Neglects, or hemispatial neglect, are caused by neurological injury and result in an inattention to one side. The person may ignore the entire left side of his or her body and environment. In severe cases, when tracking a finger, his or her eyes will follow toward the side of the neglect and bounce back to the other side once the finger hits midline. People typically are not aware of their neglect and require intervention. Clinicians typically place objects on that side to draw the attention in that direction. In terms of aging in place, if it is a chronic neglect that has not remediated, it should be noted so that important objects, such as the telephone, are not placed on the side that does not exist to the person. Neurological conditions Neurological conditions range from primary conditions to symptoms of other disorders. They are frequently associated with cerebral vascular accidents, diabetes, Parkinson’s disease, lumbar stenosis, multiple sclerosis, and carpal tunnel syndrome, to name a few. Neurological conditions impacting older adults can originate from either the central or peripheral nervous system. Neuropathy Neuropathies are either part of the aging process, due to demyelination or vitamin deficiencies, or as part of another condition. Peripheral neuropathy, or tingling and/or numbness in the hands and feet, commonly develops with people who have diabetes, nerve impingements, carpal tunnel syndrome, multiple sclerosis, and rheumatoid arthritis. At times, it develops without an easily identifiable cause. Numbness, tingling, or pain in people’s hands can cause trouble with manipulation of objects and discrimination of temperature. Neuropathy in feet can place the person at a higher risk of balance deficits and falls. It can also cause the person to have more foot abrasions during functional mobility without their knowledge, which is problematic due to the slower wound healing time associated with diabetes. Pain Pain is considered one of the geriatric syndromes, and unfortunately, is a daily reality for many older adults. The causes of pain range from arthritis and neuropathies to structural changes, such as rotator cuff tears and spinal stenosis. All have a distinct impact on the daily functioning of the person experiencing it. Being mindful of proper body mechanics can prevent future pain development or avoid increasing pain. Pain due to arthritis and rotator cuff tears has already been discussed. Neuropathies and spinal stenosis cause significant pain due to the tingling sensation that can worsen with pressure. Other causes of neuropathies include nerve impingements and carpal tunnel syndrome. People with spinal stenosis will have sharp, electric pains at various points of their back, depending on the location of the narrowing spinal column. It is common in the lumbar region; older adults will experience significant pain that may radiate down their legs during extended standing periods, especially during meal preparation and bathing. Parkinson’s disease Parkinson’s disease is caused by the death of dopamine producing neurons in the substantia nigra portion of the brain. As the neurons die, motor functions become impacted. As many as one million Americans have Parkinson’s disease (Parkinson Association of the Carolinas, 2017). The disease is commonly diagnosed over the age of 50; to be diagnosed under 50 years old is to have early onset Parkinson’s disease. Every person experiences the symptoms differently; however, it is progressive. Special considerations must be made in the environment to support people as they age with this condition. Motor symptoms include a shuffling gait, a resting tremor, flat affect, bradykinesia, and decreased initiation of movement. Multitasking and combining motor functions with other functions, such as cognitive or sensory processing, also becomes more difficult. Righting reflexes lessen, making this group of people at a higher risk of falls. The brain interprets small movements as normal sized, even though the reality is the steps are small and
voices are very soft. People with Parkinson’s disease often find it difficult to navigate around objects; turning requires more motor coordination than they may have available to them. They also tend to freeze when changing floorings, traversing thresholds, or when confronted with contrasting colors in floors and carpets. The ability to continue walking cannot occur while they are processing the change in the environment. Fine motor coordination is also impacted with Parkinson’s disease, and most people will develop Parkinson’s dementia. As time continues, the disease progresses to the point where people are no longer able to ambulate themselves and require assistance with all daily activities. Multiple sclerosis Multiple sclerosis is caused by demyelination of the neurons in the central nervous system; it is often diagnosed in young adulthood. Older adults will have had it for many years and will be dealing with the progression of the disease. Because most research has been aimed at the younger population, and multiple sclerosis can be harder to diagnose in older adults, the actual number of older adults living with multiple sclerosis is unknown. Multiple sclerosis symptoms will also vary from person to person; however, people typically will have some motor problems, ranging from decreased fine and gross motor coordination to paralysis of limbs. Along with these symptoms comes decreased balance and a higher risk of falls and injuries during functional mobility, transfers, and standing ADLs. They also can develop peripheral neuropathies. Because multiple sclerosis does affect the central nervous system, people also experience cognitive deficits, which have been described as a brain fog. Symptoms can vary based on the day, the individual’s fatigue level, and the type of multiple sclerosis. Other conditions Older adults may also live with other conditions not mentioned above. These also require considerations to help them maintain their safety in their home, reduce potential injuries, and decrease the impact of these conditions on their daily lives. Chronic obstructive pulmonary disease Chronic obstructive pulmonary disease (COPD) is a progressive disease of the lungs. People who were smokers or sustained environmental exposure to smoke or other chemicals/irritants to their lungs often develop this in their later years. It impacts their ability to breathe and expel oxygen. The misconception is that people with COPD cannot get enough oxygen into their bodies. The reality is that with poor exhalation, carbon dioxide remains in the lungs and cannot be replaced with fresh oxygen. Some people may be on 24-hour oxygen, therefore outlet locations and ensuring power during outages would be very important. Because people with COPD became out of breath and fatigued with simple activities, consideration of the size of spaces is important. It is not uncommon for someone to move their entire daily life into one or two rooms of a larger house because moving between multiple rooms is too exhausting or the oxygen saturator tubing cannot reach all areas of the home. Congestive heart failure Congestive heart failure is another progressive disease in which the heart pumps become weaker, causing fluid buildup in the system and more pressure placed on the heart. Heart muscles have to work very hard to move blood through the body, and oxygen often does not reach where it should. Edema in the extremities due to the lack of blood flow may also occur. The edema causes balance problems; it can be difficult to stand on swollen legs and feet. People with congestive heart failure experience fatigue through the day, and may also be on supplemental oxygen, as a person with COPD. A congestive heart failure consideration is the medications used to manage the fluid. Diuretics are often prescribed; once taken, someone may need to use the restroom multiple times within a short time frame as the fluid is removed from their system. Therefore, bath locations in the home close to commonly used spaces and the ease of entering and utilizing the commode would be very important.
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Book Code: PTNY3622B
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