FIRST INTERNATIONAL SOCIETY FOR GERONTECHNOLOGY MASTERCLASS IN GERONTECHNOLOGY TUE, EINDHOVEN, NL November 13-14 2007 TE

2. Extended Health�What�s that??What is technology�s role in it?? Extended health links the WHO definition of health to the opportunities and challenges of aging. WHO definition of health includes: Physical, Mental, and Social well being Technology�s roles include: Preventing or delaying age related limitations in functioning Compensating for age related declines in functioning Care and support for elderly with illnesses and limitations in function Enhancing quality of life for all 3 applications

3. Achieving Extended Health requires us to change how we think about aging Negative stereotypes about old age and aging are detrimental to the well being and personal fulfillment of young and old alike Agism is apparent in many jokes: Pervasive negative stereotypes about aging Poor parental training about aging to the young Poor appreciation of individual differences

4. Let�s change our way of thinking about aging�starting here Pervasive negative stereotypes about aging If I knew I was going to live this long, I would have taken better care of myself One senior to another: �When does old age begin?� Answer: �Later� Young adult�s most serious life decision? Answer: � When to begin middle age�

5. Let�s change our way of thinking about aging�continuing here Poor parental training of the young about aging Dennis the Menace to his father�s friend: �What age are you in the middle of?� Child to grandmother: �If I�m only young once, how many times do I have to be old?�

6. Let�s change our way of thinking about aging-continuing here Poor appreciation of individual differences Old man answers question about his age: �What age do you mean--My anatomical, physiological, psychological, or chronological? This gentleman is both smart and wise, smart because of the critical distinctions and wise because chronological age is at the end of the list When asked what his doctor thought about his lifestyle choices at age 100+, George Burns replied, �I don�t know, my doctor�s dead.�

7. Technology can help education and training activities related to aging Create simulations to educate people for aging in various situations (BJ Fogg) Cause and effect simulations (social skills) Environmental simulations (treat phobias) Object simulations (drunk driver) Simulations of aging for young people can reduce negative attitudes toward aging

8. Virtual simulations of aging and healthy lifestyles Since the 1970s, many simulations of age related sensory and mobility limitations have been devised to educate the young Clouded lenses, ear plugs, gloves, weighted shoes etc. Limitation is lack of linkage of these devices and preventive and compensatory interventions Virtual reality simulations can improve education by linking simulations of limitations to effects of compensatory and preventive measures

9. Gerontechnology Contributes in many Ways to aging and health Education about and training for aging Enhancement of quality of life Prevention or delaying of age-associated losses in sensory-perceptual and motor systems Technology to lower impact of long-term exposure to environmental hazards and maintain cardiovascular health and strength Compensation for age-associated losses Care for elderly persons with functional limitations

10. High speed networking expands scope of gerontechnologies Telemedicine and communication applications using video over Internet Mobile-Health Toolkit wirelessly measures blood pressure, blood glucose, etc. and relays information to patient records Ultra-wideband radio allows for precise location of persons within a home and communication among appliances Common feature of examples is, ��enhanced communication between people and people, people and machines and among machines that themselves are networked.� Kearns WD, Fozard JL High-speed networking and embedded gerontechnologies. Gerontechnology 2007;6:135-146

11. Preventing or delaying age-related limitations in functioning Technology can contribute to motivating people of any age adopt healthy life styles that prevent or delay limitations in functioning Diet, weight control, exercise, substance abuse Idea rests on the capacity of technology for monitoring physiological functioning and changes in location of one or more persons

12. Prevention to delay age declines in cardiovascular and strength Effects of cardiovascuclar training on preventing heart disease and stroke as well as facilitating rehabilitation are well known Positive effects of strength training on preventing age related decline in physical functioning, personal mobility, and physical frailty are being demonstrated continuously in new research Technology can help promote motivation for exercise and in setting targets for exercise

13. Background: Old Adults perform ADLs closer to max strength than young adults Hortobagyi T, Mizelle C, Beam S, DaVita P. J. Gerontology:Medical Sciences, 2003, 58A,453-460.

