Lucilla Monteleone Roberto Steindler

PHYSICAL AND PSYCHICAL CONDITIONS DECLINE OF OLDER PEOPLE WITH AGE, MEASURED BY FUNCTIONAL REACH TEST AND BY MINI MENTAL STATE EXAMINATION

ASME 2008 Engineering System Design and Analysis ConferenceESDA 2008July 7-9, 2008, Haifa, Israel

Lucilla Monteleone

Roberto Steindler

Marianna Costarella

Stefano Maria Zuccaro

21/04/23Physical and Psychical Conditions Decline of Older people with Age, Measured by Functional Reach Test and by Mini Mental State Examination

Page 2

Aim of the work

• There are several tests to value the

psychophysical characteristics of

older people and, among all, the

most suitable to this aim are here

considered the Functional Reach

(FR) test, as an index of the

aptitude to maintain balance in

upright position, and the Mini

Mental State Examination

(MMSE), as a global index of

cognitive abilities.

Tests considered Population examined

• The sample of older people we have

analysed concerns 50 healthy subjects

divided into three groups according to the

age:

• 15 from 55 to 64 years old

• 19 from 65 to 74 years old

• 16 more than 75 years old.


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Psychical test (MMSE)

• The MMSE is a means, with international validation, of global estimation of the cognitive function of older subjects.

• It is a test easy to be given and executed; it consists in 11 items, each one corresponding to a cognitive functional area, as time-space orientation, attention and calculus abilities, short period memory, recall ability, praxis-constructive and mind ability.

• The total score is 30/30 in normal cognitive performances.

• An MMSE score >24/30 indicates cognitive abilities inside normal values for subjects more than 65 years old.

Mini Mental State Examination


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Functional Reach

• The Functional Reach is defined as the maximum forward displacement that a subject can succeed in achieving, with a closed fist, starting from an upright position with the dominant arm extended forward so as to form a right angle with the torso, while, simultaneously maintaining a fixed support, and the fist always at the same level throughout the movement; the torso must not rotate during the test


Page 5

Functional Reach (FR) test

• The Functional Reach (FR) test consists:

– first in the measurement of the anthropometric characteristics: gender, age, height

– then in the execution of the test itself by measuring the value of the FR

– and finally in the study of the upright posture by the analysis of the Centre of Pressure (COP) trend.

Age (years)

Number of

subjects

Mean age

(years)

Height (cm)

55-64 1560.4 (2.5)

167.5 (6.6)

65-74 1669.2 (3.3)

159.3 (9.2)

>75 1978.9 (3.2)

163.0 (8.5)

Characteristics of the examined subjects (whole people)

According to the exclusion criteria, each subject has first undergone a short anamnesis interview to control his health conditions: the subjects have been selected taking care of two important criteria: ability of keeping upright position for at least 10 minutes, and cognitive function in the normal ranges according to the age (MMSE>24/30). Then anthropometric data (height, body mass etc.) have been measured.


Page 6






Age (years)

Number of

subjects

Mean age

(years)

Height (cm)

55-64 959.9 (2.8)

170.1 (4.2)

65-74 870.0 (3.5)

167.4 (6.6)

>75 1179.5 (3.4)

166.1 (8.0)

Characteristics of the examined subjects (male people)


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Age (years)

Number of

subjects

Mean age

(years)

Height (cm)

55-64 661.2 (1.7)

159.2 (4.0)

65-74 1168.6 (3.2)

153.5 (5.5)

>75 577.6 (2.3)

156.2 (5.3)

Characteristics of the examined subjects (female people)


Page 8




– then in the execution of the test itself and in the measure of the value of the FR


All the subjects have been invited to stand barefoot on the pressure map sensor and to keep the upright position with one arm at a right angle with the torso and with the fist closed. The subject remains for about 5 seconds in this position and then he performs the FR test extending forward as far as possible compatibly with his conditions; then the subjects goes back to the starting position standing up some seconds more; the total time required for the test is 15 seconds and during this period the heels must not lift. The test must be repeated three times and each time FR and ΔCOP are measured.


