laurie duke rn supportingpeople with disabilities through the · pdf file ·...

Laurie Duke RN

Supporting People With Disabilities Through The Aging ProcessPrepared for the SARC Saskatchewan Conference

Situating ourselves among the privileged few May 2015

Copyright © GigaLuma 1

Situating ourselves among the privileged few

Created by GigaLuma Technologies Inc. with adapted statistics based on Government of Canada Report ‐ Seniors on the Margins ‐ 2004

Total Population of Canada is 35 million

• 5 million Canadians are seniors 14 % of total population

• 170,000 Canadians have a developmental disability 0.5% of total population

• 44,770 Canadians with a developmental disability are between the ages of 45‐65

0.1% of total population

25% of people with a developmental disability

• 12,000 Canadians are now seniors between ages of 65 ‐ 74 who have a

developmental disability 0.03% of total population

10% of people with a developmental disability

0.25 % of all seniors

We are caring for people who may be very frail and who may be challenged by a wide variety of health concerns

The burden of responsibility for their health and well‐being can feel very weighty on us



Two of the most stressful times I see in our organizations are:

When a person’s health declines rapidly and questions emerge about our feelings of confidence or competence to care for them

When a person has been unwell for a prolonged period and questions emerge about our ability to sustain their care and supports

Identifying the major stress points can help strengthen ourselves, our teams and our organizations!

Stressors (needs) are often linked to:

• Knowledge and Education• Communication around Values• Resources and Supports

By focussing on these key areas (personally and in our teams) we can grow tremendously!

Here is some very Good News!

We have 30 years of experience in community‐living under our belt

Much excellent reflection has gone into summarizing our experiences over these years

Many are taking time to compile the learning across the different organizations and it is happening in exciting ways!



Communication around our Opinions, Values and Beliefs

No one person knows the answers to all the questions that we have. But there is a lot of wisdom among us when we gather together and focus on our experiences in an effort to understand and grow.

We can be encouraged when we see we are not alone and that others are grappling with the same questions. We can take heart that we are growing together.

We put the well‐being of the person with a disability at the centre of our conversation and believe that decisions we make when we are truly doing the best we can, are the best decisions that we can make.

We grow by learning from our efforts.

(If we fail, let’s plan to fail forward)

We do not need to know everything.

Our role is to see and to communicate our observations

Did you know?

Education and Knowledge:

Here are some important learnings:

Many of the defining boundaries between us get

blurred as we age.

Much of what is true for all seniors is also true for

seniors with disabilities.

3 Normal Aging Changes May 2015


DAILY LIVING

SUPPORTIVE ACTIONS

CARE NEEDS

IMPACT & RISKS

VISION CHANGES

VISION

Vision changes are the first changes to occur associated with aging at approximately 40, this is called presbyopia.

Normal Physical and Sensory Changes in the Older Adult

DAILYLIVING

SUPPORTIVE ACTIONS

CARE NEEDS

IMPACT & RISKS

VISION CHANGES

VISION

• Seeing in dim light becomes harder

• Pupils react slower to decreases in light

• Decrease in peripheral vision• Decreased night vision • Loss of depth perception

DAILYLIVING

SUPPORTIVE ACTIONS

CARE NEEDS

IMPACT & RISKS

VISION CHANGES

VISION

“A 60 year old person requires 30% more light to read than a 20 year old”

• Eyes become drier and watery

• Eyes take on a sunken look• Difficulty with color discrimination

• Delayed recovery from glare



DAILYLIVING

SUPPORTIVE ACTIONS

CARE NEEDS

IMPACT & RISKS

VISION CHANGES

VISION

• Inability to read fine print • Cost of regular eye exams / glasses

• Negative Impact on Hobbies / Job

• Possible Driving Consequences• Falls / injuries

DAILYLIVING

SUPPORTIVE ACTIONS

CARE NEEDS

IMPACT & RISKS

VISION CHANGES

VISION

• Eye glasses / daily cleaning

• Every 2 years a professional eye exam is recommended

DAILYLIVING

SUPPORTIVE ACTIONS

CARE NEEDS

IMPACT & RISKS

VISION CHANGES

VISION

• Increase lighting by 3x • Non‐reflective surfaces reduce glare• Color strips on stairs • Safety barrier at top of stairs• Use of bright colours • Reading glasses / magnifiers handy

