Cells and Surveys Should Biological Measures Be Included in Social Science Research? (2001) / Chapter Skim
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Indicators of Function in the Geriatric Population
Indicators of Function in the Geriatric Population
Pages 159-179
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From page 159... ...
However, with rapid advances in technology, assessment of function of individual organs or organ systems, of individual cells, and even of specific molecules will become increasingly feasible, even in the context of a household survey or evaluation. This chapter will review aspects of function at each of these levels in humans, the various types of total organism functions that are usually assessed clinically and can predict outcomes, and issues related to choice of measures of function for this population.
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From page 160... ...
The amount of glucose attached to other important body proteins can be assessed in tissue samples, as from a skin biopsy. Again, not only does such a measurement provide an estimate of exposure to increased blood sugar, but functional characteristics of the glucose-modified molecules are affected and may contribute directly to diabetes-related complications.
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From page 161... ...
Sleep monitoring equipment can be used in the home setting to document nocturnal activity and sleep patterns. Noninvasive continuous monitoring of the blood glucose level will be available in the near future.
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From page 162... ...
Already, portable ultrasound equipment can be used to obtain quantitative measures of cardiac function and evaluate whether there is evidence of significant atherosclerosis in major blood vessels such as the carotid artery or leg arteries. Portable equipment can also be used to quantitate body composition and to carry out sophisticated pulmonary function testing.
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From page 163... ...
Measurement of physical functional status has been used for several purposes, including: to gauge the functional status of individuals and populations, to provide prognostic information, to determine the need for assistive services, to assess the effectiveness of specific interventions in individual persons, and to monitor the course of illness. Physical function can be conceptualized as a series of increasingly integrated steps beginning with basic components and progressing through three levels of increasingly more integrated function (Figure 7-1~.
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level, goal-oriented functional tasks are integrated into behaviors aimed at fulfilling societal roles and recreational activities, the so-called advanced activities of daily living (Reuben and Solomon, 1989~. At this level, function is often determined by personal choice rather than by physical capacity.
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From page 166... ...
Commonly evaluated language functions include spontaneous verbal output, comprehension of spoken language, repetition of spoken language, naming, reading, and writing (Cummings and Benson, 1992~. Although some unusual neurological diseases can cause isolated language impairment, usually these deficits are in the context of cerebrovascular disease (e.g., stroke)
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Executive function represents integrative cognitive function that requires sequencing and manipulation of information to perform tasks such as problem solving, abstract reasoning, and planning ahead. Some common tests of executive function include calculations, interpreting proverbs, and identifying similarities and differences.
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The standard method of screening for problems with visual acuity is the Snellen Eye Chart, which requires the patient to stand 20 feet from the chart and read letters, using corrective lenses. Several interviewer and self-administered instruments to detect functional problems due to visual impairment have been developed, including the "Activities of Daily Vision Scale" (Mangione et al., 1992)
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We measure the blood pressure, blood sugar, or blood lipid levels quantitatively and use established criteria to assign a diagnostic category. Quantitative measures of overall functional capability are increasingly in use as well.
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From page 170... ...
Abnormal glucose metabolism meeting criteria for diabetes mellitus can be detected in many individuals by simple measurement of the blood glucose level after an overnight fast. However, in some individuals, the fasting glucose level may not exceed diagnostic limits, but glucose values after ingesting a challenge dose of glucose (called a glucose tolerance test)
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A summary of some of the measures commonly made from blood samples is provided in Table 7-2. However, a blood sample provides only certain TABLE 7-2 Some Indicators of Function in Blood Measure Organ System Cellular elements PMNs Lymphocytes Platelets Red blood cells/hemoglobin Plasma Hormones Metabolic products Glucose Lipids Protein Enzymes Coagulation factors Creatinine, urea nitrogen Vitamins Minerals Inflammatory markers (e.g., cytokines, C-reactive protein)
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From page 172... ...
The population of white blood cells in the circulation may not accurately reflect the much larger population at extravascular sites in terms of subtype distribution or functional characteristics. The concentration of a substance in blood reflects the kinetics of the turnover of that substance, that is, the balance between the rate of entry of the substance into the blood and the rate of its removal.
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From page 173... ...
White cells in blood can be kept viable for a period of time after collection and can be kept alive in culture in the laboratory, providing an opportunity to study dynamics of gene expression as well as simply documenting gene content. While less applicable for household surveys, minor office-type procedures such as skin biopsy or needle biopsy can provide specific tissues for analysis.
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From page 174... ...
Objective Testing Over the past decade, there has been increasing interest in using performance-based measures to assess physical function. In this context, a performance-based measure can be defined as a test in which a subject
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From page 175... ...
Currently available performance-based instruments measure physical function at the basic component, specific physical movement, and task- or goal-oriented levels of integration. Many instruments measure physical functioning at more than one level.
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From page 176... ...
Journal of the American Geriatrics Society 44:356-362. American Association of Retired Persons/Administration on Aging 1998 A Profile of Older Americans: 1998.
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Owsley, and P.P. Lee 1998 Identifying the content area for the 51-item National Eye Institute Visual Function Questionnaire: Results from focus groups with visually impaired persons.
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McIntyre 1992 The Mini-Mental State Examination: A comprehensive review. Journal of the American Geriatrics Society 40:922-935.
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From page 179... ...
Van Nostrand 1990 Measuring the activities of daily living: Comparisons across national surveys. The Journals of Gerontology: Social Sciences 45:S229-237.
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