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. 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.
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 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. 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
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