dementia. People with vascular dementia benefit from quieter environments and do well with recognition cues in their daily activities. Fronto-temporal dementia (FTD) is one of the rarer forms of dementia, caused by atrophy of the frontal and temporal lobes. Pick’s disease and supranuclear palsy are also part of this large family of diseases. FTD differs from other forms of NCD in that it often manifests at a younger age, around 60 to 70 years old. It also tends to be misdiagnosed as a personality disorder, because some of the major symptoms are apathy, lack of empathy for others, poor judgment, and behavior changes. People retain their memories for much longer with this condition. They also may exhibit self-identity changes and lack of inhibitions. Some people suddenly develop new talents for which they had no prior affinity, such as painting. The environment would need to keep these people safe through security measures to combat the decreased judgment and lack of inhibitions. Lewy Body and Parkinson’s dementias are both forms of NCD that are characterized by clumps of protein in the brain. The location of clump development and the initial symptoms differentiate the two conditions. Lewy Body dementia starts in the cortex; there are often visuospatial deficits, poor sleep quality, and hallucinations before parkinsonism develops. With Parkinson’s dementia, the person has Parkinson’s disease first with the motoric symptoms. The protein develops in the substantia nigra in this case, before the delusions, poor judgment, memory and attention deficits, and sleep disturbances begin. For both types of these NCDs, it helps to have a visually calmer environment to combat the visuospatial deficits and reduce the need to pay attention to multiple stimuli. Vision conditions Low vision is another common ailment of older adults. As we age, the lenses in our eyes naturally thicken and yellow. People tend to experience presbyopia, or far-sightedness, which is why older adults tend to hold items further away from them. If they were already near-sighted, they will need bifocals. The natural yellowing of the lens also impacts color discrimination, making the use of contrast important. Assessing glares, contrasts, and patterning of counters, floors, and walls in the home must occur if someone has low vision. Cataracts Cataracts are caused by clouding of the lens of the eye. These are easily treated through surgery and the placement of a new glass lens. Adults who have had the surgery often have a glint in their eye in the light. With clouding of the lens, vision becomes blurry and colors muted; the clouded lens reduces the amount of light entering the eye. Night vision becomes difficult, and people may see halos around lights and a yellow tint in their daily vision. It is also not uncommon for people with cataracts to have double vision in that eye. Driving, reading, and watching television all become difficult due to impacts on distance vision and halos around light sources. People with cataracts tend to be sensitive to ambient lighting due to the halo, but prefer high task lighting because it increases the amount of light available to enter the eye (Newsham-Beckley, 2016). Glaucoma Glaucoma tends to have a genetic component; it is caused by a buildup of fluid and increased interocular pressure that eventually compresses the optic nerve. It is treated with eye drops if caught early enough. Glaucoma affects the peripheral vision first, causing people to develop tunnel vision. Eventually, the central vision becomes impacted, but typically not until the very end of the disease process. People will also have decreased color vision and decreased contrast sensitivity, meaning similar colors, such as gray and white, would look almost the same. Ambulation and any tasks requiring peripheral vision can be challenging for them. They tend to be moderately sensitive to ambient lighting and prefer moderate task lighting in order to complete tasks (Newsham-Beckley, 2016).
Most older adults who obtain this injury later in life will not have the necessary surgery to repair the tear. Most physicians and surgeons decide the risk of the surgery is too great, especially with those who are of advanced age. As a result, older adults will live with varying degrees of limited shoulder flexion, decreased strength, and increased pain. When compounded with other issues, such as arthritis, reaching for items in the kitchen and the use of grab bars by toilets can be difficult. Postural changes The hunched-over posture of an older adult has become a stereotype. Kyphosis is fairly common and is related to osteoporosis. It can also be connected to shoulder and lumbar pain due to changes in bone positioning and musculature. Often, the scapulae drift laterally and may present with a wing. As a result, the scapulae will not glide as smoothly with shoulder flexion, which causes a problem during item retrieval and upper extremity dressing. The change in posture also affects the ability of older adults to breathe due to increased compression of the lungs. It can also contribute to lumbar pain due to changes in the back musculature. The most obvious effect, however, is the loss of height, making it harder to reach items on higher shelves. Cognitive conditions In addition to orthopedic conditions, older adults often experience changes in cognition. These changes can make it very difficult for them to age in place, especially when their safety is at risk. However, people can remain at home despite cognitive challenges when the clinicians recommend the appropriate environment. Normal age-related changes Normal age-related changes cause older adults to rely more on their environment for support in their daily activities. It is not uncommon to see them utilizing calendars and other memory aids to support their decreasing short-term memory. Due to difficulties with short-term memory, they may have trouble learning new tasks because they take longer to make long- term memories. However, with practice, overlearning, and modifications that are obvious in terms of use, they can learn new habits and routines. They also begin to have trouble with environments that are noisy or have too many competing stimuli. These are all considered normal age-related changes that are easily compensated for with adaptations. Neuro-cognitive disorder The Diagnostic and Statistical Manual of Mental Disorders (DSM‑5; American Psychiatric Association, 2013) renamed dementia as neuro-cognitive disorder (NCD). NCD is not considered part of normal aging. In fact, the brain of a typical 80 year old shows little difference from the brain of a young adult. There are several different types of NCD, all with their own unique symptoms. It is also common and possible to have a mix of two variants, called mixed dementia. Alzheimer’s disease is the most common form of NCD, and is characterized by plaques outside of neurons and tangles of protein inside parts of the brain. People with Alzheimer’s disease will first demonstrate memory deficits with names, conversations, and events. They will also demonstrate language deficits. As the disease progresses, they become more forgetful. Executive functioning declines over time, and they do not respond well to recognition cues such as signage. They do respond to familiar objects, especially their own possessions or ones that mimic items from the period of their 20s and 30s. Vascular dementia is the next most common form of NCD because it is frequently the second disorder in mixed dementia. People develop vascular dementia as a result of a cerebral vascular accident (CVA). The CVA could have been either an occlusion or hemorrhage. They exhibit deficits with planning, making decisions, and judgment, rather than forgetting names and events. They may demonstrate decreased attention to task and decreased working memory, which compounds the normal age-related changes in short-term memory. Many cognitive changes that happen post-CVA become vascular
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