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2. What Does it Mean to Age Successfully? Many scientists would label the man at the right aging successfully, because he is relatively healthy at age 95.
However, I believe that nursing home residents can be models of ideal aging, if they live fully in the face of disease.
But successful aging depends ON MORE THAN THE PERSON. The wider world must offer people support to function at their best.
In this chapter you will learn to provide this person- environment fit for the older people you love!
3. 3 Basic Aging Principles/Definitions
Normal age changes: Progressive signs of physical deterioration that occur with age
We all experience these changes but at different rates.
Age-related Chronic diseases: illnesses often the endpoint of normal aging changes
Example: bone density loss, when extreme, is called Osteoporosis
Many are not fatal but cause problems handling daily life (e.g. Osteoporosis)
ADL (activities of daily living) impairments: difficulties physically functioning
Become far more frequent among the old- old as the number of chronic diseases accumulates
4. Two Types of ADL Problems
Trouble performing tasks such as cooking, and cleaning, but still can get around
Common in advanced old age
Problems caring for the self, such as dressing, sitting or getting to the toilet
Relatively rare until the old-old years
Require full time help or nursing home care
5. Age Risk of IADLS and Basic ADLS
6. Final Aging Fact: We all must die Maximum human lifespan= the absolute limit of human life (roughly 105).
Possibly programmed into our human genetic code.
Or maybe wear and tear on our bodies simply makes death inevitable beyond this age.
With average life expectancies in the late 70s in the developed world, we are making amazing progress getting close to it.
Especially for well off WOMEN in affluent countries
CONCLUSION=SES AND GENDER—once again—make a difference in aging and death!
7. Force #1 SES, Aging and Death In every nation, there is an SES health gap– with affluent people living longer and enjoying better health.
Although the relationship between SES, aging and disease shows up in middle age, its roots go back to health practices earlier in life.
Poor people are vulnerable to a host of life-shortening influences (see a list in the text).
Don’t blame the person—Many of these forces are due to the “toxic” environment of being poor.
BOTTOM LINE : There are many interacting reasons why poor people tend to die sooner and develop age related diseases at a younger age.
8. Force #2: Gender, Aging, and Disease Basic principle: women survive longer but are more 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 ADL problems but don’t kill.
But women rank higher on sickness indicators, such as seeing a doctor throughout adult life.
Bottom line: Both nature (biology) and nurture ( health sensitivity) explain why women outlive men in every developed world nation by at least 4 years.
9. The Aging Pathway and How it Varies by SES and Gender
10. Normal Vision Changes Presbyopia=Impaired near vision
universal change that happens in mid life
classic tip-off of being older
Poorer dark vision=cannot see as well in dimly lit places
More troubles with glare= being blinded by bright light shining in the eye
11. The Main Cause: The lens Lens not able to bend
Causes presbyopia (bending is what helps us see close objects)
“Cured” by wearing bifocals
Lens gets cloudier
Less light gets to the retina= special probs. seeing in the dark
Light hits the more opaque lens= rays scatter, glare sensitivity
12. 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 surgery—for the end point of lens clouding—is an easy outpatient procedure (and look into the cutting edge medical interventions that are being developed for less treatable aging eye diseases)
13. Hearing Issues, fact sheet
Very common in later life, especially for men
Have an environmental cause=exposure to noise (and therefore may be increasing in our Ipod oriented culture!)
Hearing impairments may be worse than vision problems because they limit the ability to connect with the human world through language!!
14. Presbycusis The Classic Age-Related Hearing Loss:
Selective problems hearing higher pitched tones
Caused by atrophy of hearing receptors in the inner ear
Background noise (typically of lower pitch) overpowers the sounds people want to hear.
Traditional hearing aids-which magnify all sounds-don’t help much.
15. Hearing Interventions
Avoid noisy environments, such as crowded restaurants
Install carpeting in the house (it absorbs noise) and replace noisy air-conditioners or fans
Face person when you talk and speak more loudly
(reading lips can help)
Similar to infant-directed speech used with little children
Makes it sound like you are treating the person like a baby!
Prevention is key. AVOID EXCESSIVE NOISE!!!!!
16. Motor Slowness: Fact Sheet Characteristic of old age— a main reason why we have such prejudices against the old
(Think of the last time you were behind a slow older person at the supermarket )
Caused mainly by slowed reaction time
Symptom of overall information processing speed change
Begins in late 20s or thirties, and gradually gets more pronounced (see also the discussion of fluid IQ)
Amplified by skeletal system disorders:
Osteoarthritis—wearing away of joint cartilage
Osteoporosis= bones porous and easily break
(Note: hip fractures are a major risk factor for nursing home admissions)
17. Interventions for Motor Problems Be careful in speed-oriented situations.
Keep active but don’t overdo it (exercise can prevent osteoporosis; and even improve joint problems)
Modify Person’s home to guard against falls:
Increase lighting, install low pile carpeting
Install grab bars in dangerous places like bath
Put shelves within reaching distance, and use doors that open easily
IN GENERAL, make streets, sidewalks etc more age friendly for older walkers and anyone prone to falls
18. Driving in Old Age Vision, hearing and reaction- time problems converge to make driving more dangerous esp. in the old- old years.
