Janet Belsky’s Experiencing the Lifespan, 2e

Chapter 14:The Physical Challenges of Old

Age

What Does it Mean to Age Successfully?

Successful aging means: drawing on what gives one’s

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)

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.

Three basic principles of Age-Related Disease

1. 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).

2. 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

3. Lifespan has a defined limit Aging process has a fixed end. But, the 100-plus group is the fastest-growing age group of all!

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

Age Risk of Instrumental ADLs and Basic ADLs

What affects the physical aging path?

Socioeconomic status

Ethnicity

Gender

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).

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.

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 (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.

The Aging Pathway and How it Varies by Socioeconomic status and Gender

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

Sensory-motor changes with age

Vision

Hearing

Motor abilities

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

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

Interventions for “older eyes”

Use strong indirect lighting. Avoid florescent 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, Cataract

easy outpatient procedure Cutting-edge medical interventions are being

developed for less treatable aging eye diseases.

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.

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.

The Human Ear

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!

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

Interventions for Motor Problems

1. Exercise moderately. Can help prevent falling

2. Keep ADL problems from developing or getting worse.3. Encourage activities – attend church, outside

activities.4. Remodel house.

Indirect lighting Install low-pile, wall-to-wall carpeting; can prevent tripping. Install grab bars in places where falls can occur (bathtubs).

5. Reduce medications to prevent dizziness or problems sleeping at night.

6. Be careful in speed-oriented situations.

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).

Driving in old age: Issues and Solutions

The problem: Giving up one’s 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.

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 Alzheimer’s disease. Causes a dilemma for young people who have seen a parent deal with

the disease. Should I be tested?

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.

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

Alzheimer’s 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.

Preventing Alzheimer’s 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 Alzheimer’s 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

How to diagnosis Alzheimer’s

1. 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.

2. Rule out other physical and psychological causes.

3. Explore performance on a battery of neuropsychological tests.

Dealing effectively with Dementia

Goals during illness:1. Protect people and keep them functioning as long

as possible.2. 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 doors—to prevent wandering.

Remove toxic substances and deactivate dangerous appliances (such as stove).

Consider admission to a nursing home with Alzheimer’s unit.

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 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.”

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.

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

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.

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 resident’s individual years

However, nursing homes can vary dramatically in quality

Research shows 1 in 4 nursing homes provide substandard care.

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.