14. Purpose/Methods Walking, going up and down stairs and rising from chair requires relatively higher percentage of maximum reserve capacity in older than younger adults--True for cardiovascular and muscle function Study measured relative effort to perform these tasks by assessing maximal leg strength on a machine and by the force used when going up or down stairs or standing up from a chair. Force was measured by special recording plate embedded in the floor or steps Participants were healthy women in two age groups mean ages 22 and 74 years.

15. Relative effort (%) of maximum strength required to perform ADLs

16. Long-Term Consequences of Age Differences in Strength Midlife strength predicts functioning 25 years later Grip strength measured at age 45 to 68 in Japanese-American men. 25 years later speed of walking, ability to stand up from chair, and self-reports of difficulty lifting 10 lbs, doing housework, etc were measured. Rantanen T, Guralnik JM, Masaki K et al Midlife hand grip strength as a predictor of old age disability JAMA 1999;281:558-560

17. Proprioception, Balance and Movement: Prevention 3 Grip strength divided into thirds: <37, 37-42, >42kg; outcome measures included Walking speed<0.4m/s (6.2%) Chair rise without using arms (2.2%) Difficulty doing housework (18.2%) Difficulty walking up 10 steps (14.1%) Rantanen T, Guralnik JM, Masaki K et al Midlife hand grip strength as a predictor of old age disability JAMA 1999;281:558-560

18. % with Limitations in Strength Groups Measured 25 Yrs Ago

19. Effects of strength training on mobility�basic findings Strength training and physical activity improve muscle mass, control of movement, and balance Fiaterone MA, Marks EC, Ryan ND et al. High-intensity strength training in nonogernians:Effects of skeletal muscle. J Am Med Ass, 1990;263:3029. Ivey FM, Tracy BL, Lemmer JT, NessAiver M, SM, Metter EJ, Fozard JL, Hurley BH. The effects of strength training and detraining on muscle quality : Age and gender comparisons J Gerontol:Biol Sci 2000;55A:B152-B157. Miller ME, Rejeski WJ, Reboussin BA, Ten Have TR, Ettinger WH Physical activity, funtional limitations and disability in older adults J Am Ger Soc 2000;48:1264-1272. Since 2000, dozens of well designed studies extend these early studies e.g., J. Gerontology: Med Sci 2007;62A;(June);2007; 62A(Aug)

21. Strength and Gait Speed Leg exension strength and leg power correlate with gait speed. The distributions of leg power associated with different speeds may provide the basis for setting goals for strength needed for walking. Rantanen T, Avela J Leg extension power and walking speed in very old people living independently. J Gerontol Med Sci 1997;52A:M225-M331. Correlations between power and speed ranged from .4 to.7 in old people Kwon I, Oldaker S, Schrager MA, Talbot LA, Fozard JL, Metter EJ. Relationship between muscle strength and self-paced gait speed: Age and sex effects. J Gerontol Biol Sci 2001;56B:B398-B404

23. Technology and setting goals for strength training Prevention requires that we set standards for reserve strength needed for adequate functioning at a later age Early estimates--we need 40% of our strength at age 25 to function well at age70 Wearable transducers provide information on quality and required number of maneuvers New technology development at University of Pisa by Dr. E. Piaggio allows for Kinesthetic sensing by use of smart fabrics in gloves, socks and leotards http://www.piaggio.ccii.unipi.it/kine.htm

25. Korhonen et al

29. Networking improves coaching in strength training Motivation is major issue for utilizing strength training�machines can have motivational properties Networking can improve motivation and quality of feedback from strength training Reinforcement from sharing information by peers doing similar workouts

31. Technology and motivation: Computerized coaching FitLinxx is a computerized system that attaches directly to existing fitness equipment FitLinxx �learns� users' programs, �coaches� them individually through their workout for better form, safety and confidence during every exercise, and �tracks� their progress over time. On strength equipment, FitLinxx appears as an easy-to-read touch-screen display that's attached to the machine. For cardiovascular equipment, each machine's existing console is simply networked to FitLinxx Users simply tap in their PIN to display their targets - FitLinxx then coaches them on speed, form, heart rate, etc., and tracks the workout session - every rep, set and step. http://www.fitlinxx.com/Article.htm?ID=976

34. Summary: Technology and Extended health Physical, mental and social well being included in the WHO definition of health The role of technology in extended health is to create what former UN Secretary General Kofi Anan called �enabling environments� that support human endeavors for all regardless of age