AGING PROCESS

Overview

The purpose of this section is to provide an overview of the normal and abnormal changes a person may experience due to aging. The changes included are: physical, mental and emotional.

Objectives

Understanding of the normal physical changes due to aging;

Understanding of the sensory changes that occur as part of the aging process;

Understanding how these changes affect the older person’s interaction with the environment;

Become familiar with the major diseases that affect the older person

Understanding of the normal emotional and mental changes due to aging;

Become aware of changes that can be made in the environment to make functioning easier for the older person.

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Notes

Current Knowledge

Let’s find out what you already know about the aging process. Please place a check mark under either the “normal” or “abnormal” column for the CHANGES which an older person experiences. This list is to help you distinguish between what is normal and abnormal in aging.

CHARACTERISTIC NORMAL ABNORMAL

1. Senility

2. Dry skin

3. Increased sensitivity (heat/cold)

4. Loss of muscle strength

5. Loss of appetite

6. Bones become light and brittle

7. Needs more light to see well

8. Needs TV turned UP slightly

9. Feels people are talking behind their back

10.No longer learns new things

11.Becomes very forgetful

12.No longer as smart as before

13.Personality becomes very different

14.Cannot handle stress well

15.Spends time talking about “Good old days”

16.Feels life is no longer worth living

17.Spends excessive amounts of time in bed

18.Talks about committing suicide

19.Changes from neat to sloppy and careless

20.Loss of interest in sex

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Normal & Abnormal Changes in Aging

For thousands of years, age and old age have been viewed as abnormal, as a disease process and as a disease. So negative was the view of old age that the early Greek philosopher, Plato wished “Life would begin in old age and end in the Mother’s womb.” Early Romans had a saying: “To be an old man is not to be at all.” And prescribed that old people be thrown off of bridges. During the Dark and Middle Ages, old people were burnt at the stake for witchcraft because they looked and behaved differently. In the 1800’s, death was commonly attributed to “old age.”

Even today, some physicians attribute a health problem to aging and old age. There is a story – humorous in nature –, which clearly expresses the serious consequences of not being able to define what is normal and abnormal during the later years of the life cycle.

An older man came into the doctor’s office complaining of pain in his right knee. The doctor told the man that his right knee was suffering from old age. The old man then remarked to the doctor: “But, doctor, my left knee is as old as my right knee and yet it doesn’t bother me.”

It has been only in the last 20 years that clinicians, psychologists and sociologists have begun to define what is normal and abnormal aging and identify what people can expect to occur in old age. The scientific principle accepted by the vast majority of professionals today is: “There are normal and abnormal changes which occur as people grow older. Aging is not a disease process and old age is not a disease.”

This section has been designed to help you distinguish between normal and abnormal physical, psychological and social changes in old age. It focuses on what is already known through research.

THE MAJOR GOAL OF THIS SECTION IS TO PUT TO REST THE MYTHS AND MISCONCEPTIONS ABOUT AGING AND OLD AGE!

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Notes

Skin

One of the first areas that a person is likely to notice change that is a normal process of aging is the skin. The skin loses some of its elasticity and there is a decrease in fat under the skin. As a result, aging skin develops folds and becomes flabby in appearance. This change will alter the person’s ability to maintain constant body temperature and they will become more sensitive to heat and cold. The older person may also experience greying hair or thinning hair due to skin changes.

The skin becomes drier which can make the individual more sensitive to skin irritation from soap, tight clothing or weather changes. If a person is bedridden, the dry skin makes it necessary to turn the person at least every two hours and keep the skin well lubricated to avoid bedsores or pressure sores.

Most older people have difficulty in cutting finger and toenails. Increased dryness makes nails harder. “Liver spots” (brown colored spots that appear on hands, wrists and face) may appear and are unrelated to the liver and harmless. The incidence of skin cancer does increase with age, so it is important to report any change in size or color of moles to a doctor.

Due to decrease in fat under the skin, an older person may have a difficult time balancing their body temperature with the environment. Hypothermia may occur in anyone exposed to severe cold. It is a condition of below normal body temperature (95F or under). Other signs may include: change in appearance or behavior; a slow, irregular heartbeat; shallow and/or very slow breathing; sluggishness; and confusion. Treatment involves rewarming the person. This should be done under a doctor’s supervision.

Heat related illnesses include stroke and heat exhaustion. Heat stroke requires immediate medical treatment. Some of the symptoms are: faintness, dizziness, headache, nausea, body temperature of 104F, rapid pulse and flushed skin. Heat exhaustion is a result of loss of body water and salt. The symptoms include: heavy sweating, nausea, giddiness, pale and cool skin. Treatment involves resting in a cool environment and drinking cool liquids.

