Adulthood and Aging

immune system changes

Decreased T cells, altered surveillance of cancer, slow destruction of thymus, increased autoantibodies Consequences: infectious diseases, cancer, autoimmune disease

endocrine system changes

Decreased efficiency of hormone release, thyroid activity, aldosterone, insulin production, elevated cortisol response Consequences: decreased cognition, strength, sexual fx. Reduced metabolic rate and mental alertness, increased BP, hyperglycemia, immunosuppression, disease exacerbation

hematologic changes

Decreased erythropoiesis (production of RBCs) leads to anemia 1. Hypo proliferative- not making enough RBCs 2. Ineffective erythropoiesis- RBCs dying

respiratory system changes

Decreased forced vital lung capacity, lose elasticity & alveoli surface area, stiffened rib cage, decreased oxygen saturation Consequences: decreased tolerance for physical activity, difficulty expanding rib cage, disease- COPD, emphysema, chronic bronchitis, pneumonia

Community Mobility

IADL that includes driving, walking, using transpo Most seniors live in suburbs or rural areas- lack public transpo - Prefer personal automobile, reservations about other forms

neurocognitive disorders

In older adults were formerly called dementia acquired deficit in 1+ areas of cognitive fx. - Complex attn, learning/memory, language, exec fx, perceptual-motor, social cognition Mild NCD- characterized by impairment in a single cognitive domain, usually memory. Don't meet criteria for dementia Delirium- acute, dateable onset. Treatable/reversible Dementia (major NCD)- atypical changes in cognitive functioning - Types 1. Dementia with Lewy bodies- impairments in exec fx, perception, memory, visual hallucinations, ANS & sleep disturbances, Parkinson's like motor dysfx 2. Vascular dementia- inefficient blood supply to brain resulting in neuronal death. Symptoms vary 3. Alzheimer's disease- amyloid plaques, neurofibrillary tangles care in US- PACE, person-centered memory care communities, informal caregiving, therapy- light, music, art, storytelling, gardening, etc.

genitourinary system changes

Less efficient, diminished substance concentration regulation, weakened pelvic floor muscles/sphincters, decreased bladder capacity, enlarged prostrate, reduced hormones Consequences: prone to renal failure, difficult to excrete drugs, increased BP, dehydration, UTI/kidney damage, urinary incontinence, sexual dysfunction

digestive system changes

Loosened teeth, dry mouth, weak structures, alterations in taste/smell, decreased gastric acid & vitamin absorption, increased bile, decreased liver detoxification efficiency, slow motility, sphincter weakening Consequences: dysphagia, decreased desire to eat, cognitive fx, bone density, anemia, peptic ulcers, gastritis, osteoporosis, gallstones, medication overdose, constipation, fecal incontinence

nervous system changes

Loss of neurons & myelin, frontal lobe atrophy, unbalanced neurotransmitters, cognition, altered motor skills, diminished sensory input Consequences: Alzheimer's, reduced exec fx, less stage 3/4 sleep, shorter hesitant gait, slower FM & postural reflexes Age-related cognitive decline: episodic memory, attention, need more time for complex activities, slow processing, decreased working memory, sensory changes Changes in cognition that negatively impact function are NOT part of healthy aging

