Workshop Two - Understanding Normal Aging

Welcome - 5 minutes

• Facilitator greets participants by name as they arrive. Welcome them warmly to this session. Introduce the topic for today - Understanding Normal Aging.

Discussion of Workshop 1 - 10 minutes

• Refer to Workshop 1: Reflections on Aging and Caregiving: Myths and Realities
• Encourage caregivers to share their feelings about this Workshop.
• Was there an opportunity to use any of the information gained in last week's discussion?

Presentation - 60 minutes
(see #4 after presentation)

• Refer to Workshop 2 - Understanding Normal Aging

Presentation

Workshop Two - Understanding Normal Aging

Introduction

The more understanding a caregiver has about the aging process and the normal age-related changes, the better able she or he is to respond to care needs. Increased knowledge helps the caregiver with decisions about when to seek outside advice.

Increased knowledge often enhances our ability to cope and adjust.

In the first workshop, Reflections on Aging and Caregiving: Myths and Realities, we attempted to dispel some common myths. This session will go a step further and explore 1) the normal, expected changes of aging, 2) the resulting effects, and 3) some ways to adapt.

Aging as a Process

• Aging is a progressive and cumulative process of change occurring over time and affected by many factors.
• Age-related changes occur throughout our lives. For example, learning to walk as a toddler is an age-related change. It is only for the later stages of our lives that we tend to perceive these changes with negative overtones because we view the changes as losses in some area.
• There are about a dozen theories that attempt to explain aging. Most of them have a common underlying theme of a programmed process (in other words, it's in your genes).
• The significance of everyday wear and tear is considered a major factor in the aging process.
• It is accepted that in order to understand aging, we must look at many factors which affect this process - there is no "one simple explanation".
• Basically, aging is affected by:
  1. Intrinsic factors:
     • Heredity
     • Age-Related Changes
  2. Extrinsic factors:
     • Environment
     • Disease
     • Lifestyle
• The rate of decline as we age is related to the sum of biological aging, loss of fitness, disease, and social changes.
• It is true that we do tend to slow down as we get older, but what is unclear is when does that start to significantly affect a person's ability to function?
• In the absence of disease, any limiting effects of normal aging are often not even felt until sometime after age 75.
• As a result of many studies, research projects, observations and reporting, all of our previous assumptions about aging are coming into question. People are now asking: What is really a true effect of aging and what is a result of other factors?

Example: Wrinkled and dry skin was normally associated with aging, yet we know that exposure to the sun exacerbates these effects. The skin that has always been protected by clothing does not "age" in the same way as the skin on our faces and hands.

• It is true that our immune competence is compromised with the passing of years, making us more susceptible to many diseases. We know that there are more malignancies in the elderly, yet we know that many malignancies are environmentally related. It makes sense that those who have lived longer would have more exposure to toxic materials.

The Aging Body

• Every system in the body is affected to some extent by age-related changes.
• Each individual ages at a different rate (intrinsic and extrinsic factors); and within the individual, each system ages at a different rate. Again, other factors need to be considered.

Example: Disease in one system could cause a "biological" age of that system which is much older than the chronological age (actual age in years). This, in turn, could affect other systems.

An overview of some of the changes occurring in body systems follows:

Nervous System

• This is the communications system of the body relaying information to and from the brain from all parts of the body. The "transmission" of messages can be affected with aging.
• There are slower reflexes which can affect driving or lead to falls. There is decreased speed and slower response time.
• Balance may be affected, which can trigger falls.

Sensory Losses

• Sensory losses (deficits) occur as we age. There is a loss of acuity in the senses, so that by age 65 or 70, 90% of adults have some visual loss and 30% have significant hearing loss (NACA, Vignette 85, 1999).
• Losses in hearing and/or vision can cause inappropriate responses, confusion, anger, disorientation or social isolation. Deficits must be properly addressed and corrective measures taken whenever possible.
• Losses in sensory function affect our ability to interact with our environment.

