Transcript Janet Belsky’s Experiencing the Lifespan, 2e

Janet Belsky’s
Experiencing the Lifespan, 2e
Chapter 14:
The Physical Challenges of Old Age
What Does it Mean to Age
Successfully?
 Successful aging means:
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drawing on what gives one’s life
meaning to live fully not matter
how the body behaves
having an internal sense of selfefficacy
having support to function
living with the potential chronic
disease that may come with old
age
combines nature (personal
capabilities) and nurture
(environmental fit)
Understanding the physical
aging process
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Normal age changes Progressive signs of
physical deterioration
that occur with age
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Age-related changes are
universal (happen to
everyone) but differ
according to the time of
onset.
Three basic principles of
Age-Related Disease
1.
Chronic disease is often normal aging “at the
extreme.”
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2.
ADL impairments – difficulty performing everyday
tasks that are required for living independently
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3.
Bone density loss, when extreme, is called Osteoporosis.
Arthritis is the top-raking chronic illness in later life.
Many age-related diseases are not fatal, but interfere with ADLs
(activities of daily living).
Become far more frequent among the old-old as the number of
chronic diseases accumulates
Lifespan has a defined limit
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Aging process has a fixed end.
But, the 100-plus group is the fastest-growing age group of all!
Two Types of ADL Problems
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Instrumental ADLs
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Difficulties performing everyday household tasks
(cooking, cleaning)
Common in advanced old age
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Basic ADLs
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Difficulties performing essential self-care activities
(eating, getting to the toilet)
Relatively rare until the old-old years
Require full time help or nursing home care
Age Risk of Instrumental ADLs and Basic
ADLs
What affects the physical
aging path?
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Socioeconomic status
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Ethnicity
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Gender
Socioeconomic status and
physical aging
 Socioeconomic/health gap - affluent people living longer and
enjoying better health
 This occurs universally (happens in every nation).
 The relationship between income and illness begins in middle age.
 However, accelerated aging process begins at the beginning of
life.
Low birth weight, which is often linked to social class, can cause
obesity and poor health later in life.
 Elevated blood pressure, diabetes, asthma are all diseases that are
prevalent in disadvantaged children.
The poverty-illness relationship is bidirectional.
 Childhood illness can lead to poverty (missing school, less likely to
attend college)
 Poverty can lead to poor choices in later life (smoking, poor nutrition,
less exercise, less access to good health care).
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Ethnicity and physical aging
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Ethnicity can lead to poverty, often due
to:
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stress caused by dealing with
discrimination.
Less access to good health care
Hispanic-Americans seem to fair better
against physical aging than AfricanAmericans.
African-Americans are more susceptible
to illness and premature death than any
other ethnic group.
Careful not to blame the person for the
many forces that affect aging due to
the “toxic” environment of being poor.
Gender and physical aging
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Basic principle: women survive longer but
may live with illness
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Due to fewer heart attacks
Presence of estrogen helps slow aging
process
Men are twice as likely to die from a heart
attack earlier in life (it’s biological).
Women are more prone to illnesses that
cause problems with ADLs but are not fatal.
But women rank higher on sickness
indicators, such as seeing a doctor
throughout adult life.
Both nature (biology) and nurture (accessing
health care and awareness of health
concerns) explain why women outlive men in
every developed world nation by at least 4
years.
The Aging Pathway and How it Varies
by Socioeconomic status and Gender
How to improve the physical
aging process
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Preventing premature births
Encouraging exercise and healthy
nutrition in children
Increasing access to health care
Sensory-motor changes with age
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Vision
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Hearing
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Motor abilities
Normal Vision Changes
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Presbyopia – age-related difficulties
with seeing close objects
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Poorer dark vision
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universal change that happens in mid-life
often leads to the need to purchase reading glasses
cannot see as well in dimly lit places
More troubles with glare
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being blinded by bright light shining in the eye
The Main Cause: The lens
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Lens not able to bend
 Causes presbyopia
(bending is what helps
with seeing close objects)
 “Cured” by wearing
bifocals
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Lens gets cloudier
Can lead to cataracts
 Less light gets to the retina
- special problems seeing in
the dark
 Light hits the more opaque
lens - rays scatter, glare
sensitivity
Interventions for “older eyes”
 Use strong indirect lighting.
 Avoid florescent lighting—especially on bare floors
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(produces glare).
Use adjustable lighting and larger numerals on
appliances, and provide non-reflective surfaces
Look into low-vision aids such as magnifiers,
Cataract
 easy outpatient procedure
 Cutting-edge medical interventions are being developed for
less treatable aging eye diseases.
