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Addressing the Needs of
Older Persons
MOBILITY
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Where are the worldsolder persons?
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In Asia
3
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Projected Number of People 65+, 1997-2050according to WHO Regions (in Millions)
0 100 200 300 400 500
Africa
The Americas
EasternMediterrane
Europe
SE Asia
WesternPacific
2050
2025
1997
4
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Mobility in Older Persons
Mobility as affecte by architectural esig
a assistive tech ology Mobility as affecte by physical ability
5
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Mobility and architectural design
Circulatio of i ivi uals
withi /to/from a structure
must be e sure
For most structures
accommo ati g ol er
perso s, the wheelchair
becomes a basic esigco si eratio
6
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Mobility and architectural designHow to design?
Circulatio i the horizo tal
pla e
Sufficie t space to tur a
wheelchair arou
Doors must be at least 3 ft
wi e
Threshol s must be
elimi ate at oorways Glossy floors a scatter
rugs must be avoi e
7
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Mobility and architecturaldesign
How to design?
Reachi g
Access to
esse tials
Cleara ce
Vertical reach
10
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Physical ability
1/3 of perso s over 65 y/o fall every year (US
statistics)
of all falls result i severe soft tissue abo e i jury
Falls result i :
I crease cautio a fear of falli g
Loss of co fi e ce i i epe e t fu ctio
Re uce motivatio a activity
I crease risk of recurre t falls11
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FALLS AND INSTABILITYFalls are multifactorial in nature
I tri sic factors
1. physiological factors
2. psychosocial factors
Extri sic (e viro me tal
factors)
Activity relate factors
13
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FALLS AND INSTABILITYFalls are multifactorial in nature
I tri sic physiological factors
Age
Se sory/Musculoskeletal/N
eurologic/C
V cha ges Drug i take
I tri sic psychosocial factors
Depressio
De ial of agi g
Fear of falli g Relocatio
Extri sic e viro me tal
factors
I stitutio alize or
commu ity- welli g?
Surfaces a lighti g
Be room a bathroom
Activity relate factors
Normal aily activitiesassociate with falls
Improper assistive evice
use
14
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Mobility Enhancement &Fall Prevention
Assess for fall risk a elimi ate if possible
FALL RISK ASSESSMENT
Improve fu ctio al mobility
Stre gth a flexibility trai i g
Se sory compe satio strategies
Bala ce a gait trai i g
Fu ctio al trai i g
Environmental mo ification
15
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Nutrition in
the Later
Years
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Outline
The Later Years
Nutrition in the Later Years
Energy and Activity
Carbohydrates and Fiber
Fats
Protein Vitamins, Minerals and Water
Other interesting issues
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The LaterYears
The life span of human beings is now 130 years.
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Nutrition in the Later Years
Should be highly
individualized!
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Nutrition in the LaterYears
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Examples of Physical Changes ofAging that Affect Nutrition
Digestive Tract
Intestines muscle strength resulting in sluggish
motility that leads to constipation.
Stomach inflammation, abnormal bacterial
growth, and greatly reduced acid output impair
digestion and absorption.
Pain
and
fear of choking may cause foo
davoidance or reduced intake
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Examples of Physical Changes ofAging that Affect Nutrition
Hormones
For example, the pancreas secretes less insulin
and cells become less responsive causing
abnormal glucose metabolism.
Mouth
Tooth loss, gum disease, and reduced salivary
output impede chewing and swallowing.Choking may become likely; pain may cause
avoidance of hard to chew foods.
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Energy and Activity
Energy (Caloric) needs decrease with advancing
age.
Decrease in active cells, diminished lean tissue
Reduced physical activity
Physical activity and a diet adequate in
nutrients and rich in phytochemicals is
necessary to maintain energy needs and upholda healthy immune system.
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Benefits of Physical Activity
Greater flexibility and
endurance
Greater lean body mass Better sense of balance
Greater blood flow to the
brain
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Benefits of Physical Activity
Stronger immune
systems
Suffer fewer falls and
broken bones
Enjoy overall better
health
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Carbohydrates & Fiber
6-11 servings of breads,
grains and pasta
Fiber is necessary toprevent constipation
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Fats
Should be limited for the following reasons:
foods lowest in fats are richest source of vitamins,
minerals and phytochemicals
diets rich in certain fats are associated with many
diseases
high fat diet correlates with obesity
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Protein
Needs remain about the
same through adult life,
but choosing low-fatfiber-rich protein foods
may help control other
health problems.
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Vitamins, Minerals & Water
Vitamin A absorption increases with aging.
Older people suffer more from deficiencies
of Vitamin D and B12 than young people do.
Dehydration is a major risk for older adults
Thirst mechanism become imprecise
Go for long periods without drinking fluids
Kidneys become less efficient
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Vitamins, Minerals & Water
Iron status generally improves, especially
for women.
Iron deficiency may occur due to: Chronic blood loss from ulcers, hemorrhoids
Poor iron absorption
Antacid use
Some medications
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Foods/Supplements and
Alzheimers Disease
Nutrition bears only weak links to the
disease
Food sources, not concentrated
supplements, of trace minerals are
advisable for people with the disease.
A causal connection with the mineral
aluminum seems unlikely.
No proven benefits are available from
herbs or other remedies.
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Foods/Supplements and
Alzheimers Disease Preventing weight loss may be the
most important nutrition concern.
