“The more impairments there are, the more or severe the functional limitations.” Stride length is shorter; double-limb support duration is longer. Stair Climbing Ability – Maximal step height is reduced. Height, weight, metabolism are all affected. To have a better understanding of how an aging person transitions to a person with disabilities, we need to be-come familiar with the Nagi Model.(6). The first disablement model was intro-duced in 1965 by Saad Nagi (6). He recognized the importance of the envi-ronment and that family, society, and community factors could all influence disability. Based on this assumption, the consequences of disease and injury for an individual should be described at both the level of the person and at the level of society: Disease Pathology > Impairment > Functional Limitations > Disability Later, it was modified to include Life-style Inactivity, which also impacts Im-pairment. Let’s expand on each of these headings for understanding and clarity: Disease Pathology may include such health issues as diabetes, obesity, cardiovascular disease, cancer, neuro-logical diseases eg. (Parkinson’s, Mul-tiple Sclerosis), osteoporosis and oste-oarthritis, etc. Lifestyle Inactivity including been sedentary, sitting most of the day, alco-hol use, smoking, decreased sleeping and poor diet. Disease Pathology and Lifestyle Inac-tivity contribute to the development of impairment. Impairment issues can begin to express themselves as decreased mus-cle strength, power, endurance, de-creased cardiovascular and respiratory function, decreased flexibility/range of motion of the spine, hips, knees and ankle joints, decreased speed of mobil-ity and reaction time. These impairments contribute to Functional Limitations. www.Cndoctor.ca NAGI MODEL: Functional Limitations may lead to decreased ability to stand up from sitting, slow walking, difficulty climbing stairs, decreased long term standing, cooking, decreased ability to grasp ob-jects, open doors, unstable balance and carrying bags. All of these limitations can contribute to decreased mobility and social interaction, contributing to anxiety, depression and being lonely. The more Impairments there are, the more or severe the Functional Limita-tions. The Functional Limitations con-tribute to Disability. Disability is caused by cognitive and mobility decline. In summary, variance of disability can be accounted for by functional limitations, disability and age. Age can directly influence disability, through its effect on functional limitations and its inherent disability. Given our aging population, there’s great interest in identifying modifiable risk factors for cognitive decline. Studies have high-lighted the relationship between as-pects of mobility and cognitive pro-cesses. However, cognition and mobility are both multifaceted con-cepts and their interrelationships re-main to be well defined. In one study, Steinman(7) showed that individuals with poor vision had significant difficulty doing leisure activ-ities at home. Poor vision will affect mobility, reading, watching TV, cooking and socializing. With poor vision people begin to get anxious regarding their capabilities and limit their interactions with family and friends. Poor vision also contributes to cognitive decline. Li (8) suggests that the cognitive involvement in postural control and gait increases with aging. This happens because of the neural overlap of cogni-tion and some brain areas which are related to the aging process. Posture and gait are complex activities which encompass large areas of the brain. To maintain good posture entails our visual, vestibular and cerebellar (somatosensory) systems, along with the neuro muscular junction and the long tracts taking information to and from the brain. Gait involves additional areas, as gait involves initiation of and rhythmic movement. This involves the motor Cortex and Basal Ganglia as the main areas for understanding. Demnitz(9) found that all cognitive measures were related to indices of mobility, suggesting a global associa-tion. Mobility affects all aspects of our lives. Movement affects all our body systems, from our joints, the cartilage between, the blood supply, the nerve muscle interaction, our lifestyles and our ability to function as human be-ings. Movement is part of our person-ality make up, and because it is so pervasive to us being human, it is now been used to help diagnose health conditions. As we age our movement patterns change, and these changes affect our body and brain, because they are so interrelated, contributing to this issue of cognitive decline. Wanigatunga(10) found that daily physical activity, which benefits health and quality of life, typically decreases in older adults. We all need to be more physical and we need to specifically encourage our aging population to in-corporate physical activity into their lifestyles. As an example, physical ac-tivity causes muscles to move. As mus-cles move, they function better and there are feedback mechanisms be-tween muscle and bone, which help both to function better. Physical activ-ity improves circulation to all parts of the body and the brain. With a good diet and physical activity, more nutri-ents will get to the muscles, body sys-tems and the brain, to improve the quality of life of the individual. Gaskin(11), stated that the burden of neurological disease is expected to in-crease as the population ages. This bur-den that we as a society face can be sig-nificantly decreased if we provide for and encourage our aging family and friends to be more active, eat well, exercise more and spend time with family and friends. The purpose of this and following arti-cles is to help us look after ourselves, our family, our patients and our friends. For the references in this article, visit cndoctor.ca/life-longevity-reference June 2020 Chiropractic and Naturopathic Doctor 17
Chiropractic + Naturopathic Doctor June 2020: Page 17