Driving

Means of driving- sign of adulthood, extension of one's personality/taste, freedom to make decisions as to where/when to go, enabler of participation in valued activities, sign of continued competence, loss of privilege threatens role as a respected person 1. Driving cessation can result in mental health issues, i.e. depression, reduced life satisfaction, isolation, loneliness 2. Pros about older adult drivers- # of accidents decrease, tendency to drive when conditions are safest, highest rate of seat belt use, lowest incidence of impaired driving 3. Importance of OT driving intervention- population is aging and driving into advanced age, higher crash rates when mileage controlled, changes in physical/mental abilities impact driving, frailty makes driving risky, self reg 4. OTs can address driving: meaningful activity, know medical diagnoses/aging process implications on driving, skilled in task analysis 5. OT generalist vs specialist roles in driving - Generalist- pre-driving screens, simple adaptations, identify alternatives, start retirement conversation - Specialist- can perform clinical and behind the wheel assessments, recommend special equipment, and establish driving potential & recommend cessation Certified Driving Rehab Specialist (CDRS) and Specialty Certification in Driving and Community Mobility (SCDCM- AOTA) Factors 1. Vision - Conditions that can interfere with driving: cataract, age-related macular degeneration, glaucoma, diabetic retinopathy, stroke - Visual acuity is not related to crash risk - Visual fields- side vision decreases with age; driver may not see signs, people stepping off curb, other vehicles - Contrast sensitivity- affects distance judgement; found to be a valid predictor of crash risk - Light/dark adaptation- night driving more difficult, more time needed to adjust to abrupt light changes - Color vision- not related to crash risk involvement - Dynamic visual acuity/depth perception- seniors inaccurately estimate approaching vehicle speed; use distance rather than speed to gauge when safe to proceed; may account for over representation in crashes when turning left across traffic, changing & merging lanes - Useful field of view- area that can be seen and cognitively processed and interpreted; becomes harder to process info quickly and track multiple items with age; visual attn restricted to area directly in front of driver; reduction of UFOV greater than 40% increases risk of crash by 16x 2. Cognition - Attention- selective, sustained, alternating, divided, lateralized deficit (neglect) - Memory- working memory declines, procedural intact - Exec functions decline with age- initiation, problem solving, planning/sequencing/anticipating, flexibility in thinking, impulse control - Older adult crashes related to: Inattention & slowed visual processed speed, intersections & left hand turns (high cognitive/perceptual demands), failure to heed signs & grant right of way - Visual perception/processing/spatial- visual perception remains stable with age, but visual processing skills appear to decline 3. Physical function- only small % must cease driving solely to due physical limitations - Reduced muscle mass & osteoporosis from aging contributes to physical frailty & increases death/injury risk - Old age diseases can cause neuropathies (diabetes), limit ROM, and cause pain (arthritis) - History of falls is associated with an increased risk for MVA 4. Medications - Can cause side effects, i.e. drowsy, dizzy, sleepiness. Seniors more susceptible to side effects due to # of meds taken and aging changes - Using certain meds, many meds, or not taken when needed increases chance of being in a crash - Ex) benzo, tricyclic antidepressant, opioid analgesic Generalist OT duty: determine whether driving is a risk for the client 1. Screen for red flags. Can administer pre-driving screen to identify need for referral to a DRS, not determining fitness to drive 2. Can make anonymous report to DMV regarding safety concern 3. Treat performance skills underlying driving 4. Plan ahead for conversation about driving retirement and alternative transportation options - Fit: eligibility, affordability, accessibility 5. Refer to DRS if you question medical fitness to drive

cardiovascular system changes

More adiposity, endocardium scarring, loss of autorhythmic cells, decreased cardiac output/max HR, atherosclerosis, ulcerations Consequences: hypertension, SOB, orthostatic hypotension, stroke, heart attack, aneurysms, peripheral vascular disease

addressing sensory changes

PEO Environment 1. Adaptable design- modifications for a person w/disability 2. Transgenerational/lifespan design: accounts for changes persons experience as they age 3. Universal design- for all ages/abilities, without adaptation - Why OT: knowledge of occupational performance, PEO, impact of conditions/disability/aging - 7 principles 1. Equitable use- useful for diverse abilities 2. Flexibility in use- provides choice of method 3. Simple and intuitive use 4. Perceptible information- communicates necessary info effectively, words & visuals 5. Tolerance for error- minimize hazards 6. Low physical effort 7. Size and space for approach and use Technology and tools 1. Assistive tech (AT) device (item) vs service 2. Augmentation of existing pathway- strengthen what is already available to them - Amplification- sound, i.e. hearing aid - Magnification- vision, i.e. glasses, magnifiers, etc. 3. Alternative pathway- can't use info from primary pathway - Tactile, substitution- slow, i.e. braille - Visual substitution - Auditory substitution 4. AT for vision loss - Optical aids- magnifiers, telescopes - Non-optical aids- enlarged print, high intensity lamps, high contrast - Electronic aids- CCTV, magnifiers - Computer access- high contrast, enlarged keyboards, Microsoft ease of access center, Mac accessibility features - Alternative pathways- automatic reading of text 5. AT for hearing loss- hearing aids, telephone access, closed captioning, assistive listening devices, alerting devices - Computer access- Microsoft visual cues for sounds. Mac closed captions and screen flash 6. Tech for active aging- smart phones, health monitors, smart homes, video games - Factors to encourage use for older adults: easy to use, meaningful, social support, economical, available training, privacy - Factors to encourage use for clinicians: customizable reports, tailored patient info, practicality, cost, clinically valuable info, more vs less care