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Conductive strips

velostat

kapton

kapton

row

kapton

column

velostatContact

resistencesLateral view

Sensor of 80x80=6400 sensing elements

Dimentions: 40x40 cm2

The P-mat sensor

Physical and Psychical Conditions Decline of Older people with Age, Measured by Functional Reach Test and by Mini Mental State Examination

21/04/23 Page 11

Characteristics:

• Thickness:150 m• Range: 400 – 500 kPa• No hysteresis• No response delay


Page 12






From each acquired pressure map it is possible to calculate COP coordinates and therefore to determine its trends in the anterior-posterior and in the medial-lateral directions. The difference between the anterior-posterior at the beginning of the test and at the maximum extension gives the displacement of the COP, DCOP. It must be pointed out that only the anterior-posterior component of the displacement is considered significant for the test


Pagina 13

COP trendsExamples

slow and regular forward trend till the maximum extension and a back trend to the upright position with the same features

a forward trend till the maximum extension characterized by small steps and a fast back trend to the upright position

a short initial back displacement then a forward trend with an intermediate stop before the maximum extension and a fast back trend to the upright position is quick

a very fast forward trend till the maximum extension and an equal fast back trend with an intermediate stop to the upright position


Pagina 14

Global resultsWhole people

AGE (years)

MMSE (score)

FR (cm)

FR/H COPMMSE/FR (score/cm)

55-64 28.2 (1.3) 30.7 (4.3)0.185

(0.023)5.5 (1.3)

0.933 (0.122)

65-74 26.3 (1.5) 23.5 (4.8)0.147

(0.028)3.9 (1.2)

1.162 (0.250)

>75 25.3 (1.3) 21.4 (6.0)0.130

(0.033)2.8 (1.2)

1.307 (0.457)

• The first four parameters show a predictable loss both of cognitive abilities and of

physical performances with the increase of age.

• The Fisher test to the four examined parameters, only the 55-64 year group is

significantly different from the other two (p>99% for all the four parameters): the

difference of the data between the other two groups is not statistically significant

(p<95% in the four cases). Shortly there is a dramatic fall of the psychophysical

features in the people over 65.


Pagina 15

Global resultsMale people

AGE (years)

MMSE (score)

FR (cm)


55-64 28.7 (1.2) 31.5 (5.0)0.185

(0.027)5.5 (1.6)

0.931 (0.152)

65-74 26.4 (1.4) 25.7 (3.9)0.153

(0.023)4.3 (1.1)

1.048 (0.170)

>75 25.3 (1.3) 22.8 (6.2)0.137

(0.033)2.7 (1.2)

1.213 (0.429)

• With regard to the MMSE, the results are quite similar: there is a small prevalence

of male subjects in the first two groups and a little prevalence of the female

subjects in the oldest group; none of these three differences is statistically

significant.

• With regard to the FR, the male subjects have superior performances in all the

three groups; the differences, even if considerable in some cases, are not

statistically significant (p<95%).


Pagina 16

Global resultsFemale people

AGE (years)

MMSE (score)

FR (cm)


55-64 27.5 (1.1) 28.3 (4.7)0.178

(0.032)5.5 (0.8)

0.936 (0.069)

65-74 26.2 (1.7) 24.0 (4.4)0.156

(0.026)3.7 (1.3)

1.246 (0.273)

>75 25.8 (1.3) 18.5 (6.0)0.119

(0.037)3.1 (1.2)

1.513 (0.497)

• The ratios FR/H show very small differences; the differences are quite not significant.

• Also the COP don’t show remarkable differences; none of the two genders is superior to the other;

statistic differences are not significant.

• The ratios MMSE/FR show that the decrease of physical performances compared to cognitive abilities is

greater in the male subjects; however the high dispersions of data (look at standard deviations) make the

differences not significant.


Pagina 17

Discussion

• There is a higher and more significant decrease of psycho-motor

and cognitive performances getting from the first to the other two

groups of age; what above could mean a critic “threshold” level of

the psycho-cognitive damage of each subject.

• The results don’t show any prevalence of the male people with

regard to the female one, both from a physical and from a psychical

point of view; in fact even if male subjects look as being superior to

female subjects in physical performances, this superiority is valid

only with regard to absolute values of the performances (FR), not

to the relative ones (ratios FR/H).


Pagina 18

Discussion

• It could be assumed that a regular physical activity, that improves

the psycho-physical performances of older people through an

improvement of the physical form indexes (aerobic ability, muscular

strength, balance), could also be a protective element for older

subjects in the terms of cognitive and subsequently physical

functional abilities.

• The tests have been executed during two months. The authors

think that it might be considerable, in order to estimate psycho-

physical trends with age in one subject, to repeat the tests on the

same subjects after 2 or 3 years.


Pagina 19

Thank you

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Lucilla Monteleone Roberto Steindler

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