Transcript Supporting People with Developmental Disabilities During the Aging Process Prepared and funded through collaboration between: The Developmental Disabilities Council of Washington, The University of Washington Center.

Supporting People with
Developmental Disabilities During
the Aging Process
Prepared and funded through collaboration between:
The Developmental Disabilities Council
of Washington,
The University of Washington
Center on Human Development and Disability,
Northwest Center,
and Washington State
Division of Developmental Disabilities
Project Staff

Sharan Brown, JD, EdD
Principal Investigator

Kathleen Watson, PhD, RN
Project Director/Trainer and Parent

Esther Moloney
Project Assistant and Parent
Effects on Health During the
Aging Process
 Normal aging process
 Lifestyle choices
 Genetic effects
 Environment
Aging With a Developmental
Effects of the
Disability
disability
Normal
effects of aging
Inadequate funding
for health care
Negative attitudes about
people with disabilities
Limited access to
quality
health care
Person with
a Disability
and its treatment
Lack of knowledge
about aging for
people with DD
Lifestyle
effects
Decreased
Quality
of Life
Support During the Aging
Process

Need to document current level of function.
Consider PCAD assessment

Recognition of changes that need attention, especially
in non-verbal residents.
e.g., dementia vs. more treatable problems
Agency plan for aging in place or alternative care.
 End-of-life planning.
 End-of-life care.

Vision Changes of Aging
Loss of acuity.
 Loss of accommodation (presbyopia).
 Decrease in light transmission.
 Changes in color perception (esp greens, blues, violets).
 Decrease in dark adaptation.
 Less able to adapt to glare.
 Decreased visual field.

Symptoms of a Problem
 Rubbing eyes.
 Squinting.
 Shutting or covering one eye.
 Tilting or thrusting head forward.
 Redness of eye or area around eyes.
Changes in Function
 Stumbling.
 Hesitancy on a step or curb.
 Holding page or object closer to eyes.
 Refusing to participate in previous activities.
 Sitting close to TV.
Eye Diseases
Dry eyes - scratchy, irritated
 Blepharitis - red, itchy lids, person may rub too much.
 Age-related macular degeneration (ARMD).
 Cataracts - gradual clouding of lens.
 Diabetic retinopathy -damage to retina leading to blindness.
 Glaucoma – gradual tunnel vision, then blindness.
 Keratoconus – disease of eye surface (cornea). More
common in persons with Down Syndrome.

Types of Vision Loss
 Loss of central vision
Blind spot for central field
Unable to see faces, read.
Loss of acuity or clarity
Caused by macular disease
Types of Vision Loss (cont’d)
 Loss of peripheral vision
From glaucoma or retinitis pigmentosa
Affects safe mobility
 Diffuse loss across visual field
From diabetes, cataracts, keratoconus.
Vision may fluctuate based on amount and direction
of light.
Support Strategies for Vision
Get regular eye exams to check for asymptomatic
problems or unexplained symptoms.
 Get professional explanation of the problem.
 Modify the environment:

Use high contrast colors, non-glare lighting and surfaces,
large print.
Red, oranges, yellows better than blues, greens, violets
Provide increased lighting, use night lights.
Organize belongings and keep locations consistent.
Keep eyeglasses clean and prevent scratches.
Support Strategies for Vision
 Modify activities:
Engage in daytime activities.
Provide support for night-time activities.
Allow time to adjust to change of light.
Protect the “good” eye.
Hearing Changes of Aging
 Loss of auditory nerve cells and fibers
 Reduction of blood supply to auditory nerve
transmission area
 Thickening of eardrum
 Increased ear wax
 Presbycusis (loss for high pitched speech
sounds)
 Decreased tone discrimination, localization.
Types of Hearing Loss

Conductive –
Problem with the physical conduct of sound through the ear
structures.
From earwax, infection, head trauma, damage to ear drum.

