In the zone of maximum comfort, people are supported in their abilities by the environment. In the zone of maximum performance potential, people are challenged by the environment to improve their skills to achieve occupational performance; they reach the “just right challenge.” Home modifications should bring people into the zone of maximum comfort, where the difficulties imposed upon the older adult by the environment are lessened to meet his or her level of competence. An example of this would be someone faced with a bathtub that is too high. The environmental press is strong, and the person may have low to moderate competence in terms of balance, safety awareness, and ability to step over the bathtub edge. The installation of a grab bar would reduce the environmental press enough to allow the person to move from either maladaptive or marginal zones into the zone of maximum comfort. Then the person could perform a tub transfer safely and independently. Context is important in the completion of ADLs. These contexts include the physical, social, virtual, temporal, and cultural environments that directly impact people. These all need to be considered when recommending home modifications; they will directly influence people’s need for home modifications and receptiveness to said recommendations. As one can see, the above-mentioned environments and contexts directly influence several factors related to aging in place, including a general opinion about the aging process, possible considerations in regard to features of the home, and who may live together. Clinicians must always consider these factors when assisting a client with aging in place.
Figure 3: Lawton’s Theory of Environmental Press
Strong
Too much press
Marginal
Stimulation
Negative affect and maladaptive behavior
Positive affect and adaptive behavior
Maximum comfort
Environmental Press
Support
Maximum performance potential
Marginal
Negative affect and maladaptive behavior
Too little press
Weak
Low
High
Competence
Note. From Western Schools, © 2018.
THE AGING PROCESS
The process of natural aging begins early in our lifespans. Between the ages of 25 and 30, our body functions and strength have peaked. Natural aging includes several age- related conditions and general decline in function. These natural
declines are found in various body functions, including memory, sensory, and musculoskeletal functioning. Table 1 describes the typical symptoms of natural aging.
Table 1: Natural Aging Process Cognition
• Decreased processing speed. • Decreased ability to maintain attention in distracting environments. • Decreasing short-term memory. • Longer time to learn tasks, but possible through overlearning. • Presbyopia (near-sightedness). • Changes in color sensitivity due to yellowing of the retina. • Loss of peripheral vision by 20° to 30°. • Increased risk of age-related eye conditions described below. • Decreased vision in low light.
Vision
Hearing
• Gradual loss of hearing over time in one or both ears. Vestibular System • Natural decline in righting reactions and ability of central nervous system to interpret signals from inner ear causing a feeling of unsteadiness called presbyastasis. • Development of “fear of falling.” Musculoskeletal System • Changes in posture such as development of kyphosis. • Increased body fat with decreased body water content. • Decreased range of motion. • Decreased flexibility, especially in the spine. • Decreased number of motor neurons causing decreased strength, postural changes, gait impairments, and decreased balance. • Increased stiffness in joints and ligaments.
Cardiovascular System
• Decreased sensitivity in baroreceptors, which detect pressure in blood vessels for blood pressure management. • Increased resting blood pressure. • Increased thickness and decreased flexibility of the aorta. • Decreased toleration of extreme aerobic demands. • Slightly lower heart rate with slightly increased size of the heart.
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