Understanding hearing in later life
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Hearing loss is very common in later life.
 Men are more likely than women to develop
hearing loss.
 Have an environmental cause - exposure to noise
 Problems may increase in the Ipod-oriented
culture!
 Hearing impairments may be more problematic
than vision problems because they limit the ability
to connect with the human world through
language.
Presbycusis Defined
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Presbycusis – the classic age-related hearing loss.
 Caused by atrophy of hearing receptors in the
inner ear.
 This condition is permanent.
 Selective problems hearing higher pitched
tones.
 Background noise (typically of lower pitch)
overpowers the sounds people want to hear.
 Traditional hearing aids that magnify all
sounds may not help much and are difficult to
manage.
The Human Ear
Interventions for hearing loss
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Avoid high noise environments (crowded restaurants).
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Cover ears when passing by noisy places.
Install carpeting in the house (it absorbs noise).
Replace noisy appliances (air-conditioners or fans).
Face person when you talk and speak more loudly
(reading lips can help) .
Avoid elderspeak – a mode of communication used
with older adults who seem to be physically impaired.
 Involves speaking loudly and with slow,
exaggerated pronunciation
 Similar to infant-directed speech used with little
children
Prevention is key. AVOID EXCESSIVE NOISE!
Motor abilities in later life
 Primary motor ability change - Slowness
 Caused by loss in information-processing speed
 Primary reason why older adults experience such prejudices
 People become annoyed by the lack of their ability to keep up with
the fast-paced, task-oriented society.
Consider your reaction to an elderly person driving slow.
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 Problems with reaction time – decline in the ability to
respond quickly to sensory input
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Poor reaction time can cause problems with making quick decisions
(accelerating when traffic light turns green) or performing some
routine tasks (counting change).
 Changes in skeletal structures affect motor abilities
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Osteoarthritis - wearing away of joint cartilage
Osteoporosis - bones become porous, brittle, and fragile; tend to
break easy
Women are more susceptible
Hip fractures are common problem due to skeletal changes
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Most common risk factor for nursing home admissions
Interventions for Motor Problems
1. Exercise moderately.
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Can help prevent falling
2. Keep ADL problems from developing or getting worse.
3. Encourage activities – attend church, outside
activities.
4. Remodel house.
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Indirect lighting
Install low-pile, wall-to-wall carpeting; can prevent tripping.
Install grab bars in places where falls can occur (bathtubs).
5. Reduce medications to prevent dizziness or problems
sleeping at night.
6. Be careful in speed-oriented situations.
Driving in Old Age
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Vision, hearing and reaction-time problems converge to make driving
more dangerous especially in the old- old years.
 This chart refers to
accidents per miles
driven. The elderly
drive less than the
young, so overall
their accident rates
are much lower.
 Age accident rates
are higher with the
elderly than highrisk populations
(teenagers and
emerging adults).
Driving in old age: Issues and
Solutions
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The problem: Giving up one’s car means loss of
independence.
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Driving is essential in car-oriented society.
Prevents elderly person from getting to doctor or going to the
store
Can mean having to enter a nursing home.
Potential Solutions:
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Some advocate for yearly license renewals along with vision
tests.
Changing driving conditions
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Larger signs, better lighting on exit ramps, etc.
Extending yellow light signals
Roundabouts
Construct less care-dependent communities
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Build communities with stores within walking distance of homes.
Understanding Dementia
 Dementia – term for any illness that produces serious, progressive,
usually irreversible cognitive decline.
 Total erosion of personhood; complete unraveling of inner self
 Can be seen in younger adults who experience brain injury or
illnesses such as AIDS.
 Considered a chronic disease.
 Time from diagnosis to death can be from 4 to 8 years.
 Typically, dementia is an illness in advanced old age, not young old.
 Number one risk factor for developing dementia is old-old age.
 However, it can be linked genetically .
 Genetic marker (APOE-4) linked to Alzheimer’s disease.
 Causes a dilemma for young people who have seen a parent deal with the
disease. Should I be tested?
Symptoms of Dementia
 Symptoms:
 Forget semantic information- recalling core facts about their
lives (name, address, etc.)
 Impairment in executive functions – the ability to inhibit one’s
actions
 Thinking is affected – abstract thinking, decision making,
impaired judgment.
 Language is compromised.
 Later in life – loss of all functions such as ability to speak or
move
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May become bedridden, unable to remember how to eat or swallow
 May lead to infections or pneumonia, which can lead to
death.