If the older person is having trouble stopping or bending or lacks the strength required, they may need your help in trimming toe and fingernails. If they have persistent skin itching or irritation, have them checked by a doctor. While caring for a bedridden person, the areas around the joints may need to be massaged to increase circulation. The person will definitely need to be turned frequently (every two hours) to avoid bedsores.

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Notes

Muscular-Skeletal

As a normal part of aging there are changes in the muscular-skeletal system. There is a normal decline in muscle fibre. Muscles become less elastic and lose flexibility. Some of this loss can be reduced as use of muscles and joints is maintained through daily activity or exercise.

As aging progresses, bones may become more porous and less dense. This is referred to an Osteoporosis. This is more common in women than men and becomes apparent in the middle years. No one cause has been identified. However, possible factors include: deficiencies in calcium, vitamin D and estrogen. Since the bones are porous they cannot adequately support the body and are easily broken and healing takes longer. Osteoporosis may also alter back alignment and cause “stooped” posture.

Early detection of Osteoporosis is now possible through medical tests. Treatment usually consists of calcium tablets and can also include vitamin D and estrogen. Exercise which stimulates the formation of new bones and diets rich in calcium can also be useful. Treatment should be done under the supervision of a doctor. Also, women taking estrogen should be aware of its link to uterine and breast cancer.

Changes in the spine affect stability, balance and movement. Often a wide stance or waddling gait is an adaptation made to offset this. Another change is a wearing away of the padding between spinal discs which can result in back pain.

The changes that take place may also produce poor posture, which adversely offsets the functioning of other organ systems. In particular, the curvature of the spine reduces the overall volume of the lungs wile loss of muscle strength offsets breathing. Alterations in muscle tone may also affect the ability to digest food and to regulate elimination, which can be a source of discomfort and embarrassment.

Arthritis refers to joint inflammation. Degenerative arthritis is the most common form of arthritis in people after age 50. The causes include: heredity, obesity, living environment, and wear and tear on joints. This disease involves the degenerative of the connecting cartilage of the joints, displacing it with new bone formation. The result is pain, stiffness upon rising and creaking joints. Due to the discomfort, people try not to use the affected joints resulting in restriction of joint motion.

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Notes

As a caregiver, you may be in a position to encourage non-strenuous exercises that maintain whatever level of strength and flexibility is there. In the home environment, you can help the older person make changes that will help them get around. In a later section we will discuss furniture, bathrooms, etc., that may be modified to make use easier for older persons. For those who are less ambulatory and using aids such as walkers or wheelchairs it is useful to know how to assist this person. This will be covered in the Personal Care Section.

Heart & Circulatory

Another area of age-related change is the heart and circulatory system. Changes that commonly occur in the heart are:1. There is an increased amount of fatty substance (cholesterol) in

the blood vessels which can cause them to narrow and lose flexibility;

2. The walls of blood vessels become harder, thicker and less elastic. This relates to circulatory and blood pressure problems;

3. The heart requires a longer rest period between beats, which may limit behavior in situations in which the heart is stressed.

Blood pressure, which relates to the functioning of the heart and circulatory system, is a common concern among the elderly. The incidence of high blood pressure increases with age at least to the age of 70.

A reading is taken to measure blood pressure. The upper number in the blood pressure reading is the systolic pressure (blood pressure as your heart pumps). The lower number is the diastolic pressure (blood pressure as your heart rests between pumps).

120/80 is often considered the “normal” blood pressure. However, what is normal varies from person to person. Your blood pressure will also vary with the time of day (lower when you first get up; higher as you start activities and lower in the evening.) Exercise will temporarily raise your blood pressure, but it will return to a lower level when you rest. Emotional stress also raises blood pressure temporarily.

Doctors often consider an older person who consistently has a blood pressure higher than 160/95 as having high pressure which is called hypertension. “Consistently” means the doctor has taken the reading at least three different times. Some doctors will medicate when an older person has a systolic reading between 140 and 160, and a diastolic reading between 90 and 94. Others will just monitor. As a result of high blood pressure some people may develop

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headaches, dizziness, fatigue and shortness of breath. However, many people will have no symptoms, which is why it has the nickname “The Silent Killer.” It is recommended that older persons get 6-month blood pressure checks.

Avoiding cigarettes, good diet, exercise and reduced stress are factors that help in managing blood pressure. Diet should be discussed with a doctor as studies have shown that the Pritikin diet (reducing cholesterol) has an enormous impact on reducing high blood pressure in this country. Another dietary help is cutting back on salt as salt absorbs water and causes fluid retention. Excess fluid in the blood vessels raises blood pressure and makes your heart work more. Caffeine is another substance known to raise your blood pressure.

Coronary Artery disease results when the blood supply flowing through the arteries is reduced or blocked. This reduces the oxygen supply to the heart. When this occurs a warning is triggered called “angina pectoris.” This may be experienced as a squeezing pain in the center of the chest and pain radiating to the left arm.

