Exam Flashcards
Aging Population or “seniors or “older Adults =
People above the age of 65 years
What’s the population growth rate (seniors)
Median ages over the years:
-fastest growing population in Canada- 15.3% of the population in 2013
1956 - 27.5
2006 - 38.8
2056 - expected to reach 46.9 years
Indigenous Trends (population)`
The proportion of persons aged 65 and over may nearly triple, from 5.9% in 2011 to 15.1% in 2031
Factors that contribute to the aging population
- Reduced mortality at younger ages
- fertility rates are falling (having less children, children are also surviving more so less pregnancies, and contraception, women in workforce having fewer children)
- Life expectancy in older age is increasing at faster rate in higher-income countries vs. lower-resource setting
Life expectancy at birth:
2009/2011:
2036:
2009/2011 -79.1 years for males and -83.4 years for females 2036 -84 years for males -87.3 for females
Factors that impact life Expectancy
Heredity (genics)
Lifestyle (good diet and exercise, healthy habits)
Exposure to toxins in the environment
-Healthcare Access
The oldest age to which people can live has changed little
The chance of living to be 120 is very small
Madame Jeanne Calment had the longest record lifespan of 122 years (1875 to 1997)
-hearing more people over the age of 100 tho
Working age graph (number of working age people for each senior)
- slope is going down -there are going to be fewer and fewer people working per senior
- repercussions for seniors
- might affect the age people retire
Chronologic age
a person’s age in years
Biological Age
Changes in the body that commonly occurs as people age
-lifestyle factors will affect this
Psychological Age
How people act and feel
Healthy Aging definition
as the process of developing and maintaining the functional ability that enables well-being in older age
-Being able to do the things we value for as long as possible
Goals of healthy aging
Maintaining physical and mental health; avoiding disorders
-remaining active and independent ( consider do they need to be independent to be healthy)
Developing healthy lifestyle habits can help - nutritious diet, exercising regularly, and staying mentally active
Different experiences of healthy aging
Mavis Lindgren 103, is the most accomplished elder marathoner
-She ran 75 marathons in competition, in a career which did not begin until she was 70 years old and spanned until she was 90
Another perspective of being happy relying on family and friends spending time doing things you love
World Health Organization Framework:
Report on Aging and Health (2015)
Address key issues related to the aging population:
Diversity of experiences
- inequities
- ageism
- empower older adults
- environments
- perspective of health
World Health Organization Framework:
Report on Aging and Health (2015)
Assumptions
- Ageing is a valuable if often challenging process
- Older people will experience significant losses
- Older people make multiple crucial contributions to society (not often recognized) -change a perspective to getting old is good
World Health Organization Framework:
Report on Aging and Health (2015)
Healthy aging definition
The process of developing and maintaining the functional ability that enables well-being in older adults
- in this model healthy aging is represented by functional ability ( comes from pervious definition)
- intrinsic capacity vs functional ability
Intrinsic Capacity is affecting by several things (3)
Genetic
personal - defined as fixed and both non-fixed (moment in time) (gender, wealth, education, shape our opportunity and what we are exposed to)
health characteristics
- Underlying age-related trends and skills
- Physiological changes and risks factors
- Diseases and injuries
- Changes to homeostasis
- Boarder Geriatric syndrome
A public -health framework for healthy Aging: Opportunities for public-health action across the life course
High and stable capacity Decling capacity Significant Loss of Capacity Vs (how these change dependent on the capacity of the person) how we can support them health services long-term care Environments Multiple prong approach
National Seniors Strategy: 2nd Edition
Identifies:
Meeting the needs of Canada’s aging population will require concerted coordination and effort from all levels of government as well as between the private and public sectors
- 12 specific policy issues that Canada faces
- 4 Overarching pillars that can support a National Seniors Strategy for Canada
- 5 fundamental principles
National Seniors Strategy: 2nd Edition
the 5 Fundamental principles underlying a national strategy
Access Equity Choice Value Quality
Pillar 1: Independent, productive and engaged citizens
- making addressing ageism, elder abuse and social isolation a national policy
- ensuring Older Canadians do not live in Poverty by Improving their income Security
- Ensuring older adults have Access to Affordable Housing and Transportation options
- Enabling the Creation of Age-friendly physical Environments and Spaces
Pillar 2: Healthy and Active Lives
Ensuring Canadians are supported to engaged in wellness and prevention Activities that enable healthy aging
- Improving Access to Medically Necessary and Appropriate Medications
- Ensuring OLder Canadians and their Caregivers are Enabled to Participate in Informed Health Decisions Making and Advance Care Planning
Pillar 3: Care Closer to Home
- Ensuring Older Canadians have Access to Appropriate, High Quality Home and Community Care. Long-Term Care, Palliative and End-of-Life Services
- Ensuring Older Canadians have Access to Care Providers that are Trained to Specifically Provide the Care they Need
- Developing Standardized Metrics and Accountability Standards to Enable a National Seniors Strategy
Pillar 4: Support for Caregivers
- Ensuring Older Canadians are Supported in the Workplace
- Ensuring Caregivers are Not Unnecessarily Financially Penalized for Taking on Caregiving Roles
IFA Copenhagen Summit (2016): Reablement and Older People
- meeting of representatives consisting of 4 working groups,
- scientists, medical specialists and researchers in the fields of dementia, other neurodegenerative disorders, frailty, diabetes and technology
- Base is bio psycho model-idea being reablement helps astore their autonomy in their own space and helps reduce their need for supportive care
