Continuing education online courses on Aging Well: Combating Changes.

N17. End of Life Care: Aging Well: Combating Changes, 3 CE-hours, $21

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N17. Aging Well Combating Changes, 3 CE course hours

Course Main Points

1. Understanding what physical changes to expect with aging can help people prepare for change, allow them to cope with changes, and sometimes allow them to delay changes.
2. Health is the most important factor in successfully coping with aging.
3. The depression that can result from aging and the accompanying losses can be successfully treated and is not a normal part of aging.
4. Using fun, everyday mental activities, exercise, and meditation, the effects of aging can be delayed and maybe reversed.
5. When educating seniors it is important to value the life experience of the elderly, and to make learning a collaborative effort.

Introduction

Great improvements in medicine, public health, science, and technology have enabled today’s older Americans to live longer and healthier lives than previous generations. Older adults want to remain healthy and independent at home in their communities. Society wants to minimize the health care and economic costs associated with an increasing older population. The science of aging indicates that chronic disease and disability are not inevitable. As a result, health promotion and disease prevention activities and programs are an increasing priority for older adults, their families, and the health care system.

Many Americans fail to make the connection between undertaking healthy behaviors today and the impact of these choices later in life. Studies by the National Institute of Aging indicate that healthy eating, physical activity, mental stimulation, not smoking, active social engagement, moderate use of alcohol, maintaining a safe environment, social support, and regular health care are important in maintaining health and independence.

Promoting the healthy lifestyles of older people is vital in helping them to maintain health and functional independence and lead healthy and independent lives. Providing information to you about disease prevention and health promotion activities will help us help you and your loved ones become more knowledgeable about the health problems you may face and how you can prevent, delay, or manage them. The overarching goals of the most recent update of the report, Healthy People 2010, include increasing the quality and years of healthy life and eliminating health disparities.

Source:http://www.aoa.gov/eldfam/Healthy_Lifestyles/Healthy_Lifestyles.asp

 

1. Changes Associated with Aging

Physical Changes of Aging

Understanding the physical changes of aging can help people prepare for change.  This knowledge can also help people cope.  If someone knows why he or she moves more slowly, they may be less frustrated with themselves. Normal changes of aging show great individual variation in when they occur.   These changes accelerate after age 65.  Here are some changes that can be expected:

1. Each sense organ suffers some loss:  the eye loses elasticity, so that focusing becomes more difficult, and the eyes adapt to dark more slowly; hearing loss occurs, usually at higher frequencies; taste becomes less acute; the sensation of thirst is reduced, increasing the risk of dehydration; pain is reduced-which in some ways is good, however it means that signs the body is in trouble are not as loud and may be ignored.
2. There is a very slow decrease in heart output and an increase in blood pressure, and a slow decline in endurance.
3. Kidney function slows, and this affects medication amounts (medications stay in the bloodstream longer).  Bladder capacity declines. Dehydration is not handled as well.
4. Joints may become stiff, decreasing mobility and range on motion of limbs.
5. Osteoporosis, the thinning of bone tissue, makes it more likely that bones will break, and that they will heal slowly when they do break.
6. Nerve impulses are slower, so thinking and reacting occur more slowly and there is some loss of neurons.
7. Muscle strength is decreased. Daily activities then become more taxing.  By the age of 70, most people will have lost 30-50% of their strength, associated with loss of muscle mass or sarcopenia. (Win in the Second Half, a Guide to Better Aging and Fitness for Men and Women, Sheldon S. Zinberg, MD, 2003)
8. Skin becomes thinner and less elastic. Less oil is produced, sop the skin is more dry.
9. Digesting is slowed, again affecting medication (the time it takes for medication, such as pain medication, to take action is increased).
10. The nervous system is altered so that the co-ordination of muscles, glands and blood vessels is changed.  This can affect daily activities such as walking and sitting. These activities can also be affected by loss of vision, hearing and reaction time, so that accidents are more likely. The person understandably becomes more cautious, which is appropriate.
11. Lungs decrease in capacity.
12. There is increased susceptibility to infection.
13. Sleep is interrupted more and there is less deep sleep.
14. Reserves are less, making it is more difficult to fight off disease quickly.

