Janet Belsky’s Experiencing the Lifespan, 3e

1. Janet Belsky’s Experiencing the Lifespan, 3e Chapter 14: The Physical Challenges of Old Age Robin Lee, Middle Tennessee State University

2. What Does It Mean to Age Successfully? • Successful aging means: • drawing on what gives one’s life meaning to live fully no matter how the body behaves • having an internal sense of self-efficacy • having support to function • living with the potential for chronic disease that may come with old age • combines nature (personal capabilities) and nurture (environmental fit)

3. Tracing Physical Aging • Normal age changes – universal and progressive signs of physical deterioration that occur with age • Age-related changes are universal (happen to everyone) and genetically programmed into our DNA but differ according to the time of onset.

4. Three Basic Principles of Age-Related Disease • Chronic disease is often normal aging “at the extreme.” • Moderate physical losses are normal; extreme changes are considered chronic. • 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). • ADL impairments – difficulty performing everyday tasks that are required for living independently • Become far more frequent among the old-old as the number of chronic diseases accumulates • Lifespan has a defined limit. • Aging process has a fixed end. • But, the 100-plus group is the fastest-growing age group of all!

5. Two Types of ADL Problems • Instrumental ADLs • Difficulties performing everyday household tasks (cooking, cleaning) • Common in advanced old age • Basic ADLs • 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

6. Age Risk of Instrumental ADLs and Basic ADLs

7. What affects the physical aging path? • Socioeconomic status • Ethnicity • Gender • Age

8. Socioeconomic status, aging, and disease • 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 (fetal programming hypothesis). • Low birth weight, which is often linked to social class, can cause obesity and poor health later in life. • Diet, illness, and life stresses can lead accelerated aging. • 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).

9. Ethnicity, aging, and disease • Despite poverty, Hispanic Americans seem to fair better against physical aging than African-Americans. • African Americans are more susceptible to illness and premature death than any other ethnic group. • Be careful not to blame the person for the many forces that affect aging due to the “toxic” environment of being poor.

10. Gender, age, and disease • Women survive longer due to less life stressors, support from family and friends, their second X chromosome. • Due to fewer heart attacks • Presence of estrogen helps slow aging process • May live longer but frail • 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.

11. Cohort, aging, and disease • Are we seeing more age-related illness at younger ages? YES! • By early twenty-first century, odds of successfully aging physically has declined by 25 percent. • Baby boomers are more disabled than previous cohorts. • Obesity epidemic leads to diabetes and other later-life conditions.

12. Taking a holistic lifespan disease-prevention approach • Focusing on total personal responsibility is unfair. • The solution is to alter the health environment in the beginning by the following: • Focusing on children − preventing premature births, eliminating child poverty, improving education • Focus on communities – making it easier to exercise, promoting healthy nutrition

13. Sensory-motor changes with age • Vision • Hearing • Motor abilities

14. Normal Vision Changes • Presbyopia – age-related difficulties with seeing close objects • universal change that happens in mid-life • often leads to the need to purchase reading glasses • Poorer dark vision • cannot see as well in dimly lit places • More troubles with glare • being blinded by bright light shining in the eye

15. 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 The Main Cause: The Lens • Lens not able to bend • Causes presbyopia (bending is what helps with seeing close objects) • “Cured” by wearing bifocals

16. Interventions for “older eyes” • Use strong indirect lighting. • Avoid fluorescent lighting—especially on bare floors (produces glare). • Use adjustable lighting and larger numerals on appliances, and provide non-reflective surfaces. • Look into low-vision aids such as magnifiers.

17. Understanding hearing in later life • Hearing loss is very common in later life, causing as many barriers as vision loss. • Hearing impairments may be more problematic than vision problems because they limit the ability to connect with the human world through language. • One in three older adults suffers from hearing loss. • 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!

18. Presbycusis Defined • Presbycusis – the characteristic 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.

19. The Human Ear

20. Interventions for hearing loss • Avoid high-noise environments (crowded restaurants). • Cover ears when passing by noisy places. • Install carpeting in the house (it absorbs noise). • Replace noisy appliances (air-conditioners or fans). • Face the 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!

