Aging and Function for People with Developmental Disabilities

Common age related changes and
medical conditions:
Impact on function for Persons with
Developmental Disabilities

Sandy Ceranski, MS, OTR
August 23, 2005
For Phoenix Health Care Systems
sceranski@cco-cce.org
age.r/t.chges.impact.function.persons.w.d.d.
1

Learner Objectives:

1. Understand signs and symptoms of typical “age-
related” changes and medical conditions
experienced by older adults
2. Understand the impact these changes can have on
daily function, participation and quality of life
3. Identify common strategies that support
– Function
– Participation
– Quality of Life

2

Lead with your conclusion…
• Age related changes and medical conditions affect all
persons including persons with DD
– May not be able to adequately communicate the changes they
are experiencing
– Care providers must be responsible to identify changes and
arrange for necessary professional assessment and
interventions
– Many interventions exist that can
• Restore lost skill, develop new skill
• Compensate for lost skill by modifying activity, environment,
objects, expectations
• Prevent further disability and promote health

3

Aging is a developmental process
• Starts at birth
• Gradual changes in body structures and systems
• We all experience
• Not all changes at same rate and same impact
• Changes can impact function, participation and
quality of life

4

Next 4 slides are from presentation:
HOME MODIFICATIONS
(permission granted to use 10/2004)

Thanks to:
Kenneth R. Tremblay, Jr., Adetania Pramanik,
and the Gerontology Action Team

2002

5

Aging Process
How time takes its toll
How time takes its toll
Your 80s
• Women become particularly susceptible to
Your 70s
Your 60spressure is hip to 25% higher than in
Your 40s disabling 20 fractures. They are
falling and
• Blood
Your 50s
••generally out conversations and by now have
Making weaker than men becomes harder,
The body burns 120 fewer calories a day
the 20s.
• The ability to see in dim light orhips and
especially for men, bone mass in the under
thanover half the as noises and other stimuli is
• Reaction to loud high-frequency hearing
lost at age 30 making weight control harder.
deteriorates further. or to catch sight of
conditions of glare,
•upper legs. thethe inner ear erode the massages
delayed as in brain’s ability to send ability to
Changes
•moving objects, diminishes.more people about
•Blood-sugar levelsat maximum exertion, are
The heart beats, rise and
hear higher frequencies for men -- who lose
slows.
• Loss of strengthcompensates by diminishes.
diagnosed with adult-onset diabetes. expanding
but as muscle mass
25% slower --than twice as fast ability to learn
• Short-term memory and the as women do.
•hearing are stiff in the morning. cancer
• Joints more moreinfections and
and pumping totoblood per beat.focusing as
Vulnerability
••spoken sexual daydreams all but vanish after age
Men’seyes begindecline. trouble personality
The material
increases.
have
• The stereotype not withstanding,
• lenses become thicker.
the Researchers don’tmen why.
65. More change with age. show signs of
doesn’t
than half of know
A cranky 80-year-old
coronary-artery disease.
was a cranky 30-year-old.
sceranski@cco-cce.orgfrom US News & World Report, “How6time takes its toll”
Adapted

Aging Process
Normal aging process means:
Normal aging process means:
• Health-related changes -- The most common
•health limitations are arthritis, heart-- Visual
Sensory and perceptual changes problems,
and auditoryproblems,decline with aging. The
respiratory systems and stroke-produced
eye loses acuity, becomes more sensitive to
difficulties.
glare, and is less able to distinguish between
• Motor capacities: strength, dexterity, and
colors. Hearing capacity degenerates, with the
higher frequencies effected first. capacities
flexibility -- A decline in motor
results from reductions in muscle mass. Older
•adults often changes -- Cognitive decrements
Cognitive experience difficulties in
bring about decreases in reaction time,bending
performing daily activities, including spatial
visualization, word fluency, processing, chair,
knees or back, sitting and rising from a short-
term memory, and retrieval. faucet, and
crouching, turning on/off a
switching a lamp.
7