There are improvements with age!

1. Ability to comprehend what is seen improves with experience (for example, older workers can make up for lack of speed with more understanding).
2. Problem solving skills improve. And older people can solve difficult interpersonal problems better than younger people. (Win in the Second Half, a Guide to Better Aging and Fitness for Men and Women, Sheldon S. Zinberg, MD, 2003)
3. Some illness decreases in severity-for example, ulcers, and cancers grow more slowly.   (You and Your Aging Parent, Barbara Silverstone and Helen Kandel Hyman, 1989.)

The leading causes of disability in people over 65 are coronary heart disease, stroke, arthritis, hypertension, lung disease, accidents, diabetes, cancer and diseases of the eye and ear.

2. Social Changes

Few of the elderly say they are lonely. The aging process does bring with it losses, however.  Gradual isolation can occur in a geographical sense (a move to area away from friends) or a physical sense (difficulty in traveling, or in seeing and hearing that make communication and development of new contacts difficult).  Each loss necessitates more coping and a change in the equilibrium the person had arranged in their living situation. Multiple losses over a short time period can be especially difficult.  Some people become tired of going through the grieving process and become stuck, ending up depressed.  On the other hand, families continue to grow, and new friends are made.  With the availability of computers, online friendships are possible which do not require good hearing, good vision, or stability of location to be maintained.

The role a senior adult plays in their family or in society can change, and this can result in loss of status, prestige or self-esteem. The elderly may experience losses in the sense that they have begun to think of themselves differently.  Some hold on to physical objects because they have permanence, when much else in their life may be changing. This is an adaptive response (unless extreme).  Health losses are the most important.  Many elderly seem to be able to adapt to the other life changes if their health is retained.  In Depression and Aging, Lissy Jarvik, who has worked with people ranging from their 70s to 100s writes “given adequate health, we can bear the loss of work, the loss of status, the loss of prestige, the loss of financial security, even the loss of relatives and friends-provided they don’t all occur at the same time”.

 

 2. ADAPTIVE REACTIONS TO AGING

1. Acknowledging and adjusting to age related changes (e.g. use of hearing aids, giving up driving when necessary) while maintaining as much freedom as possible.
2. Mourning losses.
3. Making new friends when necessary; maintaining a number of social relationships (providing a cushion against loss).
4. Spending time looking over one’s life, recalling the past.
5. Keeping mementos that trigger happy memories.
6. Using available technical equipment to stay active and connected (computers, telephone aids, magnifying glasses).
7. Exercising the abilities you do have, physical and mental.
8. Getting treatment for depression or other psychological problems (signs of deterioration may be signs of a treatable illness and not just age).
9. Planning ahead with children or family for future changes (e.g. Give power of attorney to a family member).
10. Making your own choices and decisions in as many areas as possible.
11. Limiting the number of stressful changes that are made at one time (e.g. If spouse has died, wait a while before changing residences).
12. Maintaining engagement in activities that interest you.

Other common responses to losses

1. Denial of loss or of the importance of the loss.  This can postpone mourning.
2. Concealing memory loss.  Some older adults are very good at this, so only those who are around often are aware of memory problems.
3. Disengagement from life.
4. Feelings of fear or anger.
5. Hoarding or hanging onto objects or food.
6. Depression.  This is most likely to occur when losses or events change a persons important life circumstances, ones they must deal with frequently over time. Loss of a person, or a pet, with whom there was daily contact is more difficult than loss of someone where contact was infrequent

Old age itself is not a problem and people generally adjust well to the changes in their life. Most people carry on normal activities as they age, only 20% do not, and they are mostly over 75. Less than 5% of seniors are in nursing homes. (Geriatric Psychiatry, James E. Spar, M.D. and Asenath La Rue, Ph.D., 1990.) Combined losses become more difficult to cope with and may result in increased mourning for small losses.  The striking thing is that those who become depressed tend to have endured multiple losses within a short period of time, such as losses of several family members, or loss of family member plus health or mobility losses. The ability to adapt to loss may determine how satisfactorily one adjusts to aging.

