Chapter 14: Late Life Physical Challenges

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 Instrumental ADL’s Trouble performing tasks such as cooking, and cleaning, but still can get around Common in advanced old age Basic ADL’s 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) Avoid elderspeak Similar to infant-directed speech used with little children Makes it sound like you are treating the person like a baby! FOR YOU 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 Solutions: 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” Middle stages Serious impairments in memory, language, and judgment Inappropriate actions such as wandering and reckless behavior Later stages 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 Comments Difficult to distinguish between these two as they cause similar symptoms; very old people with dementia may have both of these diseases

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 Consider medications Middle stages 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 Every stage 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 communities 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 relatively wealthy.

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” Assisted living: Specifically for elderly with instrumental ADL problems Fastest growing option– offering care in a more homey, humane environment than a nursing home Day-care programs: 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!)