• Artificial Tears

3x



DAILYLIVING

SUPPORTIVE ACTIONS

CARE NEEDS

IMPACT & RISKS

VISION CHANGES

VISION

4 Common Eye Diseases / Conditions that are not related to normal aging:

• Age Related Macular Degeneration

• Cataracts• Glaucoma

• Diabetic Retinopathy

DAILY LIVING

SUPPORTIVE ACTIONS

CARE NEEDS

IMPACT & RISKS

PAIN &SENSITIVITY CHANGES

PAIN and SENSITIVITY

Many studies have shown that with aging, one may have reduced or changed sensations of pain, vibration, cold, heat, pressure, and touch. Many people experience changes in the touch‐related sensations as they age.


DAILYLIVING

SUPPORTIVE ACTIONS

CARE NEEDS

IMPACT & RISKS



• Nerve function that controls the sense of touch declines slightly

• Decreased sensitivity and decreased ability to respond to pressure, pain, warmth, and cold After age 50, many people have reduced sensitivity to pain.

• Fine touch may decrease.



DAILYLIVING

SUPPORTIVE ACTIONS

CARE NEEDS

IMPACT & RISKS



• PAIN MAY NOT BE FELT

• Decreased temperature sensitivity increases the risk of injuries such as frostbite, hypothermia, and burns or cuts

• Risk of infection• Reduced ability to detect vibration, touch, and pressure increases the risk of injuries, including pressure ulcers

• PAIN MAY BE CONSTANTLY FELT

DAILYLIVING

SUPPORTIVE ACTIONS

CARE NEEDS

IMPACT & RISKS



• Inspect your skin (especially feet) for injuries, and if you find an injury, treat it. Don't assume that just because an area is not painful, the injury is not significant.

• Podiatrist care as needed (People with diabetes should have their feet cared for and nails cut by a podiatrist only)

DAILYLIVING

SUPPORTIVE ACTIONS

CARE NEEDS

IMPACT & RISKS



• Inspect skin when bathing and look for bruises, burns and open areas

• Limit the maximum water temperature in your house to reduce the risk of burns.

• Look at the thermometer to decide how to dress rather than waiting until you feel overheated or chilled.



DAILYLIVING

SUPPORTIVE ACTIONS

CARE NEEDS

IMPACT & RISKS



4 Common Sensory Diseases / Conditions that are not related to normal aging:

• Peripheral Neuropathy• Diabetic Neuropathy • Phantom limb pain

• Acute sensory loss

DAILY LIVING

SUPPORTIVE ACTIONS

CARE NEEDS

IMPACT & RISKS

MUSCLE & JOINT

CHANGES

MUSCLE and JOINT

Muscles may become rigid with age and may lose tone, even with regular exercise. The rate and extent of muscle changes seem to be genetically determined.


DAILYLIVING

SUPPORTIVE ACTIONS

CARE NEEDS

IMPACT & RISKS

MUSCLE & JOINT

CHANGES

MUSCLE and JOINT

• Age related degeneration affects tendons and ligaments

• Muscles grow larger and stronger until mid‐30’s then gradual loss of muscle mass and function occurs

• Muscle structure is noticed especially in leg muscles

• Decreased flexibility



DAILYLIVING

SUPPORTIVE ACTIONS

CARE NEEDS

IMPACT & RISKS

MUSCLE & JOINT

CHANGES

MUSCLE and JOINT

• Decreased size and number of muscle fibers is called sarcopenia

• Body Fat increases (ratio of body fat to lean muscle changes)

• Increased joint diseases such as Osteoarthritis

• Loss of motor neurons that communicate with brain

DAILYLIVING

SUPPORTIVE ACTIONS

CARE NEEDS

IMPACT & RISKS

MUSCLE & JOINT

CHANGES

• Lost muscle tissue may be replaced with a tough fibrous tissue. This is most noticeable in the hands, which may appear thin and bony.

• The joints become stiffer and less flexible. Minerals may deposit in and around some joints (calcification). This is common in the shoulder.