19. The Issue and Some Solutions The problem:
Driving is essential in our car-oriented society; giving up may mean having to enter a nursing home.
Not driving infantilizes people, forcing them to depend on others
To weed out incompetent drivers, use tests that go beyond simple vision measures
BUT MAINLY CHANGE THE ENVIRONMENT
Larger signs, better lighting on exit ramps, etc.
Build communities with stores within walking distance of homes
Invest in transportation systems that don’t involve cars
20. Dementia: fact sheet
General term for any illness that produces, serious progressive, usually irreversible cognitive decline
Prevalence low in the 60’s and 70’s, jumps in the old-old
(but some centenarians are still very cognitively sharp)
A long term illness (the time from diagnosis to death is 4 to 8 years) in which every function gets progressively worse
Two main causes in later life are Alzheimer’s disease and Vascular dementia
21. Symptoms Early stages
Forgets basic semantic information like address
Often a fuzzy in between period where diagnosis is unclear
Person knows “ I have serious problems thinking”
Serious impairments in memory, language, and judgment
Inappropriate actions such as wandering and reckless behavior
Bedridden, may be unable to talk, eat, or swallow
The course is variable from person to person
22. More About the Two Types of Dementia Alzheimer’s disease= neurons are lost.
Replaced by neurofibrillary tangles and senile plaques
Vascular dementia= small strokes
Impaired blood flow causes neural death
Difficult to distinguish between
these two as they cause similar
symptoms; very old people with
dementia may have both of these
23. Research Findings, Alzheimer’s Disease Exercise—because it reduces the risk of cardiovascular disease—may be helpful in prevention
Major focus is on why amyloid, a core component of the senile plaques, develops.
There is a genetic predisposition: People with a special APOE marker much more likely to develop the disease.
We are not yet close finding a cure or targeting the causes of this devastating disease.
Therefore the key lies in modifying the environment to provide the right person-environment fit.
24. Interventions: For the Patient Early stages
Use external aids like note cards
Consider enrolling in an early Alzheimer’s support group
Lock and put buzzers on doors—to prevent wandering
Remove toxic substances and deactivate dangerous appliances (such as stove)
Consider admission to a NH Alzheimer’s unit
Be caring, loving, and supportive
25. Interventions: For Caregivers Issue: the person you love is now an unpredictable stranger
Enroll in a caregiver support group to problem- solve (and get emotional support)
Look into nursing homes and other options
Don’t take insulting comments personally. Realize it’s the disease talking not the person.
Respect the person’s humanity (see quotes on page 442!)
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”.
26. Options for the Frail Elderly: Some Facts In collectivist cultures (and in the past) family members took on all the elder-care, but this network is not in place like before.
Nations vary in whether they provide innovative quality elder care—with Scandinavia leading the way.
A big issue is whether society pays for “chronic care services”. In the US we don’t unless the person is in a nursing home (and poor enough to qualify for Medicaid).
It’s a myth that families abandon their elderly. Children in every nation take responsibility for caring for parents when they are old and ill (or for monitoring their care).
27. Alternatives to Institutionalization Options for frail older people who don’t require nursing home care:
Continuing care retirement
Assisted living facilities
Day care programs
Home health services
Basic fact: Medicare only
pays for cure oriented services.
So most of the above
are only available to the
28. Exploring the 3 Elder Care Options Continuing care retirement community:
Person enters relatively healthy then gets care (at different levels) when needed
Offers peace of mind “I don’t have to burden my children and I know where I am going if I need a nursing home”
Specifically for elderly with instrumental ADL problems
Fastest growing option– offering care in a more homey, humane environment than a nursing home
For older adults who live with relatives
Gives family a place to take the person during the day, when they are afraid to leave loved one at home
29. Nursing Homes, the Last Stop
Designed for people with Basic ADL impairments
Residents are mainly very old and female
Entry often occurs after trauma such as breaking a hip, or—in many cases– when the person has dementia
People without families (or the money for assisted living facilities) are most at risk of entry
Vary dramatically in quality, but in general leave a good deal to be desired (yes, abuse does occur!)
The primary caregiver, the CNA is terribly underpaid, but some people find this an INCREDIBLY GENERATIVE JOB (your author did!)