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Normal Ageing and Age Related Changes in Health

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Normal Ageing and Age Related Changes in Health Powered By Docstoc
					Ageing with an
 Intellectual
  Disability
      A Higher Burden of
            Illness
• Undetected illness

• Untreated illness

• Delayed treatment

• Less likely screening

• General risks related to ageing
  What Can Group Home
        Staff do?
• Anticipate and prevent problems that are
  preventable
• Identify indicators of illness
• Advocate for appropriate screening and
  treatment
• Prevent premature relocation
• Protect from harm and suffering
Normal Ageing
    Predictable Changes
• Sensory     • Skin
  • Hearing
              • Reserve, repair
  • Vision      and replenish
  • Smell
  • Taste     • Response to
                illness
  • Touch
              • Sleep patterns
HOW WE SEE
 Signs of Vision Problems
• Sheltering eyes       • Poor table manners
  from light
                        • Change in personal
• Squinting, tilting      appearance
  head
                        • Change in activity,
• Being unusually         withdrawing
  cautious, falling,    • Confusion
  tripping
                        • Difficulty recognizing
• Bumping into things     people or objects
 People with Intellectual
        Disability
• Increases with age like all older adults
• Higher vision conditions before old age
• People with Down Syndrome high risk
• Often goes undetected
• May require specialized vision screening
     Age Related Eye
   Conditions: Glaucoma
Treatable, preventable blindness
Irreversible vision loss, blindness
Silent and painless
Easily detected with exam
Treated with daily drops
Affects peripheral vision
   Diabetic Retinopathy
• Irreversible blindness
  • Bleeds from small vessels in back of
    eye
  • Stains tissue and blocks vision
• Prevent diabetes
• Control blood sugar
• Mostly preventable with laser
  Macular Degeneration
• Not reversible or treatable
• Central vision affected
• Leads to blindness
• Optic nerve
• Smoking major risk
• Protection is important
        Role of Caregiver
• Preventable (diabetes)

• Detectable: prevent vision loss
  • Often slow and subtle changes

• Advocate for screen and treatment

• Support follow through

• Behavior change is major indicator
Hearing
Sound Transmission
    Signs of Hearing Loss
• Difficulty hearing with background noise

• Misunderstanding

• Confusion

• Withdrawal

• Anger, irritation

• Uncooperative
Intellectual Disability and
       Hearing Loss
• Much higher than general population

• Almost 100% in Down Syndrome

• Tremendous amount undetected

• May require specialized testing

• Poor follow through

• Challenges managing hearing aids
    Communicating with
       Hearing Loss
• Decrease background noise (fan, dishwasher,
  TV)

• Face-to-face, gain attention

• Indicate, gesture

• Change words, rephrase

• Change pitch (women’s voices)

• Most people cannot lip read
  Other Sensory Changes
• Smell               • Taste
  • Decreased           • Linked to smell
    olfactory cells     • Taste buds 1/6
  • Medications         • Decreased saliva
                        • Medications
  • Spoiled food,
    gas leaks, fire     • Consequences
                          • Eat more
  • Body odor
                          • Eat less
                          • Eat spoiled food
                          • Eat odd foods
                          • Salt and sugar
         Sleep and Ageing
• Less sleep needed and changed patterns

• Causes of sleep problems (Expectations)
  •   Sleep during the day
  •   Insufficient exercise
  •   Medications
  •   Pain, restless leg
  •   Frequent urination (infection, diabetes)
  •   Prostate enlargement
  •   Cardiac problems
       Reserve, Repair,
          Replenish
• Reserve decreases with age
  • Decreased ability to maintain body
    temperature
  • Diminished response to illness
    • Fever
    • Pain
    • Heart rate
      Role of the Caregiver
• Identifying cues (behaviour change)

• Supplement to lost body cues and responses
  •   Temperature
  •   Food
  •   Sleep
  •   Environment
  •   Protection (vision and hearing)
Health Conditions
Common in Older
      Adults
      General Comments
• Beware of sudden changes

