Aging and Function for People with Developmental Disabilities

[email protected] age.r/t.chges.impact.function.persons.w.d.d.

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Common age related changes and medical conditions:

Impact on function for Persons withDevelopmental Disabilities

Sandy Ceranski, MS, OTR

August 23, 2005

For Phoenix Health Care Systems


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Learner Objectives:

1. Understand signs and symptoms of typical “age-related” changes and medical conditions experienced by older adults

2. Understand the impact these changes can have on daily function, participation and quality of life

3. Identify common strategies that support – Function– Participation– Quality of Life


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Lead with your conclusion…• Age related changes and medical conditions affect all

persons including persons with DD– May not be able to adequately communicate the changes they

are experiencing

– Care providers must be responsible to identify changes and arrange for necessary professional assessment and interventions

– Many interventions exist that can • Restore lost skill, develop new skill

• Compensate for lost skill by modifying activity, environment, objects, expectations

• Prevent further disability and promote health


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Aging is a developmental process

• Starts at birth

• Gradual changes in body structures and systems

• We all experience

• Not all changes at same rate and same impact

• Changes can impact function, participation and quality of life


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Next 4 slides are from presentation:Next 4 slides are from presentation:HOME MODIFICATIONSHOME MODIFICATIONS

(permission granted to use 10/2004)(permission granted to use 10/2004)

Thanks to:Kenneth R. Tremblay, Jr., Adetania Pramanik,

and the Gerontology Action Team

2002


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Aging ProcessAging Process

Your 40s• The body burns 120 fewer calories a day than at age 30 making weight control harder.• Changes in the inner ear erode the ability to hear higher frequencies for men -- who lose hearing more than twice as fast as women do.• The eyes begin to have trouble focusing as the lenses become thicker.

Your 50s• The ability to see in dim light or under conditions of glare, or to catch sight of moving objects, diminishes. • Loss of strength as muscle mass diminishes.• Vulnerability to infections and cancer increases.

Your 60s• Making out conversations becomes harder, especially for men, as high-frequency hearing deteriorates further.• Blood-sugar levels rise and more people are diagnosed with adult-onset diabetes.• Joints are stiff in the morning.• Men’s sexual daydreams all but vanish after age 65. Researchers don’t know why.

Your 70s• Blood pressure is 20 to 25% higher than in the 20s.• Reaction to loud noises and other stimuli is delayed as the brain’s ability to send massages slows.• Short-term memory and the ability to learn spoken material decline. • More than half of men show signs of coronary-artery disease.

Your 80s• Women become particularly susceptible to falling and disabling hip fractures. They are generally weaker than men and by now have lost over half the bone mass in the hips and upper legs.• The heart beats, at maximum exertion, about 25% slower -- but compensates by expanding and pumping more blood per beat.• The stereotype not withstanding, personality doesn’t change with age. A cranky 80-year-old was a cranky 30-year-old. Adapted from US News & World Report, “How time takes its toll”

How time takes its tollHow time takes its toll


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• Health-related changes -- The most common health limitations are arthritis, heart problems, respiratory problems, and stroke-produced difficulties.

• Motor capacities: strength, dexterity, and flexibility -- A decline in motor capacities results from reductions in muscle mass. Older adults often experience difficulties in performing daily activities, including bending knees or back, sitting and rising from a chair, crouching, turning on/off a faucet, and switching a lamp.

Aging ProcessAging Process

• Sensory and perceptual changes -- Visual and auditory systems decline with aging. The eye loses acuity, becomes more sensitive to glare, and is less able to distinguish between colors. Hearing capacity degenerates, with the higher frequencies effected first.

• Cognitive changes -- Cognitive decrements bring about decreases in reaction time, spatial visualization, word fluency, processing, short-term memory, and retrieval.

Normal aging process means:Normal aging process means:


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Aging with a Developmental Disability

• Experience same age related changes• Same medical and mental health problems as general

population (Hotaling, 1998)• May start earlier, as early as 35 (Connolly, 1998)• May occur faster rate, especially persons with Down

Syndrome (Lubin, 1985)• Chronological age:

– inconclusive as to whether it is an appropriate measure to use when looking at aging


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• Persons with profound MR ’d mortality rates r/t respiratory disease than higher

functioning persons

• Persons with CP or Down Syndrome ’d risk osteoporosis at earlier age– Immobility & Vitamin K deficiency (Wageman, 1998)

• High incidence of fractures with epilepsy– Anti-epileptic drugs may produce osteomalcia (Lohia,

1999)


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• Higher Nutritional risks– Complications from diets high in

• sugar, fat, cholesterol, excessive caffeine & tobacco

– Malnutrition– Medications effects and dietary outcomes– Eating habits and stress