Aging with a
Developmental Disability
• Experience same age related changes
• Same medical and mental health problems as general
population (Hotaling, 1998)
• May start earlier, as early as 35 (Connolly, 1998)
• May occur faster rate, especially persons with Down
Syndrome (Lubin, 1985)
• Chronological age:
– inconclusive as to whether it is an appropriate measure to use
when looking at aging

8

Aging with a
• Persons with profound MR
↑’d mortality rates r/t respiratory disease than higher
functioning persons
• Persons with CP or Down Syndrome ↑’d risk
osteoporosis at earlier age
– Immobility & Vitamin K deficiency (Wageman, 1998)
• High incidence of fractures with epilepsy
– Anti-epileptic drugs may produce osteomalcia (Lohia,
1999)

9

Aging with a
• Higher Nutritional risks
– Complications from diets high in
• sugar, fat, cholesterol, excessive caffeine &
tobacco
– Malnutrition
– Medications effects and dietary outcomes
– Eating habits and stress

10

Aging with a
• Higher “Lifestyle Risks” for health status
– Sedentary lifestyles – higher levels of inactivity
• Obesity and its health related problems
– CAD, Type 2 Diabetes
– Challenge:
• How to ↑ participation in physical activity daily
• How to best promote healthy aging
– Mind-body factors, nutrition, wellness and physical activity

11

Aging with Down Syndrome
• Unique medical needs and concerns (Burt, 1995)
↑’d epilepsy, mitral value prolapse, infection susceptibility,
hypothyroidism
• Functional consequences: lethargy, fatigue, ↓’d participation in
ADL, confusion and depression (Fenderson, 1998)
– 35% to 60% congenital heart malformations
• Many are uncorrected from baby boomer generation
↑’d visual & auditory problems & ↑’d severity
• Cataracts in 46%
↑’d sensori neural hearing loss
• Chronic and excessive accumulation and impaction of ear wax

12

Aging with Down Syndrome
(cont.)
• Hypotonia in 88% to 98%
– Joint hyper flexibility causes orthopedic and
motor problems
• Most significant: atlantoaxia (AA) instability
– Usually asymptomatic, but AA dislocation or subluxation
can lead to compression of spinal cord, quadriplegia and
possible death (Fenderson, 1998)

• Alzheimer’s Disease
↑’d likelihood with DS than general population
13

Impact of Age Related Changes
and Medical Conditions
• Substantial ↓ in Function and Societal
participation
– Made worse by imposed “Activity Limitation”

14

Common Medical Conditions that
affect Vision
• Some of these conditions can be treated, slowed or
reversed with early and professional intervention
– Cataracts
– Macular Degeneration
– Diabetic Retinopathy
– Glaucoma
• Combined with “normal aging” vision changes
– Can cause severe deficits in functional vision also
known as “low vision”

15

Normal Vision
• A person with
normal vision or
vision corrected to
20/20 with glasses
sees this street scene.

16

Cataracts
• An opacity of the lens
results in diminished
acuity but does not
affect the field of
vision. There is no
scotomoa (a distorted,
empty or dark area),
but the person's vision
is hazy overall,
particularly in glaring
light.
17

Macular Degeneration
• Central vision is
decreased because of
scotoma
• Peripheral (side)
vision is unaffected

18

Diabetic Retinopathy
The leaking of retinal blood vessels
may occur in advanced or long-
term diabetes, and affects the
macula or the entire retina and
vitreous. Not all people with
diabetes develop retinal changes,
but the likelihood of retinopathy
and cataracts increases with the
length of time a person has
diabetes, along with the
consistency and level of blood
glucose control.

19

Glaucoma
• Diverse group of eye diseases,
all of which involve progressive
damage to the optic nerve.
Glaucoma is usually, but not
always, accompanied by high
intraocular (internal) fluid
pressure. Optic nerve damage
produces certain characteristic
defects in the individual’s
peripheral (side) vision, or
visual field.

