology 20
Theories of Aging 20
Biological Theories of Aging 20
Neuropsychological Theories of Aging 21
Psychological Theories of Aging 22
Sociological Theories of Aging 24
Client-Centered Approaches With Older Adults 26
The Systems Theory of Motor Control 26
The Model of Human Occupation 27
The International Classification of Functioning, Disability, and Health and the Occupational Therapy Practice
Framework, Third Edition 28
The ICF 28
The Occupational Therapy Practice Framework, Third Edition 29

xi
4605_FM_i-xxvi 02/11/17 10:50 AM Page xii

xii CONTENTS

3 Public Policy and Advocacy in North America 33

Nancy Richman
Public Policy and Aging 33
Federal Policy 34
State Policy 38
Local Policy 38
Public Policy in International Context 38
Models of Advocacy 39
How Policy Is Made 39
Advocating for Policies 40
Advocating for Individuals 40
The Role of OT and PT in Advocacy 41
Advocacy at Work: The Olmstead Act 42

4 Aging Around the World 45

Services for Older Adults in Israel 45
Yael Zilberslag, Maayan Katz, Jenny Brodsky, and Iris Rasoolu
The Demography of Aging in Israel 46
Health and Welfare Services 46
Long-Term Care for Disabled Elders 47
The Social Formal System of Care 47
The Health System of Care 48
Issues and Challenges 49
Health Care for the Elderly in Mexico 49
Laureano Reyes Gómez and Susana Villasana Benítez
Sociodemographic Context 49
Health-Care Systems 50
Conclusion 52
Aging in South Africa 53
Kim Lewitte and Anupa Singh
The Effect of Apartheid on South African Aged 53
The Rainbow Nation: Current Status of Older Adults 54
Health Care in South Africa 54
The Role of the Aged in the South African Community 56
Challenges for the Aged in South Africa 57
Conclusion 58

5 Meaningful Occupation in Later Life 61

Bette Bonder
The Search for Meaning 61
Occupation and Meaning 62
Themes of Meaning 63
Supporting Meaning in Occupational and Physical Therapy Interventions 66

6 Culture, Ethics, and Elder Abuse 75

Bette Bonder and Georgia J. Anetzberger
Culture and Aging 75
Aging in International Context 76
Culture and Aging in the United States 77
4605_FM_i-xxvi 02/11/17 10:50 AM Page xiii

CONTENTS xiii

Aging, Culture, and Function 77

Occupations 77
Performance Skills 79
Performance Patterns 79
Context 80
Activity Demands 80
Client Factors: Body Functions and Body Structures 81
Culture and the Intervention Process 81
Cultural Competency 81
Analysis of Occupational Performance 81
Intervention 82
Ethical Issues in Later Life 82
Elder Abuse 83
Definition and Forms 83
Prevalence and Incidence 83
Reporting 84
Examples, Signs, and Risk Factors 84
Addressing Elder Abuse 85

PART II Aging: Body Structures and Body Functions 91

SECTION 1 Normal Age-Related Changes 93
7 Cognitive Function 93
Katherine S. Judge and Nicole T. Dawson
Bases of Cognitive Aging 94
Key Tenets of Cognitive Aging Across the Life Span 94
Methodological Considerations 94
Foundations of Cognition Aging: Basic and Higher Order Cognitive Processes 95
Basic Cognitive Processes 95
Higher Order Cognitive Processes 99
Additional Cognitive Processes 101
Theories Of Cognitive Aging 102
Speed of Processing Theory 102
Working Memory 102
Inhibition 103
Common Cause Hypothesis (Sensory Functioning) 103
Optimizing Cognitive Aging and Health 103

8 Cardiopulmonary and Cardiovascular Function 109

Elizabeth Dean
Interrelationships Among Structure and Function, Activity, and Social Participation: Cardiovascular and Pulmonary
Function 110
Age-Related Changes in the Cardiopulmonary System and Its Function 110
Airways 110
Lung Parenchyma 110
Alveolar Capillary Membrane 110
Chest Wall 110
4605_FM_i-xxvi 02/11/17 10:50 AM Page xiv

xiv CONTENTS

Respiratory Muscles 111

Net Effect of Age-Related Cardiopulmonary Changes 111
Age-Related Changes in the Cardiovascular System and Its Function 111
Heart 111
Blood Vessels 112
Net Effects of Age-Related Cardiovascular Changes 112
Functional Consequences of Age-Related Cardiopulmonary and Cardiovascular Changes 112
The Functional Performance Threshold 112
Functional Capacity 116
Functional Consequences of Fitness in Older People 118
Deconditioning 118
Conditioning 118
Implications for the Management of the Care of Older People 119
Safety 124
Customizing the Environment to Maximize Function 124