21. Motor performances • 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 who is driving slowly. • Problems with reaction time – decline in the ability to respond quickly to sensory input • 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: • Osteoarthritis − wearing awayof joint cartilage • Osteoporosis − bones become porous, brittle, and fragile; tend to break easy • Women are more susceptible. • Hip fractures are a common problem due to skeletal changes. • Most common risk factor for nursing home admissions

22. Interventions for Motor Problems • Exercise moderately. • Can help prevent falling • Keep ADL problems from developing or getting worse. • Add aids to help (e.g., scooters). • Encourage activities – attend church, outside activities • Remodel house. • Indirect lighting • Install low-pile, wall-to-wall carpeting; can prevent tripping. • Install grab bars in places where falls can occur (bathtubs). • Be careful in speed-oriented situations.

23. Driving in Old Age • 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 high-risk populations (teenagers and emerging adults).

24. Driving in Old Age: Issues and Solutions • The problem: Giving up one’s car means loss of independence. • Driving is essential in a 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: • Some advocate for yearly license renewals along with vision tests. • Changing driving conditions • Larger signs, better lighting on exit ramps, etc. • Extending yellow light signals • Roundabouts • Construct less care-dependent communities. • Build communities with stores within walking distance of homes.

25. Understanding Dementia • Dementia – general label 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 • Typically, dementia is an illness in advanced old age, not young-old. • Number one risk factor for developing dementia is old-old age.

26. 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 • May become bedridden, unable to remember how to eat or swallow • May lead to infections or pneumonia, which can lead to death

27. Two Types of Dementia • Vascular dementia – caused by multiple small strokes • Involves impairments in the vascular system (blood flow in body) • Blood flow that feeds brain • Alzheimer’s disease – a type of age-related dementia characterized by neural atrophy and abnormal by-products of that atrophy, such as senile plaques and neurofibrillary tangles. • Attacks the core structure of human consciousness • Neurons decay and wither away. • Neurons are replaced by neurofibrillary tangles and senile plaques (think: bullet-shaped bodies of protein). • Genetically linked (Genetic marker (APOE-4)) • Causes a dilemma for young people who have seen a parent deal with the disease: Should I be tested? • Difficult to distinguish between these two because they cause similar symptoms; very old people with dementia may have both ofthese diseases.

28. Targeting the Beginning of Alzheimer’s Disease • Major focus is on the protein amyloid, a fatty substance that is the basic constituent of the senile plaques. • Efforts to dissolve plaque in the brain of those who already have Alzheimer’s have been unsuccessful. • Therefore, the key lies in dealing with amyloid and halting 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: • Healthy diet • Physical exercise, particularly treatments or running wheels • Mental exercise, such as brain-stimulation games

29. How to Diagnosis Alzheimer’s • Look for a history of steady mental deterioration. • 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.

30. Dealing with Dementia • Improving the environment is key, focusing on: • Using external aids and making life predictable and safe • Note cards to jog memory • Focus on safety. • Lock and put buzzers on doors—to prevent wandering. • Remove toxic substances and deactivate dangerous appliances (such as stove). • Providing caring and loving support • Rely on faith. • Relish the time you have.

31. Caregivers and Dementia • Issues caregivers must face: • 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 his or her own parent. • Interventions: • 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.”

32. 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 elder care. • However, government often provides home health services allowing people to stay in their homes (“age in place”) • Money provided to help remodel home • Presence of multigenerational villages

33. Alternatives to Institutionalization • Continuing-care retirement • Residential complex that provides different levels of services • Independent apartments to nursing home care • Designed to provide person−environment fit • Allows person to not burden family members • Assisted-living facilities • For those who are experiencing ADL limitations but do not need 24-hour care • Offers care in a less medicalized setting • More of a homey setting • Residents have private rooms and personal furniture. • Day-care programs • For elderly who live with families • Provides place for impaired elderly to go when caregivers are working • 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 • “in place” care – provides care in home • Paid caregivers provide help with ADLs – cooking, cleaning, bathing

34. Nursing Home Care • Nursing homes or long-term care facilities • Designed for people with basic ADL impairments • Provides 24-care intensive care • Residents are mainly very old and female. • Entry often occurs after trauma: • 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.

35. Evaluating Nursing Homes • Nursing home system is often misunderstood and misrepresented. • Myths include: • often viewed as “dumping ground” • abuse is widespread • residents are poorly care for until they die • Movement to change nursing home culture: • person-centered • attentive to resident’s individual years • However, nursing homes can vary dramatically in quality. • Research shows 1 in 4 nursing homes provide substandard care.

36. Nursing Home Providers • Certified nurse assistant or aid – the front-line care provider in a nursing home, who helps elderly residents with basic ADL problems • 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.