HLR Updates  

	November 2006.  Although there have been minor updates and “bug fixes” in the last couple of years, this revision has been a complete rewrite of the HLR code.  In addition to the new look, we have made navigation easier and have developed a more consistent tool set.  Clients, Reviewers, Physicians, and Reviews can now be deleted by Chief Reviewers.  An example of easier navigation would be the Back to Top option that appears on any page that scrolls beyond the current fold.  A simple click returns the user to the top where the sidebar or top navigation options are accessible.  The HLR now opens directly into the Client List avoiding extra mouse clicks.  Options are now available for editing clients and starting new reviews right from the Client Listing page.  Physician findings can now be modified beyond the first entry screen.  When editing on the Chronicity page, the Physicians Finding Data can be edited.
	January 2002.  Each facility now has the capability to have a permanent customized review.  You can choose which assessments you want to include in the review based on your facility needs.  This review appears as the name of your facility in the Review Type List when a new review is started.
	November 2002.  We have added some exciting new features.  After several requests, we have cleaned up the Output Summary Report.  This report will now only include the assessments that were actually completed.  We also added the ability to turn on and off sections of the Summary Report.  You can turn off sections like Reviewers Notes, Directors Notes, or Outcomes if your facility does not use this information.  We also added the ability to classify the type of care being provided at the time of a review.  We welcome your comments and feedback at hlr@thehlr.org.

Research Abstracts

The following are abstracts of research that has been conducted with data collected from the HLR. 

 

Effect of a Chair-Based Exercise Class Using  Elastic Bands on Physical Performance Measures in Independent Older Adults D. J. Robelli, A. L. Hall, L. Stumpfhauser, B.S. Chaparro, and T. Hart. Larksfield Place d.b.a. Cramer Reed Center for Successful Aging, Wichita, KS, USA. Finding practical cost effective ways to help maintain functional fitness in ‘old’ and ‘old-old’ adults is of utmost importance as it contributes significantly to preserving functional independence.  PURPOSE: To determine the impact of participation in a chair-based exercise class using 4-inch wide Elastic Bands on physical performance in older adults. METHODS: Upon entry to an independent living retirement community, residents have the option to participate in a variety of physical fitness activities, one of which is a chair-based class using Elastic Bands.  Twenty independently living residents (M = 88.78, Range = 81-95) of this community participated in a 35-minute three times a week chair-based exercise class using  Elastic Bands for a year. Participants averaged at least 2 classes a week to be included in the study. Class participants were compared using several different physical performance measures to 18 non-active residents of comparable age (M = 87.00, Range = 79-99) and cognitive ability, as assessed by the Clock test and Digit Symbol Substitution test. All participants in the study were screened by their physician for participation in the class and/or the assessment. The use of canes and/or walkers was permitted during the assessment. The components of the assessment included Fullerton’s functional fitness test (30-s chair stand, 30-s arm curl, 6-min walk, chair sit-and-reach, back scratch, 8-ft up-and-go), Guralnik’s Lower Extremity Performance (LEP) evaluation (8-ft walk, tandem balance, and 5-time chair stand), and other fitness tests (4-m walk, total grip strength). RESULTS: Results indicate significantly better performance for the exercise group in the 8-ft up-and-go (9.54s vs. 12.54s, p < .01), arm curl (14.35 vs 10.87, p < .01), 6-min walk (429.09yds vs 349.25yds, p < .01), LEP score (9.67 vs 6.94, p < .01), 4-m walk (3.56s vs 4.91s, p < .01) and total grip strength (41.81kg vs 30.56kg, p < .01). CONCLUSION: Based on a variety of physical performance measures, this study shows that regular participation in a chair-based exercise class using Elastic Bands is a practical and cost-effective way to keep older adults functionally fit. REFERENCES 1.        Westhoff, M.H., Stemmerik, L., & Boshuizen, H.C. (2000). Effects of a low-intensity strength-training program on knee-extensor strength and functional ability of frail older people. Journal of Aging and Physical Activity, 8, 325-342. 2.        Penninx, B.W., Gerrucci, L., Levelille, S.G., Rantanen, T., Pahor, M., & Guralnik, J. M. (2000). Lower extremity performance in non-disabled older persons as a predictor of subsequent hospitalization. Journal of Gerontology: MEDICAL SCIENCES, 55A(11), 691-697. 3.        Graulink JM, Simonsick EM, Ferrucci L., et al. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. Journal of Gerontology: MEDICAL SCIENCES, 49, 85-94. 4.        Berg, W.P., & Lapp B.A. (1998). The effect of a practical resistance training intervention on mobility in independent, community-dwelling older adults. Journal of Aging and Physical Activity, 6, 18-35. 5.        Brown M., Sinacore, D.R., & Host, H.H. (1995). The relationship of strength to function in the older adult. The Journals of Gerontology, 50A, (Special Issue), 55-59. 6.        Judge, J.O., Whipple, R.H., & Wolfson, L.I. (1994). Effects of resistive and balance exercises on isokinetic strength in older persons. Journal of the American Geriatrics Society, 42, 937-946. 7.        Lord, S.R., Ward, J.A., Williams, P. & Strudwick, M. (1995). The effect of a 12-month exercise trial on balance, strength, and falls in older women: A randomized controlled trial. Journal of the American Geriatrics Society, 43, 1198-1206. 8.        Lord, S.R., & Castell, S. (1994). Physical activity program for older persons: Effect on balance, strength, neuromuscular control, and reaction time. Archives of Physical Medicine and Rehabilitation, 75, 648-652. 9.        Brown, M., & Holloszy, J.O. (1991). Effects of a low intensity exercise program on selected physical performance characteristics of 60- to 71-year-olds. Aging, 3(2), 129-139. 10.     Stumpfhauser, L., & Lavacek, C. Response of elderly to regular exercise with VitaBands. The XVth Congress of the International Association of Gerontology. Budapest Hungary, July 4-9, 1993. 11.     Mikesky, A.E., Topp, R., Wigglesworth, J.K, Harsha, D.M., & Edwards, J.E. (1994). Efficacy of a home-based training program for older adults using elastic tubing. European Journal of Applied Physiology, 69(4), 316-320. 12.     Tuokko, H., Hadjistravropoulos, T., Miller, J., Horton, A., & Beattie, B.L. (1995). The Clock Test: Administration and Scoring Manual.     Toronto: Multi-Health Systems Inc. 13.     Wechsler, D. (1981). Manual for the Wechsler Adult Intelligence Scale-Revised. New York: Psychological Corporation.