9 Sensory Function and Function Related to the Skin 129

Linda A. Hunt, Amanda Stead, and Bobby Nijjar
Vision System and Functional Performance 130
Normal Age-Related Vision System and Vision Changes 130
Auditory System and Functional Performance 132
Normal Age-Related Auditory System and Hearing Changes 132
Effects of Normal Age-Related Auditory System and Hearing Changes 134
Taste and Smell: Physical Changes and Functional Performance 136
Somesthesis: Physical Changes and Functional Performance 138
Skin Changes With Aging 138
Touch and Pressure 138
Pain 138
Temperature 139

10 Neuromuscular and Movement Function: Muscle, Bone, and Joints 145

Vanina Dal Bello-Haas, Norma J. MacIntyre, and Sirirat Seng-Iad
Neuromusculoskeletal and Movement Function in Older Adults 146
Age-Related Changes in Muscle Strength and Power 148
Age-Related Muscle Changes and Function 150
Age-Related Changes in the Skeletal System 151
Age-Related Changes in the Nervous System 153
Assessing the Neuromusculoskeletal System in Older Adults 154
Range of Motion and Flexibility Assessment 154
Muscle Strength and Power Assessment 154
Management of Neuromusculoskeletal Impairments in the Older Adult 155
Strength and Resistance Exercises 156
Flexibility (Stretching) Exercises 158

11 Neuromuscular and Movement Function: Coordination, Balance, and Gait 163

Vanina Dal Bello-Haas, Norma J. MacIntyre, and Sirirat Seng-Iad
Age-Related Changes in Postural Alignment 163
Age-Related Changes in Coordination 165
Age-Related Changes in Balance and Gait 166
Changes in Proprioception 167
Changes in Gait 167
4605_FM_i-xxvi 02/11/17 10:50 AM Page xv

CONTENTS xv

Assessing Posture, Coordination, Balance, and Gait in Older Adults 167

Static Posture Assessment 167
Coordination Assessment 168
Balance Assessment 169
Gait Assessment 172
Management of Posture, Coordination, Balance, and Gait Problems in the Older Adult 174
Postural Problems and Skeletal Deformities 174
Coordination 174
Balance and Gait 174

SECTION 2 Age-Related Health Conditions, Impairments, and Limitations 181

12 Cognitive and Emotional Function: Health Conditions 181
Katherine S. Judge and Nicole T. Dawson
Key Tenets for Understanding and Maximizing Success With Atypical Cognitive Changes 182
Neurodegenerative Illnesses: Dementia and Associated Disorders 184
Prevalence of Dementia and Associated Disorders 184
Etiology and Types of Dementia 184
Symptoms of Dementia 185
Diagnosing Dementia 186
Pharmacological and Nonpharmacological Interventions for Dementia 187
Stroke 188
Prevalence 188
Etiology and Types of Stroke 188
Symptoms of Stroke 188
Diagnosing Stroke 189
Pharmacological and Nonpharmacological Interventions for Stroke 189
Mental Health Conditions 189
Depression 190
Anxiety Disorders 191
Schizophrenia 192
Bipolar Disorder 192
Substance Use Disorders 193
Understanding the Illness Experience of Individuals With Cognitive Conditions 194
Translating Research Findings Into Rehabilitation Treatment Plans for Cognitive and Emotional Disorders 194

13 Cardiopulmonary and Cardiovascular Function: Health Conditions 201

Elizabeth Dean
Factors Affecting Cardiopulmonary and Cardiovascular Health in Older People 202
Pathophysiology, Etiology, and Epidemiology 203
Gravitational Stress and Exercise Stress 208
Extrinsic Factors 209
Intrinsic Factors 209
Exercise Testing and Training Older People With Cardiopulmonary and Cardiovascular Health Conditions 210
Assessment Findings and Implications for Exercise Testing 210
Exercise Test Findings and Implications for Exercise Training 211

