Aging With a Disability
How Getting Older Affects Your Clients
Last December, the United States Census Bureau released the Census Report on Seniors. Not surprisingly, the numbers painted a telling portrait of America's growing population of senior citizens (65 years and older) as of 2000, the report stated, seniors numbered 34.9 million strong.
Perhaps even more interesting about the Census Bureau's survey was the number of respondents who lived alone (28.2 percent) or with others in a household environment (66.1 percent). A scant 5.7 percent of that 34.9 million lived in group quarters such as an assisted living center or long-term care facility, indicating that the over-65 population continues to cling to its independence while staying healthy and strong enough to do so.
Despite these encouraging numbers, the fact is that many individuals who already have disabilities as they enter their golden years still need special attention and care. While there are plenty of sturdy seniors who require little more than ADLs because of weakened strength and stamina, there are also seniors who have been living with disabilities for most or all of their lives. Both kinds of cases present interesting challenges, and it's a good idea to keep your eyes and ears open for telltale shifts in physical, social and medical conditions that might aggravate your aging clients and affect their equipment needs.
Gary Plakias (ATS/CRTS), rehab sales manager for Travis Medical Sales in Austin, Texas, says he sees the following physical changes in his older clients: Decreased strength and increased fatigue; decreased activity level due to loss of strength (and/or) increase in pain; range-of-motion limitations at joints (ankles, knees, hips, shoulders elbows, wrists, hands); fixed contractures; muscular atrophy (loss of body mass); skin integrity (loss of elasticity); existing or past history of wounds, and incontinence.
Laurie Johnson, PT and seating associate for Travis Medical Sales, also says a key factor affecting her assessment of an older client involves one of the more prevalent diseases among today's seniors: diabetes. One of the most important things wed need to know is whether (the client is) diabetic and, if so, is sensation decreased (and) if there is a risk of hitting his feet and legs against footrests, etc. Johnson also says, I've noticed an amazing number (of senior clients) have scoliosis and degenerative back problems with resulting deformities, none of which are ever addressed in the elderly patient. Almost all elderly have decreased range-of-motion, making it difficult to reach the wheels. None of them have the strength to roll (a wheelchair) over carpet.
Meanwhile, other age-related shifts that can affect a clients ability to operate a mobility device include:
Drier, less elastic skin
Thinner, more brittle bones
Decreased eyesight and/or hearing
Slowed reaction time
Weakened bladder control
Memory loss and/or confusion
The aging process affects more than just bones and muscles. Socially, an aging client is going through a lot of changes that impact your interaction with him or her, many of which are difficult to immediately detect and/or understand, especially if you are younger than the client.
As Klaus Koch (ATS) of Travis Medical Sales puts it, Social changes are a bit more complex. A younger rehab professional is often unable to be sensitive to the level of life experience with which he or she is dealing in the geriatric population. Also, as the human body ages, the ability of the client to adapt to changes in his or her cultural context becomes increasingly limited. The client will often express a sense of bewilderment and isolation as independence and self-determination become increasingly compromised. Cognitive decline can make this situation even more difficult.
Likewise, many senior clients experience stressful shifts within their own families or support systems. For instance, Plakias cites as an important factor affecting a senior the existence of or lack of familial support, companionship and financial changes that come about as a result of aging with a disability.
Apart from these stressors, Plakias notes that an aging client's body image and self-esteem can be affected by equipment selection (a client's sense of) dignity and freedom of choice and participation affect quality of life. Furthermore, he says, poor seating posture, an unfortunate reality for many seniors suffering from age-related scoliosis, for example, may not allow for good eye contact and social interaction with others.
Finally, aging clients with more involved disabilities could have progressive medical conditions that affect your assessment and treatment of those disabilities. Plakias notes that it's a good idea to be aware of any physiological trauma or significant change in physical abilities; any neurological, pulmonary, respiratory, gastroenterological, or urological implications, and dramatic changes in cognitive level or awareness.
ATS Koch adds, As for medical changes, I feel it is incumbent upon the rehab professional to maintain a continuing study of the etiology and progress of disease conditions specific to every client with whom he or she is working. Nevertheless, there is no common thread in the elderly population any more than there is a reliable set of terms that can be applied to other medical populations. While specific diagnoses are common, the unique nature of each client's physical, mental, and cultural situation makes presumption a dangerous practice. Thus, knowledge of the diagnostic elements of an individual's condition must be coupled with a careful analysis of the client's personal needs and expectations.?
