The many facets of functional ability

Welcome to the first article in this monthly series on aged care, where I will explore current issues to provoke reflection on aged care from a range of perspectives.

As a podiatrist with almost 40 years of practice experience, I know that my views on ageing and the care of older people have changed considerably over this time. My own experience of becoming older provides a very different lens to that which informed my perspective as a new podiatry graduate in 1982.

For the purpose of this series, aged care will be interpreted in the broadest sense. That is, the care of older people in our communities, rather than limiting the conversation to the support provided to older people. To care for someone implies an interest in or a concern for their health and wellbeing.

The link between healthy ageing and functional ability

Here I will focus on:

The concept of healthy ageing and;
The interdependence of factors that influence a person’s functional ability.

On this latter point, we need to consider how multiple factors impact an older person’s lived experience, particularly in the context of healthcare.

Podiatrists are in a position of privilege and power in relation to our clients; highlighted when working with older people. An understanding of the relevance of socio-cultural and environmental influences is so important to ensure that we apply an equitable approach to enabling healthy ageing for all our clients.

This line of thinking sits comfortably within the broader context of the World Health Organisation’s (WHO) definition of healthy ageing as ‘the process of developing and maintaining the functional ability that enables wellbeing in older age’.

The key words here, for the purpose of this article, are ‘functional ability’. As podiatrists our purpose is to facilitate a person’s functional ability, which is not solely limited to maintaining mobility.

This also encompasses enabling a person to:

The facets of functional ability

A person’s functional ability is dependent on the interaction between intrinsic capacity and environmental factors. ¹ As podiatrists, we are educated to focus primarily on addressing a person’s intrinsic capacity (such as managing a disease process, injury or age-related change) to enable pain-free walking.

How often do we as practitioners, however, spend time discussing with our clients the environmental characteristics which influence their functional ability?

These include:

The built environment
People and their relationships
Attitudes and values
Health and social policies; and
Systems and services.

Inequities around healthy ageing

If you were asked to consider whether all Australians live in an environment that supports and maintains their mental and physical (intrinsic) capacities you would likely respond ‘no’. This infers that not all Australians have an equal opportunity for healthy ageing.

Yet to ensure an equitable approach with our clients, we have a duty of care to address these perhaps unseen or unspoken socio-cultural and environmental factors which influence their functional ability. Whilst podiatrists may not be able to influence a person’s social environment or their personal characteristics, we should all engage in health promotion with our clients to promote the development and maintenance of healthy lifestyle behaviours.

Following this same line of thinking, it is beneficial to reflect on the WHO’s advice around factors that influence healthy ageing. It reminds us which aspects should be implicit in routine podiatry practice.

Despite such advice, it can be easy to neglect factors that are not immediately apparent in connection to a client’s presentation, especially when faced with the busy-ness of service delivery.

The end goal

We need to remind ourselves and each other that a more multifaceted approach can make all the difference when it comes to caring for our clients, particularly for older people.

By focusing on the intrinsic capacity of a client (and the interactions between their socio-economic and physical environments) it is said to ‘reorient public health and clinical practice away from the disease-orientated approach.’ The outcome being, ‘a more effective person-centred approach based on functional evaluation, which will identify earlier opportunities for intervention’.

Our role in enabling functional ability

On a more practical note, the importance of strength training to maintain muscle mass for stability and mobility is of course essential to reduce falls and delay care dependency. Additionally, podiatrists are well placed to advocate for safe, accessible and supportive environments to enable activity for healthy ageing.

This is all the more relevant given the leading risk factors contributing to chronic disease are:

a) Tobacco use (9%)

b) Overweight and obesity (7%)

c) Alcohol use (5.1%)

d) Physical inactivity (5%), and;

e) High blood pressure (4.9%)

Highlighting a need for action globally, ‘healthy ageing’ has been targeted through the United Nations Decade of Healthy Ageing 2021-2030. This international initiative is providing ‘an opportunity to bring together governments, civil society, international agencies, professionals, academia, the media, and the private sector for ten years of concerted, catalytic and collaborative action to improve the lives of older people, their families, and the communities in which they live’.

More information?

If you are interested in any of the concepts raised here, I encourage you to take a look at:

The National Seniors Australia website to see what they are saying about the decade of healthy ageing. There is a link to ‘Get Involved’ so you can see what’s happening in your region.
The Australian Institute for Health and Welfare’s exploration of the links between the built environment and health, with further links to additional resources.
The Heart Foundation has a great community-focused program that encourages walking in local groups for all ages. For more information on this, and to complete a ‘walkability checklist’, head here. Once at this link you can also upload feedback on how ‘walkable’ your local area is (such as whether specific footpaths are flat or even missing in parts, and so forth) or you can encourage your clients and their families and / or carers to do so. This information is collated by the Heart Foundation and sent to the relevant local council as structured feedback.

Footnote

¹ Intrinsic capacity (IC) is a composite of all the physical and mental attributes on which an individual can draw, not only in older age, but across their lives. Healthy ageing of an individual (“the process of developing and maintaining the functional ability that enables wellbeing in older age”) depends upon their IC and their socio-economic and physical environments and the interactions between them (Araujo de Carvalho, I. et al).