20

Hemianopia
• Damage to the optic pathways
in the brain, which can result
from acquired brain injuries due
to stroke, tumor or trauma, can
cause vision loss in half of the
field. The most common
defect, right homonymous
hemianopia, occurs in
corresponding halves of the
right field of vision.

21

Visual Changes - age related
• Acuity
• Accommodation
• Lighting
• Glare
• Sight recovery
• Color perception
• Depth perception
• Response to light
• Upward gaze
22

Acuity

Problem: A white telephone on a white wall plus no color contrast
between the letters and numbers and the rest of the telephone.
23

Acuity

Solutions: To enhance acuity, major color contrasts should be
maintained between signs and symbols/ lettering, dishes and
table, telephone and buttons, food on plate and plate color, etc.

24

Acuity

Solution: Select items in the environment that contrast with the
surroundings, such as the red tea kettle in this kitchen.
25

Acuity

Solution: Some of these talking products are shown above: a
thermometers, scale, watch key chain and a clock. Others
include, microwave, timers, money identifiers, TV Remotes,
clothing color identifiers, and screen reading software.
26

Accommodation

Problem: When an older person focuses on objects at a distance
and then attempts to focus on items close at hand, it takes more
time to make the adjustment than it does for a younger person.
27

Accommodation

Solution: The average age for obtaining bifocals is forty-two. Correction
to adapt for change continues into the late sixties.

28

Accommodation

Solution: When bifocals no longer compensate for an older person’s
inability to read fine print, use large print newspapers, books,
magazines etc. Also, explore the array of audio tapes.
29

Accommodation

Solution: Magnifiers are very helpful in accommodating for Presbyopia.
30

Accommodation

Solution: A large numbered overlay on a thermostat increases a persons
ability to read the numbers.
31

Lighting
No bulb
40 watt
bulb

Problem: Many seniors exist with very poor lighting. Reasons vary but
may include: think it’s more economical, lack of someone to change bulb,
unaware of benefits of good lighting, oversight, etc.

32

Lighting - Task

Table Lamps: Task lamps:

33

Kitchen Lighting

34

Glare

A painful and often disorienting
problem caused by too much illumination

Direct: Occurs when light reaches the eye
directly from it’s source
Indirect: Arises when the light reflects into
the eye after rebounding off of
another surface

35

Direct Glare

Problem: When talking to an older person,
NEVER sit with your back to the window so they must look directly
into the sunlight to talk to you.
36

Indirect Glare

Problem: On the floor of a hospital corridor, indirect glare results
from a highly polished vinyl flooring which makes it look wet and
it’s perception is complicated by the slight incline of the floor.
37

Indirect Glare

Solution: The same corridor as previous slide but use of the
space has changed. Carpet has replaced vinyl and more
attractive but functional handrails have been added.
38

Color Perception
With increasing age, the lens of the eye turns yellow

This change in the lens effects the quality of light
entering the pupil and impairs the perception of certain
colors.
39

Color Perception

Problem: Due to the yellowing of the lens, the older person
should be careful when taking medications because many
have similar colors and may be difficult to distinguish.
40

Color/Depth Perception

A monochromatic color scheme such as the one shown in
this slide does not have enough color contrast for the older
person to easily distinguish the edge of the couch or chair.
41


When the chair/couch appear blurred, as in the above
simulation, it is difficult to determine the exact edge of
the furniture and the distance to the floor. Falls occur
when the distance is miss-judged.

42


Solution: To provide a color contrast between the edge of
the tub and the floor and the inside of the tub, either use a
darker color on the bottom of the tub and the floor or place
color strips on the tub edge itself.
43

Depth Perception

Problem: Most falls on stairs occur when the person trips on
the top or the bottom step. Seeing the edges of steps may
be difficult if they appear blurred.

