Chapter 24: Exercise for the Older Adult

Introduction

The "graying of America" and "graying of the world" are realistic descriptors of the population trend in the United States and many parts of the world. The graying of the population is a universal, developmental gift of 20th century science and technology. With the introduction of antibiotics, insulin, vaccinations, modern surgical techniques, and other medical advancements, adults are living longer.

The life expectancy in North America, most of Europe, and Australia is an average of 75 years of age.²⁰¹ In the US, life expectancy at birth for the total population is 78.8 years, 76.4 for men and 81.2 for women.⁴⁷ Thirteen percent to 14% of the 318 million citizens of the US (approximately one out of eight) are over 65 years of age.

This is in comparison to 20% of the German and Italian populations and only 3% of the population in Uganda. The age structure of the world has also changed; between 1970 and 2014, the world's population of individuals over 65 years of age or older increased from 5% to 7%. Thus, in the profession of physical therapy, most clinicians can anticipate working with the older adult in some capacity.

"Aging leads to a decline in strength and an associated loss of independence."⁶⁵ The importance of this specialty chapter is succinctly stated in the above quote! Physical therapists are able to appropriately adapt interventions to meet the needs of the older adult and enable them to optimize their functional potential. Throughout this chapter, the value of exercise and physical activity for older adults will be addressed.

Definitions and Descriptions Applied to Older Adults

Definitions: Quantitative and Qualitative

Who are older adults? The answer is quite variable when considering roles that change as one ages. Historically, the standard has been 65 years of age based on Medicare eligibility. With the increase in life expectancy, coupled with a 117% increase in the percentage of adults over 65 years of age employed in the workforce,⁵² one could question if this continues to define the "older adult." But, 65 years of age is still being used as the "specified age" for categorizing an individual as an "older adult."

The presentation of an older adult is quite variable.¹⁷⁵ A 75-year-old individual may be an athlete, may be working full or part time, or may be a sedentary individual with multiple medical problems having difficulty performing basic activities of daily living (ADLs). Clinicians may document, "patient appears younger than chronological age" or "patient appears older than chronological age." In reality, there is great variability in the older adult population which is reflected in the three case scenarios described in Box 24.1.

As illustrated in Box 24.1, the older adult population can be subdivided into young-old, mid-old, and old-old. However, these ...