Ageing and Adults Ageing and Adults with with

Developmental Developmental DisabilitiesDisabilitiesCatholic Community ServicesCatholic Community Services

Patricia Auerbach, R.N.Patricia Auerbach, R.N.

September 2005September 2005

Goal of ClassGoal of Class

Talk about ageing

Talk about ageing in adults with developmental disabilities

Talk about aspiration, ageing and our residents

Talk about our feelings about ageing in ourselves and in our residents

Talk about death

InstructorInstructor

Who I am

Why I have this passion

Objectives of classObjectives of class

• Describe normal ageing

• Describe ageing in our clients

• Describe how aspiration affects the ageing process

• Express our feelings about the ageing of our clients

• Express our feelings about the dying process of our clients

LimitationsLimitations

• Cannot give a comprehensive review about ageing– So many factors come into play with a limited

time to address the subject

• Examples are limited to our current clients

Ground RulesGround Rules

• Encourage discussion

• Encourage questions

• Respect for everyone’s feelings and opinions

Definition of ageingDefinition of ageing

• General definition– Chronological age of 65 years– “any change in an organism over time”

• Ageing in adults with

developmental disabilities– Chronological age of mid-50s– Dependent upon changes in functional status

Usual Changes in Neurological Usual Changes in Neurological SystemSystem

• Brain size decreases

• Slowing of movement and reaction time

• Decrease in ability of senses: hearing, sight, smell

Usual Changes in Gastrointestinal Usual Changes in Gastrointestinal SystemSystem

• Difficult in swallowing

• Gastric juices diminish

• Constipation increases

• Potential decrease in weight

Usual Changes in Respiratory Usual Changes in Respiratory SystemSystem

• Decline in elasticity of the bony thorax

• Loss of muscle mass with weakening of the muscles of respiration and reduced mechanical advantage

• Decrease in alveolar gas exchange surface

• Decrease in CNS responsiveness

Usual Changes in Musculoskeletal Usual Changes in Musculoskeletal systemsystem

• Loss of flexibility

• Osteoarthritis

• Loss of strength 25-43%

Usual Changes in Psychiatric Usual Changes in Psychiatric SystemSystem

• Cognitive function declines

• Depression is a common ailment

• Dementia can be side effect of medications

• “Many changes in mental health are difficult to attribute to ageing per se: they are often the result of disease”

Similarities of ageing in normal Similarities of ageing in normal population compared with DD population compared with DD

populationpopulation

• Numbers are growing

• Similar prevalence (12% of population)

• Die from similar causes

Differences of ageing in normal Differences of ageing in normal population compared with DD population compared with DD

populationpopulation

• Earlier ageing trends• Average life expectancy is less• Adults with DD have not been exposed to

same ageing influences:– Not had same stress, tobacco, alcohol

exposure as general population– Have had uneven health care

Neurological Changes in DD Neurological Changes in DD PopulationPopulation

• Decrease in sensory systems

• Seizure disorders are associated with a higher frequency of cardiovascular diseases and infectious diseases

Gastrointestinal changes in DD Gastrointestinal changes in DD PopulationPopulation

• Long term problems with constipation lead to more problems

• Esophagus lining thickening leading to difficulty swallowing

• Decreased production of saliva• Fewer calories needed• Decreased smooth muscle tone which

leads to problems with moving food through tract

Respiratory changes in DD Respiratory changes in DD PopulationPopulation

• Age-related change in joint function and bone density is added to immobility

• Inactivity accelerates loss of bone density and mass

• AED link with osteoporosis• Arthritis is noted at an earlier stage than in

“normal” people• DD population have increased pain, soreness,

weakness of muscles and energy decline

Psychiatric considerations in DD Psychiatric considerations in DD populationpopulation

• “Alzheimer’s Disease represents a major health concern for adults with DD.”

• More difficulty processing, organizing new information, recalling old information

• Mental illness more prevalent in those with developmental disabilities than in general population

Effects of AspirationEffects of Aspiration

• Effects of aspiration on our clients

• Risk of our clients

• How aspiration risk changes with age

Feelings about ageing and deathFeelings about ageing and death

Normal feelings about deathNormal feelings about death

• Shock

• Denial

• Emotional release

• Depression, loneliness, sense of isolation

• Physical symptoms

• Panic

Normal feelings about deathNormal feelings about death(continued)(continued)

• Guilt

• Hostility

• Inability to resume usual activities

• Glimpse of hope

• Acceptance

Deaths at CCSDeaths at CCS

Stages of GrievingStages of Grieving

Ending…or Beginning?Ending…or Beginning?