 

Determining the best physical performance Measures as predictors of independent living in older adults L. Stumpfhauser, B.S. Chaparro, and T. Hart.   Larksfield Place d.b.a. Cramer Reed Center for Successful Aging, Wichita, KS, USA. Current trends among older adults are to compress morbidity and extend the time of living independently.  The use of valid field-based physical performance measures to signal potential functional limitations holds a great promise for implementing appropriate intervention programs.  However, there is much debate about which physical performance measures best predict the ability to live independently. PURPOSE: To determine physical performance measures as predictors of functional independence based on the Activity of Daily Living (ADL) and Instrumental ADL (IADL) scales. METHODS:  Eighty-four independently living older adults (AGE,SD) were assessed using Fullerton’s functional fitness test (30-s chair stand, arm curl, 6-min walk, chair sit-and-reach, back scratch, 8-ft up-and-go), Guralnik’s Lower Extremity Performance (LEP) evaluation (8-ft walk, tandem balance, and 5-time chair stand), and Katz’s ADL and Lawton’s IADL scales. The use of canes and/or walkers was permitted in the assessment. All participants were screened by their physician prior to participation in the assessment. In addition, participants were screened for acceptable levels of cognition using the Clock Test and Digit Symbol Substitution test. RESULTS: Scores from the ADL assessment indicated an overall ceiling effect (only 8% of the participants scored below the perfect score; the majority of these were due to incontinence). As a result, only the IADL was used in the analysis. Results indicate significant correlations between the IADL scores and the 6-min walk (r = .514, p < .001), chair stand (r = .336, p < .01), arm curl (r = .289, p < .01), sit-and-reach (r = .291, p < .01), 8-ft up-and-go (r = -.37, p < .01) LEP score (r = .53, p < .001). Regression analysis shows the 6-min walk to be the best predictor of functional independence accounting for 25% of the variance.  CONCLUSION: In this sample, the 6-min walk proved to be the best predictor of daily functioning as measured by the IADL. The Guralnik’s LEP score and 8-ft up-and-go also proved to be valid predictors.  Physical impairments are often not detected until there is a manifestation of loss of functional ability.