44

Depth Perception

Solution: Highlighting the top and the bottom of the steps
can improve depth perception. Outdoor steps or stairs
leading to a basement can be marked with tape or paint.
45

Depth Perception

Solution: A solution more suited to the indoors is to place
stair lights along steps. Highlighting the edges of steps with
light aids the ability to see the edge of each step.
46

Sight Recovery

Issue: When an older person is coming from a very
bright light to a darker area, or visa versa, allowing
adequate time for the older eye to adapt to a darker
space is absolutely crucial.
47

Sight Recovery

Issue: If the older person has low vision, sight recovery
principles must be considered throughout the home.
Particular attention should be given to areas of potential
danger such as stairs and landings. Be sure stair lights can
be switched on at the top and bottom of the stairs.
48

Upward Gaze
An older person may
have
1) Reduced upward
gaze,
2) Eyelids that do not
open as wide
3) Forward body tilt
of several
degrees.

If the person is in a
wheelchair,
regardless of age,
their eye level is
about 48” from
the floor.
49

Upward Gaze

Solution: Direction signs for seniors, should be placed
within the field of vision. Ideally, this will be about 3 ½ to 5
feet above the floor. If there is a border, place the sign
just above border
sceranski@cco-cce.orgage.r/t.chges.impact.function.persons.w.d.d.
50

Sense of Smell
Olfaction or the sense of smell provides
both protection and pleasure. It
generates associations of past
experiences.

Loss of sensitivity: To body and household odors.

Loss of protection: By a reduced ability to smell
smoke or gas fumes

51

Sense of Smell

Solution: Install and maintain a well
functioning smoke detector; install a
natural gas leak detector; organize
food in the refrigerator so that the
person can keep track of expiration
dates.

52

Auditory
As people age their ability to hear high
frequency sounds, as well as sounds in
general, is diminished.

 Hearing aids have been developed
that amplify sound at different
frequencies

 However, hearing aids may still
transmit background noise

53

Auditory

Solution: When speaking to an older person, move closer,
speak slower with separation between the words, slightly
louder, and consciously lower the tone.

54

Auditory

Solution: When eliminating background noise is important or a hearing aid
doesn’t work, try a one-to-one pocket talker. When it is placed by a
television speaker, the volume can be turned down.
55

Age-Related Physical Changes

Adaptations need to be found for problems
that occur with:

Stability Sitting and Rising
Mobility Bending and Reaching
Climbing Stairs Grasp and Pinch

56

Stability
Problem:
Towel bars are not
designed to be used for
support and weight should
NEVER be placed on them
when entering or exiting a
tub.

57

Stability
Solution:
Grab bars

58

Stability

Solution: A grab bar running along the entire length of the vanity provides
a handhold for someone needing a maximum amount of support.
59

Stability

Solution: When removing all loose or scatter rugs isn’t possible,
place non-slip material between floor and rug.
60

Stability and Mobility
Bench

Chair

Solution: Handrails along walk with chairs and bench near path for person
that cannot walk long distances without support or rest.
61

Home AT-EI in Bathroom
 Showerheads that come with
long hoses that let you bathe
while sitting on a chair or
bench.
 Grab bar.
 Elevated toilet is about 17-18
inches high, compared to the
standard toilet.
 Bathtubs with a built-in
transfer bench can help
anyone having difficulty
getting in or out of a bathtub.
 A shower seat that attaches
permanently to the shower
wall and folds up when not in
use.
62

Mobility

Problem and Solution: Basket for walker allows person to carry items when
hands are occupied holding onto walker.
63

Mobility

Solution: Vanity is designed with a narrow apron to allow
wheelchair to roll under counter.
64

Mobility
Solution:
If there is a raised
threshold, a small
wood/metal wedge-
type ramp can be
placed against it to
create a smooth
transition for the
wheelchair or for
someone that has
difficulty lifting their
foot

65

Mobility

Solution: Non-slip wood/vinyl flooring is easy to maintain and
easy to roll or walk on.
66

Mobility

36” Yardstick

Solution: Ideally, interior doors should be 36” wide.