- Reablement Goal = “enable people to be and to do what they have reason to value
- ->Aim is to engage individuals in a process of identifying their own strengths and capacities during selection of goals/targets and during planning
- ->Older people are encouraged to focus on what they can do (safely) and what they value, instead of focusing on things they cannot do anymore
- making sure they are socially engaged
- Really consistent with occupational therapy, work towards their goal, different approaches, adapting or restoring
Active Aging: A Policy Framework (WHO, 2002)
- Is the precursor to the healthy aging framework that was presented earlier
- Active Aging is the process of optimizing opportunities for health, participation and security in order to enhance quality of life as people age
Active Aging: Key Premises
- A life Course Approach
- Goal of Maintaining autonomy and independence as one grows older
- Interdependence (with family, friends, colleges)
WHO Active Aging Policy Framework: The determinants of active aging
Active aging in the center
Gender and culture on the outside
6 determinants Health and social services Behavioural determinants Personal determinants Physical Environment Social Determinants Economic Determinants
the interaction is not clearly represented in the model but does recognize that there is interaction
Biological Theories of Aging
Hayflick Limit Theory
Limited number of cell divisions possible
–>Impacted by diet, exposure to toxins, pollution or trauma
Biological Theories of Aging
Free radical Theory: `
Aging caused by production of free radical in cells resulting from energy production by mitochondria
–>occurs naturally but accelerated by certain diet, drugs, radiation and pollution
Biological Theories of Aging
Genetic Theories:
Multiple genes influence aging and longevity
-25% genetic/75% lifestyle and environment
this is important
Psycho-Social Theories
Disengagement Theory
- Aging is inevitable, and one’s abilities, including the ability to come into contact with friends and relations, reduce over time - reciprocal process
- allows older adults to focus on life meaning
- as a result people gradually lose ties with others in their society and become physically inactive and lonely
Psycho-Social Theories
Activity Theory
- Increased engagement in meaningful and creative = increased life satisfaction
- older adults keep physically active and healthy as a result of their significant social engagement
- Keep in mind this relationship is not causal more like a reciprocal
Continuity Theory
- People become more like themselves and maintain identifying activities as they age
- People develop habits, commitments, preferences, and other dispositions which become a part of their personality. They are predisposed toward maintaining continuity in these.
- it does not explain variation in activity patterns, people may discontinue or they may choose to learn new ones and this theory does not explain this
Productive Aging
- Focus on civic Engagement
- Engagement in activities that create goods or services of value
- Productivity continues throughout life but changes
- Being productive is associated with health and can confer status `
Theory of Goal Achievement Strategies
-People set goals in relation to their resources: (time, social economic status, health or social support)
Selective Optimization
-Compensation when usual ways of doing become ineffective
Successful Aging
Definitions
-Feeling of happiness and satisfaction with one’s current and past life
Ability to maintain 3 key behaviours/characteristics
- Low risk of disease and disease related disability
- high mental and physical function
- Active engagement with life
Ablest view of aging you have to be successful without disability
Successful Aging Older adults perspective 4 components
- Attitude/adaption
- Security/stability
- Health/wellness
- Engagement/stimulation
Common themes among successful aging theories
- Productivity (ability to contribute in some way)
- Adaptation (adapt expectations, environment, ability)
- Resilience (cope with changes as they come, continue to keep engaged)
Physical Changes
Aging is characterized by changes in anatomical structures and physiological functions of the body
Changes occurs in all the systems:
-Integumentary - skin
-Cardiovascular, Respiratory and Immune Systems
-Digestive, Metabolic and Endocrine
Neuromusculoskeletal
-Genitourinary and Reproductive
Skin (physical changes)
- Less elasticity with wrinkles, sags, dryness and extra folds
- Loss of underlying subcutaneous fat tissue
- Reduction in oil production
- slower to heal –>there maybe more prone to infection
- -> seating with older adults –> pressure ulcers –> skin would not heal as well as prone because of the loss of fat
- decreased thermoregulation
changes to Cardiovascular System
- Decreased max. Heart rate and takes longer to get back to baseline
- Decreased number of pacer cells in the heart which initiate the heartbeat
- stiffening of cardiac valves, arteries, and veins
- Despite changes the cardiovascular system has considerable reserve and efficiency and effectiveness is generally maintained in normal aging
- important to introduce pacing or energy conservation if they are getting fatigued
changes to Respiratory System
- Older adults may experience a moderate decline in respiratory function
- ->decreased in vital capacity
- ->stiffening of chest wall:change in shape, ossification of cartilage, decreased vertebral disc space
- ->weakening of muscles that contribute to breathing
- Increased reliance on diaphragm for breathing - affected by body position
- Decreased mucus production that helps prevent infection
- diaphragmatic breathing –> like putting on your shoes, they might need breaks and look at how you are positioning the trunk. Position so that there chest is open
changes to Endocrine System
Decreased growth hormone associated with decreased muscle mass, bone density and increased fat mass
Estrogen - decreased production with menopause. Leads to bone mineral density changes - Osteopenia and osteoporosis
Pancreas - decrease in insulin production
Overall slowed transit through Gastrointestinal system - reflux, constipation, changes in nutrient absorption
-Decreased drug metabolism
Changes to the central nervous System
- Cerebral atrophy
- ->Increased in size of lateral ventricles
- ->Particularly in frontal and pre-frontal regions
