meghan quiz 1

Different older adults have different perspectives in different countries

ex. western countries vs. indigenous people

• Indigenous older adults are mentors, wisdom, critical, valuable

Myth
Most older people feel depressed and lonely

Reality

“Older people may, in fact, be somewhat better off—happier, less depressed, and even less lonely than the other adult age-groups” (Zarit, 2009)

Ageism

Ageism: prejudice against older people

• Phrase coined by Robert Butler in 1969

• Examples of ageism experienced by older people include jokes and feeling ignored, patronized, or treated with less dignity

Myth

Most old people live in institutions

Reality

Most seniors (91 percent of women and 95 percent of men) live in private households

Key findings from Rivera report

• Ageism is the most tolerated form of prejudice

• 63% seniors say they have been treated unfairly due to their age

• 79% canadians agree that seniors aged 75 years and older are seen as less important and more often ignored than younger generations

• 7 in 10 agree that Canadian society values younger generation more than older generations

• 1 in 5 canadians say older generations are a burden on society 

• Younger people and healthcare professionals are the biggest sources of ageism 

Grignon, Spencer, and Want (2010) report that older patients are less likely to get therapeutic treatment for acute myocardial infarction compared to younger patients. 

• 2 reasons

1. Older adults and their families may choose not to have invasive procedures

2. Doctors can rationalize care on the basis of age (beside ageism)

Elderspeak

• a simplified speech like baby talk that some people use when they speak to older people

• This form of speech uses few clauses, shorter phrases, filler phrases, simpler words, slower speech, longer pauses, use of words like dearie, cutie, and sweetie

• Implications: low self-esteem, lowers a person's ability to communicate effectively, decrease the quality of interaction, reduces the older person’s sense of control 

Ageism and discrimination in the workplace

• employers often think

• Older job hunters conceal their age 

• Overt and covert ageism 

Employers often think older workers as:

• Less flexible or creative

• Less alert

• More prone to accidents

• In poorer health

• Unfamiliar with new technologies

• More resentful toward innovation

• Harder to train

• Lacking in physical strength

• Less ambitious

• Less productive

• Less financially beneficial

Ageism and social policy/economy

• See aging population as a burden

• Higher cost for pensions and healthcare

Ageism and the third age myth vs. reality

• Third age: person lives in relative affluence, free of work and child-rearing duties, in generally good health

• Fourth age: at this stage of life, people lose their autonomy, their physical health, and their ability to care for themselves

Aging as disease

• Billion dollar anti-aging industry

• Sees aging as undesirable and preventable 

Combating ageism- TR's role

• Shift views about aging

• Examine our own myths, stereotypes, and behaviour toward other people

• Enhance our own knowledge about aging and the older population

• Notice how OA are treated in everyday life and media

• Contribution of research, more positive views of aging

• Education: as an antidote to ageism, more knowledge 

• Intergenerational equity: the call for balanced support of older and younger people through public policy and public expenditures

• Society for all ages: promotes the well-being and contributions of older people in all aspects of life, recognizes their valuable contributions, and reflects the goals and elimination of ageism 

• Guided by core principles: dignity, independence, participation, fairness, and security 

Gerontology: interdisciplinary vs. multidisciplinary

the study of aging

• Looks at how aging affects the individual 

• How aging populations will affect society

• Gerontology brings the opportunity for change through population study and recommendations

  can be interdisciplinary or multidisciplinary

• Inter

  • the process of developing an integration of methods that is traditionally thought of different fields

  • New approach of treatment 

  • many research projects today take this perspective

  Multi

  • working alongside each other, may share the data, no integration

  • Everyone comes with their own ideas, thoughts, research and lenses

• these are interchangeable

three areas of gerontology study: B, S, P

biomedicine 

• changes in physical health

Ex. Alzheimer disease, reaction time

Psychosocial

• Changes that take place within individuals and between individuals and groups

Ex. Alzheimers memory and learning, personality, family and friendship, rec and leisure

Socio-economic environmental

• Effects of aging on social structures such as 

  healthcare and education

Ex. Health care and education, policies

social gerontology

• Subfield within the wider field of gerontology

• Examines social side of aging as well as practice-related issues

• Looks at aging from perspective of individuals and society

theory

• how to explain something

• No one theory can explain the facts

• One theory will not apply to every older adult u work with

• valuable because it guides research and how we understand data

Alzeimers 

• how it impacts friend and family

• The work force 

Key Concepts in Functionalist Theories

• Age cohort

• a group of people born in the same period of time (e.g., between 1980 and 1995)