Mental Function

• There is little change in intellectual ability if a person remains healthy; however, changes in cognitive function do increase as we age. Cognitive changes affect memory, reasoning and abstract thinking.
• As we get older, more time is required to learn new things but the ability is retained.
• One of the things that compensates for the mild changes is experience and judgement gained over a lifetime.
• In general, the changes that do occur in normal aging do not preclude people from doing things that are meaningful to them. It is important for older adults to "exercise" their mind as well as their body as decline in intellectual function can result from lack of stimulation as well as other factors.
• Long-term memory remains intact but there may be some changes in short-term memory. Under normal conditions, memory aides solve the problem. Remember that we all use memory aids such as lists, and notes to ourselves so this is not isolated in a particular age group.
• A significant decline in mental function may be an important clinical sign of illness and should always be investigated.

Cardiovascular System

• There is a decrease in the efficiency of the heart muscle and an increased susceptibility to atherosclerosis (hardening of the arteries).
• These changes result in decreased reserves - that is, a lessening in the ability to respond to stress of any type, physical or emotional, and a possibility of increased blood pressure.
• We can do a great deal to prevent or minimize cardiovascular disease. According to the Canadian Heart and Stroke Surveillance System (CHSS), the high prevalence rate of major risk factors - smoking, physical inactivity, high blood pressure, dyslipidemias, obesity and diabetes - contribute significantly to heart health in Canada (Statistics Canada 2000).
• Healthy lifestyles reduce the risk of having any of these conditions.

Respiratory System

• Changes in bones, muscles, and lung tissue can result in decreased lung efficiency. These changes are complicated by life-long exposure to pollutants, damage from disease, and habits such as smoking.
• The effects of changes in the respiratory system, including shortness of breath and fatigue, may lead to decreased activity levels for older adults. For example, anxiety resulting from being slower and not able to cross streets before the light changes can make some people cut back on regular walking. Inactivity then results in further decreases in overall function and fitness.
• Regular, appropriate activity will help to maintain optimal function and counteract some of the physiological changes that are occurring in the respiratory system. Studies tell us that, with proper conditioning, older adults can continue to remain very active and benefit from the results of physical activity at any age.

Gastrointestinal System

• Changes occur in every part of this system which begins with the mouth and ends at the anal opening. The effects of these changes can be minimized with attention to healthy eating patterns.
• Some of the changes that occur can affect nutritional status and enjoyment of food:
  • Reduction in saliva production can lead to a dry mouth and cause problems chewing.
  • Reduction in digestive enzymes can cause some problems with digestion.
  • Slowed peristaltic action (smooth muscle contractions) can result in constipation (worsened by a sedentary lifestyle).
  • Changes in the mucosal lining of all parts of the digestive tract can affect absorption of nutrients.
  • Dental problems may affect ability to chew.

Skin

• Normal age-related changes in the skin can result in wrinkles, dryness, and thinning of skin (making it more susceptible to breaks, with slower healing).
• There is diminished skin resiliency and an increase in "liver spots".
• There is an increased susceptibility to hypothermia and hyperthermia (the causes of this involve more than changes in the skin).
• There is loss and thinning of hair as well as greying.
• Nail growth slows and nails become thicker and more brittle. Care of the nails, especially for the feet is very important and requires more attention.

Musculoskeletal System

• There are structural changes in ligaments, joints and bones. Bone loss occurs as we age. The most serious form of bone loss is a disease called osteoporosis which occurs most frequently in post-menopausal women, although it also occurs in men. This disease leads to frequent fractures which occur with relatively little "stress". There is a decrease in muscle bulk and strength. Regular exercise helps to slow the process of loss of bone and muscle mass.
• There is a decrease in speed, strength and endurance which is worsened by inactivity.
• The tendency to more sedentary activity as we age exacerbates the aging of the musculoskeletal system. It has been shown that regular physical activity enhances the function despite age-related changes.