- ->loss of neurons and white matter
- ->Hippocampus is an area of early cell loss - associated with Alzeimer’s disease
- Senile plaques and neurofibrillary tangles
- Decreased in neurotransmitters eg. Decreased cholinergic and dopamine transmission
- Still capable of plasticity
Changes to the Peripheral Nervous System
-Decreased in number of lower motor neurons
-Decreased speed of nerve impulses
-Decreased ability of peripheral nerves to regenerate
Causes: associated with decreased myelination and decrease nerve growth factor
Changes to bone
- Reabsorption begins to exceed bone deposition - bone density decreased by 1% per year
- Bones become more brittle due to deterioration of collagen matrix
- Bone loss is accelerated post menopause in women and there is increased risk of osteoporosis
- However, regular progressive exercise can result in increased bone mineral density into the 8th decade
- really important to continue and encourage in our clients
Joint Structures and Tissues
- Joint capsules and ligaments stiffen and loss of elasticity
- Synovial production decreases; Decreased quality of synovial fluid
- Cartilage thins
- Most people over 70 years old have some osteoarthritis
Changes in Muscles
- Decreased in skeletal muscle mass:
- ->decreased in number and size of muscle fibers
- ->increase in connective tissue and fat within the muscles
- Impacts strength, endurance, flexibility, reaction time
Changes in Posture
- Increased postural sway
- Changes in spine : head forward position, increased kyphosis and flattened lumbar spine
- Rounded shoulders
- Slightly flexed elbow, hips and knees
- Changes in articular surfaces or joint capsules can lead to valgus or varus deformities of the hips knees and ankles
- impact gait and balance
Key threats related to changes with age
Physical inactivity:
- Physical exercise and activity is important for maintaining health
- Lack of physical activity can lead to spiralling decline in health
- ->Muscle atrophy
- ->Joint stiffness and instability
- -> Less efficient venous return - risk of venous thrombosis, oedema,
- ->decreased cardiac output
- ->bone loss
*thinking about how quickly we can get someone up and active after an injury
Key threats related to changes with age
Frailty
- Age-associated declines in physiologic reserve and function across multiple systems
- Operationally defined as meeting 3/5 criteria:
- ->low grip strength, low energy, slowed walking speed, low physical activity, unintentional weight loss
- Carries an increased risk for poor health outcomes including falls, disability, hospitalization, and mobility
Key threats related to changes with age
Undernutrition, malnutrition and obesity
-Related to unbalanced food intake
-Undernourishment may be under-reported/recognized
(hard to cook for one person, tea and toast kind of diet risk of undernourishment)
-Risk factors:
–>Dysphagia, slow eating, low protein intake, poor appetite and presence of a feeding tube
–>living in long-term care or with long-standing illness
-Leading to increased risk of other illnesses - diabetes, cardiovascular disease, MSK conditions
How can OT address these Treats?
Physical inactivity
Frailty
Nutrition
education we can help people at the impairment level,
preventing decline, encouraging participation in physical activity, think about access to services, enabling them to adapt their approach, adapting the task (assistive devices), preparing food do they need help?\
adapting the environment
adapting the task
-Improving the capacity of the person
Hand Function
The hand is the most active and important part of the upper extremity
The hand serves as:
- An important creative tool
- An extension of intellect
- A means of nonverbal communication
- A major sensory tactile organ
Hand Function
The health hand has to be able to :
- Undertake extremely fine and sensitive movements
- Perform tasks requiring considerable force
Changes in Hand Function
- Age-related declines in the CNS and PNS
- A large area of the CNS specifically is devoted to controlling the hands and particularly the thumb
Changes in hand function
- Changes in hand function occur as a result of normal aging in both men and women, especially after age 65
- ->sensation, skin, muscle, bone
- Hand pain is prominent cause of disability in older adults
- ->prevalence of hand pain in older adults ranges from 12% to 21%
- Severity of specific hand-related disability including cosmetic concerns, increasing in 80+ yrs., particularly in women
- only a minority of older adults reach out for help for hand pain
Changes in hand function
Common metabolic and skeletal diseases impaired hand function in elderly adults are:
- osteoarthritis
- Rheumatoid arthristis
- Osteoporosis
- Hormonal Changes –> can include skin dryness and thinning
- impact the ability to manipulate and healing
Factors affecting function in aging hands
Intrinsic Factors
Genetic factors
Diseases (osteoarthritis, rheumatoid arthritis,osteoporosis)
Soft tissue changes (muscle tendons, blood vessels and nerves)
Hard tissue changes (bones, cartilages and fingernails)
Factors affecting function in aging hands
Extrinsic Factors
Environmental factors (Ultraviolet, radiation, chemical irritants)
Physical activities (work related, recreational, sports, and hobbies)
Nutrition
Traumatic injury
Sensory Changes in the Aging Hand
- Senses and sensory integrity decline with aging
- Functional sensory input is essential for well controlled manipulation of small objects during activities of daily living
- Tactile impairments alone does not explain the effects of age on a pick up and grasp task
Skin Changes in the Aging Hand
- Less elasticity with wrinkles, dryness
- Slowed repair processes
- Older adults are more likely to feel cold in their hands due to the poor blood flow
- -Reduced sensitivity to local heat sources or slower reflexes
- ->increase incidence of burns to the hands
- important to think about when thinking about safety
changes to fingernails
- Nails are important tools for fine grip strength and manipulation
- Nail changes include
- ->Discoloration with changes in colour from white-pink to yellowish-grey
- ->changes in contour (longitudinal ridges, or less concave shape)
- ->changes in the thickness and roughness of the nail surface
- ->decreased rate of fingernail growth
Muscle Strength
- After 60 years of age: decline in grip strength, by as much as 20-25%