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• Higher “Lifestyle Risks” for health status– Sedentary lifestyles – higher levels of inactivity

• Obesity and its health related problems– CAD, Type 2 Diabetes

– Challenge:• How to participation in physical activity daily

• How to best promote healthy aging – Mind-body factors, nutrition, wellness and physical activity


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Aging with Down Syndrome

• Unique medical needs and concerns (Burt, 1995) ’d epilepsy, mitral value prolapse, infection susceptibility,

hypothyroidism• Functional consequences: lethargy, fatigue, ’d participation in ADL,

confusion and depression (Fenderson, 1998)

– 35% to 60% congenital heart malformations• Many are uncorrected from baby boomer generation

’d visual & auditory problems & ’d severity• Cataracts in 46%

’d sensori neural hearing loss• Chronic and excessive accumulation and impaction of ear wax


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Aging with Down Syndrome (cont.)

• Hypotonia in 88% to 98% – Joint hyper flexibility causes orthopedic and

motor problems• Most significant: atlantoaxia (AA) instability

– Usually asymptomatic, but AA dislocation or subluxation can lead to compression of spinal cord, quadriplegia and possible death (Fenderson, 1998)

• Alzheimer’s Disease ’d likelihood with DS than general population


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Impact of Age Related Changes and Medical Conditions

• Substantial in Function and Societal participation – Made worse by imposed “Activity Limitation”


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Common Medical Conditions that affect Vision

• Some of these conditions can be treated, slowed or reversed with early and professional intervention– Cataracts

– Macular Degeneration

– Diabetic Retinopathy

– Glaucoma

• Combined with “normal aging” vision changes – Can cause severe deficits in functional vision also

known as “low vision”


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Normal Vision

• A person with normal vision or vision corrected to 20/20 with glasses sees this street scene.


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Cataracts• An opacity of the lens

results in diminished acuity but does not affect the field of vision. There is no scotomoa (a distorted, empty or dark area), but the person's vision is hazy overall, particularly in glaring light.


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Macular Degeneration

• Central vision is decreased because of scotoma

• Peripheral (side) vision is unaffected


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Diabetic RetinopathyThe leaking of retinal blood vessels

may occur in advanced or long-term diabetes, and affects the macula or the entire retina and vitreous. Not all people with diabetes develop retinal changes, but the likelihood of retinopathy and cataracts increases with the length of time a person has diabetes, along with the consistency and level of blood glucose control.


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Glaucoma

• Diverse group of eye diseases, all of which involve progressive damage to the optic nerve. Glaucoma is usually, but not always, accompanied by high intraocular (internal) fluid pressure. Optic nerve damage produces certain characteristic defects in the individual’s peripheral (side) vision, or visual field.


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Hemianopia

• Damage to the optic pathways in the brain, which can result from acquired brain injuries due to stroke, tumor or trauma, can cause vision loss in half of the field. The most common defect, right homonymous hemianopia, occurs in corresponding halves of the right field of vision.


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Visual Changes - age related • Acuity

• Accommodation

• Lighting

• Glare

• Sight recovery

• Color perception

• Depth perception

• Response to light

• Upward gaze


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Acuity

Problem: A white telephone on a white wall plus no color contrast between the letters and numbers and the rest of the telephone.


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Solutions: To enhance acuity, major color contrasts should be maintained between signs and symbols/ lettering, dishes and

table, telephone and buttons, food on plate and plate color, etc.

Acuity


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Acuity

Solution: Select items in the environment that contrast with thesurroundings, such as the red tea kettle in this kitchen.


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Acuity

Solution: Some of these talking products are shown above: a thermometers, scale, watch key chain and a clock. Others include, microwave, timers, money identifiers, TV Remotes, clothing color identifiers, and screen reading software.


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Accommodation

Problem: When an older person focuses on objects at a distance and then attempts to focus on items close at hand, it takes more time to make the adjustment than it does for a younger person.


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Accommodation

Solution: The average age for obtaining bifocals is forty-two. Correction to adapt for change continues into the late sixties.


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Accommodation

Solution: When bifocals no longer compensate for an older person’s inability to read fine print, use large print newspapers, books,

magazines etc. Also, explore the array of audio tapes.


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Accommodation

Solution: Magnifiers are very helpful in accommodating for Presbyopia.


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Accommodation

Solution: A large numbered overlay on a thermostat increases a persons ability to read the numbers.


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Lighting

Problem: Many seniors exist with very poor lighting. Reasons vary but may include: think it’s more economical, lack of someone to change bulb,

unaware of benefits of good lighting, oversight, etc.