MUSCLE and JOINT

DAILYLIVING

SUPPORTIVE ACTIONS

CARE NEEDS

IMPACT & RISKS

MUSCLE & JOINT

CHANGES

MUSCLE and JOINT

• Inflammation, pain and stiffness result from breakdown of joints

• Increased falls risk due to change in center of gravity and decrease in coordination

• Almost all elderly people are affected by joint changes, ranging from minor stiffness to severe arthritis



DAILYLIVING

SUPPORTIVE ACTIONS

CARE NEEDS

IMPACT & RISKS

MUSCLE & JOINT

CHANGES

MUSCLE and JOINT

• Flexibility exercises help stretch the muscles protect against injury and allow the maximum range of motion for joints

• Necessary to ensure adequate intake of CALORIES and daily PROTEIN to sustain muscle mass.

DAILYLIVING

SUPPORTIVE ACTIONS

CARE NEEDS

IMPACT & RISKS

MUSCLE & JOINT

CHANGES

MUSCLE and JOINT

Loss of Muscle mass reduces strength. However,endurance may be enhanced somewhat by changes inmuscle fibers.

Aging athletes with healthy hearts and lungs may findthat performance decreases in events that require shortsbursts of high‐speed performance and improves in eventsthat require endurance.

DAILYLIVING

SUPPORTIVE ACTIONS

CARE NEEDS

IMPACT & RISKS

MUSCLE & JOINT

CHANGES

MUSCLE and JOINT

What does it mean for PAIN to become Normalized as we age?



DAILY LIVING

SUPPORTIVE ACTIONS

CARE NEEDS

IMPACT & RISKS

KIDNEYS & BLADDER CHANGES

KINDEYS and BLADDER

The kidneys filter the blood and help remove waste and extra fluid from the body. The kidneys also help control the body's chemical balance. In a healthy aging person, kidney function remains normal.


DAILYLIVING

SUPPORTIVE ACTIONS

CARE NEEDS

IMPACT & RISKS


KINDEYS and BLADDER

• Decreased kidney function (from age 40) causes increased concentration in urine

• Blood vessels supplying the kidneys can become hardened causing the kidneys to filter blood more slowly.

DAILYLIVING

SUPPORTIVE ACTIONS

CARE NEEDS

IMPACT & RISKS


KINDEYS and BLADDER

• The elastic tissue becomes tough and the bladder becomes less stretchy

• The bladder muscles weaken and cannot hold as much urine as before

• Decreased bladder emptying

• Less thirst response



DAILYLIVING

SUPPORTIVE ACTIONS

CARE NEEDS

IMPACT & RISKS


KINDEYS and BLADDER

• Dehydration a great risk• Sleep disruption• Infection risk urinary retention, or obstruction risk

• Psychological impact of dribbling or Incontinence

• Financial impact (pads)

DAILYLIVING

SUPPORTIVE ACTIONS

CARE NEEDS

IMPACT & RISKS


KINDEYS and BLADDER

Illness and medications can significantly affect kidney function.

Increase in fluids is

necessary butoftenresisted

Drink most fluids early in the day to decrease

number of trips to bathroom at

night

DAILYLIVING

SUPPORTIVE ACTIONS

CARE NEEDS

IMPACT & RISKS


KINDEYS and BLADDER

Call your health care provider right away if you have any of the following:

• Signs of a urinary tract infection, including fever or chills, nausea and vomiting, extreme tiredness, low back pain

• Very dark urine or fresh blood in the urine• Trouble urinating• Urinating more often than usual

• Sudden need to urinate

Monitor

Temperature

Pulse

Respiration



DAILYLIVING

SUPPORTIVE ACTIONS

CARE NEEDS

IMPACT & RISKS


KINDEYS and BLADDER

Blockage of the urethra

• 50% of Men over 60yrs often experience enlarged prostate

Kidney Stones

• A kidney stone may be as small as a grain of sand or as large as a pearl. It may get stuck in the urinary tract, block the flow of urine and cause great pain.