3. Dementia

Dementia is the loss or impairment of mental powers, and consists of a set of symptoms:  mental confusion, memory loss, disorientation and intellectual impairment in a person who is clearly awake.  Dementia can be caused by a variety of diseases, some of which are treatable.  Major depression can be misdiagnosed as dementia, and treatment for depression eliminates many dementia cases. Alzheimer’s disease is the most frequent cause of irreversible dementia, and vascular (or multi-infarct) dementia is the second most frequent cause of irreversible dementia.

Depression

Many cases of depression in the elderly go undiagnosed. Many older people with depression see their doctors with physical complaints instead of psychological complaints. Also, 40% of people with depression do not feel sad, but feel irritable. (“Dealing with Difficult Depression” John Preston, PsyD, audiotape, 2003)

Depression is a mental disorder and is different from having a temporary down or “blue” mood.  The following are symptoms:

1. Depressed mood with changes in posture, speech, facial expressions and grooming.
2. Loss of appetite with weight loss or the increased appetite with weight gain.
3. Insomnia, early morning awakening or the reverse with excessive sleeping.
4. Agitated movement or slowing of movements.
5. Anxiety or feelings of dread, fear or foreboding.
6. Anhedonia or loss of ability to experience pleasure.
7. Fatigue, lethargy, difficulty concentrating.
8. Feelings of low self-esteem.
9. Suicidal thoughts or thoughts of death.

There is no single cause of depression, but genetics, life events, experience and personality can contribute.  Depression is treatable and there is good potential for a favorable outcome.  Mental health generally improves in the elderly, and no increase in depression is seen in women in menopausal years.  Suicide is, however, more successful in the elderly population.  Depression can be an extension of unresolved mourning.

 

 

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4. Losses

If you are a caretaker or family member, here are some ways to help:

1. Establish as much freedom as possible for the senior.  If they are confused, create a structured environment.
2. Consider home sharing as a possible step in between living alone and living with relatives.
3. Arrange for outings if possible so senior keeps in contact with the world.
4. Regularly scheduled pleasure is helpful, that is, having something to look forward to such as food, a walk, visiting with someone or a pet, movies or music that the senior finds pleasurable.
5. Find areas where the senior can have control.
6. Find contributions the senior can make-what can they help with? How can they help the community?
7. Notice and comment on small successes.
8. Exercise the abilities they have.  Many abilities deteriorate not with age, but with disuse.
9. Combat losses of physical abilities with technology-hearing aids, orthopedic devices, ramps, easy to use phones, and computers.

A nursing home  (which is generally temporary) should be considered if the following signs occur:

1. Incontinence that has become burdensome so that there is a threat of skin breakdown.
2. The caregiver is doing or needs to do too much heavy lifting.
3. The caregiver is sleep deprived.
4. The caregiver is ill or injured.
5. There is another major stress on the caregiver.

 

 

5. Combating The Deterioration Of Aging

Benefits of exercise

Health is the most important factor in aging well.  All adults benefit from healthy routines, and for seniors this can make a major difference in their quality of life.  Exercise of various muscle groups promotes health and can actually reverse loss of muscle tone and lung capacity. In one study, women “on a strength training program twice weekly for one year became biologically twenty years younger.” (Win in the Second Half, a Guide to Better Aging and Fitness for Men and Women, Sheldon S. Zinberg, MD, 2003). Aerobic exercise can increase endurance significantly. Stretching and moving your joints through their full range can prevent stiffness. Stronger muscles can help prevent falls, help maintain abilities needed to live on one’s own (weak muscles make daily chores tiring) and enhance mobility and pleasure in everyday life. Weak muscles make daily chores tiring. Resistance training can increase bone density. ((Win in the Second Half, a Guide to Better Aging and Fitness for Men and Women, Sheldon S. Zinberg, MD, 2003). Exercise does not need to be strenuous to accomplish this, moderate exercise works well. Exercise can be done in short periods several times a day rather than all at once, making it more manageable.  It has been shown that 15 minutes of activity will boost mood for several hours, so exercising for at least this long will give an added benefit. (The Biopsychology of Mood and Arousal, Robert E. Thayer.) Exercising for 30 minutes, at least 3 times a week, can lift depression.  Often it is disuse, not age, which leads to deterioration. This is both preventable and often reversible. Here is a website for signs to see a doctor before exercising: http://nihseniorhealth.gov/exercise/safetyfirst/01.html

Sexual behavior

Using ones capabilities maintains them, and this is also true of sexual behavior. Sexual activity can reduce stress and help keep a sense of well being.