Genitourinary

• Incontinence is not a normal part of aging and should always be investigated.
• There are changes in kidney function as well as bladder capacity. The message that "you have to go" can be slowed resulting in greater urgency so that when you realize you have to go, it is now.
• Prostate gland problems in men are more common with advancing age.
• People retain the capacity for sexual activity well into old age.

What Do These Changes Mean?

• Currently, it is impossible to prevent normal aging. The challenge is to determine which changes are the result of normal aging and which changes are the result of other factors which can be altered. With normal aging, people retain the capacity to do things that have meaning for them and to remain physically and mentally active.

Example: We know there is decreased lung efficiency as we age but we also know that:

1) Lifestyle habits such as smoking cause damage to body systems, thus worsening the normal aging process. This damage is preventable. 2) Exercise increases lung efficiency and maximizes function, therefore the effects of normal aging can be minimized.

• Changes in lifestyle and environment will not halt the aging process but they can improve the quality of life significantly and minimize the effects of the process. In addition, you can reduce the risk of contracting some diseases which we know accelerate the aging process.
• Defining the effects of an age-related change on an individual is not easy.

Example: We know that joints stiffen as we age. Suppose we consider a man who has some arthritis (thus, there is a disease coupled with the effects of normal aging) and who leads a sedentary life. The inactivity will lead to more joint problems, increased loss of muscle, bone mass and strength. The inactivity will also affect other systems: the digestive system may be sluggish, leading to constipation. The man may take in too many calories and put on weight, putting further stress on the joints and creating challenges for other systems. If he is taking some medication for arthritis, this may cause more digestive problems and on and on. Thus, the question arises - what is caused by normal aging and what is caused by other factors?

• A major point needs to be made: the age-related changes we discussed are little noticed in a normal routine. The normal routine can be adapted to meet the changing needs. They become more obvious when we are subjected to stress of any type, such as running for the bus, recovering from surgery, coping with several losses or illnesses.
• In the absence of disease, people continue to function very well into old age.
• To fully understand aging, we need to look at more than just biological changes.

Nutrition and Aging

• There is a decreased need for calories as we age but not for nutrients, so we face a challenge to ensure a healthy diet but avoid excessive weight gain (exercise, once again, helps to maintain weight).
• We mentioned that there are several changes in the digestive tract which obviously would have an impact on nutrition.
• Along with these changes, we need to understand the psycho-social context as it affects good nutrition.

Example:

Statement: "Mom doesn't eat much anymore - it must be her age."
Question: What other factors can cause poor appetite?

Possible causes for poor appetite:

1. Poor dental health affecting ability to chew.
2. Loneliness, lack of desire to prepare food and eat by oneself.
3. Change in taste may make food seem bland.
4. Drug interaction or side effects can cause a loss of appetite.
5. Decreased saliva production can cause chewing difficulty.
6. The times of meals are not "good" times for the individuals.
7. Diseases that affect digestion, i.e. causing pain, discomfort.
8. Poor eyesight affecting ability to distinguish food or resulting in embarrassment when food is spilled.
9. Decreased sense of smell removing some of the anticipatory delight.
10. Mental confusion.

• All of these possible causes can be addressed with techniques to overcome the difficulty. How would you respond to the statement above in light of this information?

Sexuality and Aging

• With age, there are some changes in both sexual function and response in males and females. However, these changes do not preclude a sexually active life well into old age. In fact, the greatest obstacle may be lack of partners. It is a fact that in the over-65 age group, older women outnumber older men.
• Another major obstacle is attitudes: many older people fear being ridiculed by family and friends and so avoid a sexual relationship.