2 COMMON COMPLICATIONS

DAILY LIVING

SUPPORTIVE ACTIONS

CARE NEEDS

IMPACT & RISKS

BOWELS & DIGESTION CHANGES

BOWELS and DIGESTION

Successful aging depends on a well functioning digestive system


DAILYLIVING

SUPPORTIVE ACTIONS

CARE NEEDS

IMPACT & RISKS



• Your digestive system is extremely important in meeting nutritional needs.

• The digestion process becomes less effective with age, and is one of the most common causes of malnutrition in older people.



DAILYLIVING

SUPPORTIVE ACTIONS

CARE NEEDS

IMPACT & RISKS



• Small intestine becomes less effective at absorbing nutrients

• Proteins, fats, mineral (calcium) , vitamin B12 and carbohydrates are absorbs more slowly and in lesser amounts

• Gastric acidity is reduced

DAILYLIVING

SUPPORTIVE ACTIONS

CARE NEEDS

IMPACT & RISKS



• Common complaint is constipation

• Vitamin B12 deficiency

• Reflux Disease causing painful heartburn

• The causes of malnutrition can include improper or incomplete digestion

DAILYLIVING

SUPPORTIVE ACTIONS

CARE NEEDS

IMPACT & RISKS



Production of digestive enzymes declines so even if your food is

healthy and packed with nutrients, you may not get as much of what you

need even with a good diet!



DAILYLIVING

SUPPORTIVE ACTIONS

CARE NEEDS

IMPACT & RISKS



• Exercise and diet are best allies• Monitoring bowel records

• Increased fiber in diet can help prevent out‐pouching in colon by decreasing time stool is in colon

• Digestive support in the form of digestive enzymes can be very beneficial

DAILYLIVING

SUPPORTIVE ACTIONS

CARE NEEDS

IMPACT & RISKS



The symptoms of incomplete or improper digestion are:

• Feelings of bloating after a meal

• Belching• Burning sensations• Feelings of fullness• Flatulence (gas)• Nausea

DAILYLIVING

SUPPORTIVE ACTIONS

CARE NEEDS

IMPACT & RISKS



Constipation is a condition in which you have one or both of the following:

• fewer than three bowel movements a week

• bowel movements with stools that are hard, dry, and small, making them painful or difficult to pass



DAILYLIVING

SUPPORTIVE ACTIONS

CARE NEEDS

IMPACT & RISKS


DAILYLIVING

SUPPORTIVE ACTIONS

CARE NEEDS

IMPACT & RISKS


The 3 D's and Aging With a Disabilty May 2015


CARERISKSYMPTOMSONSETCAUSES

Delirium is a state of mental confusion with marked fluctuations in degree of alertness and ability to focus on external stimuli. Delirium can be life threatening if not treated.

DRUGS OR BUGS

Suspect delirium in the older adult when you see:

SUDDEN onset of altered behaviour with decreased ability to focus and pay attention

Perceptual disturbances and impaired thinking

Awake and agitated at night



Suspect delirium in the older adult when you hear:

This is not like my motherHis dementia is suddenly much worseShe was picking at her covers

He seems fine some times of the dayShe goes from agitated to sleepyHis thoughts just rambled

What are we seeking to rule out?

Drug toxicity Infection Unrelieved pain Constipation Urinary retention Exacerbation of chronic illness Metabolic disease Recovery from general anesthetic Dehydration Sleep deprivation Alcohol and substance misuse Psychosocial issues such as grief

A RAPID ONSET! (Hours - Days)

Can last days to weeks until it is reversed



Symptoms fluctuate over the course of the day

Person is disoriented Level of Consciousness

fluctuationsSleep-Wake cycle may be

reversed

• Those of advanced age

• Those taking multiple drugs

• Those experiencing infection

• Those with chronic illnesses & comorbidities

• Males are at greater risk than females

ACTION IS REQUIRED AS DELIRIUM IS A MEDICAL EMERCENCY

It requires immediate investigation and rapid response.

Unfortunately, delirium is missed in as many as 70 percent of cases.




Depression is one of the major causes of decline in the health-related quality of life of elderly persons … Quality

of life is a crucial outcome of depression treatment.

—Dombrovski, A. Y. et al. (2007).