Using your brain

Exercising one’s brain likewise can maintain intellectual functioning.  Learning new skills and subjects appears to be important in this regard.  This learning does not have to be strenuous and should be fun or interesting for the person. What is important that you learn something new.  Engage in a variety of activities. Just reading, playing games and watching TV daily can help maintain or improve intellectual functioning. Creating a complex environment for yourself can help keep you mentally stimulated. Treatment of high blood pressure reduces the risk of vascular dementia and may reduce dementia in people with Alzheimer’s disease as well. (Lifelines, Muriel R. Gillick, M.D., 2001.)Using specific memories keeps them intact, so spending time recalling good times helps to keep them in your memory.

There can be a synergistic effect with exercise decreasing depression and improving mood as well as increasing ability to move.  As a person experiences increasing energy and alertness, they are more likely to increase their intellectual simulation, maintaining brain function. With these improvements, they are also more likely to maintain social connections.

Alzheimer’s

In their book “Preventing Alzheimer’s: Preventing Alzheimer’s: Ways to Prevent, Delay, or Halt Alzheimer’s and Other Forms of Memory Loss” Daniel G. Amen, M.D. and William Rod Shankle, M.D. give a number of ways people can decrease their risk for Alzheimer’s disease: These include the following:

1. Eat good fats, ones that contain Omega 3, such as avocados and salmon.  (Reduces risk by 20%

2. Exercise, including cardiovascular exercise and resistance training, which needs to be done at least every 3 days. (Reduces risk by 50%).

3. Mental exercises which uses several areas of the brain- to do this learn something new and recall it later (Reduces risk by 33%).

4. Take non-steroidal anti-inflammatory medication, such as aspirin daily (Reduces risk by 50%).

(Preventing Alzheimer’s: Preventing Alzheimer’s: Ways to Prevent, Delay, or Halt Alzheimer’s and Other Forms of Memory Loss,  Daniel G. Amen, M.D. and William Rod Shankle, M.D. 2004.

Eating and drinking

Diet is important in combating the effects of aging.  Older adults need to be sure to drink enough fluids, since their sensation of thirst is not reliable.  They also need to eat a variety of foods, and possibly use vitamin supplements.  As taste declines, some older adults restrict their diet. Adding flavor and aroma can offset this decline in snesitivity. Antioxidants, such as vitamin E, may prevent or reduce the severity of heart attacks (Successful Aging, John W. Rowe, M.D. and Robert L. Kahn, Ph.D., 1998.) Avoiding alcohol is important in keeping memory functioning well. (“Memory, A seminar for health professionals”, Dr. Stuart Zola, 1999.)

Sleep

Sleep is important in maintaining good health, both physical and mental. Getting deep sleep helps regulate brain chemicals that promote calmness and a good mood. The following are simple ways that can empower you to sleep well:

1. Regular exercise

2. Regular time for sleeping and waking.

3. Exposure to early morning sunlight.

4. Little of no caffeine or alcohol (There inhibit sleep).

(“Dealing with difficult depression,” John Preston, PsyD., audiotape 2003)

Skin

Much deterioration of the skin is actually damage from exposure to the sun, so limiting such exposure can reduce this deterioration.

Medical care

Getting regular medical checkups is important.  Because of the decline in sensory acuity, especially of pain, older adults may be unaware of minor symptoms.  By getting regular checkups, they can have a better chance of effective treatment and of avoiding the negative effects of the illness or condition.  Treating depression, if it occurs, is very important. Depression often reduces physical and mental activity, which are important in combating aging. Research shows that many other diseases can be helped when an accompanying depression is treated.