• Be mindful of slow changes over time, baseline

• Don’t assume ‘its just getting older’

• Behavior change is common indicator of illness

• Ask the most familiar person or people

• The same symptom can be many things

• Sometimes there is more than one thing
    Common Conditions:
• Incontinence
• Falls
• Dehydration
• Untreated pain
• Obesity
• Delirium
           Incontinence
• Common, multiple causes, often reversible
  • Infection
  • Diabetes
  • Medications
  • Treatment for heart disease
  • Mobility
  • Fluids/caffeine
  • Overactive bladder/prostate
  • Don’t assume ageing
                     Falls
• Not normal

• Serious consequences

• General decline from inactivity

• Vision

• Medications (blood pressure drop)

• Pain

• Balance, tripping (feet, shoes, rugs)
             Dehydration
• Thirst reflex blunted
• Less water in muscles than younger
  (reserve)
• Mobility
• Fluid loss (diarrhea, vomiting, fever)
• Can be life threatening
         Unrelieved Pain
• Until recently believed to be pain insensitive

• High level of undetected and untreated

• Same population comparison (much lower)

• Many chronic conditions associated with pain

• GPs and specialists sensitive to verbal cues

• Patient report is gold standard

• Facial expression reliable indicator
                Delirium
• Commonly missed in all older adults

• Often mistaken for dementia
• Caused by
  • medications
  • illness, infection
  • dehydration
  • impaction
              Delirium

• Characteristics
  • Altered attention
  • Change in cognition
  • Sudden onset
  • Variable
  • Associated with illness
          What We Know
• People with ID are:
  • less likely to be diagnosed
  • less likely to be treated
  • suffer needlessly

• Untreated illnesses are often irreversible if left

• Caregivers are in a pivotal position to identify,
  advocate and protect and keep people home
        Older People with ID

• Same illnesses as all older   Increasing
  adults                          • Cancer (GI, testicular)
• Higher rates                    • Arthritis
  • Respiratory (leading             • Less likely to treat
    cause of death)               • Heart disease
  • Diabetes (obesity,               • Related to disability
    inactivity)                      • Obesity
  • Gastrointestinal                 • Inactivity
         Gastrointestinal
           Conditions
• Much higher rate
  • Constipation up to 70% (meds, inactivity)
  • Reflux 50% (vs 7%)
  • Bowel and GI cancer
  • Hepatitis and H Pylori (institutional
    exposure)
  • Choking
  • Highly associated with behavioral changes
  • Even with speech, unable to articulate
    symptoms
           Why so Many
           Unidentified?
• 80% of diagnosis based on history

• Caregiver misinterpreting symptoms as age

• Misinterpreting symptoms as behavior

• Caregiver not noticing symptoms

• Change in caregiver

• Assumptions that screen will not be tolerated

• GP unfamiliar
  Working with GPs and
       Specialists
• Double appointment time
• Familiar person
• Decrease the wait time
• Accompany throughout
• Explain services at group home
      General Comments
• Beware of sudden changes

• Be aware of slow changes over time, baseline

• Don’t assume ‘its just getting older’

• Look for patterns

• Behavior change is common indicator of illness

• Ask the most familiar person

• The same symptom can be many things
The Manual
                 The Manual
• Not a novel!

• Targeted use

• What’s normal

• Working with providers, families

• Advocating

• Common symptoms: providing the 80%

• Common conditions

• Resources
       Uses of the Manual
• General learning

• Support for advocating

• Creating expectations (Screening)

• Symptoms
  •   Brief background/causes/consequences
  •   Information needed
  •   Team approach
  •   Useful information for professionals
The Trainer’s Guide
         Using the Guide
• Response to resident
  • Symptoms
  • Conditions

• General learning

• Practice problem solving

• Tips for trainers
           Group Activity
• Pick a trainer

• Review the case

• Guide your staff through the case

• Pick a resident you know

• Reconvene to discuss

				
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posted:6/13/2014
language:English
pages:42