Healthy People 2020 National Agenda

Reduce proportion of older adults who have moderate to severe functional limitations Increase proportion of older adults who engage in leisure-time physical activities Increase the proportion of health care workforce with geriatric certification Reduce the rate of ED visits due to falls among older adults

musculoskeletal system changes

Reduced bone density/mass, collapsing of vertebrae, decreased motor units/muscle fibers/synovial fluid, thinned cartilage Consequences: prone to fractures, decreased height, kyphosis, slowed reaction time, decreased strength/endurance/flexibility

integumentary system changes

Slow skill cell turnover, less melanin/collagen/elastin, decreased elasticity/hydration, inflammation, subpar sweat, decreased tactile/thermal sensitivity, decreased hair growth, fat layer thins Consequences: prone to abrasions/bruises/cancer, thinned skin, pigmentation changes, wrinkles, thermoregulation issues/overheating, increased pain threshold, white hair

Alzheimer's disease

Stages: 1. Preclinical- detection of biomarkers that indicate earliest signs 2. Mild AD- physical abilities not yet affected; cognitive changes emerge; anxiety and/or depression are common 3. Mod AD- more intensive supervision/care necessary - Older adult might transition to long-term care facility - Possible symptoms: memory loss, confusion, shortened attn span, less impulse control, wandering, motor impairment, behavioral & psychological symptoms 4. Severe AD- requires extensive support with daily activities - Possible symptoms: profound cognitive impairment, may not respond to own name or recognize family, difficulty communication, incontinence, dependence on others Various causes of death to which AD was a contributing factor: sepsis related to incontinence, aspiration pneumonia, skin ulcer, cardiac arrest, minimal oral intake Interventions 1. Activity mod, ADL training, tailor social activities, exercise, errorless learning, cognitive stimulation, enhance sleep, Montessori methods, multicomponent intervention to improve/maintain QOL 2. Environment- room design consistent with intended purpose, monitoring devices for fall prevention, compensations for perceptual changes, ambient music, multisensory, visual access to important amenities to reduce disorientation Early stage or mild dementia - Client/family education, impact on occupation, plan for future, available resources, routine is critical, compensatory strategies Middle stage or moderate dementia - Problem solve how to maintain independence, overlearn tasks to preserve habits/routines, sleep/rest, leisure/social, implement measures to decrease fall risk, bx management, caregiver training - must discontinue driving Late stage or severe dementia - maintain QOL, preserve routine & valued occupations, structure environment for sensory stimulation & safety, bed/ wheelchair positioning, stretching/ROM, family/caregiver ed, manage challenging behaviors, support services for caregivers

incontinence

Types 1. Transient- acute onset due to unexpected illness 2. Established/persistent- can only be managed vs cured 3. Urgent incontinence- overactive bladder, usually associated with leakage. "key in the lock" syndrome 4. Stress incontinence- related to lifting heavy things 5. Mixed incontinence- both stress and urgent 6. Overflowing incontinence- leakage 7. Functional incontinence- can't go to the bathroom when you need due to lack of functional mobility Intervention- habit/routine, pelvic floor exercises, fluid intake education, environmental, double voiding, prompted voiding