Heart attack is the lay term for coronary vascular occlusion or myocardial infarction. The blood supply has not been able to get to all areas of the heart. A blockage in the arteries is usually caused by a clot. It can also be caused by the bursting of a tiny vessel due to high blood pressure. When the blood supply has been cut off, the tissue in that area dies from lack of oxygen and starts to form scar tissue.

The person experiencing a heart attack may experience a great deal of pain in the center of the chest and pain radiating to the left shoulder, arm and back. Some experience pain from the jaw to the abdomen, while others feel tightness in their chest as though they are suffocating. They may also experience seating and nausea. A heart attack requires immediate emergency assistance.

A stroke is referred to as a cerebrovascular accident (CVA), which means that the blood supply to the brain is reduced or completely shut off. The most common stroke is due to a blood clot in an artery of the brain or neck. The offset of a stroke depends upon the functions of the part of the brain that is damaged and the severity of the damage. Muscle movement, speech, memory or emotions can be impaired. If started early, rehabilitation is often successful. High blood pressure is a frequent concern as one grows older. It is important to understand the causes and ways it can be controlled in order to avoid strokes.

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Notes

Respiratory

Age Related Change:

1. Skeletal changes and calcification limit rib cage expansion.

2. The muscles that are needed for inhalation and exhalation may become weakened and atrophied.

3. The lungs become less elastic, which reduces the amount of air that is expelled. This leaves less air available for oxygen-carbon dioxide exchange.

For many older persons these changes do not affect normal daily activities. However, the incidence of emphysema increases with age and can be inhibiting. Emphysema is the breakdown of the air pockets in the lungs. Smoking can cause and/or heighten the effects of emphysema. The lack of oxygen getting to the heart and brain has a major impact on energy level and mental functioning. Lack of oxygen can cause a person to experience memory loss, disorientation, insomnia and irritability.

Urinary

Loss of urinary control is a frequent problem particularly for older women. Incontinence can range from the discomfort of slight loss of urine to the disability of severe, frequent wetting. In many cases, incontinence can be treated and controlled, if not cured. Persons having problems in controlling urine should seek prompt medical attention to determine the cause and lessen the chances of complications. The following are the three different types of incontinence:

Stress Incontinence : leakage of urine during exercises, coughing, sneezing or body movement, which puts pressure on the bladder. It occurs most often in women (of all ages). The Kegal Exercises noted later in this section should help.

Urge Incontinence: inability to hold long enough to reach toilet. It is often associated with some disease, but can occur in otherwise normal older people.

Overflow Incontinence : leakage of urine in small amounts from a constantly filled bladder. This condition may be attributed to an enlarged prostate in men.

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Notes

Prostate problems are common in men over 50. Because it surrounds the urethra, an enlarged prostate can make urination difficult. Most problems can be treated effectively without harming sexual function.

Regular physical checkups that include a rectal exam increase the chances of detecting prostate cancer before symptoms appear and in its early, most curable stages. When symptoms do appear, they are usually similar to those caused by BPH*. Cancer can be treated with surgery or radiation therapy.

Prostate Problems

Acute Prostatitis: a bacterial infection that presents symptoms that include fever, chills, painful or difficult urination, and pain in the lower back and between the legs. It is usually treated successfully with antibiotics.

Chronic Prostatitis: a recurring prostate infection, which is sometimes brought on by change in sexual activity and acidic liquids. The symptoms are similar to acute prostatitis but are usually milder. Fever is uncommon. Treatments often include the use of antibiotics and massage. The massaging method causes the prostate to release fluids, which is sometimes helpful. Decrease in intake of acidic liquids such as juices, coffee, wine, etc also seems to help.

Benign Prostatic Hypertyophy: (BPH*) an enlarged prostate. It is caused by small noncancerous tumors, which grow inside the prostate. Symptoms include: difficulty urinating, dribbling after urination and the urge to urinate frequently. Drugs have no yet been successful in treating BPH. In severe cases surgery may be necessary to remove the overgrown portion of the prostate.

Prostate Cancer: in the early stages of prostate cancer the disease stays localized (in the prostate) and does not endanger life. But without treatment the cancer can spread to other tissues and eventually cause death. Prostate cancer usually progresses very slowly.

Kegal Exercises for Women

Kegal or pelvic floor exercises are designed to strengthen the muscles and other tissues that support the uterus, tubes, ovaries, vagina, bladder and lower bowel. To do these exercises, concentrate on contracting the muscles around the vagina and urethra when urinating, until you stop the stream of urine. Hold three seconds, relax three seconds, repeat until finished urinating.

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Notes

Eventually, you will most likely be able to control these muscles without difficultly. After you have mastered control when urinating, you can do the exercise any time. Although the exercise may be easier while sitting, use whatever method works best for you.