Key Concepts in Functionalist Theories

• Age grade

• concept used in age stratification theory to describe a period of life defined by society, such as young adulthood

  • Childhood, Adolescence, Y.A., Adult, 3^rd age (retirement), 4^th Age (late old age – physical decline)

Age Stratification Theory

• Movement of age cohorts over the life course

• People in each cohort flow through society’s predetermined age grades as they age

• Experiences of cohorts are similar

• Society changes as people age

• People change society; different norms,
  values, and roles of cohorts

• Each age grade has some expectations of roles and behaviour

Life Course Theory

• People develop and age at every stage of life

• Historical conditions and people’s environment influence experiences and opportunities in life

• The impact of life transitions (such as marriage or retirement), vary depending on when they take place in a person’s life

• People live interdependently. Their lives are influenced by the lives of others in their social network

• Individuals shape their lives through action and by making choices

Distinction between Transitions and Trajectories in the Life Course Perspective

• Transitions: changes in social status or social roles, such as marriage, parenthood, divorce, remarriage, and widowhood

• Trajectories: long-term patterns of stability and change that often include many transitions

Life course researchers' study three types of environmental effects:

• Non-normative events

• Normative history-graded events

• Normative age-grade events

Non-normative Events

• unexpected events such as illness, lay offs, and accidents

• not everyone experiences them

• people cannot plan for them

history graded events

Normative history-graded events shape the lives of many age cohorts, such as the Great Depression of the 1930s or World War II, covid-19

• Cohorts refer to a group of people born within the same period of time and who experience historical events at roughly the same age

• Generation refers to people who share an awareness of their common historical or cultural experiences but who may come from different age cohorts

Normative Age-Graded Events

Normative age-graded events: socially sanctioned events that occur most often at a certain age, like marriage or retirement

• Industrialized society includes stages of infancy, childhood, adolescence, young adulthood, middle age, and old age

 Age-status asynchronization: someone for whom major life events come early or late—a teenaged mother or a newlywed octogenarian—may feel out of sync with the age-status system in Canada

policy and programs as the outcome of research

• Research can have more than one purpose

• Can show how to improve the lives of individuals or prevent health problems

• Influence public policy that shapes government spending on senior-assistance programs

• Evidence-based practice promotes the use of research findings in the delivery of services to older people

• A way to bridge the gap between research and practice

• Promotes the use of research findings in the delivery of services to older people

• ex. fall prevention

Ethical Issues in Research

• • At least three ethical issues must be considered by researchers: 

  • The need for informed consent

  • The need to guard subjects against harm or injury

  • The need to protect individuals’ privacy

CLSA - canadian longtiudinal study on aging

• who was studied and when

Findings from Baseline Data Collection 2010-2015 using data collected from 50,000+ Canadians aged 45-85.

CLSA - canadian longtiudinal study on aging

what is the purpose of this study

• ^{why do some us age better than others}

• ^{Get a better understanding how people manage the challenges of aging}

• ^{Database for future research  and policy change}

• ^{Understand  health and disease of the group in terms of health care costs}

CLSA - canadian longtiudinal study on aging

what are they studying

• ^{look at longterm health and QOL} 

• ^{Collect information on the biological, medical, psychological, social, economic, and lifestyle aspects of peoples lives over 20 years}

• ^{Epigenetics are studied (25,000 genes can be turned off/on) seeing how these switches are changed} 

• ^{See how our environments and social aspects affects our health} 

CLSA - canadian longtiudinal study on aging

what are the benefits of the CLSA

• ^{we can identify factors that affect health}

• ^{Ex. Diet} 

• ^{They can help their children and grandchildren to live better} 

CLSA - canadian longtiudinal study on aging

how does it impact policy

• ^{as policies change, we can compare data on provincial and international levels}

• ^{We can follow trends} 

• ^{Come up with new technology}

CLSA - canadian longtiudinal study on aging

why should it continue

• ^{Database for future research  and policy change}

• ^{We can follow trends}

• ^{Come up with new technology}

What are the new patterns of health with older adults (ET and CHP)

Epidemiological transition: the transition a society makes when it moves from a rate of acute illness (mostly in youth) to a rate of chronic illness

Chronic health problems: long term illness such as arthritis, hypertension, diabetes, or heart disease

5 determinants of health and well being

1. income

2. social suppports

3. habits

4. environment

5. personal history

education is also a factor

aging differences between women and men

• Women live longer than men, but they also experience poorer health in later life 

• Women are more likely to have at least one chronic condition

• Women report higher rates of hypertension, arthritis, and rheumatism than men

• Older women also use more healthcare services

Social context can impose various constraints on personal choices when people strive to age healthfully. - social norms and expectations

Social Norms and Expectations: Society often has established norms and expectations regarding aging. These norms may include beliefs about what constitutes "healthy" aging, such as staying active, eating a certain way, or adhering to specific beauty standards. These expectations can pressure individuals to conform to these norms, limiting their personal choices.