Well Elderly Study

WE I- goal to assess whether a preventive OT lifestyle redesign leads to improved health and well-being in ethnically-diverse, independent living older people WE II- replicated previous results, examine mediating mechanisms, and focus from efficacy -> effectiveness - Mediating mechanisms for depression outcome- activity frequency, activity significance, social connections, perceived control Vivir mi vida (VMV)- primary care, examine mediators, evaluate cost-effectiveness - Mechanisms of change 1. Behavior change- prompting focus on activity-health link (OT focus), activating patients (CHW) 2. Health behavior change- adaptive coping, heart healthy habits, physical activity

geriatric syndrome

a common health condition in older adults that does not fit into the category of a discrete disease multifactorial health conditions that occur when accumulated effects of impairments render an older person vulnerable to situational changes Functional decline, pressure ulcers, incontinence, falls, dementia Emerging syndromes- sarcopenia, polyprovider, polypharmacy, pain, frailty

dry macular degeneration

accounts for 90% of these cases, is caused by the slow deterioration of the cells of the macula thinning, white/yellow deposits of fatty protein. Fuzzy, blurred spot in central vision, decreased visual acuity Functional impact: reading, driving, details, safety

successful aging

across age continuum, unique per individual in physical, psychological, and social domains

Biological Theory of aging

addresses aging processes at the organism, molecular, and cellular levels Free radical- aging changes are due to the production of free radicals (antioxidants can combat the effects to a certain extent)

wet macular degeneration

an advanced form New blood vessels growing beneath the retina leak blood and fluid, damaging the retinal cells. These small hemorrhages usually result in rapid and severe vision loss abnormal blood vessel growth. White-out or dark blurriness in central vision; straight lines look wavy; decreased intensity of color brightness Functional impact: reading, driving, details, safety

fall

an unexpected/unintentional event in which the person comes to rest on the ground, floor, or lower level in older adults, falls are the lead cause of: nonfatal injuries, hospital admissions for trauma, fatal injuries risk factors: muscle weakness, history of falls, gait deficits, balance deficit, use of assistive device, visual deficit, arthritis, impaired ADL, depression, cognitive impairment outcomes of falls: injuries, costs, loss of independence, psychological trauma - causes 90% of hip fractures- decrease QOL, institutionalization safe falling: - backwards in squatted position (flexing knee and hip joints with muscle contraction) - forward with elbows flexed (outstretched arms) - sideways forward rotation to outstretched hands - stepping (reposition the foot more laterally when falling) - martial arts rolling and slapping techniques - relaxed muscles when falling

-narian

based off of decade age descriptor

Glaucoma

build-up of excess fluid that leads to pressure on the optic nerve Common in African Americans Peripheral blindness and tunnel vision Functional impact: bumping objects; difficulty reading, walking, driving. High fall risk

diabetic retinopathy

capillary leakage, bleeding, and new vessel formation (neovascularization) leading to scarring and loss of vision damaged retinal capillaries, fluid leaks into macula 1. Decreased near & distance vision - Scotomas 2. Functional impact- night driving, reading, mobility Types 1. Non-proliferative- most common. Micro aneurysms in your eye, hard exudates 2. Proliferative- associated with type I. abnormal blood vessel growth. Need strict glycemic and BP control to manage

cataracts

clouding of the lens build up of lens protein leading to cloudiness, blurriness, faded colors, halos of light Makes vision blurry and affects color discrimination

Adult Day Health Care (ADHC)

community-based program serving older adults and adults with chronic conditions/disabilities that might otherwise require a higher level of care objectives: restore/maintain optimal capacity for self-care; delay/prevent inappropriate or personally undesirable institutionalization