Sensori-neural –
Problem with the conduct of the sound signal through the
nerve to the brain or the processing of the information in the
brain.
From head trauma, drugs, diabetes, high blood pressure,
heredity, kidney failure, coronary artery disease.
Possible Symptoms
 Turning TV up loud.
 Speaking loudly.
 Inappropriate response to questions.
 Confusion in noisy situations.
 Isolating.
 Self injurious behaviors.
Support Strategies for Hearing
 Get regular exams with a hearing professional to
check for wax, disease, gradual hearing losses.
 Hearing aid if indicated.
 Speak slower, with lower tones, clearly.
 Reduce background noise.
 When speaking, face person with light on your
face, not behind you.
 Keep hearing aid batteries fresh and aid clean.
Aging Effects on Mouth/Taste
 Decrease in taste buds
 Recession of gums,
 Thinning of dental enamel
Abnormalities and Disease in
Mouth
 Decreased saliva from drugs or diseases.
 Dental caries.
 Root caries and abscesses.
 Periodontitis (gum disease).
 Sores, especially with dentures.
 Infection of mucus membranes.
 Cancers.
Support Strategies
Mouth/Taste
 Regular dental checkups and good oral hygiene,
even if no teeth.
 Floss or use proxi-brush.
 Consider battery-powered toothbrush.
 Alcohol-free mouth wash.
 Ask dentist about chlorhexidine mouthwash to
decrease bacteria and infections (prescription).
 Increase seasonings of food except salt.
Nose/Smell
 Decrease in nerve fibers.
 Drying of mucous membranes in nose.
 Decreased sensitivity to odors.
Support Strategies for
Nose/Smell
 Use of smoke detectors.
 Care if using propane stoves or water heaters.
 Discarding food after recommended time, check
for spoilage.
 Assist with awareness of body odor or over-use
of fragrances.
Skin/Touch
 Decrease sweat glands, subcutaneous fat, blood
supply, elasticity, thickness of skin
 Loss of pigment
 Decrease skin cell production and hair growth
 Changes in nail matrix
 Decreased sensation of touch, pain
Protecting Skin
Minimize use of soap and rinse well.
 Dry well and use moisturizers.
 Reposition frequently if mobility is limited.
 Check skin frequently for problems.
 Label hot and cold water and monitor water
temperatures.
 Increased risk with Down Syndrome, immobility, poor
nutrition.
 Use sun protection.

Aging of the GI System
 Decreasing total calorie needs every decade
 Less gastric juice may lead to increased indigestion
and ulcers
 Decreased saliva production may lead to more gum
disease
 Decreased smooth muscle tone, slower emptying
and digestion, less absorption of nutrients.
Strategies
 Promote elimination through fluids, fiber and
physical activity.
 Observe for constipation.
 Encourage slower eating, smaller, more frequent
meals.
 Avoid empty calories.
Urinary and Reproductive Genitourinary
 Bladder capacity and muscle tone decrease
 Kidneys become less
efficient
 Enlargement of prostate common
 Relaxation of pelvic muscles
 Effects of decreased hormones
Support Strategies
 Observe for voiding patterns- increased or
decreased frequency, changes in continence.
 Observe for signs of infection- frequency,
urgency, accidents, discomfort, unusual odor,
color or bleeding. There may be no fever or
usual symptoms.
 Regular screening tests and examinations.
 Good hygiene practices.
Heart and Blood Vessels
Decreased responsiveness to stress, leading to difficult
breathing, fatigue.
 Heart rate decreases due to slower contraction of muscle
fibers.
 Slow return to normal HR after elevation.
 Build up of calcifications and fat in arteries.
 Decreased elasticity of arteries leads to heart needing to
pump faster.

