last notes-geron

8/7/2019 last notes-geron

1/104

Addressing the Needs of

Older Persons

MOBILITY


2/104

Where are the worldsolder persons?


3/104

In Asia

3


4/104

Projected Number of People 65+, 1997-2050according to WHO Regions (in Millions)

0 100 200 300 400 500

Africa

The Americas

EasternMediterrane

Europe

SE Asia

WesternPacific

2050

2025

1997

4


5/104

Mobility in Older Persons

Mobility as affecte by architectural esig

a assistive tech ology Mobility as affecte by physical ability

5


6/104

Mobility and architectural design

Circulatio of i ivi uals

withi /to/from a structure

must be e sure

For most structures

accommo ati g ol er

perso s, the wheelchair

becomes a basic esigco si eratio

6


7/104

Mobility and architectural designHow to design?

Circulatio i the horizo tal

pla e

Sufficie t space to tur a

wheelchair arou

Doors must be at least 3 ft

wi e

Threshol s must be

elimi ate at oorways Glossy floors a scatter

rugs must be avoi e

7


8/104


9/104


10/104

Mobility and architecturaldesign

How to design?

Reachi g

Access to

esse tials

Cleara ce

Vertical reach

10


11/104

Physical ability

1/3 of perso s over 65 y/o fall every year (US

statistics)

of all falls result i severe soft tissue abo e i jury

Falls result i :

I crease cautio a fear of falli g

Loss of co fi e ce i i epe e t fu ctio

Re uce motivatio a activity

I crease risk of recurre t falls11


12/104


13/104

FALLS AND INSTABILITYFalls are multifactorial in nature

I tri sic factors

1. physiological factors

2. psychosocial factors

Extri sic (e viro me tal

factors)

Activity relate factors

13


14/104

FALLS AND INSTABILITYFalls are multifactorial in nature

I tri sic physiological factors

Age

Se sory/Musculoskeletal/N

eurologic/C

V cha ges Drug i take

I tri sic psychosocial factors

Depressio

De ial of agi g

Fear of falli g Relocatio

Extri sic e viro me tal

factors

I stitutio alize or

commu ity- welli g?

Surfaces a lighti g

Be room a bathroom

Activity relate factors

Normal aily activitiesassociate with falls

Improper assistive evice

use

14


15/104

Mobility Enhancement &Fall Prevention

Assess for fall risk a elimi ate if possible

FALL RISK ASSESSMENT

Improve fu ctio al mobility

Stre gth a flexibility trai i g

Se sory compe satio strategies

Bala ce a gait trai i g

Fu ctio al trai i g

Environmental mo ification

15


16/104

Nutrition in

the Later

Years


17/104

Outline

The Later Years

Nutrition in the Later Years

Energy and Activity

Carbohydrates and Fiber

Fats

Protein Vitamins, Minerals and Water

Other interesting issues


18/104

The LaterYears

The life span of human beings is now 130 years.


19/104


20/104

Nutrition in the Later Years

Should be highly

individualized!


21/104

Nutrition in the LaterYears


22/104

Examples of Physical Changes ofAging that Affect Nutrition

Digestive Tract

Intestines muscle strength resulting in sluggish

motility that leads to constipation.

Stomach inflammation, abnormal bacterial

growth, and greatly reduced acid output impair

digestion and absorption.

Pain

and

fear of choking may cause foo

davoidance or reduced intake


23/104

Examples of Physical Changes ofAging that Affect Nutrition

Hormones

For example, the pancreas secretes less insulin

and cells become less responsive causing

abnormal glucose metabolism.

Mouth

Tooth loss, gum disease, and reduced salivary

output impede chewing and swallowing.Choking may become likely; pain may cause

avoidance of hard to chew foods.


24/104


25/104

Energy and Activity

Energy (Caloric) needs decrease with advancing

age.

Decrease in active cells, diminished lean tissue

Reduced physical activity

Physical activity and a diet adequate in

nutrients and rich in phytochemicals is

necessary to maintain energy needs and upholda healthy immune system.


26/104

Benefits of Physical Activity

Greater flexibility and

endurance

Greater lean body mass Better sense of balance

Greater blood flow to the

brain


27/104

Benefits of Physical Activity

Stronger immune

systems

Suffer fewer falls and

broken bones

Enjoy overall better

health


28/104

Carbohydrates & Fiber

6-11 servings of breads,

grains and pasta

Fiber is necessary toprevent constipation


29/104

Fats

Should be limited for the following reasons:

foods lowest in fats are richest source of vitamins,

minerals and phytochemicals

diets rich in certain fats are associated with many

diseases

high fat diet correlates with obesity


30/104

Protein

Needs remain about the

same through adult life,

but choosing low-fatfiber-rich protein foods

may help control other

health problems.


31/104

Vitamins, Minerals & Water

Vitamin A absorption increases with aging.