Schedule:Day #1 – 10 contractions 4 times per dayDay #2 – 20 contractions 4 times per dayDay #3 – 30 contractions 4 times per dayDay #4 – 40 contractions 4 times per dayDay #5 – 70 contractions 4 times per day

Continue with Day #5 regime daily.

Sexuality

Except for the reduction of fertility in women, there is little change in sexual functioning due to aging. Some couples find that it takes longer to achieve orgasm and lubricants are sometimes needed. However, these factors do not hinder sexual functioning or satisfaction. Social pressures, self-esteem and a general feeling of well-being will affect sexual desire during the later years.

It is important to remember that a sexual relationship provides more than a means of releasing sexual tensions. Companionship – someone with whom to share emotionally and physically – intimacy and touch are all important aspects of sexuality.

For many older couples, intercourse itself is not the focus of their sexual interaction. They get a great deal of pleasure and comfort from hugging, kissing and just plain affectionate touch.

In caring for older people, one can respond to this desire for affection and touch by remembering to hug the person we care about. As we are talking, reach over and hold their hand – or even give a little shoulder massage or back rub while we’re talking.

Remember also that treating a man as a man and a woman as a woman is important. Too often older people are treated as being neither male nor female. Older men still like to feel in charge. Talk with them about areas regarding which they have strong opinions or have a lot of experience. Encourage them to keep in touch with men’s social groups to which they have belonged.

If it can be arranged, take them to/or have a barber come to the house so they can get a shave and haircut from a man. Often as

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men grow frail, they are surrounded by female caregivers so it is important to encourage men in the family or friends to make a special effort to visit. Some male visitors may need your advice or prompting as they may feel ill at ease with someone who is frail.

Women, even when frail, want to look their best. Helping them wear clothes that are attractive, having their hair done and applying a little make-up can go a long way toward making them feel a little better.

Nutrition

Nutritional needs of the elderly are essentially the same as the average adult. A high-fibre diet (vegetables, fruit and whole grain) is generally recommended. Although, if there is a low activity level calorie requirements should decrease. Loneliness, depression, decreased energy and fatigue may result in a loss of interest in food.

Water is vital to good health. One and ½ to two quarts are needed on a daily basis to maintain body temperature and efficient cell metabolism. Older persons frequently have a problem with dehydration resulting in a disruption of the circulatory and urinary systems.

In order to increase an older person’s interest in mealtime, some suggestions include:

Arrange for companionship whenever possible to share a meal

Arrange the eating space or dress up the dinner with placemats, flowers, etc.

Plan mealtime in relation to some enjoyable event in the day.

The eating habits of an older person are influenced by their cultural and ethnic backgrounds as well as their income. In order to stretch the dollar, people sometimes buy less nutritious food and decrease the amount and variety.

Many old people have difficulty chewing, so softer foods are preferred. There is also frequently a decrease in the amount of saliva in the mouth that makes it hard to swallow some foods. In order to make sure the person is getting proper nutrients and not just bland foods, one can: grind or chop meats, use gravies or natural juices to keep food moist, and chop fresh fruits and vegetables.

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Notes

When a person feels full quickly or has poor digestion, it is advisable to eat smaller, more frequent meals. Diseases such as diabetes, high blood pressure and heart disease frequently require diet modifications determined by medical advice.

For excellent information on nutritional requirements for older persons and ways to prepare tasty diets, contact a nutritionist or dietitian.

Neurosensory

Sensory changes due to aging affect primarily vision and hearing with very little change in taste, touch and smell. Sensory changes tend to begin in the 40’s and 50’s in a gradual manner without appreciably limiting behavior until about the 70’s and 80’s.

Most older people experience change in vision. These include changes in the lens, pupil size, composition of vitreous humor and ability to shift from near to far vision all of which decrease sharpness of the visual image. Reading material that is geared to the older person should contain large, clear type.

An older person requires more light because the pupil of the eye becomes smaller. At the same time the older person’s ability to adapt to light and dark is slower. The lens of the eye tends to become more yellow making discrimination between blues, greens and purples difficult. The lens also becomes more rigid and less pliable. Fast accommodation from near to far decreases, which is referred to as “Presbyopia.”

Many older persons experience cataracts. However, it is not known whether this is a normal age-related change. A cataract consists of increasing cloudiness of the lens. Cataract removal by surgery is now quite common and almost always successful. The risks and benefits of cataract surgery should be discussed beforehand with the doctor. If cataract surgery is done, only one eye should be operated on at a time to prevent disorientation from occurring.

As a caregiver it is important to be sensitive to the potential for change in vision and encourage older persons to have regular eye examinations. This change in vision can be the result of too much fluid pressure in the eye. Referred to as “Glaucoma,” if it is not detected and treated early, blindness can result.

We use visual cues to respond to people and our environment. A person may give an inappropriate response because they cannot see or identify an object. They may not keep their house as clean

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or tidy because they literally do not see the dirt or clutter. When you notice such things, it may be a clue that the older person is experiencing vision or other health problems. Modification in the environment can be made, such as more intense direct lighting on work areas as well as reducing areas of possible glare. More information on this will be covered later.