14 Sensory Function, Function Related to the Skin and Pain: Health Conditions 217
Linda A. Hunt, Bobby Nijjar, and Amanda Stead
Pathological Changes in the Visual System 217
Cataracts 218
Age-Related Macular Degeneration 219
4605_FM_i-xxvi 02/11/17 10:50 AM Page xvi

xvi CONTENTS

Glaucoma 219
Diabetic Retinopathy 220
Functional and Behavioral Adaptations 221
Other Diseases That May Affect Vision, Visual Processing, and Functional Performance 222
Pathology of the Auditory System 224
Skin 224
Pain 225
Assessment 225
Interventions 226

15 Neuromuscular and Movement Function: Health Conditions 231

Norma J. MacIntyre, Vanina Dal Bello-Haas, and Sirirat Seng-Iad
Osteoarthritis 231
Risk Factors and Signs and Symptoms 232
Management of Osteoarthritis 232
Osteoporosis 233
Clinical Diagnosis 233
Fractures 233
Management of Osteoporosis 234
Amputation in Older Adults 236
Physical and Psychosocial Challenges of Limb Amputation 236
Management of Limb Amputation in Older Adults 236
Complications of Limb Amputation 237
Parkinson’s Disease 238
Management of Parkinson’s Disease 238
Stroke 241

16 Neuromuscular and Movement Function: Falls 249

Vanina Dal Bello-Haas and Norma J. MacIntyre
Definition of Fall and Near-Fall 249
Fall Facts 249
Where and When Do Older Adults Fall? 250
Consequences and Sequelae of Falls 250
Risk Factors for Falls 251
Risk Factors—Age-Related and Biological 251
Risk Factors—Behavioral and Cognitive 252
Risk Factors—Environmental and Community 253
Fall Risk and Fall Prevention Assessment 253
Fall Risk and Fall Prevention Intervention 255
Exercise 256
Prescription of Assistive and Adaptive Devices and Activities of Daily Living, Mobility, and Gait Training 257
Fear of Falling Interventions 257
Environment/Community: Prevention and Intervention 257
Other Interventions 257

17 Considerations for Medical Care of Older Adults 263

Patrick Bray and Bette Bonder
Differential Impact of Disease and Disorder in Later Life 264
Physiological and Psychosocial Factors and Disease 264
Severity of Specific Conditions 264
4605_FM_i-xxvi 02/11/17 10:50 AM Page xvii

CONTENTS xvii

Presenting Symptoms 264

Preexisting Conditions 264
Acute Conditions 265
The Impact of Hospitalization 265
Common Medical Conditions in Later Life 265
Cancer 265
Diabetes and Obesity 266
Urinary Tract Infection 268
Infectious Diseases 268
Nutritional Deficiency and Oral Health 269
Frailty Syndrome and Posthospital Syndrome 269
Medication 270
General Principles for Effective Medication Use in Later Life 270
Pain Management 271
Substance Abuse 271
Implications for Occupational Therapy and Physical Therapy 272

PART III Active Aging: Supporting Client Activities and Participation 277
18 Self-Care 279
Kristine Haertl
Defining Self-Care 280
Models to Explain Everyday Functional Abilities 280
Competence, Value, and Meaning in Self-Care 280
Significance of Self-Care 281
Prevalence and Type of Limitations of Activities of Daily Living Among Older Adults 282
Effects of Medical Conditions on Self-Care 282
Stroke 282
Cardiovascular Disease 283
Dementia and Cognitive Decline 283
Joint Inflammation and Disease 283
Sensory Problems 283
Measuring Self-Care Performance 284
Assessing Factors Contributing to Self-Care Deficits 284
Assessing Instrumental Activities of Daily Living 285
Assessing Environmental Factors 285
Safety 286
Activities of Daily Living Intervention 286
Skill Training 286
Environmental Modifications 287
Assistive Devices for Self-Care 288
Task Modifications 289

19 Leisure 295
Anita C. Bundy, Sanetta H. J. Du Toit, and Lindy M. Clemson
Leisure and Aging 296
Leisure as a Statement of Identity 297
Leisure as a Fully Engaging Experience 298
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