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Published: Saturday, 11/9/2002

Strength therapy will benefit frail

Sound the alarm. Raise the warning flag. Stop and realize what may lie ahead when an older person grows physically frail.

Frail elderly people live on the edge. Their bodies are in a precarious, unstable situation.

With no reserves to call up in an emergency, small changes in health can tip them over the edge. A bad cold, a fall, or emotional stress can lead to hospitalization, a nursing home, or death.

Some experts term frailty “pre-disability” because frail older people often become disabled and can't live independently in their own homes. Weak muscles and a poor sense of balance may lead to falls and cause growing difficulty in performing the critical activities of daily living (ADLs).

ADLs are basic tasks of life such as eating, bathing, dressing, using the toilet, and transferring from one position (such as sitting) to another (such as standing).

What's to be done when mom or dad or grandma or grandpa grow frail?

That question is becoming more important with the graying of America. More people are living longer - the over-85 age group is growing faster than any other - and facing frailty. And the costs are increasing.

Prehabilitation is one of the newest and most promising answers.

Rehabilitation involves physical therapy and other ways of restoring body function in people who already have had strokes, broken hips, or other health problems.

Prehabilitation is an emerging way of slowing or reversing loss of body function in frail elderly people. Prehabilitation may delay or avoid the need for rehabilitation.

One of the biggest prehabilitation studies found that it reduced disability in 188 physically frail people age 75 or older, who lived at home.

Dr. Thomas M. Gill of Yale University headed the study, which was reported in October in the New England Journal of Medicine.

Researchers used a simple definition of frailty: Anyone who needed more than 10 seconds to walk back and forth over a 10-foot course, or could not stand up from a hardback chair with their arms folded.

About half of the group received physical therapy aimed at increasing muscle strength, balance, and mobility. A therapist made an average of 16 visits to their homes, for 10 to 15 minutes, to teach balance exercises and muscle training with elastic resistance bands. Researchers asked them to continue the exercises for a year.

The other half got educational materials on good health.

Researchers monitored the two groups when the programs ended, and the prehabilitation group had 45 percent fewer admissions to nursing homes within seven months than the medical education group. Prehabilitation improved their ability to do ADLs and reduced the risk of further physical decline.

People in the prehabilitation group had few fall-related injuries, for instance, and were less likely to be admitted to a nursing home.

Prehabilitation cost about $2,000 per person in the study. Researchers termed that “relatively modest” when compared to the much higher average cost (nearly $60,000 a year) for a nursing home.



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