It's usual to feel low, blue or unhappy at various times in our lives, but clinical depression is more than this in its severity. When the feelings have got to a point of being disruptive to a person's social functioning and daily life, and last for more than two weeks, that may be a sign of clinical depression.

Depression appears to occur more frequently among older people, but is nota "normal" consequence of aging. In fact,

depression is now recognized as a contributor to a wide variety of health-

related problems among the elderly. These range from delays in recovering from other

illnesses, increased severity of pain, inability to access support services and

medical care, alcohol abuse, and frequency of emergency room visits.

—Stoil, M. (2003)

Medications

Malignancies

Infections

Metabolic disturbances

Endocrine disorders

Neurological disease

Vitamin deficiencies

Genetic predisposition

Chronic physical illness

Psychosocial conditions



A GRADUAL ONSET(Weeks - Months)

People often do not recognize their depression

Early morning awakening

Somatic presentations

Anorexia, weight loss

Onset or recurrence of substance abuse

Depression/Anxiety affects about 6 million elderly people

Depression/anxiety occurs in about 15 % of those over 65

Depression in nursing home residents can reach as high as 25 %

Only about 10% of the elderly experiencing depression/anxiety seek professional help.



People with Depression usually experience: Guilt – self-blame, worthlessness,

hopelessness, regrets Energy decreased, fatigue Concentration difficulties Appetite disturbance-weight loss or

weight gain (weight loss more common in older adults)

Psychomotor retardation or agitation Suicidality, suicidal thoughts

Older people, as a group, are most at risk for suicide.

One quarter of all suicides are committed by the elderly.

Suicide among older adults is a critical public health problem. The suicide rate for the elderly in most countries is higher than that of any other age group, with the rates among people aged 75 and older roughly three times that of adolescents.


Dementia is the most common mental disorder and is characterized by intellectual deterioration that impairs social and occupational function



THE WORD DEMENTIA IS AN ‘UMBRELLA TERM’

USED TO DESCRIBE A NUMBER OF MENTAL ILLNESSES THAT ARE

ALL SIMILAR IN THE EFFECT THAT THEY HAVE ON MEMORY BUT WITH DIFFERENT CAUSES.

Alzheimer’s Dementia 50%Vascular Dementia 10%Lewy Body Dementia 15%Fronto-Temporal Dementia 15%Other 10% (Jacob-Cruzfield, Parkinson’s,

Korsakoff, Aids)

A SLOW AND INCIDIOUS ONSET

(Months - Years)



People with Dementia experience Changes in:

MemoryReasoningPlanningCaring for themselves

Over 27 Million People world-wide are living with a dementing Illness

There is no cure for Dementia

Treatment is focussed on supporting the problematic symptoms of this disease if they occur – anxiety, agitation, aggression



SUPPORTING PEOPLE IN

COMMUNITY WITH

DISABILITIES WHO ARE

AGING WILL …

Affect the daily rhythms of our homes and the community as a whole

Push us to build upon and reinforce their strengths and gifts so that their quality of life is enhanced

challenge us to find creative ways for people to continue to do the things they like to do and to continue to have a valued role in the home and day program

Specific groups of persons with developmental disabilities have particular health risks.

People with Down Syndrome are at greater risk of early onset of visual and hearing disorders, epilepsy and dementia.

People with Fragile X may have musculoskeletal disorders, visual impairments, early menopause, and epilepsy



People with Prader-Willi Syndrome may experience obesity, a high risk of cardiovascular disorder and diabetes

People with developmental disabilities associated with problems with the central nervous system (FAS, Spina Bifida, Cerebral Palsy) are likely to experience higher rates of acute respiratory disease, epilepsy, autism, mental health problems and vision disorders.

Compared to the general population, a greater number of people with disabilities have uncorrected or unidentified visual problems such as glaucoma, or inadequate prescription eyewear, in part because of their inability to communicate their needs clearly.

Older adults with a developmental disability may experience more severe loss of flexibility as age-related changes in joint function and bone density combine with their existing mobility problems



Caregiving often calls us to lean into love we didn't know possible.” Tia Walker, The Inspired Caregiver: Finding Joy While Caring for Those You Love

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