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.
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.” • 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. • 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. • 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.
Musculoskeletal System
Cardiovascular System
Integumentary System
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
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