67

Climbing Stairs
Problem:
Unfortunately, this is
common basement
stairway,
i.e. no railing, no light
switch at top and
bottom, no marking on
steps, poor lighting and
the added feature of a
very narrow step
surface on one side.

68

Climbing Stairs
Solution:
Handrails on both
sides of a
relatively narrow
stairway provide
support. The
addition of stair
lights provides
compensation for
depth perception
problems.

69

Sitting and Rising
Problem and
Solution:
This is a stable chair
with arms that
provide a handhold
when arising.
However, the design
includes a board in
the front which
prevents a persons
center of gravity to
be placed directly
over feet.

70

Sitting and Rising
A bath lift
allows the person
to be lowered
gradually to the
bottom of the tub,
these use a
battery pack for
power. The
transfer board
facilitates the
transfer.

71

Sitting and Rising

Solution:
When the placement of a
grab bar is not possible,
in-stall a grab pole.

72

Sitting and Rising

Solution: When installing a raised toilet seat, select the type that is
placed between the bowl and the seat; it is more stable then one placed
on top of the seat.
73

Sitting and Rising

Solution: Place a grab bar by the commode/toilet. The fold-down type allow for more
flexibility in use of space. If wall on right side, place fold-down on the left side and a wall
mounted grab bar on wall on the right; if no wall, place fold-downs’ on each side.
74

Bending and Reaching

Problem: A shorter person of any age or persons with stability problems often
have difficulty reaching the high cupboards.
75

Bending and Reaching

Solution: A pocket door, lowered closet rod, and shoes stored on the
closet shelf make clothing storage and retrieval easier.
76

Grasp and Pinch

Solution: Lever door handle should have a filled or enclosed back; the
elimination of rough surfaces is easier to manipulate
77

Grasp and Pinch

Solution: Lever faucets require less grip function and can be operated
with a closed fist.

78

Cognitive Interventions

Safety Awareness is always
the
FIRST
consideration.

79

Safety

Concern: Check to see if flammable items have been
placed on the stove or stored in the oven.
80

Wayfinding

Solution: Use landmarks that are easy to see and have
meaning to residents, i.e. pictures of activities.
81

Visual Cues

Solution: To help a person with CI be as independent as
possible,
items that are used together should be placed together.
82

Visual Cues

Solution: Putting clothing of one type in a drawer and
labeling the drawer with words or pictures can be helpful

83

Visual Cues

Solution: Placing clothing in open baskets is better then
drawers because the items are more visible. This wardrobe
unit would be even better if the drawers were placed higher.
84

Memory Aids

Solutions: Whenever possible, select appliances with
automatic timed turn-off.
85

Memory Aid
Solution:
Use a calendar and
marked off days to
help orient a person
to time.

86

Medications
Both taking and not taking of
medications may be problematic
with the person with CI.

Products from simple reminders
and organizers to those that
prevent over medication may be
beneficial.
“KISS”
87

Medication Management

Solution: This medication management system has been modified to meet the
specific needs of the client, these changes include: rubber binders around
certain holders when additional medications need to be given and a black
outliner to frame the day, this piece is attached with velcro at the top.
88

Providing Reassurance

Solution: An emergency response system can give both the
caregiver and the person with CI peace of mind.
89

Wandering

Solution: A variety of person identifiers are available from the Alzheimer’s
Association. These include pendants, bracelets, key chains and clothing
labels. Identification is for the caregiver as well as for the person with
dementia. Caregivers identification reads “I am the caregiver for ________”
and is carried in case the caregiver becomes incapacitated.

90

How does this affect you and the
people you care about?
• What did you learn that was
meaningful to you?
• What questions do you have?
• What ideas might you incorporate
into your care giving, practice or
lifestyle?

91

Sandra Ceranski, MS, OTR
Quality Monitor
Community Care Organization, Inc.
1555 S. Layton Blvd.
Milwaukee, WI 53215
Ph: 414.902.2405
FAX: 414.944.0001
email: sceranski@cco-cce.org

92

Aging and Function for People with Developmental Disabilities

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