Another sensory age-related change is a gradual change in hearing. Men, in particular, tend to show a loss in the hearing of high frequency sounds. There are a variety of areas within the ear that may change and cause this loss. One common cause is the thickening of earwax as one grows older. It is best to have this loss diagnosed in order to know whether a hearing aid would be useful.

When speaking to someone who has a hearing loss, it is best to have eye contact, speak slowly and lower your voice. Speaking loudly tends to put the voice in a higher frequency making it difficult to hear. It is important to realize that if a person has a high frequency loss, loudness will not help. Background noise also is more disruptive for the older person, so hearing will be better in a quiet space. Loss of hearing can produce a sense of isolation and distress.

Changes to the sense of taste, smell and touch are less acute. Taste is often affected by the decline in taste buds and/or the taking of certain type of medicines. The result is that food may more frequently taste bland with “normal” seasoning.

Changes in smell seem to be minimal. However, the primary effect may be in not being satisfied by the smell of food or in the areas of personal hygiene and safety. These factors can cause an older person to get less satisfaction from eating and lead to poor diet habits.

Parkinson’s DiseaseParkinson’s Disease is the most common movement disorder involving the central nervous system among the elderly. It is a chronic, progressive disease of the central nervous system. The symptoms involve stiffness or muscle rigidity, tremors, a shuffling gait, and difficulty in initiating movement.

There is also slower, monotonous speech, reduced voice volume, drooling, tearing of the eyes, difficulty in swallowing, loss of balance, difficulty in urinating and a masklike facial appearance. Usually the intelligence level of the individual remains normal. However, some form of memory loss may occur.

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Notes

The person with Parkinson’s Disease should be encouraged to be as physically active as possible. Exercise can help to prevent joint contractions, although it will not reverse rigidity. They should be provided with an unhurried environment and not be expected to rush through any activity.

Mental

There are very few changes in mental ability due to aging. Studies show that intelligence is affected by education, social class, and personal losses, but not aging itself. Stored information is unaffected by advancing age. However, it does take longer to retrieve this information. Speed seems to be most affected by aging, in both retrieving old information and mastering new problems. In general, an older person does better with situations and tasks where accumulated experience and knowledge is important rather than tasks that involve time pressures and developing new approaches.

It is normal to have slight memory loss as one ages although the cause is not clear. Significant memory loss is often the result of illness. Sometimes it is caused by medicines. The most common change in memory is the decline of short-term memory, or the ability to recall recent events.

The aging process does not change a person’s personality. A person may become angry or upset as they age, but only if this is their normal way of reacting to change and/or stress. If someone has what seems to be an extreme personality change, this should be brought to the attention of the doctor.

It is important to keep in mind that physical or emotional stress and medication can affect the mental functioning of a person. Often when a person has a fever they will be “delirious”, yet with an older person this might be viewed as senile behaviour. There is no such disease as senility. All mental changes should be reported to the doctor as it could be due to physical illness.

Dementia: describes a decline in intellectual ability severe enough to interfere with a person’s daily functioning. The symptoms of dementia can be caused by many diseases. Some of the diseases are treatable – others are not.

Most research indicates that about 50% of the cases of dementia are caused by Alzheimer’s Disease. The symptoms of Alzheimer’s disease are usually a gradual decline in many areas of intellectual

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abilities and an accompanying physical decline. In the early stages, only memory may be noticeably impaired. As the illness progresses, impairment in both language and motor abilities are seen. Late in the illness the person becomes severely impaired, incontinent and unable to walk. Alzheimer’s disease usually leads to death in seven to ten years.

Mufti-infarct Dementia occurs when repeated strokes within the brain destroy small areas of the brain. The cumulative effect of this damage leads to dementia. Memory, coordination or speech may be affected depending on what area of the brain is damaged.

Depression is a treatable cause of dementia. Whenever a person with a memory problem is depressed, he/she should be evaluated to determine whether the depression is the cause of her dementia or vice versa. The depression should be treated whether or not there is an irreversible dementia.

The word senility means “old” and does not describe a disease. Chronic Organic Brain Syndrome and Acute Organic Brain Syndrome are terms that been used to refer to dementias. The classic symptoms association with Organic Brain Syndrome are disorientation of time, place and person; memory loss; impaired judgment and abstract thinking; inappropriate emotional responses.

Acute Brain Syndrome comes on rapidly and is treatable. Causes include such factors as drug intoxication, metabolic disorders, malnutrition, extreme hot or cold environment, internal infections and disease and severe stress.

Chronic Brain Syndrome (CBS) comes on gradually and increases in severity over time. The causes of Chronic Brain Syndrome are unclear. The most common type is referred to as Alzheimer’s disease. Providing a structured, supportive environment, communication and routines are important factors for persons with CBS.