Social context can impose various constraints on personal choices when people strive to age healthfully. - financial constraints

financial Constraints: Access to resources for maintaining a healthy lifestyle, such as nutritious food, gym memberships, and healthcare, can be limited by an individual's socioeconomic status. Economic disparities can significantly impact the choices available to people, making it difficult for some to make healthful choices.

Social context can impose various constraints on personal choices when people strive to age healthfully. - cultural beliefs

Cultural Beliefs: Cultural values and traditions can play a significant role in shaping personal choices related to aging healthfully. For example, in some cultures, certain dietary practices or forms of physical activity are highly valued, and individuals may feel obliged to adhere to these traditions even if they conflict with their personal preferences or needs.

Social context can impose various constraints on personal choices when people strive to age healthfully. - peer pressure

Peer Pressure: The influence of peers and social circles can be powerful. People may feel compelled to make choices that align with their social group's preferences, even if those choices aren't necessarily the best for their individual health. For instance, if a person's friends engage in unhealthy behaviors like smoking or excessive drinking, they may be more likely to do so as well.

Social context can impose various constraints on personal choices when people strive to age healthfully. - media and ads

Media and Advertising: The media and advertising industry often promotes unrealistic ideals of aging, emphasizing youthfulness and beauty. These portrayals can create pressure to take extreme measures to combat the natural aging process, such as pursuing costly cosmetic procedures or crash diets.

Social context can impose various constraints on personal choices when people strive to age healthfully. - health care access and info

Healthcare Access and Information: The availability of healthcare services and access to accurate information about healthy aging can vary significantly based on an individual's location, income, and social context. Limited access to healthcare and reliable information can hinder one's ability to make informed choices about aging healthfully.

Social context can impose various constraints on personal choices when people strive to age healthfully. - workplace demands

Workplace Demands: Many people continue to work well into their later years, and workplace demands can influence lifestyle choices. Long working hours, job-related stress, and limited opportunities for physical activity during work hours can pose challenges to healthy aging.

Social context can impose various constraints on personal choices when people strive to age healthfully. - family dynamics

Family Dynamics: Family obligations and responsibilities, such as caregiving for aging parents or raising grandchildren, can also impact personal choices related to health and well-being. These responsibilities may limit the time and resources available for self-care.

Social context can impose various constraints on personal choices when people strive to age healthfully. - Stigmatization and Ageism

Stigmatization and Ageism: Ageism, or discrimination based on age, can influence personal choices by reinforcing negative stereotypes about aging. When individuals experience age-related stigmatization, they may internalize these stereotypes and make choices that align with societal expectations rather than their own preferences and needs.

In summary, social context can exert significant influence on personal choices related to healthy aging, affecting individuals' behaviors and decisions in various ways. Recognizing and addressing these social constraints is essential for promoting more individualized and holistic approaches to aging healthfully that align with each person's unique circumstances and values.

theories associated with aging: SOC

Selective optimization with compensation (SOC): Those who age successfully use the SOC method. They select activities that optimize their ability. When they can no longer engage in an activity, they compensate for losses by setting new priorities.

• Senior Games – optimize ability

• SES impacts outcomes (high or low)

• 98 year old swimmer 

• Strength approach

Healthy aging: Canadian perspective

• two main reasons for making heathy aging a policy priority

The government of Canada has made healthy aging a policy priority

Two main reasons drive these efforts:

• The people of Canada want to have programs that improve the lives of older people

• Health promotion can delay and/or decrease the use of expensive healthcare services 

What Accounts for Population Aging?