Protecting the Heart
 Encourage regular, moderate exercise
 Slow the pace of activities
 Watch for signs of decreased endurance - distress,
dizziness, confusion
 Change position slowly to prevent dizziness
 Reduce or stop cigarette smoking
 Healthy, low sodium diet, blood pressure checks.
 Decrease fat and trans fatty acids from diet.
 Learn signs and symptoms of a heart attack
Signs of a Heart Attack
Chest discomfort that lasts more than a few minutes or
goes away and comes back.
 Discomfort in other areas of the upper body, including
one or both arms, neck, jaw, back, stomach.
 Shortness of breath with or without chest discomfort.
 Other symptoms: nausea, lightheadedness, breaking
out in a cold sweat.

Lungs - Pulmonary System
 Lungs become less elastic, less able to take in
oxygen
 Breathing becomes less efficient, tolerance for
exercise decreases
 Decreased cough reflex.
 Decrease in cilia lining respiratory tract.
Protecting the Lungs
 Avoid smoking and second-hand smoke.
 Encourage deep breathing, physical activity.
 For persons with difficulty, slow pace of activity, allow rest.
 Help alleviate stress.
 Proper diet and enough fluids.
 Immunizations for lung diseases (flu and pneumonia).
 Watch for signs of infection (increased coughing,
shortness of breath, colored sputum, increased
confusion).
Protecting the Lungs (cont’d)
 Observe for signs of reflux:
Heartburn, discomfort after meals or at night.
Difficulty or painful swallow.
Swallowing or excessive salivation when not eating.
Coughing during night.
Nervous System
 Loss of nerve cells and fibers with decreased
conduction.
 Decreased blood flow and oxygen to brain.
 Less REM stage of sleep.
 Altered pain response
Behavior and Cognitive
 Intelligence, ability to learn, don’t necessarily
change
 More difficulty processing, organizing new
information, recalling old information
 Mental illness more prevalent in those with I/DD
than in general population -depression most
common.
Balance and
Protective Responses
 Sense of balance decreases due to loss of hair cells
in middle ear.
 Slow movement and less sensation lead to slower
reaction time and decreased protective responses.
Age-related Musculo-skeletal
Changes
 Decrease in muscle mass, strength and tone
 Decrease in joint mobility
 Increased porosity and fragility of bones
 Shortening of the spinal cord
 Increased likelihood of developing arthritis
Protecting the
Musculo-skeletal System
Encourage independent movement and self-care.
 Promote regular exercise.
 Implement safeguards to prevent falls.
 Promote safe use of mobility aids.
 Provide seating that is comfortable, firm, and not too deep.
 Ask health care provider about calcium and vitamin D
supplements, weight-bearing exercise, hormone
replacement therapy.