- ->loss/decrease of number and length of muscle fibers, particularly in the Thenar muscle group
Bone ans joints (norms)
- Age related (over 70 yr) declines in wrist flexion (12%),wrist extension (41%) and ulnar deviation (22%)
- ->decline progresses with increasing age
- After the age of 50, the bone density of the hand decreases by approx 0.72% per year
- Aging hands and finger bones are especially prone to osteoarthritis (small bones and go through a lot of use) \
Bones and joints
Impacts of osteoarthritis of the fingers include:
- Pain, swelling, joint deformities
- Bone spur formation
- Restricted range of motion of wrist and fingers
- Difficulty in performing manual activities that require grip and pinch
Aging hand - Functional Concerns
- Difficulty with tasks involving hand strength and coordination
- ->fine dexterity
- ->bilateral coordination
- ->fine-grip tasks
- ->hand-force control
- ->speed of hand-arm movements
-Reduced vision in older adults may contribute to challenges with fine motor tasks
Ergonomics Devices for Aging Hand
- Many of the common tools of everyday living are not designed for older adults consider potential age-related changes
- Example: cell phone (buttons are too small and too close, screens are hard to read for older adults with impaired vision)
- May need to modify tools and instruments of daily living for older adults
- Example: cutlery, pens, scissors, nail clippers
Gait and Balance Disorders in Older Adults
- Aging does not always come with gait disorders (up to 20% of older adults maintain normal gait patterns)
- Approx 30% of persons 65 and older have difficulty walking
- Approx 20% of older adults require a mobility aid to ambulate
- Prevalence of abnormal gait among older adults in hospital settings and living in long term care home is higher
Gait and Balance Disorders in Older Adults
Gait and balance disorders are
- Common and a major cause of falls in older adults
- Associated with increased morbidity and mortality
- Related with reduced level of function
Medical Conditions & Risk Factors Associated with Gait And Balance Disorders
- Affective disorders and psychiatric conditions
- Cardiovascular diseases
- Infectious and metabolic diseases
- Musculoskeletal disorders
- Neurologic disorders
- Sensory Abnormalities
- Other Factors (e.g. other medical conditions)
Changes in Gait with Aging
Reduction in gait velocity and step length
- Increased stance width
- Increased time with both feet on the ground
- Bent Posture
- Less force at the moment of push off
Evaluation of Gait and Balance
- History (i.e fall history, medical history, surgical history)
- Current medication review (ie. number, dosage, type)
- Physical examination (i.e. affective/cognitive, cardiovascular musculoskeletal, neurological. sensory, vitals)
- Gait and balance performance testing (i.e. observation, functional Reach Test, Timed Up and GO Test)
- Presence of environmental hazards (i.e. clutter, electrical cords, poor lighting , low chair, slippery surface)
Interventions for Gait and Balance
Falls lead to: injury, disability, loss of independence, and limited quality of life
- Early identification of gait and balance disorders and appropriate intervention prevent dysfunction and loss of independence
- A multifactorial evaluation followed by targeted interventions is the most effective strategy for falls prevention
- Effective options for patients with gait and balance disorders include OT, PT, and exercise therapy (things like tai chi)
- insoles to improve static and dynamic balance
Sexuality in Older Adults
A significant number of older adults report that sexual intimacy is an important aspect of their long-term relationships
Many older people continue to have enjoyable sex into their 80s and beyond
Sexual satisfaction correlates with:
-relationship satisfaction
-Medical health
-reliance on fewer vs prescription medications
-Traditional vs a more creative approach to intimacy
Sexuality in older adults
Changes related to age and/or illness may lead to misunderstandings (e/g interpreted as lack of interest
Research suggests that rates of sexually transmitted illnesses among elderly populations are increasing
- At risk older adults are less likely to use condoms
- Health practitioners may be less likely to bring up health sex practices with these patients
Sexual Desire in Older Adults
Women over age 75
- ->less likely to have a partner than older man
- ->less positive attitude toward or interest in sexual activity than men of the same age
- Men with or without a partner have:
- ->more frequent sexual thoughts, fantasies, and feelings of sexual desire (and self-stimulation) than women, with or without partners
Age and Medical-related changes in men
- Decreased desire (loss of libido) caused by:
- ->medical problems, depression, anxiety, medication side effects, alcohol consumption, or lack of information about the range of sexual activities that could be pleasurable
- older men require:
- ->more physical penile stimulation
- ->longer time to achieve erection
- ->duration of orgasm is shorter and less intense
Age and Medical-Related Changes in women
Aging affects the sexual response, including fewer and weaker orgasms related to:
- Hormonal changes, body image, relationship and family issues, and medical conditions
- Older women tend to have:
- -> Less pleasure sexual activity (less level of estrogen)
- ->Vaginal dryness and weakening of tissue (pain and irritation during intercourse)
- ->Risk of infection (fragile mucous membranes)
Barriers to Sexuality and intimacy
- body image, beliefs and values regarding sexual expression (e.g., outside marriage)
- Lack of knowledge about or comfort with their sexuality
- Lack of opportunity for sexual experiences
- Lack of privacy in communal living environments
- Fear of becoming the topic of conversation among staff and others
- Attitudes of adult children toward their elderly parents’ sex lives
- Lack of healthcare provider comfort with raising the topic
Implications (sexuality and intimacy)
suggested conversations starters:
Are you sexually active? If yes then “Do you have any questions regarding your sexuality that you’d like to discuss?”
“Oftentimes as people age they experience changes in their bodies that impact sexual function. Is there anything happening with your body, or your partner’s body, that is making you uncomfortable?”