Older people suffer more from deficiencies

of Vitamin D and B12 than young people do.

Dehydration is a major risk for older adults

Thirst mechanism become imprecise

Go for long periods without drinking fluids

Kidneys become less efficient


32/104

Vitamins, Minerals & Water

Iron status generally improves, especially

for women.

Iron deficiency may occur due to: Chronic blood loss from ulcers, hemorrhoids

Poor iron absorption

Antacid use

Some medications


33/104

Foods/Supplements and

Alzheimers Disease

Nutrition bears only weak links to the

disease

Food sources, not concentrated

supplements, of trace minerals are

advisable for people with the disease.

A causal connection with the mineral

aluminum seems unlikely.

No proven benefits are available from

herbs or other remedies.


34/104

Foods/Supplements and

Alzheimers Disease Preventing weight loss may be the

most important nutrition concern.

Depression and forgetfulness can

lead to skipped meals and poor food

choices.

Well-liked and well-balanced meals

and snacks served in cheerful,

peaceful atmosphere are welcome.

As function diminishes, ready to eat

foods in bite size pieces may be most

acceptable.


35/104

Obstacles to Adequacy

Living alone may bring about problems inpoor quality diets.

Tooth loss or lost taste sensitivity

Medical conditions can also affect nutrition. Unintentional weight loss, followed by illness

ordeath

Multiple medications and alcohol abuse


36/104


37/104

Source: Irwin, D., Milsom, I. et al. Impact of overactive bladder symptoms on employment, social inteactions and

emotional wellbeing in sixEuropean countries. British Journal of Urology International: 2005; 97, 96-100.http://www.blackwell-synergy.com/doi/pdf/10.1111/j.1464-410X.2005.05889.x (Subscription required. Accessed13.12.2006)


38/104

WORLDWIDE

(F)

PERCENT

(%)ASIA 14.6

JAPAN 32

US 37

EUROPE 26

ASIA (F) PERCENT

THAILAND 20.3

PHILIPPINES 13.9

MALAYSIA 13.1

INDONESIA 5.8

SINGAPORE 11.8INDIA 6.2

PAKISTAN 24

TAIWAN 7.4

KOREA 22.6

HONGKONG 12

CHINA 11.6F - FEMALE


39/104

Women Living atHome

Age 15 -

44

5% - 7%

Age 45 -

64

8% - 15%

Age 65 + 10% - 20%

Men Living at Home

Age 15 -

44

3%

Age 45 -

64

3%

Age 65 + 7% - 11-%


40/104

Seeking professional help after experience

of bladder control problems Women wait 6.5 years

Men wait 4.2 years

Women more likely to suffer stress UI thanmen

Men more likely to suffer from urinaryretention

Women are more likely to suffer interstitialcystitis than men


41/104

Urinary incontinence is a normal part ofaging

Many people at age 80 remain to be

fully continent despite the decline inbladder elasticity and bladder tone


42/104

Nothing can be done to treat UI in olderadults.

Careful assessment of the older adult with UI isrequired to determine cause of the symptom

Use the most effective combination therapy, i.e.,

weight control, smoking cessation, pelvic muscleexercises (PMEs) or Kegel exercise, assisted and

timed toileting, and medications.


43/104

The only successful treatment forUI issurgery

For the older patient, surgery may be the last option,

when all else fail.

The combination of behavioral intervention, lifestyle

modification, exercises, medications and technological

devices are the better options.

The use of a preventive absorbent wear promotescomfort and enhances self esteem.

Educate the older person and the significant other

about other options which can allay their fears in

seeking consultation.


44/104

Drinking less fluid will improve UI

Concentrated urine irritates bladder lining and

can worsen the symptom of urgency and

frequency of urination.

Restricted fluids can aggravate constipation

which can send signals to the brain that the

bladder needs emptying when in fact the

problem is in the bowel.


45/104

The older person is having accidents onpurpose

Older person does not want to lose their

independence, and their sense of dignity.Toileting accidents are more likely caused by

inability to reach the toilet in time, memory loss

makes them unaware of proper toileting habits, or

their clothing has interfered with timely toileting.Solutions to this problem are prompted toileting

and bladder retraining, simplified closure in

clothing, and safe ambulation.


46/104


47/104


48/104

Pelvic Muscle Exercises

2nd exercise works on the supportive strength of

the muscles and is referred to as a long

contraction. The slow twitch muscles aregradually tightened, lifted up, and held for

several seconds.

hold the contraction for 10 seconds before

releasing. Rest ten seconds between each long

contraction


49/104

Dietary Changes

Caffeine

Alcohol

Artificial sweeteners (sodium saccharine,acesulfame K, and to a lesserdegree

aspartame)

Bladder retraining


50/104

Use the toilet regularly - every 2 to 3hours.