• two trends worldwide

• Decline in birth rates: total fertility expected to drop from 2.8 children per woman in 1995–2000 to 2.15 in 2045–2050

• Longer life expectancy: expected to increase from 65 years in 1995–2000 to 76 years in 2045–2050

• all regions and most nations are aging

Baby Boom and Baby Bust

• Baby boom: the sharp rise in the fertility rate in Canada from about 1946 to the early 1960s (dates vary)

• Baby bust: the sharp drop in the fertility rate from the mid-1960s on

Immigration in Canada: ethnic diversity

• 1 in 4 people counted during the 2021 census are or have been a landed immigrant or pr permanent resident in Canada 

• Immigrants before 1990 came mostly from the United Kingdom or Europe

• Mostly younger immigrants (most between ages of 25 and 54)

• More recent immigration patterns will change the character of Canada’s population: more from Asia, Caribbean, South and Central America, Middle East

• increases the dviersity of all age groups

Ethnicity and Diversity in Canada

• The number of visible minorities in Canada has increased at a much faster rate than the population as a whole

•  One in five Canadians is a visible minority, defined by the Employment Equity Act as “persons, other than Aboriginal persons, who are non-Caucasian in race or non-white in colour.” 

•  The immigrant and refugee population in Canada is marked by the diversity of the migrants’ countries of origin, ethno-cultures, languages, religions and other characteristics. 

•  Language diversity is pronounced, with more than 200 languages reported as mother tongues. Most immigrants (more than 70%) report a mother tongue other than English or French. 

•  Canada’s religious landscape has changed over time. Two-thirds Canadians are affiliated with a Christian religion; one-quarter have no affiliation. The increased shares of recent immigrants are Muslim, Hindu, Sikh and Buddhist. 

Demographic Profile: Snapshot of immigrant and refugee seniors 

• Mirroring the overall pattern in Canada, the population of immigrant and refugee seniors is increasingly diverse.

•  The population of visible minorities among seniors has grown from 2% of Canada’s senior population in 1981 to 8.1% in 2011 to 18.1%  in 2021 (stats can).

•  Approx. 63% of immigrant seniors (65+) who arrived in Canada over the past five years (2012 to 2016) reported that they were unable to speak either official language.

• Immigrant and refugee seniors are more likely to live in poverty, have poorer health (perceived health status and chronic diseases), and face challenges in accessing services. 

Truth and Reconciliation and Indigenous Elders

• ➢Indigenous elders often experience problems with formal health care services

• lack of cultutral practices in HC

• Historically, marginalized groups, specifically Indigenous groups have been abused for the benefit of the health care system. 

Canadian diverse ethnicity

• Consideration for the TRP

• Not all older adults are homogenous

• Examine one's bias

• Be culturally aware and informed

  • Know the barriers and challenges face

  • Understand risks associated

• Do your own research

• Examine your language

• Include OA, their family and other disciplines 

• Understand the different benefits and challenges faced by generations 

Barriers and opportunities older adults face

Barriers:

• Stereotypes

• Language

• Access to information

• Self fulfilling prophecy 

• Cohort views

• Transportation 

• Funds 

• Lack of personal resources

Opportunities:

• community clubs 

• Offering free/lower cost programs 

• Hire translators for brochures

• Reaching out or collaborating with cultural centres 

• Having presentations on different leisure education 

• Resources, ask for funding/donations

• Intergenerational programs 

• Checking our own biases and being open to continue our learning

Sexuality and Healthy Aging

• reasons for dating

• trends

• •50-80% of adults over 60 are sexually active 

• •Men tend to be more sexually active then woman

• •Sexual satisfaction remains relatively high

• •Reasons for dating: to find a marital partner, stay socially active (women believe it brings prestige, men want a confidant and a sexual partner)

• •Generally, men seek younger partners and women seek older partners (at least until age 75)

• •Online dating likely to increase. Baby boomers are increasingly reconnecting with old friends on Twitter and Facebook, providing new dating opportunities

Sexuality and Healthy Aging

• normal aging can bring changes that impact _______

• Many stereotypes exist about older adults’ activities and their sex lives

• Normal aging can bring positive changes

• Most older people have an interest in sex throughout life, and given good health and a partner, older people can and do have sexual relations into old age 

• Women tend to stop having sexual relations earlier than men; men have a longer “sexually active life expectancy” (Lindau & Gavrilova, 2010, p. 1; Hyde et al., 2010). Whether women continue having sex depends on availability of a partner and health.

