Supporting People with Developmental Disabilities During the Aging Process

1. Supporting People with Developmental Disabilities During the Aging Process

2. 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

3. Project Staff • Sharan Brown, JD, EdD Principal Investigator • Kathleen Watson, PhD, RN Project Director/Trainer and Parent • Esther Moloney Project Assistant and Parent

4. Effects on Health During the Aging Process • Normal aging process • Lifestyle choices • Genetic effects • Environment

5. Aging With a Developmental Disability Effects of the disability and its treatment Normal effects of aging Limited access to quality health care Lack of knowledge about aging for people with DD Inadequate funding for health care Person with a Disability Lifestyle effects Negative attitudes about people with disabilities Decreased Quality of Life

6. 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.

7. 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.

8. Symptoms of a Problem • Rubbing eyes. • Squinting. • Shutting or covering one eye. • Tilting or thrusting head forward. • Redness of eye or area around eyes.

9. 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.

10. 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.

11. 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

12. 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.

13. 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.

14. 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.

15. 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.

16. 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.

17. Possible Symptoms • Turning TV up loud. • Speaking loudly. • Inappropriate response to questions. • Confusion in noisy situations. • Isolating. • Self injurious behaviors.

18. 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.

19. Aging Effects on Mouth/Taste • Decrease in taste buds • Recession of gums, • Thinning of dental enamel

20. 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.

21. Support StrategiesMouth/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.

22. Nose/Smell • Decrease in nerve fibers. • Drying of mucous membranes in nose. • Decreased sensitivity to odors.

23. Support Strategies forNose/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.

24. 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

25. 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.

26. 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.

27. Strategies • Promote elimination through fluids, fiber and physical activity. • Observe for constipation. • Encourage slower eating, smaller, more frequent meals. • Avoid empty calories.

28. 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

29. 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.

30. 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.

31. 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

32. 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.

33. 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.

34. 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).

35. 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.

36. 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

37. 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.

38. 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.

39. 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

40. Protecting theMusculo-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.

41. 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

42. 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.

43. 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.

44. 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.

45. 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.

46. 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

47. Cerebral Palsy • Abnormal movement of food through the throat and stomach: • Dysphagia (abnormal swallowing) • Reflux of stomach acid into throat (GERD gastro-esophageal reflux disease) • Delayed emptying of the stomach. • All contribute to dental erosion, irritation of the esophagus, anemia, feeding problems, aspiration and pneumonia.

48. 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

49. 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.

50. Prader-Willi Syndrome • Hypogonadism- low hormonal levels. • Problems related to uncontrolled obesity • Cardiovascular • Diabetes