sexuality and sex

consider age, relationship status, family structure, culture, gender Barriers to sexual expression- erectile dysfunction, cultural expectations, physical health, cognitive changes, prejudice, communication with healthcare providers, privacy, social - Normal physiological changes in males: less testosterone, sperm, ejaculation force, premature ejaculation, less frequency of ejaculation with increased refractory period. Increase prostate size, duration to stimulate sexual excitement, lasting erection - Normal physiological changes in females: menopause, less estrogen, progesterone, pubic hair, vaginal secretions. External genitalia and vaginal wall shrinkage & thinning. Increase duration to stimulate sexual excitement and lubrication - LGBT+ challenges: stigma, reliance on informal family of choice, unequal treatment under laws/programs, fear of accessing resources Ex-PLISSIT Model- permission giving at all stages. Limited information, specific suggestions, intensive therapy (OT cannot do intensive therapy without specific certifications) STDs in older adults - Reasons= shame, practitioners not asking about sex life, no STD testing, no targeted prevention, some chronic illness masks symptoms, don't use condoms Areas of sexual concern- self-esteem, body image, relationships, family - Arthritis 1. Symptoms- fatigue, pain, ROM, mobility 2. Strategies- rest, pillows, hot bath, joint protection positioning, exercise regularly, communicate fears with partner CVA 1. Symptoms- sensory loss, perceptual loss, communication, body image issues, visual issues, loss of strength and mobility 2. Strategies- use touch, smell, vision, instead of speech. Comfortable positions, where is visual field. Vibrator to compensate for lack of strength. Stimulate areas with preserved sensation. Create general sensory experiences Heart disease 1. Symptoms- low endurance, medication issues with erectile dysfx 2. Strategies- passive role, relaxation techniques, masturbation, allow time for foreplay to slowly increase HR, avoid sex when overly anxious or too hot/cold, energy conservation, time energy

Sociological Theory of aging

consider the context in which aging occurs and the demands of the activities and the environments Life Course Perspective- to understand older people now, need to know their past 1. Emphasizes social and cultural factors (macro -> micro) that might influence the aging experience over time 2. Pathways between life phases and circumstances in early life affect later life health Continuity theory- past experiences, decisions, and behaviors form the foundation for the present and future 1. Goal of adapting to changes is to maintain patterns of thought, activities, and habits 2. Strategies used for adaptation come from past experiences

Social Security Amendments of 1965

created medicare and Medicaid (MediCal for CA) OT and rehab not a mandatory covered benefit of Medicaid but can be covered state by state. Older adults in CA can get OT and PT Funding for Long-Term Services and Supports (LTSS) is largely supported by Medicaid with an institutional bias Medicare- eligibility at 65+yo. Run by local coverage determinants (LCDs) - 4 Parts 1. Part A: Hospital Insurance- primarily inpatient, SNF, hospice, home health 2. Part B: Medical Insurance- primarily outpatient, DME, mental health services, therapy, preventative services, other 3. Part C: Medicare Advantage- incentivized to keep you healthy to save money 4. Part D: Medicare Prescription Drug Coverage- has donut hole coverage - Medigap- supplementary insurance Centers for Medicare and Medicaid (CMMS) is the single largest healthcare payer. Determines standard Medi-Medi gives more options, but uncoordinated services

ageism

deeply held human concerns and fears about the vulnerability inherent in the later years of life can be positive or negative

dark and light adaptation

difficulty driving at night, difficulty shifting brightness, need more illumination

Fall interventions

exercise, medication, client & family education Environmental ■ bathroom- grip surfaces, high contrast, high lighting w/low glare, bars ■ bedroom- appropriate clothing, carpet, right height bed, night lighting ■ kitchen- tidy shelves/counters, stove safety, grip floor, accessible cupboards, sturdy chairs ■ living room- table positioning, tidy cords, accessible phones, just right height chairs/couches, tidy room, bags/purses off floor ■ entrances/paths- appropriate carpet height, rails, stair precautions, lighting, contrast, beveled thresholds, secure rugs behavior- slow down, assistive device use, limit carrying heavy things FOF intervention- provide mastery experiences, social modeling, positive reinforcement, increase feelings of safety injury reduction education: fall alarms, falling techniques, restraints increase fall risk, emergency response systems, hip protectors other interventions: footwear, use of assistive/adaptive devices, tech options, multifactorial, community-based interventions, i.e. CAPABLE, LIFE, Stepping On, Matter of Balance OT vs PT- OT contextualizes interventions, balance confidence, home safety, occupational risk factors, risk strategies within routine

presbyopia

farsightedness caused by loss of elasticity of the lens of the eye, occurring typically in middle and old age difficulty with near vision/reading Loss of elasticity in ciliary muscle and suspensory ligament

