Table 1: Natural Aging Process Integumentary System
• Thinning of skin, increasing risk of skin tears, and decreasing ability of skin to help retain body heat. • Less sweat production due to loss of oil and sweat glands. • Increased risk of skin dryness.
Other Changes
• Decreased sensitivity to smell (hyposmia). • Decreased sensitivity to taste (hypogeusia). • Decreased sensitivity to touch. • Decreased sensitivity to temperature and decreased ability to retain body warmth.
• Decreased proprioception. • Decreased sensitivity to pain.
• Decreased sensitivity to fine touch. • Decreased sensitivity to vibrations. • Decreased reaction time to signals from proprioceptors and muscle perturbations. Note. Adapted from Cronin, A., & Reynolds, P. (2015). Late adulthood. In A. Cronin & M. B. Mandich (Eds.), Human development and performance:
Throughout the lifespan (2nd ed., pp. 405-432). Boston, MA: Cengage. Despite the list of age-related changes above, some people do experience what is termed successful aging, which involves a higher level of health, well-being, and physical functioning; the support of the environment can play a very important role in encouraging successful aging. In addition to normal age-related changes, older adults are also at risk for a series of multifactorial, insidious conditions, called geriatric syndromes (Inouye, Studenski, Tinetti, & Kuchel, 2007). These include an increased fall risk, urinary incontinence, sleep disturbances, delirium, osteoporosis, dementia, malnutrition, and pain. Often, multiple organs and risk factors are involved in each geriatric syndrome. Each syndrome presents with its own unique challenges and they are often interconnected. For example, a person may become dehydrated from not drinking enough due to a self-attempt to manage incontinence, but then demonstrate delirium as a manifestation of a urinary tract infection, during which time the person falls. Other conditions become chronic and can become predominating issues with the lives of older adults. While home modifications and design do not eradicate these conditions, they can minimize the impact of their symptoms on someone’s daily life through a supportive environment that lessens the potential of injury with a fall or encourages good body mechanics to lessen incidents of pain, for example. Common age-related conditions Clients frequently offer the advice of “don’t get old.” Some people do age successfully and enjoy high levels of independence well into their golden years. Most older adults will have a varying number of conditions to consider as they age. The following sections will discuss some of the more common age-related conditions that require consideration within the context of aging. Orthopedic conditions Orthopedic conditions involve the skeletal system from years of wear and tear. People will experience varying degrees of these conditions, and home modifications can alleviate or even prevent the progression of associated pain and dysfunction. Arthritis People often consider only two forms of arthritis when they hear the word; osteoarthritis and rheumatoid arthritis. There are actually over 100 different types of arthritis, often as secondary conditions and symptoms to other diseases, most commonly autoimmune diseases (CDC, 2016). The most common symptoms of all types of arthritis are joint pain, stiffness, and swelling around the joints. Osteoarthritis is the degeneration of the cartilage covering the ends of bones that wears away over time. Rheumatoid arthritis is an autoimmune disease; it also has a genetic link and often runs in families. With rheumatoid arthritis, there can also be damage to the joint and multiple organ involvements. People may present with the stereotypical ulnar drift in the hands and are also at a higher risk of adhesive
Figure 4 clearly demonstrates the complex nature of the geriatric syndromes and interrelation of the syndromes to each other. Many of these can be life threatening, but a few can be either eliminated or minimized through proper home modification recommendations. Figure 4: Geriatric Vicious Circles
Geriatric Syndromes
Deconditioning
Constipation
Sleep Deprivation
Malnutrition
DELIRIUM
Dehydration
Pain
Immobility
Incontinence
Depression
Falls
Note. From Western Schools, © 2018.
capsulitis. In both cases, structural changes in the hands make it more difficult for older adults to manipulate smaller items. Clinicians may find that over time, clients have developed multiple compensation techniques. With longtime use of these compensation techniques, clients experience more pain with movement, joint changes that prevent full range of motion, or movement patterns that also decrease the range of motion, such as shoulder hiking with shoulder flexion. Rheumatoid arthritis, in particular, is progressive and is characterized by exacerbations. Typical locations for arthritis include knees, hips, shoulders, hands, and the spinal column, especially in the lumbar regions. Rotator cuff injuries Full or partial rotator cuff tears are not uncommon with older adults. Four muscles comprise the rotator cuff: infraspinatus, supraspinatus, teres minor, and subscapularis. The movement limitation and area of pain can help pinpoint which specific muscle, if not all, has the tear. The risk of a tear increases with age as bones change positions and shapes with postural changes, and muscles and tendons weaken. Some older adults experience tears due to traumatic injuries, such as a fall. Other people’s tears are a result of long-term wear and tear, especially with those who repeatedly performed overhead tasks for a living, such as carpentry, mechanic work, and farming. Others will spontaneously tear when reaching for an everyday item; their tendons may have been rubbing up against a piece of bone for years until they no longer had integrity.
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