No bulb40 watt

bulb


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Table Lamps: Task lamps:

Lighting - Task


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Kitchen Lighting


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A painful and often disorienting problem caused by too much illumination

Direct: Occurs when light reaches the eye directly from it’s source

Indirect: Arises when the light reflects into the eye after rebounding off of

another surface

Glare


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Direct Glare

Problem: When talking to an older person, NEVER sit with your back to the window so they must look directly

into the sunlight to talk to you.


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Indirect Glare

Problem: On the floor of a hospital corridor, indirect glare results from a highly polished vinyl flooring which makes it look wet and

it’s perception is complicated by the slight incline of the floor.


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Indirect Glare

Solution: The same corridor as previous slide but use of the space has changed. Carpet has replaced vinyl and more

attractive but functional handrails have been added.


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This change in the lens effects the quality of light entering the pupil and impairs the perception of certain

colors.

Color PerceptionWith increasing age, the lens of the eye turns yellow


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Color Perception

Problem: Due to the yellowing of the lens, the older person should be careful when taking medications because many

have similar colors and may be difficult to distinguish.


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A monochromatic color scheme such as the one shown in this slide does not have enough color contrast for the older person to easily distinguish the edge of the couch or chair.

Color/Depth Perception


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When the chair/couch appear blurred, as in the above simulation, it is difficult to determine the exact edge of the furniture and the distance to the floor. Falls occur

when the distance is miss-judged.


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Solution: To provide a color contrast between the edge of the tub and the floor and the inside of the tub, either use a darker color on the bottom of the tub and the floor or place

color strips on the tub edge itself.


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Depth Perception

Problem: Most falls on stairs occur when the person trips on the top or the bottom step. Seeing the edges of steps may

be difficult if they appear blurred.


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Solution: Highlighting the top and the bottom of the steps can improve depth perception. Outdoor steps or stairs

leading to a basement can be marked with tape or paint.

Depth Perception


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Solution: A solution more suited to the indoors is to place stair lights along steps. Highlighting the edges of steps with

light aids the ability to see the edge of each step.

Depth Perception


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Issue: When an older person is coming from a very bright light to a darker area, or visa versa, allowing adequate time for the older eye to adapt to a darker

space is absolutely crucial.

Sight Recovery


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Issue: If the older person has low vision, sight recovery principles must be considered throughout the home.

Particular attention should be given to areas of potential danger such as stairs and landings. Be sure stair lights can

be switched on at the top and bottom of the stairs.

Sight Recovery


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An older person may have

1) Reduced upward gaze,

2) Eyelids that do not open as wide

3) Forward body tilt of several degrees.

If the person is in a wheelchair, regardless of age, their eye level is about 48” from the floor.

Upward Gaze


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Upward Gaze

Solution: Direction signs for seniors, should be placed within the field of vision. Ideally, this will be about 3 ½ to 5

feet above the floor. If there is a border, place the sign just above border


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Olfaction or the sense of smell provides both protection and pleasure. It generates

associations of past experiences.

Sense of Smell

Loss of sensitivity: To body and household odors.

Loss of protection: By a reduced ability to smell smoke or gas fumes


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Sense of Smell

Solution: Install and maintain a well functioning smoke detector; install a natural gas leak detector; organize food in the refrigerator so that the

person can keep track of expiration dates.


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AuditoryAs people age their ability to hear high frequency sounds, as well as sounds in general, is diminished.

Hearing aids have been developed that amplify sound at different

frequencies

However, hearing aids may still transmit background noise


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Auditory

Solution: When speaking to an older person, move closer, speak slower with separation between the words, slightly

louder, and consciously lower the tone.


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Auditory

Solution: When eliminating background noise is important or a hearing aid doesn’t work, try a one-to-one pocket talker. When it is placed by a

television speaker, the volume can be turned down.


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Age-Related Physical Changes

Stability Sitting and Rising

Mobility Bending and Reaching

Climbing Stairs Grasp and Pinch

Adaptations need to be found for problems that occur with:


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StabilityProblem:

Towel bars are not designed to be used for support and weight should NEVER be placed on them when entering or exiting a tub.


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Stability

Solution:

Grab bars


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Stability

Solution: A grab bar running along the entire length of the vanity provides a handhold for someone needing a maximum amount of support.


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Stability

Solution: When removing all loose or scatter rugs isn’t possible, place non-slip material between floor and rug.


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Stability and Mobility

Solution: Handrails along walk with chairs and bench near path for person that cannot walk long distances without support or rest.

Bench

Chair


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Home AT-EI in Home AT-EI in BathroomBathroom

Showerheads that come with long hoses that let you bathe while sitting on a chair or

bench. Grab bar.

Elevated toilet is about 17-18 inches high, compared to the standard toilet.