Retirement

• Retirement is a relatively new phenomenon. As life expectancy increases, so does the period following the end of paid employment.
• Gerontologists and retired people are continuously exploring what retirement means for individuals and families.
• For many, it signals a new phase of life, a time to enjoy some freedom, explore options, spend more time with family and friends, develop new skills and so on. For others, it can affect their sense of identify, and leave them feeling lost, bereft and useless. Still others take on part-time work or mentoring roles using skills they have developed in their work lives.
• In an effort to understand what retirement means, it is necessary to look first at the meaning of work (i.e., paid labour). Work is multidimensional in nature. Besides income, it provides:
  • social identity
  • focus
  • a pattern of activity and routine
  • a network of friends and acquaintances
• The attitudes people have towards retirement depend on a number of factors:
  1. income
  2. reason for retirement
  3. health status
  4. outside interests
  5. support network

Retirement is a predictable stage in the life cycle and so can be planned for.

Medication and Older Adults

• Many older adults take one or more medications; the greater the number of medications taken, the greater the risk of adverse side effects (all drugs have side effects). The caregiver must be familiar with the side-effects of the drugs that an elderly relative is taking. In addition, many people combine over-the-counter medications and prescription drugs.
• Changes in kidney and liver function as we age mean that drugs are not metabolized in the same way as in younger people. These organs are not as efficient in detoxifying and excreting the medication. Dosages needs to be adjusted for the older adult; the risk of toxicity increases as we age.
• Changes in the digestive system may affect the absorption of drugs.
• If there are changes in short-term memory, the schedule of doses can be affected.
• Younger people often forget too; drug containers with the days printed on are useful reminders.
• Good communication with a doctor and pharmacist is exceedingly important when an elderly person is taking many medications.

Towards A Better Understanding

• We are more responsible for the way we age then we used to think.
• With all the information available today, we now understand that chronological age is not a reliable indicator of a person's ability to function.
• Biological, psychological and social processes all affect our aging. We will discuss the psychological and social process in more detail in Workshop 4: Losses As We Age.
• There are three significant observations that emerge from increased knowledge of aging:
  • Many problems that are commonly seen in older people are preventable and/or treatable.
  • Few of the problems seen in old age are actually caused by the aging process: most are caused by disease, loss of fitness, and environmental or social changes; and can be addressed.
  • Most people are too pessimistic about the scope for improvement in old age.
• As we age, we become slower with slower reflexes, speed, and response times. What does this mean in everyday functioning? In reality, it is often the environment itself that draws attention to these changes. Consider elevator doors that only remain open for seconds or traffic lights that change to red when you are half way across the street. Consider as well, poor lighting on stairways, shiny floors that reflect the light and are slippery, elevator buttons that are the same gray colour as the panel. Is it really the changes of aging that cause us problems or is it unrealistic design that exacerbates the changes?

Reminder: If you are tempted to think that old age is a downward spiral of disease and decline, just look around at the many older people who are living long and rewarding lives with little physical and mental deterioration. Remember that growth occurs in the emotional, intellectual and spiritual spheres, not just the physical sphere.

Nutrition Break- 10 minutes

• Participants can partake of refreshments and browse through Community Resource material.

Observation and Discussion - 50 minutes

• Facilitator should be sensitive to group dynamics.
• By this workshop, you may observe more interaction with each other.
• Be alert for anyone who may be in a crisis situation
• Facilitator should encourage all caregivers to participate in discussion. Skills are needed to ensure that one person does not dominate or another person is not left out.
• Caregivers should reflect on their own aging experience and that of their elderly relative.
• Attitudes and beliefs can be explored.

Evaluation of Workshop 2 - 10 minutes

• Facilitator should reinforce that the evaluation forms are reviewed after each workshop and comments are welcomed and appreciated.
• Caregivers can be thanked for completing the forms.
• Completed sheets are left in the designated spot.

Closing Remarks - 5 minutes

• Facilitator can briefly review the main points of the presentation and discussion.
• Reiterate the date and time of the next workshop.
• Inform caregivers that next week's theme is Communication Skills for Caregivers.