The following presentation was made at the American College of Sports Medicine Annual Meeting in Indianapolis, IN on May 30-June 3, 2000. The abstract is published in Medicine and Science in Sports and Exercise, 32, 5 (Suppl): S218, 2000. FUNCTIONAL FITNESS OF THE OLDEST-OLD ASSESSED BY THE HEALTH & LIFESTYLE REVIEW Jennifer D.F. Shores1, Michael E. Rogers1, Barbara S. Chaparro2, and Laszlo Stumpfhauser3.    1Center for Physical Activity and Aging, Wichita State University; 2Department of Psychology, Wichita State University; 3Quality of Life Center at Larksfield Place, Wichita, KS The oldest-old (age 85+ years) represent the fastest growing segment of the population. Physical frailty is common in this cohort and often leads to placement into assisted living programs. However, little is known about the functional capacities of the oldest-old population. Much of the disability that occurs in later life may be preventable through early detection of functional deficits followed by appropriate physical activity interventions. Information pertaining to functional capacity may also be useful in predicting the need for assisted living. The purpose of this study was to assess functional ability in the oldest-old using our Health & Lifestyle Review (HLR), a standardized functional assessment accessed by the internet. This study also contributed to our centralized national HLR database of functional ability. Independently-living persons (N=100; 38 men, 62 women) were recruited from a retirement community and were subsequently divided into two age groups (p<0.001): 76-84y (n=40, 80.9±2.3y, mean±SD) and 85-100 (n=60, 88.9±3.7y). The functional test battery included tandem balance, chair stand, 8’ and 20’ walking speed, grip strength, sit-and-reach, scratch test, dumbbell curl, Timed Up-&-Go, height, weight, BMI, and fear of falling (FOF)/activities of daily living (ADL)/instrumental ADL (IADL) scales. Height (1.62±10m), weight (66±16kg), and BMI (25.9±5.0) were not different (p=0.2-0.9) between age groups. Differences (p<0.05) in functional performance were observed for all lower body tests of strength and flexibility, balance, walking speed, and Timed Up-&-Go. Differences were not observed for upper body tests of flexibility and strength. The older group reported lower IADL (p=0.02) but not ADL (p=0.28) scores. FOF did not differ (p=0.53), supporting our earlier research that age is not associated with FOF. These results indicate that lower body functional capacity is significantly diminished in the oldest-old. These declines negatively impact the ability of the oldest-old to perform IADL. However, upper body function and ADL ability is maintained relative to lower body function and IADL in the later years of life. If upper body performance were to decline, it is possible that ADL scores would decline as well, leading to placement in assisted living programs. The HLR appears to provide a viable means for assessing functional abilities in the oldest-old and offers great potential for tracking and predicting changes.