Down Syndrome
 Longer lifespan than in the past
 More rapid aging at the cellular level-affects all
body systems
 Normal aging processes occur earlier than in
persons without Down syndrome
 Poor function of immune system
Down Syndrome
 Increased incidence of Alzheimer’s Dementia
Early onset type of AD
Begins at earlier age than in general population.
First noticed in daily function rather than memory
loss.
Progresses more rapidly.
Affects about 25% of DS population.
May have new onset of seizure disorder.
Down Syndrome
 Dry skin, more fungal infections of nails.
 Increased incidence lifelong risk of thyroid
dysfunction, usually hypothyroid.
 Earlier onset of visual and hearing problems of
aging.
 Increased incidence of sleep apnea.
 Overweight, especially those living with family.
Down Syndrome
 Joint problems of neck, knee, and hip and more
likely to develop bunions.
 Lower peak bone density and earlier risk for
osteoporosis.
 Many born with heart abnormalities.
 Increased risk of heart valve disease later in life.
 Decreased risk of atherosclerosis.
Down Syndrome
 Atlanto-axial Instability
Spinal column instability-about 14%.
May compress cord leading to neck pain, poor
posture and gait, loss of upper body strength,
abnormal neurological reflexes and changes in
bowel and bladder emptying.
Treatment controversial- ask health care provider.
Cerebral Palsy
 Amount of decrease in life expectancy related to
degree of severity of condition.
 Abnormal muscle tone
Muscular and joint pain
Hip and back deformities
Worsening bowel and bladder function
Orthopedic surgeries
Cerebral Palsy
 Abnormal movement of food through the throat
and stomach:
Dysphagia (abnormal swallowing)
Reflux of stomach acid into throat (GERD gastroesophageal reflux disease)
Delayed emptying of the stomach.
All contribute to dental erosion, irritation of the
esophagus, anemia, feeding problems, aspiration
and pneumonia.
Cerebral Palsy
 Abnormal movement
of food and waste through
the small and large intestine.
High incidence constipation, fecal impaction
Increased risk of death from bowel obstruction and
intestinal perforation
Cerebral Palsy
 Feeding and digestion problems worsen.
 Joint pain and deterioration worsens.
 Breathing difficulties worsened by above
problems. Speaking more difficult.
 More susceptible to pressure sores due to
decreased mobility and thinning of skin.
 Nutritional deficits, limited movement and
medication usage increase risk of osteoporosis.
Prader-Willi Syndrome
 Hypogonadism- low hormonal levels.
 Problems related to uncontrolled obesity
Cardiovascular
Diabetes
Fragile X Syndrome
 Increased rates of mitral valve prolapse
 Musculo-skeletal disorders
 Early menopause
 Epilepsy
 Visual impairments.
 Earlier osteoporosis
Seizure Disorders
 Change in seizure frequency, increase or
decrease
 Cumulative effects of long term use of seizure
medications
 Decreased bone density and increased trauma
and falls due to seizures may lead to fractures
What Is Dementia?
 Impaired brain function.
 Problems with memory and judgment.
 Often accompanied by confusion.
 Loss of ability to use information once known or
learned.
 Loss of basic abilities to think and understand.
Types of Dementia

Alzheimer’s Dementia (AD or DAT).
Most common type.
Gradual onset with stages of increasing severity.

Multiple Infarct Dementia (MID).
Second most common type.
Numerous tiny strokes-related to heart disease and high
blood pressure.
Can have sudden onset.

Other types.
Stages of Alzheimer’s Dementia
Mild
Confusion
Disoriented
(early stage) and memory in space.
loss.
Moderate
(mid stage)
Difficulty with Anxiety,
ADL’s
paranoia,
agitation.
Severe
(late stage)
Loss of
speech.
Loss of
weight,
appetite.
Problems
with routine
tasks.
Changes in
personality
and
judgment.
Sleep
Difficulty
difficulty.
recognizing
familiar
people.
Loss of
Total
bladder/bow dependence
el control.
on others.
What Else Could Be Causing
These Behaviors?
Medical problems- anemia, high blood pressure, brain
tumor.
 Medication side effects.
 Hearing and/or vision problems.
 Metabolic disturbances-diabetes or thyroid dysfunction.
 Alcohol or other substance abuse.
 Affective disorders-delirium or depression.
 Vitamin deficiencies.

Get Medical Evaluation
 Rule out other possible causes for symptoms,
behaviors.
 Document a progressive decline from the
person’s former or baseline status.
 Possible or probable diagnosis by process of
elimination and characteristic pattern of
difficulties.
Documenting Baseline Function
 Use a standardized test.
 Give periodically beginning before you anticipate
problems.
 Include a video recording of the person’s
functional abilities.
 Compare change over time.
 The PCAD project (see sample handout).
Service Delivery Models
 Aging in place- adaptation as client needs,
abilities and behaviors change.
 Dementia-specific environment-specialized staff
and setting.
 Referral out, usually to long-term care facility or
other generic community programs.
References

Parts of this presentation were adapted from: Factor, A.R.
(1997). Growing Older with a Developmental Disability: Physical
and Cognitive Changes and Their Implications. Chicago:
Rehabilitation Research and Training Center on Aging with
Mental Retardation,, University of Illinois at Chicago.

Many other resources at this website:
http://www.uic.edu/orgs/rrtcamr/