The Right Equipment
Some issues affecting equipment decisions and changes with seniors are the same as with younger clients. However, aging with a disability calls for some special measures. Plakias lists the following general equipment issues he considers when dealing with older patients:
Addressing sacral sitting and kyphotic back postures
Pressure distribution on all contact surfaces (skin integrity)
One-arm drive versus power mobility, both from a physiological and cognitive standpoint
Follow-up adjustments restraints and supports used over a long period of time may induce or contribute to physical difficulties
Comfort may become more important to the client than correct positioning
Armrest height for upper-extremity support and transfer issues
Proper foot positioning and support
Center-of-gravity for self-propulsion by hand or in combination with foot/feet
Seat-to-floor height for transfer issues and self-propulsion with foot/feet
Koch adds, Walkers, wheelchairs, canes, bedside commodes, hospital beds, oxygen these are the common items with which the needs of this population are addressed. The issues are as unique as are the individuals themselves.
For him, some equipment issues with aging clients revolve around their desires to maintain a certain lifestyle. I have had several elderly clients who live in a rural environment and whose mailbox is half a mile down a gravel road. The client will want a power chair that functions well in the home, but which can also make it to the mailbox.
Meanwhile, additional equipment concerns arise from, says Koch, the need for seating that assists in positioning or in the prevention of pressure ulcers. Likewise, funding provides pressure-relieving cushions based on medical history rather than on future risk. Thus the client is not eligible for needed equipment until a medical situation has cost a fortune in monetary and human resources.
Unfortunately, with funding focused more on the future than on the past or present, many seniors with disabilities find themselves facing yet another uphill battle. But if they?re equipped with an awareness of the many physical, social and medical changes that accompany the aging process, and a rehab provider who can ease them through such transitions, perhaps their golden years can shine a little brighter.
How does aging affect seniors with disabilities when they take to the streets? See Behind the Wheel with Elderly Drivers in our February 2005 NMEDA special edition. Ed.
Although it's often called light mobility, equipment like grab bars, lifts and transfer devices can make a huge impact on a senior client's lifestyle. Seniors with more involved disabilities and their caregivers can benefit from these smaller, yet no less significant, mobility items.
Products such as bath grab bars promote independence by allowing involved clients to help themselves perform daily tasks. But such items also aid caregivers who can concentrate on helping involved clients without having to carry all the weight.
In addition to helping senior clients whose disabilities are aging along with their bodies, lighter mobility equipment like ADLs, bath safety equipment and lift/transfer devices help seniors who are experiencing physical limitations and pain for the first time.
For example, a 2002 Medicare Beneficiary Survey conducted by the Centers for Medicare & Medicaid Services found the following:
9% of men polled and 17% of women were unable to stoop or kneel
14% of men polled and 23% of women were unable to walk two to three blocks
7% of men polled and 15% of women were unable to lift 10 lbs.
Likewise, the National Health Interview Survey of 2001 found that 31% of men polled and 39% of women surveyed reported arthritic symptoms.
For these less-involved clients who may only require the occasional lift or helping hand, ADLs like furniture lifts, bath safety devices such as grab bars and other light mobility such as canes or walkers can make a huge difference in quality of life.
Distribute this list of senior sites to older clients, their families and/or caregivers. The right resource might solve many of the stressors and problems that they encounter.
AARP: Care and Family www.aarp.org/life
AARP In Your Statewww.aarp.org/states
AGS Foundation for Health in Agingwww.healthinaging.org
AgeNet Eldercare Network www.agenet.com
American Association for Geriatric Psychiatrywww.aagpgpa.org
American Geriatrics Societywww.americangeriatrics.org
American Society on Agingwww.asaging.org
Children of Aging Parentswww.caps4caregivers.org
Family Caregiver Alliancewww.caregiver.org
Gray Panthers www.graypanthers.org
National Hispanic Council on Agingwww.nhcoa.org
National Indian Council on Agingwww.nicoa.org
National Strategy for Suicide Prevention: Suicide Among the Elderlywww.mentalhealth.org/suicideprevention/elderly.asp.
Older Women's Leaguewww.owl-national.org.
Resource Directory for Older Peoplewww.nia.nih.gov/healthinformation/resourcedirectory.htm.
Spinal Cord Injury Peer Information Library on Technology (SCIPILOT)
www.scipilot.comFeatures information/testimonials about aging with SCI.
Seniors aged 65 years and older
28.2% Live Alone
66.1% Live with Others in a Household
5.7% Live in Long-Term Care or Assisted Living
This article originally appeared in the March 2005 issue of Mobility Management.