• Normal aging can bring changes that impact the mechanics and enjoyment of sexual activity (chronic pain, deconditioning, incontinence, medications etc)

Changes in Sexuality Due to Aging

• men vs. women

• Men: gradual decline in testosterone production

• Women: decline in estrogen

• Change in sexual function can damage self-concept; impotence for men is very challenging and means becoming “old,” but for women growing older is sexually liberating 

• Use of drugs to enhance sexual performance increasing (e.g., Viagra)

HIV/AIDS and Sex in Later Life

• can be misdiagnosed or underdiagnosed

• HIV/AIDS may show up more among older adults due to contracting it earlier in life or sexual contact without protection in later life

• 12.4 percent of all reported AIDS cases occurred in people 50+ between 1979 and 2008 (Public Health Agency of Canada, 2010) 

• Older men (50+) face the greatest risk (through heterosexual contact and sex with other men) 

• Lack of knowledge about HIV/AIDS among older people and among healthcare and policy experts

Changes in Sexuality Due to Aging

• why has it taken so long to address?

• comfort w own sexuality

• cultural, moral values, and attitudes (ex, cultures or religion)

• lack of understanding of how aging and dementia affect sexuality

• not knowing how to talk about sexuality

• beleifs about older adults with disability and sexual expression

• not knwoing how to best respond

Sexuality in Complex Care

• common trends, behaviours

• Desire for SA remains

• Socially inappropriate disinhibited behaviour (public masturbation, taking off pants in the dining room)

• Multiple partners or non marital sexual activity

• Same sex and transgender intimacy

• Sexually explicit materials, sex workers

• Very little privacy 

• STIs

Sexuality in Complex Care

• barriers to sexuality, staff, family, children etc.

• Views of staff (religious beliefs, values)

• Facility Policies can limit a person’s sexual activity

• Adult children’s reaction to parental need for intimacy

• Fear of consensual activity between cognitively impaired residents

• Married resident’s activity with others

• Protection from exploitation or abuse (often by other residents)

Dementia, Intimacy & Sexuality

• Alzheimer’s Society Article

• why a behaviour is occuring

individual freedoms are preserved

• It is important to do a thorough investigation of why the behaviour is occurring if we are to be able to meet/address the person’s needs

  • A man may remove his pants in public to indicate he wants to go to the bathroom

  • Another may touch the genital area, and this can mean the person has a UTI

  • Some attempts at kissing may be an indicator of loneliness

Needs change

• May seek companionship with a new partner (lack of recognition, remembrance)

• Try behavioral approaches (physical exercises) as an outlet for expression, tension reduction

• Always treat with RESPECT & DIGNITY

Case Study Example

Sid, 83 years and Jean 85 years live in a care community. Sid has mild dementia and is able to make all but financial decisions. Jean has moderate dementia, needs direction with all aspects of life. They have a caring relationship holding hands and kissing. Staff have started to see Jean going into Sid’s room…

Should we involve ourselves in Sid and Jean’s sexual relationship? 

• Jean has moderate dementia needs direction in all aspects of life, issues of consent 

How do we assess the possible risk to both individuals?

• talk to Jean and Sid, talk about capacities, provide education on consent 

How do we assess capability?

• GP carries out assessments, health literacy 

Who decides? Should we include family in the decision making?

• consider values

• Involving children and immediate family 

• there is no legislated test to measure capacity 

When and how do we intervene?

Sexuality in Complex Care

• tips and strategies

• provide privacy

• distract with activities that suggest comfort/keep hands busy

• avoid approaching in ways that may be misunderstood - stroking knee/holding hands

• sexual aadvances - distract

• offer a body pillow

• put a pillow in lap

• stay calm and dont judge/scold

Sexuality in Complex Care

• change of thinking

• staff

• Give staff members information about sexuality in later life

• Examine staff attitudes toward sexuality in later life

• Provide skill training so that staff can work effectively with residents

• NEED TRAINING: to consider residents’ need for privacy and to recognize barriers to sexual expression faced by residents (physical limitations, medication, attitudes of staff and families)

Safe and Visible: Creating a Care Facility Welcoming to LGBT Seniors

How might one create a welcoming and accepting care home for someone who is 2SLGBTQ+? 

How would one maintain a safe environment for these individuals?

• small symbols

• universal bathrooms

• using the samelanguage - partner

• Showing what a safe space is 

• Celebrating pride like they would celebrate valentines day 

• Screening future employees

2SLGBTQ+ Seniors in care

• statistics

• Older  adults in the 2SLGBTQIA+ community confront the same issues everyone else does when choosing aging services -- where to live, how to afford rising costs of housing and healthcare, and how to stay with loved ones 

• Stigmatization, lack of identity-affirming treatment and experiences of discrimination and violence 

• Stigmatization can lead to avoiding necessary services, chronic stress and increased social isolation among 2SLGBTQIA+  older adults.  