Two Types of Dementia
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Vascular dementia – caused by multiple small strokes
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Alzheimer’s disease – characterized by neural atrophy and abnormal byproducts of that atrophy, such as senile plaques and neurofibrillary tangles.
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Refers to impaired in vascular system (blood flow in body)
Blood flow that feeds brain
Attacks the core structure of human consciousness.
Neurons decay and wither away.
Neurons replaced by neurofibrillary tangles and senile plaques (think: bullet-shaped
bodies of protein).
First show up in hippocampus (area of brain responsible for memory).
Then move to cortex
Comments
Difficult to distinguish between
these two as they cause similar
symptoms; very old people with
dementia may have both of these
diseases.
Preventing Alzheimer’s
Disease
 Major focus is on the protein amyloid, a fatty substance that
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is the core component of the senile plaques.
Efforts to dissolve plaque in the brain of those who already
have Alzheimer’s has been unsuccessful.
Therefore, the key lies in dealing with amyloid and halt the
neural decay early.
 Early detection becomes crucial before symptoms begin.
Although there is no cure and no proven effective
treatment, recommendations to prevent include:
 Physical exercise, particularly treatments or running wheels
 Mental exercise, such as brain-stimulations games
How to diagnosis Alzheimer’s
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Look for a history of steady mental deterioration.
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Presence of delirium – rapid mental confusion
May be caused by side-effects of medications,
dietary imbalances, or heart attack.
Rule out other physical and psychological causes.
Explore performance on a battery of
neuropsychological tests.
Dealing effectively with Dementia
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Goals during illness:
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Protect people and keep them functioning as long as
possible.
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Provide caring and loving support.
Potential interventions:
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Medications – can help with symptoms
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Use external aids like note cards to jog memory
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Focus on safety
 Lock and put buzzers on doors—to prevent wandering.
 Remove toxic substances and deactivate dangerous
appliances (such as stove).
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Consider admission to a nursing home with Alzheimer’s
unit.
Caregivers and Dementia
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Issues caregivers must face:
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Witnessing loved one deteriorate to an unfamiliar person
Loved one can become abusive, either physically or verbally.
Stress and depression
Feelings of embarrassment and guilt
Child often becomes the parental figure in the relationship with their
own parent.
Interventions:
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Get involved with support group.
Look into nursing homes and other options.
Do not personalize insulting comments. Realize it’s the disease
talking, not the person.
Respect the person’s humanity
Use this trauma as a redemption sequence– a chance to say “I
don’t care what the world thinks, let me just show my love.”
Various Cultures and Caring for the
Elderly
 Asian countries are turning to western society model.
 Scandinavian countries offer positive models for elder care.
 Family members still take primary responsibility for
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elder-care.
However, government often provides home health
services allowing people to stay in homes (“age in
place”)
Money provided to help remodel home.
Presence of multigenerational villages
 In the U.S., Medicare provides health insurance for elderly.
 However, it does not provide help for ADLs.
Alternatives to Institutionalization
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Continuing care retirement
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Residential complex that provides different levels of services
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Independent apartments to nursing home care
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Designed to provide person-environment fit
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Allows person to not to burden family members
Assisted living facilities
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For those who are experiencing ADL limitations but do not need 24-hour care
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Offers care less medicalized
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More of a homey setting
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Residents have private rooms and personal furniture
Day care programs
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For elderly who live with families
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Provides place for impaired elderly to go when caregivers are working
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Helps family members continue to care for loved one in the home by providing
support and help with care while not giving up other responsibilities
Home health services
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“in place” care – provides care in home
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Paid caregivers provide help with ADLs – cooking, cleaning, bathing
Nursing home care
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Nursing homes or long-term care facilities
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Designed for people with basic ADL impairments.
Provides 24-care intensive care.
Residents are mainly very old and female.
Entry often occurs after trauma:
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such as breaking a hip
when the person has dementia
People without families (or the money for assisted living
facilities) are most at risk of entry.
Evaluating Nursing homes
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Nursing home system is often misunderstood and
misrepresented.
Myths include:
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Movement to change nursing home culture
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often viewed as “dumping ground”
abuse is wide spread
residents are poorly care for until they die
person-centered
attentive to resident’s individual years
However, nursing homes can vary dramatically in quality
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Research shows 1 in 4 nursing homes provide substandard care.
Nursing home providers
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Certified nurse assistant or aid – the main handson care provider in a nursing home, who helps
elderly residents with basic ADL problems.
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like child-care workers, these health care providers
have very low-wages
facilities are often understaffed
care that these caregivers provide is tedious and
time consuming (feeding residents, assisting to the
bathroom)
Research suggests that most get a true sense of
satisfaction with their work.