We all understand intuitively how somebody is doing when we
see through their eyes how they experience the world.
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| Dancing Janet! Tango |
Janet
Imagine Janet. Janet is a lean, tall woman who is full of
energy. Janet wakes up at 6:30AM to do an hour of Yoga, she eats fruits and
yoghurt for breakfast. Then she is out the door and to the community center.
She loves to volunteer and provide meaningful support to her community. In the
afternoon she gets together with her friends for a coffee and they chitchat and
lough. Tonight Janet takes a class in ballroom dancing.
Angela
Now let’s meet Angela. Angela has an aide who comes at 7AM
and gets her washed and out of bed. The aide helps her with breakfast and then
sits her in front of the TV. Angela sometimes thinks that it would be nice to
go to the Park or meet her friends but she couldn’t really ask her aide to help
her with that… at least she doesn’t dare to. The hours don’t seem to pass by,
there is one game show after the other, one talk show after another… well, you
know how irritating TV can be. And then tonight Angela goes back to bed with
the help of her aide.Who is doing better, health wise? How old is Janet? How old is Angela?
This is pretty obvious: Janet seems in great health. She is
independent, energetic and very active. Angela on the other hand is probably
seriously ill. Angela needs help with the some of the most basic activities of
her daily life and might even be depressed.
What you might not expect is their ages: Janet is 92 years
old! Angela is only 63, she could be Janet’s daughter.
And that is why we don’t look at a number when we treat a
patient. Numbers play a role but not the biggest. We want to see the whole
person. And that is when we evaluate their functional status. How dependent is
someone in his or her “activities of daily living” (=ADL)? These are some ADLs:
transferring out of bed, dressing, washing, toileting, feeding. And then there
are the more advanced activities: instrumental ADLs (iADLs) such as managing
the household, the medications, finances, and transportation. When we know
which of these are done independently and which require assistance (and how
much) then we have a much better understanding of the person as a whole and of
this person’s needs.
Believe it or not: someone’s functional status may sometimes
be one of the most important factors to be considered by the physicians when
estimating whether a patient is a candidate for a procedure, a surgery, or even
chemotherapy. Functional status really matters and helps to keep the big
picture “vivid”.
Can you do something to improve functional status?
This really depends on the underlying cause of your
impairment. A person with dementia will over time become worse and worse
without much hope of significant improvement. Somebody healthy who broke a hip
may benefit from rehabilitation and may recover a very high level of
functioning.
Staying active is key. You may do this on your own (even
taking regular brisk walks 30 min. three times a week is already great!) or you
may require the help of a physical therapist – this depends on your situation
and you should ask your doctor.
There are several great physical therapist and physical
therapy clinics out there. I like to work with Fox Rehab (check out their blog:
http://blog.foxrehab.org ). They are a
“mobile” outpatient clinic and come to your house for 50 min one-on-one intense
physical, occupational, speech and cognitive therapy. And what I like best:
they have extensive experience with the older patient generation – which the
geriatrician in me loves!
I hope this helped.
Have a great day and stay active,
Dr. B
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