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Title: Janet%20Belsky


1
Janet Belskys Experiencing the Lifespan, 2e
  • Chapter 14
  • The Physical Challenges of Old Age

2
What Does it Mean to Age Successfully?
  • Successful aging means
  • drawing on what gives ones life meaning to live
    fully not matter how the body behaves
  • having an internal sense of self-efficacy
  • having support to function
  • living with the potential chronic disease that
    may come with old age
  • combines nature (personal capabilities) and
    nurture (environmental fit)

3
Understanding the physical aging process
  • Normal age changes - Progressive signs of
    physical deterioration that occur with age
  • Age-related changes are universal (happen to
    everyone) 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.
  • 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

8
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).

9
Ethnicity and physical aging
  • Ethnicity can lead to poverty, often due to
  • stress caused by dealing with discrimination.
  • Less access to good health care
  • 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.
  • Careful not to blame the person for the many
    forces that affect aging due to the toxic
    environment of being poor.

10
Gender and physical aging
  • Basic principle women survive longer but may
    live with illness
  • 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 (its 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
The Aging Pathway and How it Varies by
Socioeconomic status and Gender
12
How to improve the physical aging process
  1. Preventing premature births
  2. Encouraging exercise and healthy nutrition in
    children
  3. Increasing access to health care

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

16
Interventions for older eyes
  • Use strong indirect lighting.
  • Avoid florescent lightingespecially 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,
  • Cataract
  • easy outpatient procedure
  • Cutting-edge medical interventions are being
    developed for less treatable aging eye diseases.

17
Understanding hearing in later life
  • 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.

18
Presbycusis Defined
  • 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.

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 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 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.
  • 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 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
  • 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.
  • 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).
  • Reduce medications to prevent dizziness or
    problems sleeping at night.
  • 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 ones car means loss of
    independence.
  • 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
  • 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 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 Alzheimers
    disease.
  • Causes a dilemma for young people who have seen a
    parent deal with the disease. Should I be tested?

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 ones 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
  • Refers to impaired in vascular system (blood flow
    in body)
  • Blood flow that feeds brain
  • Alzheimers disease 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 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.

28
Preventing Alzheimers Disease
  • Major focus is on the protein amyloid, a fatty
    substance that is the core component of the
    senile plaques.
  • Efforts to dissolve plaque in the brain of those
    who already have Alzheimers 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

29
How to diagnosis Alzheimers
  • 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 effectively with Dementia
  • Goals during illness
  • Protect people and keep them functioning as long
    as possible.
  • Provide caring and loving support.
  • Potential interventions
  • Medications can help with symptoms
  • Use external aids like note cards to jog memory
  • Focus on safety
  • Lock and put buzzers on doorsto prevent
    wandering.
  • Remove toxic substances and deactivate dangerous
    appliances (such as stove).
  • Consider admission to a nursing home with
    Alzheimers unit.

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 their own parent.
  • Interventions
  • Get involved with support group.
  • Look into nursing homes and other options.
  • Do not personalize insulting comments. Realize
    its the disease talking, not the person.
  • Respect the persons humanity
  • Use this trauma as a redemption sequence a
    chance to say I dont 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 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.

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 to burden family members
  • Assisted living facilities
  • For those who are experiencing ADL limitations
    but do not need 24-hour care
  • Offers care less medicalized
  • 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 wide spread
  • residents are poorly care for until they die
  • Movement to change nursing home culture
  • person-centered
  • attentive to residents 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 main
    hands-on 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.
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