end of life care

fear of death and losing control of the death process increases with age palliative vs hospice ■ palliative- active total care for illnesses that can't be cured (life threatening illness), any stage of the disease - treatment: symptom control, QOL, range from conservative to curative approach/life-prolonging ■ hospice- minimize pain and control symptoms once cure is not an option or desired (terminal illness) - client has life expectancy of 6 months or less to live - treatment: physical, psychological, emotional, and spiritual needs; typically no life-prolonging treatment, focus on comfort OT listens to the individual's priorities to live a life with comfort and dignity ■ OTs need support to combat compassion fatigue Advance Directive (AD)- living will, durable power of attorney, do not resuscitate, organ donation care

home health care

for Medicare, need to be under the care of a doctor and homebound ■ homebound- can't leave without help, leaving isn't indicated due to medical condition OT role: ADLs, home safety, chronic health conditions management OASIS = the assessment tool used

fall assessments

gait & mobility- Timed up and go test (TUG), gait speed, 6min walk test, Tinetti Performance Oriented Mobility Assessment (POMA), contextualized balance- max step length, functional reach test, unipedal & tandem stance test, beg balance scale, postural sway, 30sec chair stand, contextualized FOF & balance confidence- yes/no FOF, activities-specific balance confidence (ABC) scale, falls self-efficacy scale-international (FES-I), survey of activities and FOF in the elderly (SAFFE) cognition- MMSE, dual-task performance, routine task inventory, executive function performance test ○ home assessment & behavior: WeHSA gold standard but long, CASPAR, HOME FAST, FaB

factors that influence aging

gender & social factors- access, pensions, widowhood, poverty, life satisfaction, research cohort effects- very old- WWII, Great Depression, conservative/financial health (1910-1924), baby boomers- liberal, vietnam war, Gen X- self reliant, family-oriented, job focused, pragmatic, Gen Y/millennials- optimistic, collectivist, persistent, stubborn, Gen Z/iGeneration- smartphones, political upheaval public policy & SES- Older Americans Act (OAA), social security (dependency ratio decreasing), education & SES residence: environment, location (urban, rural, suburban), institutionalization ■ aging in place- live in space that is meaningful to them experiences/personal characteristics- genetics, personality traits, personal attitudes, self-esteem cultural factors- less developed vs more developed, health disparities social attitudes- people focusing on life, education, careers. attitudes influenced by education and self awareness roles- societal expectations of what's "appropriate". life roles and transitions

widowhood

gender, grief, health repercussions, social participation, practice implications. social participation is a protective factor women fair better after death of spouse due to an established social network, but men are more likely to get married again

mental health service barriers

general- stigma, discrimination, poverty, isolation systemic- fragmented health care system, mental health services not available in primary care until recently, workforce not specifically trained in older adults & mental health nursing home is defacto "psychiatric institution"- 65-80% of nursing home residents have diagnosable psychiatric disorder - most do not receive mental health services- inapprop meds, less psychotherapy - greater impairments: community living skills, social skills/networks, health - early mortality associated with obesity, cardiovascular risk factors, sedentary bx, poor health EBP: mental health services, but OT not listed - behavioral activation for depression- therapists work with clients to identify the ingredients of a "behavioral antidepressant" ■ building a hierarchy from easy to hard activities. grading difficulty - depression care management model- systematic, team-based approach to treating depression in older adults

Older Americans Act of 1965

improve community social services for older persons and established Administration on Aging

elder abuse

intentional actions to cause harm or failure to protect from harm or satisfy the elder's basic needs types of elder: physical abuse, psychological abuse, sexual assault, material exploitation, neglect, resident-to-resident mistreatment - LGBT: denial of visitors, refusal to allow same-sex couples to share rooms, refusal to place a transgender elder in a ward that matches their gender identity, keeping partners from participation in medical decision-making ■ experience physical/psychological abuse, denial of personal care services, involuntarily "outed," prevented from dressing to gender identity, refused admission ■ tricky to report: fear, cognitive deficits, mindful of parties involved risk factors- be careful not to assume, but to be vigilant - individual-level (victim): functional/financial dependence, poor physical health, cognitive impairment, poor mental health, low SES, older age - individual-level (perpetrator): relationship type, marital status -community and societal-level: geography, ageism, social/cultural norms - OTs most likely to encounter elder abuse in the home and community settings no universally accepted screening tool look for signs of elder abuse: physical, mental, environmental, relationships, social support self-neglect- a person's inability, due to physical or mental impairment or diminished capacity, to perform essential self-care tasks - most common referral to Adult Protective Services - person has right to make own decisions until court steps in - 4 goals of addressing the issue: address medical problems, secure safety, restore sense of control; victim empowerment, identify/eliminate cause supporting caregivers: attend to shifting roles/family dynamics, educate about effects of disease, consider caregiver emotions/self-esteem, provide resources - management & compensatory strategies: focus on occupation, define a new normal, let caregiver be the expert, assess safety, distract from difficult topics/situations, maintain relationships, "just right" challenge