If you notice changes in a person’s ability to remember things, if they seem to be confused about the time or place or they begin to act in a manner that is very peculiar for them, you should report these changes to the person’s doctor. These could be temporary episodes brought on by stress. They could be a side effect of medication or they could be the sign of an illness. Early diagnosis could make a big difference in treatment if the illness is reversible.

Communication techniques such as “reality orientation” and “validation therapy” are particularly useful when communicating with

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someone with a chronic brain disorder. It is important to remember that as changes in behavior occur in the person, that person will be aware that something is wrong and will experience fear and anxiety. Your support and reassurance is important. As a person’s condition deteriorates, they seem to be unaware of the lapse of memory or inappropriate behavior. At this stage, being in a comfortable reassuring environment seems to help. Relocating a person to a new environment at this time may hasten the deterioration process.

Drug and alcohol abuse are common physical causes of mental health problems in older persons. Older persons will sometimes treat themselves by using a variety of over-the-counter medicines and even add these to prescribed medications. This can be very dangerous. Some older people may even need to reduce their intake of prescribed medication as recommended dosages are often based on use by younger people. Some doctors suggest beginning with lower dosages when medicating older people in order to determine the proper tolerance level. The family or older person should always check with doctor and/or pharmacist to see whether the prescribed dosage is correct or not.

Alcohol can be a problem for people who have had an alcohol problem throughout life and are now growing old while still having the problem. Some older alcoholics find that the amount of alcohol it takes for them to affect their ability to function will decrease with age. Their body and mind will respond more quickly to less alcohol, but their habits will not have changed. This can lead to people who are used to having a few drinks before dinner – which left them relaxed – finding themselves drinking the same amount and passing out or being too confused for dinner. This can be unhealthy and embarrassing.

Older people who had not previously used alcohol may turn to it to cope with loneliness, depression or anxiety. This will not help the person cope with these feelings.

It is important that the behavior be recognized and made known to the doctor or mental health professional. Sometimes by using listening skills you can help a person talk out their feelings and when they feel understood won’t have the need for the alcohol.

Emotional Well Being

The way a person feels about himself or herself and his/her life will be affected by his/her personal losses through death or distance. It will also be affected by social and physical losses such as retirement, relocation or a new environment, disease, etc.

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It is common for an older person to experience grief and to go through the grieving process, which includes a state of shock, denial, guilt or anger. The grief may be due to the loss of family, friends, their independence or their home. Helping the person explore their view of the situation and their concerns can move them towards positive adjustment.

Due to multiple losses and stress, an older person may on occasion experience depression. It is important to keep in mind the behavior and attitude expressed while depressed. It is normal for a person to have days when they feel “blue” or unhappy. This is generally short lived and is experienced by most people. There can also be times of depression when a person feels that life is not worth living and there is nothing you can do about it. This type of depression should be reported to the doctor, but can generally be worked out by talking out some of the feelings and helping the person find some area of enjoyment and interest. However, if a person is repeatedly negative about himself or life, withdrawn and won’t talk or talks about destroying himself, the doctor should be contacted immediately. Remember, suicide increased with age – especially among males.

Some other common feelings among the elderly are anxiety and loneliness. A person may adjust to loss by excessive worry, particularly if they tended to worry a lot earlier in life. Fear of isolation or being alone is another response to loss. This can also be a reflection of fearing the loss of independence. Again, being able to talk about their feelings and understanding that these feelings are a response to real loss, can open the way for a different, more positive response to the loss.

Stress and how a person responds to it can itself lead to emotional upset, anxiety and physical discomfort (i.e. headaches, backaches, asthma). The older person experiences significant losses and must often make changes within such a short period of time that there is little time for adjustment. Suggestions for easing the effects of stress will be covered in the section on stress reduction.

Many people react emotionally to reduce stress. Emotional reactions can range from mild “defense mechanisms” to reactions that are more serious. Defense mechanisms are temporary ways to deal with conflicts and frustrations. Most defense mechanisms are a form of denial and not wanting to deal with the present situation. Defense are attempts to reduce anxiety by lashing out at others. Examples are:

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“It’s not true!”“It’s not my fault!”“I don’t believe it!”“Remember the good old days.”

When stress occurs often and the emotional strain becomes too great, the defense mechanisms no longer relieve the stress. A person may withdraw from reality into a fantasy world; feel threatened when there is no obvious danger; or become overly concerned with their health. Being aware of the emotional state of the older person will help you to remain objective and not take comments or criticism personally. The communications covered in a later section will assist you in these situations.

Definitions

ALZHEIMER’S DISEASE: A progressive brain disorder characterized by memory loss; disorientation as to time, place and person; impaired judgment and abstract thinking; and inappropriate emotional responses.