What is our role as occupational therapist (sexuality and intimacy)
- Referral
- Education
- Advocacy
- Positioning for pain or function
- Energy Conservation
Sensory Changes
Touch, vibration, pressure
- ->decreased structure and number of touch receptors
- –>decreased speed of processing
- ->change to circulation
-Affects hand function, balance, safety, (burns, wounds)
Pains:
- Not well understood
- May go unreported
Vision
- Reduced lens accommodation - presbyopia, and retinal illumination
- Can affect perception of colour, depth, and distance of field
- Common eye conditions with age: cataracts, glaucoma, macular degeneration, diabetic retinopathy
Hearing
Hearing loss -common chronic condition of aging
- ->most marked at higher frequencies
- Intrinsic factors - cell loss in nervous system and stereocilia, thickening of tympanic membrane, decreased elasticity of the ossicular chins and atrophy of the cochlea
- Extrinsic factors - exposure to noise, smoking, high fat diet
Taste and Smell
-Large number of older adults complain of changes in taste and smell
-Decreased ability to detect and discriminate between sweet, salty, bitter and sour
–>medication side effects
-Decreased smell identification
Functional Implications: pleasure, safety, nutrition
Implications of sensory loss
- Communication
- social isolation
- safety
- Occupational Performance
Age-related cognitive changes
-Declining cognition is a major threat to older adults with respect to participation and quality of life
- ->Impact may be subtle but annoying for older adults
- ->all cognitive abilities do not decline with age
- ->for many tasks and occupational roles the benefits of decades of experience may far outweigh decrements associated with memory impairment
Age-related cognitive changes
Understanding patterns of preserved and impaired cognitive function provides groundwork for understanding the impact on occupational performance
- Goal of OT interventions is to
- ->Promote cognitive health
- -> Assist older adults to understand these changes
- ->Develop strategies to enhance functioning
cognitive changes: Arousal and Sleep
Changes to frontal lobe can lead to changes in arousal and sleep patterns
- increased in sleep-related disorders
- Sleep disturbances are commonly associated with depression, Alzheimer’s disease, cardiac, respiratory and musculoskeletal conditions
- Sleep disturbances can impact functioning (physical, increase risk of falls, impact cognition)
cognitive changes: Intellectual changes
- Crystalized intelligence remains intact (knowledge of learned information and facts)
- Fluid intelligence is impacted (perception of complex relationships, reasoning, problem-solving adapting to new situations)
- ->speed decreased
- ->ability to draw on better problems solving strategies
- -> Significant changes in adults <80 may indicate pathology
Cognitive Changes: Attention
- Sustained attention: - not impacted by aging
- Selective Attention -Difficulty determining which information is relevant or irrelevant to a particular task and filtering out external distractions
- Divided attention - decreased ability to attend to details of two competing stimuli - better performance when one task involves procedural memory
cognitive changes: memory
- Short-term memory remains intake with age
- Working memory and long-term episodic memory - substantial age-related deficits
- Prospective and remote memory are more stable
- Semantic and procedural long-term memory are minimally affected
- Semantic memory (Vocabulary, word knowledge) can be enhanced with advancing age
Cognitive Changes: Speed of Processing
- Decreased speed at which information is processed in working memory
- ->slowing in the peripheral and central nervous systems
- ->Slowed sensory processing
- Leads to increased reaction time and increased time to process and retrieve new information
- ->score may be influenced by test relevancy
Cognitive Changes: Executive function
- Planning, abstract thoughts, decision-making, cognitive flexibility, and use of appropriate behaviours account for most of the cognitive decline seen in aging
- Decrease in speed and efficiency of problem solving
- Abstract reasoning
- -> Decline in mental flexibility and set shifting in reasoning tasks
Intervention strategies to promote learning and occupational engagement (cognitive)
(LOTS OF ANSWERS)
-Assist clients to understand mechanisms of memory and the issues they may be experiencing (normalize it what is happening)
-Guide clients to develop strategies related to attention and working memory e.g. paying extra attention
-Attention is enhanced when information is presented through more than one modality (auditory, and written)
-Use emphasis to direct attention to what is to be learned (bold, highlight)
-Minimize distractions
-Allow Self-Pacing
-Allow time for processing, reduce content presented, slow speech rate/pause, increase exposure time
-Encourage active verbalization (talk aloud) and elaboration of new information vs just rehearsal
-Interest enhance attention - asses what the client already knows, make information relevant
-Provide clear instructions for organizing a complex task - Logically group information and focus on essential aspects
-Build on what the client already knows - associate new information with previous learned information
Encourage organisational strategies, use of routines’ and habit development - always put your keys in the same place
-Reduce stress and anxiety
-Mnemonic strategies: visual associations, acronyms, rhymes
-External strategies: lists, calendars, placing objects in conspicuous places
Cognitive training can delay cognitive and functional decline
ACTIVE Study - Advanced cognitive training for independent and vital elderly
RCT with 2800 adults aged 65-94 with age related cognitive decline at risk of loss of independence
-Study Design
Participants were randomly assigned to 1-4 groups:
10 session group training for
–>memory
–>Reasoning
–>Speed of processing
-no-contract control group
-For the 3 treatment groups, 4-session booster training was offered t 60% random sample 11 months later
ACTIVE Study - Advanced cognitive training for independent and vital elderly
RCT with 2800 adults aged 65-94 with age related cognitive decline at risk of loss of independence
Memory Training focused on Verbal episodic memory
- teaching of mnemonic strategies for remembering
- Word lists and sequences of items,
- Tect material, and
- main ideas and details of stories
- instruction in strategy or mnemonic rules
- individual and group feedback on their performance
ACTIVE Study - Advanced cognitive training for independent and vital elderly
RCT with 2800 adults aged 65-94 with age related cognitive decline at risk of loss of independence