fear of falling (FOF)

lasting concern about falling that can lead to an individual avoiding activities that they remain capable of performing consequences: fall, functional decline, restricted activity, depression, anxiety, decreased QOL & balance confidence signs of FOF: touch/hold onto objects during standing/ambulation; walk very slowly, take small steps, limit movement, express anxiety/FOF

depression

leads to premature mortality, morbidity, and diminished QOL - is not a normal part of aging. under-recognized and under-treated - often presents with unexplained physical complaints, i.e. fatigue, headaches, sleep disturbance - risk factors: changes in physical health, functioning, social support, circumstances activity engagement: - abandoned if: no longer found meaningful, no physical/cognitive energy, too much pain, has social demands because desire to be alone - sustained: tied to habits/commitments, independently made adaptations in order to continue engagement; found pleasurable, distraction, escape; "nudged" into action by family/friends, but also engaged to "hide" problems with mental health from others

time use

majority = leisure and sleep - inappropriate sleep during the day due to insomnia, medication, fatigue management

Age related changes

normal changes for older adulthood

aging

process for getting older ■ chronological- age since birth ■ biological- physiological changes, often focus on deterioration and malfunction of body ■ psychological- mental health and cognitive health ■ social- role transitions, relationships, social support, societal views

presbycusis

progressive deterioration of hearing associated w/aging, mainly involving higher frequencies Types 1. Conductive loss- blockages, infections 2. Sensorineural loss- damage to cochlea, CN VIII, related to hair cells within ear - Loud environments, head trauma, meds, tumors, HTN, diabetes Functional impact: clarity during conversations, need consonants to hear what people are saying

communication enhancement model

recognize cues based on individuality, i.e. don't automatically assume because of hearing aid, they can't speak, but speak in front of them. ■ can maximize communication

communication predicament model

recognize old age cues, stereotyped expectations, reinforced stereotyped bx, negative changes in rigidity of cues/constrained opportunities

restraints

right to be free from restraints; may be imposed only to ensure the immediate physical safety of the patient, staff and must be discontinued at the earliest possible time; right to safe implementation

tinnitus

ringing in the ears 15% of people, more males

Psychological theory of aging

seek to explain the multiple changes in the individual behavior in the middle and later years of the life span; boundaries addressed are amorphous Life Span Development Theory- ontogenetic development is biologically and socio-culturally constructed 1. Events at each stage affect future development 2. More variability in older adulthood than childhood 3. Interrelated lifespan trends - Evolutionary selection benefits decrease - Need for cultural resources increase - Efficacy of cultural resources decrease Selective optimization with compensation 1. Fundamental mechanisms: selection, optimization, compensation 2. Manage the dynamics between gains and losses as one grows older in order to successfully age

Program for All-Inclusive Care for the Elderly (PACE)

services ■ community services- specialty services, i.e. dentist, doctor; community outings ■ in home services- caregivers, home visits by nurses or therapists, install grab bars, provide equipment ■ PACE center- transportation, activities, therapy, meals access: 55+ yo, live in service area of the program, certified as needing nursing home-level of care, be able to live safely in community with the services provides a middle ground between SNF & home health - paid by government OT role: assessments, home visits/safety, evaluate need for DME, skilled treatment, supervise maintenance exercises & groups, report progress/problems/recommendations to interdisciplinary team

geriatrics

services for people who are older

work and retirement

societal norms and values- US society does not value older workers, want them to go into retirement characteristics of older workers- loyal, reliable, emotionally stable, get high ratings from employers retirement experiences vary widely successful adjustment to retirement- OTs can help with transitions

occupational deprivation

state in which a person is unable to do what is necessary and meaningful in their life due to external restrictions - factors why it happens in older adults: mobility, finances, health concerns