ANGINA PECTORIA: Intense pain in the chest caused by rapid blood flow through narrow coronary arteries. Occurs especially when exercising.

APHASIA: Loss of the ability to communicate.

ATHEROSCLEROSIS: A condition resulting from the development of a fatty coating on the inside of the arteries, which reduces the size of the pathway for circulation. Refers mainly to heart and surrounding area.

ARTHRITIS: Degeneration and/or inflammation of the joints.

CEREBROVASCULAR ACCIDNET (CVA): A sudden rupture or blockage of a large cerebral blood vessel, leading to impairment of brain functioning.

CORONARY: A heart attack, resulting from obstruction of a coronary artery and usually destroying heart muscle.

DEPRESSION: A depressed person shows signs of emotional, psychological and physical changes that last for months or years. They experience an overall mood of sadness about the past, an inability to cope with the present and a fear of the future.

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EMBOLISM: Obstruction of a blood vessel by an air bubble or other abnormal particle.

GLAUCOMA: Too much fluid pressure in the eye, which causes internal eye damage and gradually destroys vision. It is often symptomless, especially during early stages.

HIATUS HERNIA: An internal rupture in which the stomach protrudes through the diaphragm opening into the chest cavity along the esophagus.

HYPERTENSION: Abnormally high blood pressure.

HYPOTENSION: Abnormally low blood pressure.

OSTEOPOROSIS: A gradual, long-term loss in bone mass in old age, especially in elderly women; the bones become less dense, more porous and fracture more easily.

PARKINSON’S DISEASE: A condition in which the ganglia at the base of the brain’s cerebrum degenerate, causing syndrome that includes muscle rigidity, stiff gait, vocal changes and a masklike, expressionless face.

PRESBYOPIA: A condition of farsightedness resulting from a loss of elasticity of the lens due to aging. Cannot see thing close up.

SENILITY: An imprecise term used to refer to deterioration in the brain and behavior observed in some elderly individuals.

STROKE: A sudden clotting or rupture of one of the blood vessels that lead to the brain.

THROMBOSIS: Formation of a clot in a blood vessel, which can result in obstruction of blood circulation.

Environment

There are some common household modifications caregivers can make to assist their impaired elderly. Below are just a few examples.Household Modifications

Visually Impaired: Maintain surroundings that are familiar. Change little in environment where items are kept; where

furniture is placed.

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Notes

Avoid objects sticking out into a pathway. Avoid sudden floor level changes Use sound reflecting surfaces – a room with a lot of furniture. Encourage change in texture of floor and wall surfaces in

different rooms. Encourage sharp colour contrasts.

Hearing Impaired: Have doorbells and phone fitted with signal lights or sound

amplified. Avoid rooms with little furniture and smooth shiny surfaces

because they create an echo. Avoid furnishings that are too soft and which can absorb too

much sound.

Manipulatory Disabilities: Use level type handles rather than knob type handles on

cabinets and doors. Make work areas reachable and workable. Sew loops into underpants and socks to make them easier to

put on. Place loops on zipper tabs to make them easier to pull up and

down. Sew button hooks on clothes. Avoid clothing that goes over the head or fastens in the back.

Locomotive Disabilities: Make stair treads and risers of average height (not too steep or

too shallow). Both treads and risers should be the same for all steps in a flight of stairs.

Handrails should be firmly secured on each side of the steps. Handrails should be comfortable and easy to grasp. Walls

behind rails should be smooth. The chairbound person’s living space must allow enough space

in rooms, hallways and doorways for the wheelchair to pass freely.

The area of reach for someone sitting in a wheelchair is from 11” to 5’, 2” from the floor and 32” out to either side. Suitable controls and handles should be within this range.

Short flights should be replaced with wheelchair-accessible ramps.

Bathroom: A low, shallow tub with well-placed grab bars is helpful for the

ambulant person. Do not use towel racks or soap dishes as grab bars as they are

not strong enough to support a person’s weight.

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Notes

Notes

Non-slip tub and shower mats prevent falls and give a feeling of security.

A tub seat is a useful and inexpensive solution for persons who cannot stand in a shower or lower themselves into the tub.

The standard toilet seat is too low for many persons with disabilities. This can be modified by attaching a molded plastic seat and grab bars.

Exposed pipes carrying hot water should be covered to prevent burns.

Safety: Telephone numbers of the police, fire department, ambulance

service and doctor should be within easy reach of the phone. Always learn before a crisis the emergency numbers.

Always call for help when you are not absolutely certain about the extent of the person’s illness or injury. Never hesitate.

Always check on the elderly person daily. If you cannot, have a friend or neighbor call or briefly visit. Some communities have “Friendly Visitors” or “calling Networks”. Use them.

Learn First Aid. Contact your local Red Cross chapter or your local county health nurse for information on the types of First Aid programs offered: How to stem bleeding and Cardiopulmonary Resuscitation (CPR) for heart attack and chocking victims.