• Approximately 20 percent of 2SLGBTQIA+ older adults are people of color who as a group face increased health disparities, higher levels of stigma and have experienced more 2SLGBTQIA+ -related discrimination than their white counterparts, leaving them more at risk of not seeking or receiving the services they need.

• concerned about how they would be treated in LTC (refused, harassment, physical or verbal)

LTC EQUALITY INDEX (LEI)

• what does it promote

• Promote equitable and inclusive care for 2SLGBTQIA+ older people in residential long-term care communities.

• SAGE, the world’s largest and oldest organization dedicated to improving the lives of 2SLGBTQIA+ older people, and the Human Rights Campaign Foundation (HRCF), the educational arm of the nation’s largest civil rights organization working to achieve equality for LGBT people, are joining forces to launch the Long-Term Care Equality Index (LEI)

• The LEI will encourage and help long-term care communities to adopt policies and practices that provide culturally competent and responsive care to 2SLGBTQIA+ older adults.

chronical aging

Actual amount of time a person has been alive

- this does not change regardless of what you do 

Biological Aging

Physiological aging 

• the age your body is 

• Where diet/exercise/sleep patterns, stress management, genetics, attitudes 

• Benefits for those who take responsibility 

• Maintaining a healthy lifestyle may reverse symptoms of biological aging

Psychological Aging

perceived age

• How old one feels, acts, behaves

• Refers to the psychological changes including mental functioning, personality

• Subjective (one's own experience)

Common Age Associated Impairments

Arthritis

• inflammation or swelling of one or more joints. 

• More than 100 conditions that affect the joints, tissues around the joint, and other connective tissues. 

• Can cause depression, anxiety

• Being in pain can impact social relationships

Among Most Common:

• Osteoarthritis usually comes with age and most often affects the fingers, knees, and hips. 

• Rheumatoid Arthritis is an autoimmune disease where the body mistakenly attacks the lining of the joint

Common Age Associated Impairments

COPD  Chronic obstructive ____

• risk factors

• Chronic Obstructive Pulmonary Disease

• A chronic inflammatory lung disease that causes obstructed airflow from the lungs. 

• Symptoms include breathing difficulty, cough, mucus (sputum) production and wheezing.

Risk factors for COPD:

• Smoking (most common cause)

• Asthma

• Age: Most people are 40 or older when their symptoms start up.

Common Age Associated Impairments

Stroke

• Cerebral Vascular Accident

• An ischemic stroke occurs when the blood supply to part of the brain is interrupted or reduced, preventing brain tissue from getting oxygen and nutrients. 

• Brain cells begin to die in minutes. 

• A stroke is a medical emergency, and prompt treatment is crucial. 

• Early action can reduce brain damage and other complications.

Common Age Associated Impairments

Macular Degeneration

• Age-related macular degeneration (AMD) is a disease that affects a person's central vision. 

• Visual distortions, such as straight lines seeming bent.

• Reduced central vision in one or both eyes.

• The need for brighter light when reading or doing close-up work.

• Increased difficulty adapting to low light levels, such as when entering a dimly lit restaurant.

• Increased blurriness of printed words.

Common Age Associated Impairments

Glaucoma

• Not a part of normal aging, but age is a risk factor 

•  a group of eye diseases that can cause vision loss and blindness by damaging a nerve in the back of your eye called the optic nerve

How do common age associated impairments impact psychosocial well-being?

• Consider pain, immobility, fatigue, discomfort, medication, apts, impaired vision, hearing, sensory confusion impact social and emotional well being... how does it challenge relationships..