Bathtubs with a built-in transfer bench can help anyone having difficulty

getting in or out of a bathtub. A shower seat that attaches

permanently to the shower wall and folds up when not in use.


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Mobility

Problem and Solution: Basket for walker allows person to carry items when hands are occupied holding onto walker.


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Mobility

Solution: Vanity is designed with a narrow apron to allow wheelchair to roll under counter.


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Solution:

If there is a raised threshold, a small wood/metal wedge-type ramp can be placed against it to create a smooth transition for the wheelchair or for someone that has difficulty lifting their foot

Mobility


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Mobility

Solution: Non-slip wood/vinyl flooring is easy to maintain and easy to roll or walk on.


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36” Yardstick

Solution: Ideally, interior doors should be 36” wide.

Mobility


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Climbing StairsProblem:

Unfortunately, this is common basement stairway,

i.e. no railing, no light switch at top and bottom, no marking on steps, poor lighting and the added feature of a very narrow step surface on one side.


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Climbing StairsSolution:

Handrails on both sides of a relatively narrow stairway provide support. The addition of stair lights provides compensation for depth perception problems.


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Sitting and Rising

Problem and Solution:

This is a stable chair with arms that provide a handhold when arising. However, the design includes a board in the front which prevents a persons center of gravity to be placed directly over feet.


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Sitting and Rising

A bath lift allows the person to be lowered gradually to the bottom of the tub, these use a battery pack for power. The transfer board facilitates the transfer.


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Sitting and Rising

Solution: When the placement of a grab bar is not possible, in-stall a grab pole.


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Sitting and Rising

Solution: When installing a raised toilet seat, select the type that is placed between the bowl and the seat; it is more stable then one placed

on top of the seat.


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Sitting and Rising

Solution: Place a grab bar by the commode/toilet. The fold-down type allow for more flexibility in use of space. If wall on right side, place fold-down on the left side and a wall

mounted grab bar on wall on the right; if no wall, place fold-downs’ on each side.


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Bending and Reaching

Problem: A shorter person of any age or persons with stability problems often have difficulty reaching the high cupboards.


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Bending and Reaching

Solution: A pocket door, lowered closet rod, and shoes stored on the closet shelf make clothing storage and retrieval easier.


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Grasp and Pinch

Solution: Lever door handle should have a filled or enclosed back; the elimination of rough surfaces is easier to manipulate


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Grasp and Pinch

Solution: Lever faucets require less grip function and can be operated with a closed fist.


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Cognitive Interventions

Safety Awareness is always the

FIRST consideration.


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Safety

Concern: Check to see if flammable items have been placed on the stove or stored in the oven.


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Wayfinding

Solution: Use landmarks that are easy to see and have meaning to residents, i.e. pictures of activities.


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Visual Cues

Solution: To help a person with CI be as independent as possible,

items that are used together should be placed together.


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Visual Cues

Solution: Putting clothing of one type in a drawer and labeling the drawer with words or pictures can be helpful


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Visual Cues

Solution: Placing clothing in open baskets is better then drawers because the items are more visible. This wardrobe

unit would be even better if the drawers were placed higher.


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Memory Aids

Solutions: Whenever possible, select appliances with

automatic timed turn-off.


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Memory Aid

Solution:

Use a calendar and marked off days to help orient a person to time.


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Medications

Both taking and not taking of medications may be problematic

with the person with CI.

Products from simple reminders and organizers to those that

prevent over medication may be beneficial.

“KISS”


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Medication Management

Solution: This medication management system has been modified to meet the specific needs of the client, these changes include: rubber binders around certain holders when additional medications need to be given and a black

outliner to frame the day, this piece is attached with velcro at the top.


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Providing Reassurance

Solution: An emergency response system can give both the caregiver and the person with CI peace of mind.


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Wandering

Solution: A variety of person identifiers are available from the Alzheimer’s Association. These include pendants, bracelets, key chains and clothing

labels. Identification is for the caregiver as well as for the person with dementia. Caregivers identification reads “I am the caregiver for ________”

and is carried in case the caregiver becomes incapacitated.


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How does this affect you and the people you care about?

• What did you learn that was meaningful to you?

• What questions do you have?

• What ideas might you incorporate into your care giving, practice or lifestyle?


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Sandra Ceranski, MS, OTR

Quality Monitor

Community Care Organization, Inc.

1555 S. Layton Blvd.

Milwaukee, WI 53215

Ph: 414.902.2405

FAX: 414.944.0001

email: [email protected]

Aging and Function for People with Developmental Disabilities

Health & Medicine

impact changes

common age related changes

healthrelated changes

conclusion age related

perceptual changes problems

birth gradual changes

chronological age

developmental process