-Reasoning training focused on the ability to solve problems that follow a serial pattern
- Identifying patterns in a letter or number series or in everyday activities
- abstract reasoning tasks as well as reasoning problems related to activities of daily living
- individual and group exercises
ACTIVE Study - Advanced cognitive training for independent and vital elderly
RCT with 2800 adults aged 65-94 with age related cognitive decline at risk of loss of independence
Speed-of processing training focused on Visual Search Skills
- Increasingly complex speed tasks on a computer:
- ->Decreasing stimuli duration
- Adding a distraction
- ->Increasing the number of concurrent tasks, or
- ->presenting targets over a wider spatial expanse
ACTIVE Study - Advanced cognitive training for independent and vital elderly
RCT with 2800 adults aged 65-94 with age related cognitive decline at risk of loss of independence
Results:
Results:
2 years: each intervention improved the targeted cognitive ability compared with baseline durable to 2 years
10 years: Participants in each intervention group reported less difficulty with IADLs, memory, reasoning
-At mean age of 82, approx 60% of trained participants vs 50% of controls were at or above their baseline level of self-reported IADL function
-The reasoning and speed-of-processing interventions maintained their effects on their targeted cognitive abilities
Cultural Views of Older Adults:
- Negative views
- Positive Views
- Older adults with meaningful roles at home or in community are more active, healthier, have higher self-worth. and better well being
Ageism
- Stereotyping or discriminating against people based on their age
- Six-in-ten Canadian seniors report being treated unfairly or differently because of their age
- One-in-three Canadians state they have treated someone differently because of their age
- One-in-five Canadians say older Canadians are a burden on society -Working with seniors is not “sexy”
- Ageism is not an old person’s problem it is a societal problem and a collective responsibility
Three Common Forms of Age Discrimination
1) Being Ignored or treated as though they are invisible
2) Being Treated like they have nothing to contribute
3) Assumption that they are incapable
What older Adults Say About Discrimination
People assume…..
..... I have nothing to contribute .....I'm incompetent ...... I have memory loss ..... I am slow .... I am hard of hearing .... People treat me like a child
Sources of Age Discrimination
- Young People
- Employers
- Government
- Healthcare system/healthcare professionals (e.g., not accepted as a patient by family physician)
- Local Businesses
- Family members
- Peers
Practice Implications: Ageism
- Be aware of your values systems and beliefs related to aging and how these for or do not fit with those of your clients
- Be sensitive to client’s cultural needs and preferences (diversity) of older clients
- Avoid infantilising older clients - consider them as equal partners in every stages of therapy process
- Promote awareness - advocacy
Social Participation: Patterns with Age`
- Social Participation decreased with age - but only after 75
- People living at home with a spouse or other(s) have a higher level of social participation
- People 85 and over report lowest participation in recreation compared to other areas of participation
- Health problems such as osteoarthritis, respiratory problems, and hypertension are negatively associated with participation
Social Networks: Loneliness and Social Isolation
- Living alone is not social isolation, if regular contact with a variety of relatives a friends is maintained
- Loneliness is having fewer social ties or friends than a person expects, desires, or feels
- Social isolation is diminished quality, type, frequency, and emotional satisfaction of social network and social participation
Loneliness and Social Isolation
Among older people (especially over 80s): risk of all social networks shrinking
- ->vulnerability to losing relationships through retirement, illness and relocation
- ->difficulty in maintaining networks (e.g. declining health)
- ->Death of people close to them (e.g spouse)
Social Isolation
-Affects 10% to 20% of adults over age 65
Associated with
- Poor physical and mental health
- -> depression, dementia and suicide risk
- Increased risk of hospitalization and mortality
- Neighbourhood variables (e.g. transportation and other services, incidence of crime)
- Income, living situation, information access
Social Participation and Support
- The perceived availability of social support can be a source of:
- ->general positive affect
- ->enhanced self-esteem
- ->feeling of belonging and security
- The effects of stress on well-being can be reduced if an individual feels that they will receive the necessary support form their social network
Types of Social Support
- Types of social support (family members, neighbours, or friends, professionals):
1. Emotional
2. Informational
3. Instrumental/Practical Support - Peer Support
- Volunteering
- Reciprocity is important in relationships
Support Networks
1) Local Family Dependent
2) Local integrated
3) Local self-contained
4) Wider Community-focused
5) Private Restricted
Local Family Dependent
having close ties with at least some family members who live close at hand (at least within 8-10km)
- ->Regular contact, offering assistance and emotional support
- ->more common among windowed older adults, and people with poorer health conditions
- Close ties with at least some family members
Local integrated
Ties with friends and neighbours as well as family members living locally
- -> close ties with church and voluntary bodies, social network, developed over a long period, may be larger
- ->have better health conditions
- Friends and neighbours as well as family members living locally
Local self-contained
Supports consist of only a few relatives, sometimes emotionally as well as geographically distant
- ->unlikely to know many people in the local community, but may be reliant on neighbours in time of emergency
- Only a few relatives, sometimes emotionally as well as geographically distant
Wider Community-focused
- Larger number of ties with the local community (e.g. member of local clubs, societies, charitable organizations)
- ->Little needs for assistance
- Generally well, in good or fair health
- Large number of ties with the local community
Private Restricted:
Minimal contacts with a few friends
- May be due to a life-long pattern of extreme independence or, lack of seeking out friends
- Minimal contacts with a few friends
Social Networks
-There is no association between network types and depression or dementia
Older people living in