Wear clothes that are easy to get off to use

the toilet. Remain on the toilet until your bladder is

empty. If you feel there is still some urinein the bladder, stand up and then sit back

down again and lean forward slightly overthe knees. This is called double voidingand may help you empty your bladder.


51/104

Make the toilet facilities convenient andsafe. This may mean a bedside commode,bedpan, or urinal placed conveniently nearor in the bed.

Empty your bladder before you start on ajourney of an hour or more. Dont try towait until I get home to my ownbathroom.

Avoid rushing or running to the toilet. Thisactually increases the likelihood of anaccident and puts you at risk of falling.


52/104


53/104

QUESTIONS

What is caregiverstress?

What are the issues

related to caregiverstress?

What are the telltale signs ofcaregiver stress?

What can acaregiver do tomanage theirstress?


54/104

Mariel, 58, took care of her fatherduring an illness and her mother after

an accident. The first thing she did

when she realized the enormity of

what she was faced with

that she will be on call 24 hours a

daywas to cut her hair very, very

short.


55/104


56/104

John is caring for her 83 year old fatherwho has memory problems and keepsthrowing fits wanting his way in every

thing. Makes messes all through thehouse. He is not steady on his feet but isno longer wanting to do anything but goto the SM.

John would accompany his father even ifhe is tired feeling guilty when unable


57/104


58/104


59/104


60/104

Theres no question that Filipinos aside from

raising their children are also faced with

parenting their parents, too.

squeezing in quick visits to assist with simpledaily tasks or providing actual caregiving

the sacrifices and challenges of this balancing

act are taking a

dramatic toll o

nthose caught i

nthe middle.


61/104


62/104


63/104


64/104

Emotional and physical strain of caregiving becomes evident


65/104


66/104


67/104

A recent nationwide study by Evercare,

Caregivers in Decline (2006), ofcaregivers whose own health is at riskbecause of their care giving duties found

that stress is their NumberO

ne issue.


68/104

DID YOU KNOW THAT

What is most alarming is that more thanhalf (53 percent) of the caregiverssurveyed say that this decline in healthy

behaviors has already affected theirability to provide care.


69/104


70/104


71/104


72/104

PeterVitaliano,, Professor of Geriatric PsychiatryUniversity of Washington :

Chronic stress :

high blood pressure,

diabetes and

a compromised immune system.

In severe cases, caregivers can take on the symptoms

of the person that they care for


73/104


74/104


75/104


76/104

EMOTIONAL AND PHYSICAL

STRAIN OFCAREGIVING

FRUSTRATION

FRUSTRATION

ANGER/

RESENTMENTEXHAUSTION/

BODY PAIN

LONELINESS/

ISOLATIONGUILT

Sara Rom, MSW, MSG

Director of Education and Training

Southern CaregiverResource CenterRGVTAMSE820


77/104


78/104

THERE ARE THREE BASIC


79/104

THERE ARE THREE BASICAPPROACHES PEOPLE USE TO

CO

PE WIT

HSTR

ESS

avoid

suffer manage


80/104

DONTFORGET THAT

Severe stress that is sustained over a

long period of time can take a major

tollon both mental and physical well-

being.


81/104


82/104


83/104


84/104


85/104


86/104

Watch funnyMovies

Comedyclubs


87/104


88/104


89/104

TAKE A BREAK

Take single daysor even a weeksvacation.

Talk about differentthings, read thatbook you haventbeen able to get to,take naps,

whatever relaxesyou and makesyou happy.

EXERCISE 1 THE YES SIR


90/104

EXERCISE 1 THE YES-SIR

STRETCH

yes-sir

stret h.


91/104


92/104

ABDOMINAL EXERCISE


93/104

EYE SOCKET SOOTHER

Place the index fingeron the eyebrow, andmiddle finger lightly onthe eyelid.

In a slow circularmotion, gently massagethe eyeball and eyesocket. Be careful toplace no pressure on

the eyeball, and if youuse contact lenses, onlymassage the eyesocket.


94/104


95/104


96/104

IMPORTANT TOOLS TOMAKE YOU

SANE : Love yourself

Communicate


97/104

Get organized

Prioritize

Schedule wisely


98/104


99/104

Eat wisely


100/104


101/104


102/104

TAKING STEPS TO


103/104

TAKING STEPSTOREDUCE YOURSTRESS

Try to do something you enjoy

Do one thing at a time

Maintain your sense of humor.

Make lists

Dont shut out the good moments.

Dont try to cope alone.


104/104

REFERENCES

Mary Kay Morrison.Stress Survival Strategies. HumorQuest. 2008

Promoting Positive Mental Health. Health PromotionAgency. Ireland.October 2008

Randy Pausch, Time Management. CarnegieMellonUniversity.2000

Running on Empty: Family CaregiverStress .Home InsteadSenior Care Dallas

T

exas, 2007 StressManagement. Canadian Society OfIntestinal

Research.

last notes-geron

Documents