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Introduction

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"Old age ain't no place for sissies."

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—Bette Davis (1908–1989)

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LEARNING OUTCOMES

By the end of this chapter, readers will be able to:

  1. Describe the impact of health conditions on cardiopulmonary and cardiovascular function.

  2. Describe the impact of recumbency and inactivity on changes in cardiopulmonary and cardiovascular function.

  3. Describe changes in cardiopulmonary and cardiovascular function secondary to extrinsic factors, such as medical interventions and medications.

  4. Describe changes in cardiopulmonary and cardiovascular function secondary to intrinsic factors, such as the individual's characteristics, culture and lifestyle, long-term occupation, and coexistent morbidity.

  5. Describe the factors one should consider in prioritizing the goals of an intervention plan and provide the rationale for an older adult with morbidity.

  6. Outline the focus of the assessment and the measures that would be most relevant to record for an older adult with morbidity.

  7. Outline the intervention plan vis-à-vis prescribing training for functional performance (e.g., activities of daily living, functional capacity) for an older adult with morbidity.

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Clinical Vignette

Lareina Jaramillo is a 73-year-old Hispanic woman who works as a store attendant part time. She helps look after her husband who has been on a disability pension for 12 years. In addition to having hypertension and borderline diabetes, Mrs. Jaramillo has had a history of arthritis for several years. She is a nonsmoker, but her husband smoked for 42 years, quitting only a year ago. She is also significantly overweight. Two of Mrs. Jaramillo's siblings have died of ischemic heart disease. Mrs. Jaramillo reports once she gets going in the morning, she can do most things around the house. However, when walking to the bus stop two blocks from her home, she experiences leg pain (intermittent claudication), and getting on the bus is challenging when her hips are sore. Work has become difficult for her because she becomes quite fatigued when she must stand for more than a few minutes.

  1. In what ways are Mrs. Jaramillo's health and well-being compromised?

  2. Of those issues, which are closely associated with her cardiopulmonary function?

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Chapter 8 described the typical changes to the cardiopulmonary and cardiovascular systems that occur with aging and how cardiopulmonary and cardiovascular function, and in turn functional capacity including activities of daily living (ADL), can be maximized with exercise training. In Chapter 8, the essentials of exercise testing and prescription were described for the healthy older individual. This chapter extends this foundation to the needs of older people with one or more comorbidities, especially those that are directly associated with cardiopulmonary disorders. Four levels of factors need to be considered when assessing an older person's needs in terms of exercise testing and prescription for training: pathology that affects, directly or indirectly, oxygen transport and muscle strength; recumbency and inactivity; extrinsic factors related to an older adult's health care; and intrinsic factors related to the individual.

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Today, older people are at risk of ...

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