- Local integrated networks have greater level of happiness
- Sheltered accommodations with locally integrated networks feel more active and less lonely
Formal Social Support
- Formal support (social and health care professionals) provides a valued support and network for the client
- Health professionals enable older adults to achieve better outcomes through:
- ->Continuing relationships
- ->Listening effectively
- ->Collaborating decision making
- Seeking. and accepting professional help can be a source of discomfort and stigma
Pets
- The evidence to support psychological health benefits from pet ownership is mixed
- Pet’s loyalty and affection could be seen as a form of unconditional emotional support
- Benefits of having a pet (dog or cat) for older adults
- ->Maintain engagement in activities of daily living (better self-care)
- ->contribute to sense of identity
- ->health promoting (more activ routines)/Walk further
- ->Improve social context (valued sense of connection)
Dysfunctional Social Contexts
- Social context can have harmful effects on physical and psychological well-being of the older people (e.g. disempowering and infantilising behaviour with older adults)
- May be exacerbating when supports networks are shrinking or are under heavy strain (eg. demands of caregiving)
- Private networks with minimal outside contact are capable of hiding abuse
Social Context and Occupations
- Social context influences quality and quantity of: leisure occupations
- ->Life satisfaction
- ->well-being
- Engaging invalued leisure occupations offer a buffer against stress
- Rich social network provides more opportunities to stay active and engaged
- Engaging in more social activities promotes longer life expectancy for older adults
Practice Implications: Social Networks
- Client’s approach and lifestyle are important factors in engaging older adults with different social networks
- Consider use of a family-centred approach
- ->Partner with client and carers to achieve mutually acceptable solutions
- ->Use family structures, friendships, and social contacts as sources of support
- Enhance social network to improve community integration, engagement in valued leisure activities and health
Practice Implications: Social Networks
- Consider group based-therapy or supports groups (shared experiences and coping strategies) empower and assist isolated older adults
- Consider meaning ful and desirable activity, person’s abilities and social network history before encouraging client to participate in a social activity
- Consider intergenerational projects
- Social Prescribing
Emotional Well-Being
- Fro 50 to 70 yrs, positive emotions increase and negative emotions decrease
- ->before and after those ages, patterns differ across specific emotions
- Overall, older adults have a higher positive-relative-to-negative emotional experience than younger adults
Emotions Predict Longevity
Factors related to:
Longer life
Shorter life:
Longer life: Positive emotions, happiness
Shorter life: Negative emotions, regrets
Emotion and physiology -Stress
- With high levels of sustained emotional arousal, older adults have greater difficulties returning to homeostasis than young adults
- Stress situations for older adults:
1) Social isolation
2) Neurological dysfunction
3) Exposure to chronic and unpredictable stressors
4) Overload of predictable stressors
Depression
Rate of depression in older adults is lower than younger adults
- Older adults’ symptoms of depression is more harmful than younger adults
- ->decreasing cognitive, physical, and social functioning
- ->increased risk of morbidity (e.g. cardiac events). risk of suicide, self neglect, mortality
- Depression may be present as a lifetime illness or as late-life condition
Depression
Older adults tend to present with physical symptoms be emotional ones
-Sleep disturbances
-Fatigue
-Psychomotor retardation
impaired cognition
-Loss of interest in living
-Hopelessness about the future
Depression
-Risk of depression in older adults is increased with sudden events in later life including:
- Financial difficulties/socioeconomic disadvantages
- A new illness or disability/a family member with a new illness or disability,
- Retirement /change in living situation
Anxiety
- Feeling of worry, nervousness, or unease
- More common than depression in older adults (mixture is common)
- ->similar risk profiles
- Frequently related to fear of falling and/or is comorbid to other illnesses
- ->reduced activity level
Aging in Place Definitions
- The Centers for Disease Control and Prevention- “the ability to live in one’s own home and community safely, independently, and comfortably , regardless of age, income, or ability level
- Social Development Canada - “Aging in place means having the health and social supports and services you need to live safely and independently in your home or your community for as long as you wish and are able.”
Goals of Aging in Place
-The goals of aging in-place can be seen from two perspectives
- Older persons and their families; most older people prefer to stay in their homes/communities as long as possible because it provides them with control over their lives, it enables them to keep their identity and well-being
- Policy makers; institutional care is much more expensive than the provision of care in the community at the older individual’s home. The high public expenditures on nursing-home care urged policymakers as well as professionals to provide alternatives to serve frail older adults in their communities
What does it mean to older adults (aging in place)
- The overarching message around aging in place was that older people wanted to have choices about their living arrangements and access to services and amenities
- Also notable was that the phrase “aging in place”, so popular among policy makers and service providers, was not familiar to most of the older people who participated in our research
- “Aging in place” was perceived as an advantage in terms of sense of attachment or connection and feelings of security and familiarity in relation to both homes and communities. Aging in place related to a sense of identity both through independence and autonomy and through caring relationships and roles in the places people live.
Realities of Aging in Place
- Aging in place independently, in a safe, comfortable, environment of one’s choice, is philosophically attractive, whether it refers to one’s home, community dwellings, or a special facility. However, the idyllic dreams of restful recreation, vacation travel, or visits to relatives are often economically or physically impossible
- There are issues that challenge an aging adult’s safety, health, and economic security beyond the choice of location.