The following presentation was made at the 5th World Congress on Physical Activity, Aging, and Sport in Orlando, FL on August 10-14th, 1999. The abstract is published in Journal of Aging and Physical Activity, 7: 284-285, 1999. An Internet-Based Health And Functional Status Assessment for use in Older Adult Placement and Intervention Programs Laszlo Stumpfhauser1 and Michael E. Rogers2 1Quality of Life Center at Larksfield Place, Wichita, KS, 2Center for Physical Activity and Aging, Department of Kinesiology and Sport Studies, Wichita State University, Wichita, KS, USA   In an era of unprecedented change in population demographics, active life expectancy, managed care, and technological development, there is a need for a standardized, functional status assessment for independently-living older adults. Under grants from the Kansas Health Foundation, Larksfield Place — with assistance from faculty members from Wichita State University and The University of Kansas School of Medicine-Wichita — has developed a standardized assessment, called the Health & Lifestyle Review (HLR). The HLR consists of a standardized functional assessment accessed by the World Wide Web and a centralized national database that will provide managers and planners with key data. The HLR uses scientifically validated level I instruments that screen for vision, hearing, incontinence, mental status, home environment, nutrition, mobility, strength, flexibility, ADL, IADL, fall efficacy, healthy habits, and chronicity. Any organization that offers functional fitness programs for independently living older adults may join the HLR consortium, and receive training in how to access the program via the internet. Although it takes advantage of the latest technology, the HLR is user friendly: (1) it requires minimal computer skills, (2) software is automatically upgraded, (3) data transfer is instant and automatic, assuring accurate reports, (4) it facilitates networking among members, (5) discussion groups and answers to frequently asked questions are online at the web-site, and (6) technical support is available online and by toll-free phone. The internet makes it possible to send data directly to a central database where it is reviewed by research scientists. The data base will be used to analyze demographic trends, establish functional fitness standards for the elderly, develop and evaluate the effectiveness of innovative health promotion/intervention programs, and to promote cooperative research activities by consortium member scientists. Consortium members may also use their own facility (program) data to place clients in the proper health promotion/ intervention program, obtain baseline data for tracking the effectiveness of such programs, predict clients’ probable future needs for intervention services, and provide reports for planning and risk management purposes. The workshop will focus on conducting the computerized HLR, accessing and using HLR data from the centralized data base, and examples of medically prudent health promotion/intervention programs based on HLR data: (1) Functional Fitness Assessment: conducting large scale annual assessments; (2) Reconditioning: restoring clients/residents to functional levels that existed prior to illness or injury; (3) Better Balance program: learning preventative measures and adaptations to reduce the likelihood of falling; (4) VitaBands™: cost effective and practical resistance exercise programs to restore/improve functional abilities; and (5) Health Education: series of monthly education topics.

 

The following presentation was made at the American College of Sports Medicine Annual Meeting in Seattle, WA on June 2-5, 1999. The abstract is published in Medicine and Science in Sports and Exercise, 31, 5 (Suppl): S380, 1999. Measures of Functional Fitness and Fear of Falling in Individuals  76-99 Years of Age Michael E. Rogers1, Barbara S. Chaparro2, and Laszlo Stumpfhauser3. 1Center for Physical Activity and Aging, Wichita State University; 2Department of Psychology, Wichita State University; 3Quality of Life Center at Larksfield Place, Wichita, KS Declines in functional ability and the prevalence of falling are problems in the aged, particularly those over the age of 75 y. In the elderly, the fear of falling (FOF) may be as limiting as falling itself in terms of restricting daily physical activity. Therefore, measures of functional fitness may be related to FOF. Participants (N=87) were older (85± 4 y, mean± SD; range = 76-99 y) men (n=34) and women (n=53) in a continuing care retirement community. Lower extremity function was assessed by four measures: 1) tandem standing balance (TSB) for 10 s; 2) walking speed (WS), a timed 8-foot (2.4-m) walk; 3) chair rise (CR), a timed test of five repetitions of rising from a chair and sitting down; and 4) chair sit-and-reach (CSR), a test of hamstring flexibility. The FOF was assessed by a Falls Efficacy Scale (Tinetti, 1990) containing 10 ADL- and IADL-related questions, each on a 10-point continuum for rating. The FOF was correlated (p<.01) with TSB (r = .568), CR (r = .688), and WS (r = .629). The CSR (r = .083) and age (r = -.170) were not correlated with FOF. Regression analysis indicated that the strongest predictors of FOF to be CR (R2 = .465) and CR + WS (R2 = .563; p<.01). Results suggest that, among very old persons living independently, measures of lower extremity function are correlated to, and predictive of, FOF. Age was not correlated with FOF; indicating that, for the very old, FOF is determined by functional ability and not age. The efficacy of intervention programs (e.g., exercise and balance training) to reduce the FOF in people who have reached the 9th and 10th decade of life requires further attention.

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