Gerontology

the study of aging

pressure ulcers

tissue damage caused when the skin and underlying soft tissue are compressed between a bony prominence and an external surface for an extended period; tissue ischemia that leads to necrosis area of localized damage to the skin and underlying tissue caused by pressure, shear, or friction

special senses

vision, hearing, taste, smell, equilibrium decreased info processing Consequences: difficulty differentiating food/taste intensity, dry mouth, decreased appetite, malnutrition, decreased hand function/strength

fraility

weakness age-related pathological state of loss of physiologic reserve -> vulnerability to stressors -> physical impairments, fx limitations, disability

themes of meaning in late life

○ instrumental- engaged in instrumental ADLs. meaningful, structure life ○ existential- end of life. spiritual, religiosity. "has my life been worth living?" ○ evaluative- happiness, satisfaction, QOL ○ identity- mastery and sense of control over life. life purpose. where do they fit as a productive member of society

Flip that SNF

● needs of older adults: independence, empowerment, privacy, autonomy, psychosocial interaction, communication access (internet), geriatric physical fitness, meaningful recreation ● nursing home life- predictable routines, lack of meaning, limited opportunities for productivity/engagement, lack of autonomy/QOL intervention, loneliness, depression, social isolation, disempowered ● evidence shows: ○ residents are typically sedentary and inactive- can lead to disability and decreased life expectancy ○ IADLs not encouraged as much as ADLs- functional mobility, eating, drinking ○ common issues for nursing home residents: cognitive, functional, pain, falls, bowel & bladder incontinence, pressure ulcers ○ staff face lack of stability, burnout, emotional exhaustion. overworked, lack experience, can't make decisions, undervalued, stress/worry, not enough help & not paid enough ● examples of culture change: The Green House Project (Eden), Wellspring Model, LEAP initiative, Village to Village ● OT role: empower clients/staff, make people feel valued, teach independence, provide meaningful activities, life balance, equipment & modifications ● shared governance- give frontline staff responsibilities for making decisions related to their practice (a decision-making model based on accountability, equity, ownership) ○ benefits: way to implement change, improve patient outcomes/care/satisfaction, increase staff morale/job satisfaction, facilitate personal/professional growth, increases staff autonomy and improves communication between teams

ageist communication

"ignoring talk"- team talks about the older adult like they are not there "task talk"- unit is busy and it's about productivity. no time for interpersonal "elderspeak"- infantilizing, patronizing speech that is simplified and overly "sugary" - seen a lot in nursing home settings

interaction strategies

1. Preventing agitation- modify environment, remove triggers, monitor personal comfort, simplify tasks, adapt routine 2. Responding or reducing agitation- back off, ask permission, reassure, listen, avoid arguing, redirect and involve the person 3. Let caregiver be the expert, no single right way 4. DICE- describe, investigate, create, evaluate

long term care

24-hour care provided for people with ongoing conditions who are generally unable to manage their ADLs Memory care- aimed to residents with AD, dementia, and other memory-related conditions

Senior

55+ yo

young old

55-77 or 65-75 yo

older adult

65+ yo

old-old

75+ yo

oldest-old

85+ yo

continuing care retirement community

A housing option characterized by a series of levels of care for elderly residents, ranging from independent apartments to assisted living to nursing home care. People enter the community in relatively good health and move to sections where they can get more care when they become disabled

Americans with Disabilities Act of 1990

A law that requires employers and public facilities to make "reasonable accommodations" for people with disabilities and prohibits discrimination against these individuals in employment and access civil rights law

patient centered medical home

A model of primary care that provides comprehensive and timely care to patients, while emphasizing teamwork and patient involvement. comprehensive care, patient-centered, coordinated care, accessible services, quality & safety