- ->intrinsic and extrinsic factors threaten possibilities for safe and sound health in the residence of one’s choice
- -> Disparities exist between the older adult’s desire to live independently, realities of declining health and function, and the financial ability to secure adequate housing
Barriers/Facilitators
Environment
- Physical
- Institutional
- Social/support
- Geographical
Barriers/Facilitators
Personal
- Physical/cognitive
- Socioeconomic
Barriers/Facilitators
Occupation
- Valued occupations
- Task demands
- Roles and Responsibilities
Naturally Occurring Retirement Communities
- Naturally occurring retirement communities (NORCs) are broadly defined as communities where individuals either remain or move when they retire
- The NORC program model is based on the idea that many older adults reside in communities that were not planned as senior housing, yet over time contain a significant proportion of older adults relative to the number of younger residents
- The model involves identifying such communities and developing partnerships among stakeholders within them -including older adults, service providers, building owners and managers, and local government officials - to meet local needs to support aging in place and to enhance older adults’ quality of life
The village Model
- Are membership-driven, grassroots, non-profit organizations
- Are run by volunteers and paid staff
- Coordinate access to affordable services
- Provide volunteer services including transportation, inspiring health and wellness programs, home repairs, social and educational activities
- Offer access to vetted and discounted service providers
- Are based on the needs of your community
- Are one-stop-shopping. Villages do anything their members need to age safely and successfully in their own homes
- Positively impact isolation, interdependence, health and purpose of their individual members to reduce overall cost of care
Age-friendly Communities
- Population approach to enhance positive health, social participation and health equity in aging
- Encourages active aging by optimizing opportunities for health, participation and security by adapting its structures and services to be accessible to and inclusive of older people with varying needs and capacities
- In Canada, all provinces have initiated age-friendly community processes
- ->approximately 800 communities have launched age-friendly initiatives
Neighbourhood Facilitators
- Enable greater positive health, social participation, and health equity
- Examples
- ->Living close to services: grocery stores, health services, public transportation, banking services and social clubs,
- ->Neighbourhood perceived as friendly and supportive
- Neighbourhoods perceived to be physically adapted to the needs of older people (accessibility and distance to services) heightens feeling of safety
Neighbourhood Barriers
- Personal capabilities might be challenged or exceeded by environmental obstacles
- Example
- ->physical barriers
- ->Inaccessibility of services and amenities
- ->Social stress
- ->Resource inadequacy
Characteristics of Age-friendly communities
- outdoor spaces and buildings
- Transportation
- Housing
- Opportunities for Social Participation
- Respect and Social Inclusion
- Civic participation and employment
- Communication and information
- Community Support and Health Services
Guiding Principles
Prevention and Management of Elder Abuse
- Respect personal value
- Recognize the right to make decision
- Seek consent or permission
- Avoid ageism
- Know that abuse can happen anywhere
- Involve the older adult in decision making
- Respect atomony
- Respond appropriately
Types of Abuse: the 5 categories
Physical/sexual Financial Psychological Neglect Denial of entitlements
Types of Abuse:
Physical/Sexual
-Pushing shoving, unexplained bruises
Types of Abuse:
Financial
-Misuse of property or funds
Types of Abuse:
Psychological
Hurtful words “put-downs”
Types of Abuse: Neglect
-Intentional or unintentional failure to provide for basic needs
Types of Abuse: Denial of entitlements
Censoring mail
Barriers to disclosure
-the older adult may:
- Not recognize the situation as abusive;
- Not know where to go to get help;
- Fear escalation;
- Worry about what will happen if when others find out;
- Feel humiliated
- Take blame for the abuse;
- Fear loss of connection;
- Believe that family honour is jeopardized;
- Have a history of abuse; and/or
- Feel as though they have limited evidence
Warning signs and what to do
Elder abuse
- Be aware of changes in mood, behaviour, routines, or physical health
- Ask key questions (see support or legal services as needed)
- Responding to situations:
- ->Don’t judge
- ->Understand and acknowledge
- ->Do not deny
- ->Engage safety planning (consider community resources)
- Encourage the person to seek help
Elder Abuse and the Pandemic
Social isolation
- Accessing care/supplies
- Financial hardship
- COVID-19 anxiety
- Caregiver burden/hardship
Tools for Assessment (elder abuse)
- BASE: Brief Abuse Screen for the Elderly
- BLI: Being Least Intrusive - An orientation to practice for front-line workers responding to abuse of aboriginal older adults
- CASE: Caregiver abuse screen
- DMEA: Defining and measuring elder abuse
- IOA: Indicator of Abuse
Taking action (elder abuse)
- Reporting and disclosure of information
- Mandatory reporting
- ->It’s your responsibility to find out if/when you need to report and under what circumstances
- Ontario - in the community there is generally no duty to report, but if a person resides in a LTC/retirement facility there is a duty to report abuse, neglect as well as risk of harm to residents. Abuse within a LTC/retirement facility in Ontario must be reported to the Ministry of Health and Long Term Care or the Retirement Homes Regulatory Authority
Frailty - What is it
Variety of definitions
Common Descriptions
Variety of definitions
- Challenge to define and diagnose
- Systematic review highlighted 15 different components
Common Descriptions
-Vulnerability to physical, emotional and social factors
physical factors
- General lack of strength
- More vulnerable to disease and/or disability
- Decreased health more quickly/ increased difficulty with recovery
Emotional and social Factors
- ->Lack of emotion or social support
- -> Social isolation, increased risk of abuse