Social relationships

Many studies show that social relationships and connections with others improve health.  Social support can influence survival and recovery from illnesses such as heart attacks, renal failure and stroke. (Lifelines, Muriel R. Gillick, M.D., 2001.) Learning to use a computer (for emailing friends and making connections with people) before becoming isolated by illness could let you get support when you may need it most.

Stress

Stress takes a toll on the body.  Fortunately, both exercise and meditation can combat stress. Relaxation techniques also help, as does having a social support system. Exercise decreases the physical stress response, especially in people who respond more physically than psychologically to stress. (Brain Longevity, Dharma Khalsa, M.D., 1996.) People who meditate appear to be physiologically younger that those who do not.

Longevity

A study in JAMA reports that those in the 70 to 90 age range have a 50% lower death rate from all causes if they do the following:

1. Adhere to a Mediterranean diet

2. Use alcohol moderately

3. Be physically active

4. Do not smoke.

(“Mediterranean diet, Lifestyle Factors, and 10-Year Mortality in Elderly European Men and Women”, Knopps, de Groot; Komhout Perrin; Moreiras-Varela, Menotti; and van Staveren, JAMA, Sept 22/29. 2004.)

Educating Seniors

When educating senior it is important to value their life experience and past knowledge.  Seniors have rich backgrounds, and like to share and participate in learning situations.  They also are more motivated by immediate usefulness.  Connect what you are teaching to practical applications.  They appreciate being treated as collaborators in learning, so ask them what they want from your class (or from you as a teacher) and reward their participation (just respond more strongly to better responses).

If you are creating a class for senior adults, make sure the location is accessible, the seating and room temperature are comfortable and the class is scheduled for a time when they will be alert.  It is good to use visual aids, and these should be easy to see, with large print and good visual contrast.  Older eyes take more time to adjust to both darkness and glare, so keep glare to a minimum and if you need to darken the room, do so slowly. Control background noise, as seniors have more difficulty keeping sounds straight.  Make sure you are speaking loud enough to be heard (you may need to ask because seniors do not always volunteer this information).

Nursing Library for further study:

• Benefits of exercise
  • http://www.cdc.gov/nccdphp/sgr/olderad.htm
• Social relationships-computer use
  • http://www.pewinternet.org/reports/reports.asp?Report=40&Section=ReportLevel2&Field=Level2ID&ID=240
• Eating and drinking
  • http://socrates.berkeley.edu/~aging/Ames.pdf http://www.ilcusa.org/_lib/pdf/Rx.pdf
• Using your brain
  • http://www.asaging.org/at/at-19-3/diamond.html
• Stress
  • http://www.thirdage.com/news/archive/ALT02980624-02.html?hnav
• Adaptive responses to aging, mourning losses
  • http://www.griefhealing.com/column1.htm
• Government site
  • http://nihseniorhealth.gov/
• Check list before exercising:
  • http://nihseniorhealth.gov/exercise/safetyfirst/01.html
  • Alzheimer’s informationhttp://www.alz.org/
• National Institute on Aging
  • http://www.nia.nih.gov/
• Statistics on aging
  • http://agingstats.gov/chartbook2004/default.htm
• Research on aging
  • http://www.agingresearch.org/latest_research.cfm
• Personalized health check list
  • http://www.realage.com/

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The course was developed by Peggy Arndt, MFT, West Anaheim Medical Center, 515 S Beach Blvd, Suite E, Anaheim, Ca 92804, peggy.arndt@wamcoc.com. Peggy is a licensed Marriage and Family Therapist (California license #15767). She has taken classes at U.C. Fullerton in gerontology and from other professionals working in the field, done independent study, and taught courses to professionals, residents of skilled nursing facilities, and families of older adults seeking information (1993-1995).  She worked in geriatrics doing psychological assessments and working with the staff of a geropsych unit at Fountain Valley Regional Hospital and Medical Center.  She has also taught other courses (such as stress management) at the YMCA and at the Learning Annex.

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