• class discussion

Withdrawal from activities, isolation, impaired relationships, demoralising, depression, loss of independence,  strained relationship (changed roles), fear of showing disability, frustration and anger , language and communication challenges , low energy

LIMITS ON ACTIVITY  DUE TO PHYSICAL DECLINE

• Functional disability: a limitation in the performance of normal daily activities due to illness or injury

• Disability increases dramatically in later old age as a result of chronic problems

• Can decrease quality of life and subjective well-being

• Women experience higher rates of disability than men

• Disabilities impair functions such as mobility and agility

• Many seniors report needing more help than they currently receive

• About 1 in 10 people over 75 need assistance with personal care (e.g., washing, eating, dressing)

Effects of Functional Disability
on ADLs and IADLs

• Activities of daily living (ADLs): activities performed daily, such as bathing, moving from a bed or chair, dressing, getting to and using the toilet, eating, and walking

• Instrumental activities of daily living (IADLs): home-management activities such as using the phone, cooking, shopping, managing finances, and doing light housework

Prevalence of Functional Limitations and Support Needs

• 5 conditions

• Five conditions—foot problems, arthritis, cognitive impairment, heart problems, and vision—contributed most to ADL and IADL disability

  • Decline not inevitable and not linear; further, two-thirds of older people report no limitations

COPING WITH PHYSICAL CHANGE:
Changes in the Environment

• Changes in the environment—including changes in the way other people speak to or treat an older person—can help that person cope with physical decline

• Product innovations and designs for older people: such as design of cooking utensils, bathroom grab bars, anti-slip mats; talking books and computerized reading aids; better remote-monitoring technology; assistive robotics

• making things more accessible 

TR

• thicker paint brushes 

• Bigger playing cards

COPING WITH PHYSICAL CHANGE:
Improvements in Technology

• •Self-care can take many forms, from exercise, to diet, to environmental modification.
  

• •Technology can also help a person maintain good health. 

• •Despite the promise of computers to improve the everyday life of older adults, gerontologists still report the presence of a digital divide

• •Seniors with high levels of education and income have the best access to computer technology

Improvements in Technology:
The Use of Computers to Enhance Everyday Life

• Online shopping for housebound people

• internet banking from home

• Connecting with family and relatives

• Skype, Facebook, Twitter, video chats

Improvements in Technology:Digital Divide

• Digital Natives v Digital Immigrants

• Lack of familiarity, training, price, hard to use systems can present barriers 

• New cohorts of older people will

  Feel more comfortable using technology!

Improvements in Technology:
Assistive Devices

• Older adults with disabilities use a wide range of non-medical assistive devices, and many of them use  medical devices such as hearing aids, mobile phones, powered wheelchairs, corrective glasses, and powered recliners

  Three things are necessary for an aid to be useful. People must:

(1) know about them

• (2) understand their usefulness

• (3) be able to afford and access them

People must

• know about them

• Understand their usefulness and benefits

• Be able to afford and access them 

Ex. Glasses, powered beds, mobile phones, hearing aids 

Changes in Lifestyle

Diet:

• Metabolic rate decreases with age (don’t need to eat same number of calories)

• Vitamin supplements are helpful to replace nutrients if loss of appetite is experienced

• Slowing of the system with age may mean more sensitivity to extremes

• Prevent health problems by cutting salt and saturated fat

Stress Reduction:

• Variety of health promotion options: water aerobics, tai chi, yoga, acupuncture, chiropractic treatment, Reiki

• •

Exercise: Slows the effects of aging on the body. It can reverse declines in physical function, reduce the risk of chronic illness, and lead to overall feelings of well-being.

Hypokinesia

Hypokinesia: physical problems due to lack of movement

• •

• •Compared with other age groups, people aged 65 and over reported the lowest rate of moderate activity in their leisure time

Falls

• •Falls: can lead to further illness and death

• Causes of fall are multifactorial; removing tripping hazards in the home, clearing ice away, and being careful with medications can help prevent falls

• Exercise, however, is the single most important intervention for preventing falls

REAL risk 

Major consequences

• lead to further illness and death 

• Psychosocial implications 

Great fear when older adults fall

• could be multifactorial 

• Lots of preventative matters

• TR

• : increasing evercise 

Falls Management

• Agility is required for prevention and is significant in activities like DRESSING

• 1/3 of seniors are concerned of future falls

• Most common cause of injuries to seniors in Canada

• Women make up > 2/3 of seniors injured in falls

• 2008 cost for hip fracture: $21,285

• 23% who suffer a hip fracture die in < 1 year

• Programs focused on footwear, medication side effects, household hazards, and exercise benefit

• Increased knowledge and exercise can lower fall rates

Healthy aging and common age impairments

• how do we help prevent

• While we cannot control our chronological age, our biological (physiological) age and psychological age can be influenced by lifestyle

• Need to keep responding to structural lag: a mismatch between changes in the older population (better health and more active lifestyles) and the roles and places in the social structure that can meet the needs of this new older person

• Wide range of options needed to growing leisure, recreation, and educational needs of older people (considering different income, health, educational, and personal goals) 