Practice with the older person the fire escape routes. Make sure the house has smoke detectors on all floors and discourage smoking in bed or when lying on the couch. Have the Fire Department check the house for fire hazards.

Floppy gowns and robes should not be worn in the kitchen especially when using the stove. These can easily catch on fire.

Instruct your older person that if they should catch fire: DON’T RUN – DROP TO THE FLOOR AND ROLL. If you should be nearby, get the person to drop to the floor and roll and use a blanket or other heavy material to smother the flames.

A “Checklist on Possible Household Dangers” has been included for your review and use on the next page. Your responses will determine whether your house is safe or in need of added safety precautions.

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Possible Dangers Checklist

Yes No1. Do you have a sturdy handrail by your stairs?2. Is there a grab bar by your tub or shower?3. Is there a grab bar or substitute near toilet?4. Are there safety strips/no-slip mat in bathtub/shower?5. Are stairs well lighted?6. Can you switch lights on at top and bottom of stairs?7. Is there a nightlight or flashlight by the bed?8. Is the kitchen well lighted, particularly near stove:9. Do warning lights on stove indicate which burner is lit?10. Are stove’s heat settings clearly marked?11. Are all flammable fluids stored outside the house?12. Can electrical appliances meet safety standards?13. Have you planned an escape route in case fire blocks the usual exits?14. Are the stairs free from clutter that might cause a fall?15. Is furniture arranged to give a clear path within and between rooms?16. Are all small rugs tacked down or anchored with non-slip mats?17. Are all frayed spots in rugs mended?18. Are medicines for external use stored separately from those for internal use?19. Are cleaning materials stored away from medicines and food?20. Do you know the telephone numbers to call in an emergency?

Rate your answers:From 18-20 YES answers – The safety precautions are excellent.From 15-17 YES answers – Pretty good. BUT there is room for improvementFrom 10-14 YES answers – Better watch out.Less than 10 YES answers – Changes need to be made!

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Notes

Review of Topic

Let’s see if the information shared in this section changes any of your answers. Please place a check mark under either the “normal” or “abnormal” column for the CHANGES which an older person experiences.

CHARACTERISTIC NORMAL ABNORMAL

1. Senility

2. Dry skin

3. Increased sensitivity (heat/cold)

4. Loss of muscle strength

5. Loss of appetite

6. Bones become light and brittle

7. Needs more light to see well

8. Needs TV turned UP slightly

9. Feels people are talking behind their back

10.No longer learns new things

11.Becomes very forgetful

12.No longer as smart as before

13.Personality becomes very different

14.Cannot handle stress well

15.Spends time talking about “Good old days”

16.Feels life is no longer worth living

17.Spends excessive amounts of time in bed

18.Talks about committing suicide

19.Changes from neat to sloppy and careless

20.Loss of interest in sex

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Key Points

The skin loses some of its elasticity and there is a decrease in subcutaneous fat.

An older person may have a hard time adjusting body temperature and is susceptible to hypothermia, heat stroke and heat exhaustion.

Due to normal decline in muscle fibre the muscle becomes less elastic and less flexible.

Osteoporosis, porous bones, is in particular a problem for women after menopause.

Loss of urinary control is a frequent problem for older women.

Prostate problems are common in men over 50.

Vision changes due to aging include the following: the lens yellows, becomes more rigid and less pliable.

Some hearing loss is common in the elderly.

Increase in cholesterol may cause restriction in blood vessels decreasing the heart function.

The heart may require longer rest periods between beats.

There is little change in sexual functioning due to aging.

Information stored in the brain is unaffected by age, however it does take longer to retrieve this information.

Most older persons go through periods of emotional adjustment due to many losses and stress.

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Notes

References

Information for Caregivers of the ElderlyShare Decroix Bane, M.Ed.Burton P. Halpert, Ph.D.

Reprinted with permission of:Center on Aging StudiesUniversity of Missouri-Kansas City2220 Holmes StreetKansas City, Missouri 64108

Acknowledgements:Lou Anne HallJoyce GroskoPhyllis RobichaudJack SiglerMarcella WomackUniversity of Missouri-Kansas CityMissouri Cooperative Extension ServicesMissouri Extension Homemaker Clubs

Bates CountyBenton CountyCedar CountyGrundy CountyPutnam County

Center for Aging, University of Missouri-Columbia Brents, Barbara and C. Edwin Vaughn, “Aging Process,” in In-Home Care: A Self-Teaching Curriculum, Center for Aging, University of Missouri-Columbia, 1982

Halpert, Burton, “Health Tips on Aging: Selected Topics,” Center of Aging Studies, university of Missouri-Kansas City, 1983-1985.

Saxon, Sue V. and May Jean Etten, Physical Change and Aging: A Guide for The Helping Professions, The Tiresias Press, New York, NY, 1978.

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