TR Interventions/Considerations for Common Age Related Impairment

SBN lists 

• make modifications with interventions

• Ex. Bigger drumsticks with OA with arthritis 

Falls

• loss of autonomy 

• Shame 

• Prevention is key 

  • Exercise, clear spaces, use signageTR interventions: exercise (we are not PT or rehab)

• creating a safe environments 

• Leisure education: habits, daily routines, new leisure skills, community resources

COPD

• Lifestyle interventions, exercise, 

Visual and hearing:

• technology: glasses, hearing aids, VR

• Sensory rooms

• Communication: pointing, pictures 

• Use of tech if available

• Engage senses

Arthritis 

• SOC: swimmer found new activities to compensate for any losses

• Adapting to optimise and compensate for losses

• Strengths based approach, identifying barriers, need just flips the barrier 

• Self management strategies

Life After Stroke

• intrinsic motivation helped with participation in leisure interventions/rehab

• Improves social interaction 

• Improvement of F/G motor skills

• Lots of leisure education

• Choose to be active

• Identify interests 

• “ Strengths, makes making goals and objectives easier

• Consider adaptations 

• Identify supports

parkinsons disease

• what is it

• symptoms

Progressive neurodegenerative disease

• as dopamine decreases there is an impact on muscle movements

• Slower, rigid, more tremors

• 2^nd most common degenerative neurological disorder after Alzheimer’s disease 

• Progressive neurodegenerative disease

• Caused by the progressive loss of dopamine brain cells (neurons) in a part of the brain called the substantia nigra, which produces the chemical dopamine (neurotransmitter). 

• As cells die, less dopamine is produced (The Michael Stern Parkinson’s Research foundation)

• Dopamine acts as a chemical messenger, allowing nerve impulses to travel from one nerve cell to another. 

• This enables the transmission of messages to muscles of the body to begin voluntary movement.

• As dopamine continues to decrease, muscle movements become slower and more rigid, tremors can develop and reflexes become more impaired contributing to a loss of balance

parkinsons - causes

• Genetic and / or environmental 

• Definitive cause is not known

• 5% of cases are hereditary

• It is believed that there are a variety of triggers including exposure to toxins (environmental), dopamine neuron vulnerability, lifestyle, severe head injuries.

      (Parkinson’s society of BC)

parkinsons disease - signs and symptoms

Bradykinesia (slowness in movement) plus one of the following:

• tremor 

• Rigidity

• Stooped posture

• Balance issues

• Difficulty initiating movement

• Speech

parkinsons disease - cognitive challenges

Difficulties can include:

• concentrating

• planning & sequencing tasks

• Language deficits (word finding, articulation)

• Changes in perception

Some people with PD also have dementia – although this number is fairly low.

parkinsons disease - mood related symptoms

Most likely caused by physiological changes in the brain 

• Apathy – low energy, lack of interest in activities  

                   & low motivation 

• Anxiety

• Depression 

• ➢Mood related issues can be extremely hard for caregivers to deal with 

  • ➢Change of roles

parkinsons - physical effects FREEZING

• The temporary involuntary ability to move – cause unknown

• The inability to move your feet; described as your feet being stuck to the ground

• Mainly occurs when initiating movement

  • Lasts a few seconds to a minute

  • Typically occurs in doorways, initiating movement, turning, unexpected visual or auditory stimulation (changing surfaces, multitasking, stopping or slowing down)

  • Develops in later stages of disease

  • Unpredictable and anxiety provoking 

parkinsons - Managing freezing
Getting “un-stuck”

Visual Cues – teaching clients to visualize stepping over an object; walking with a friend; carrying a cane or pointing stick

Auditory Cues – counting, repeat left right, rhythmical music, verbalize that there is no rush; take their time; reassure 

Physical Cues -  take a deep breath focus on balance; shift person’s weight from side to side; keep calm and wait.

parkinsons - effects on communication - hypophonia, Micrographia, Hyponemia

Hypophonia 

•  low quiet voice​

• Voice starts off as softer and monotone, then progresses to lack of speech production

Micrographia

•  – handwriting & drawing that can look shaky, cramped small leading to reduced legibility

Hyponemia

• Reduced facial expression

Important pieces of Communication that are impacted

• hearing aids, pocket talkers, breathing techniques SLPS

• Larger pens, typing 

We want to understand our client

- ppl living with Parkinson’s can be misunderstood