Depression and forgetfulness can
lead to skipped meals and poor food
choices.
Well-liked and well-balanced meals
and snacks served in cheerful,
peaceful atmosphere are welcome.
As function diminishes, ready to eat
foods in bite size pieces may be most
acceptable.
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Obstacles to Adequacy
Living alone may bring about problems inpoor quality diets.
Tooth loss or lost taste sensitivity
Medical conditions can also affect nutrition. Unintentional weight loss, followed by illness
ordeath
Multiple medications and alcohol abuse
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Source: Irwin, D., Milsom, I. et al. Impact of overactive bladder symptoms on employment, social inteactions and
emotional wellbeing in sixEuropean countries. British Journal of Urology International: 2005; 97, 96-100.http://www.blackwell-synergy.com/doi/pdf/10.1111/j.1464-410X.2005.05889.x (Subscription required. Accessed13.12.2006)
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WORLDWIDE
(F)
PERCENT
(%)ASIA 14.6
JAPAN 32
US 37
EUROPE 26
ASIA (F) PERCENT
THAILAND 20.3
PHILIPPINES 13.9
MALAYSIA 13.1
INDONESIA 5.8
SINGAPORE 11.8INDIA 6.2
PAKISTAN 24
TAIWAN 7.4
KOREA 22.6
HONGKONG 12
CHINA 11.6F - FEMALE
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Women Living atHome
Age 15 -
44
5% - 7%
Age 45 -
64
8% - 15%
Age 65 + 10% - 20%
Men Living at Home
Age 15 -
44
3%
Age 45 -
64
3%
Age 65 + 7% - 11-%
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Seeking professional help after experience
of bladder control problems Women wait 6.5 years
Men wait 4.2 years
Women more likely to suffer stress UI thanmen
Men more likely to suffer from urinaryretention
Women are more likely to suffer interstitialcystitis than men
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Urinary incontinence is a normal part ofaging
Many people at age 80 remain to be
fully continent despite the decline inbladder elasticity and bladder tone
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Nothing can be done to treat UI in olderadults.
Careful assessment of the older adult with UI isrequired to determine cause of the symptom
Use the most effective combination therapy, i.e.,
weight control, smoking cessation, pelvic muscleexercises (PMEs) or Kegel exercise, assisted and
timed toileting, and medications.
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The only successful treatment forUI issurgery
For the older patient, surgery may be the last option,
when all else fail.
The combination of behavioral intervention, lifestyle
modification, exercises, medications and technological
devices are the better options.
The use of a preventive absorbent wear promotescomfort and enhances self esteem.
Educate the older person and the significant other
about other options which can allay their fears in
seeking consultation.
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Drinking less fluid will improve UI
Concentrated urine irritates bladder lining and
can worsen the symptom of urgency and
frequency of urination.
Restricted fluids can aggravate constipation
which can send signals to the brain that the
bladder needs emptying when in fact the
problem is in the bowel.
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The older person is having accidents onpurpose
Older person does not want to lose their
independence, and their sense of dignity.Toileting accidents are more likely caused by
inability to reach the toilet in time, memory loss
makes them unaware of proper toileting habits, or
their clothing has interfered with timely toileting.Solutions to this problem are prompted toileting
and bladder retraining, simplified closure in
clothing, and safe ambulation.
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Pelvic Muscle Exercises
2nd exercise works on the supportive strength of
the muscles and is referred to as a long
contraction. The slow twitch muscles aregradually tightened, lifted up, and held for
several seconds.
hold the contraction for 10 seconds before
releasing. Rest ten seconds between each long
contraction
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Dietary Changes
Caffeine
Alcohol
Artificial sweeteners (sodium saccharine,acesulfame K, and to a lesserdegree
aspartame)
Bladder retraining
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Use the toilet regularly - every 2 to 3hours.
Wear clothes that are easy to get off to use
the toilet. Remain on the toilet until your bladder is
empty. If you feel there is still some urinein the bladder, stand up and then sit back
down again and lean forward slightly overthe knees. This is called double voidingand may help you empty your bladder.
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Make the toilet facilities convenient andsafe. This may mean a bedside commode,bedpan, or urinal placed conveniently nearor in the bed.
Empty your bladder before you start on ajourney of an hour or more. Dont try towait until I get home to my ownbathroom.
Avoid rushing or running to the toilet. Thisactually increases the likelihood of anaccident and puts you at risk of falling.
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QUESTIONS
What is caregiverstress?
What are the issues
related to caregiverstress?
What are the telltale signs ofcaregiver stress?
What can acaregiver do tomanage theirstress?
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Mariel, 58, took care of her fatherduring an illness and her mother after
an accident. The first thing she did
when she realized the enormity of
what she was faced with
that she will be on call 24 hours a
daywas to cut her hair very, very
short.
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John is caring for her 83 year old fatherwho has memory problems and keepsthrowing fits wanting his way in every
thing. Makes messes all through thehouse. He is not steady on his feet but isno longer wanting to do anything but goto the SM.
John would accompany his father even ifhe is tired feeling guilty when unable
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Theres no question that Filipinos aside from
raising their children are also faced with
parenting their parents, too.
squeezing in quick visits to assist with simpledaily tasks or providing actual caregiving
the sacrifices and challenges of this balancing
act are taking a
dramatic toll o
nthose caught i
nthe middle.
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Emotional and physical strain of caregiving becomes evident
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A recent nationwide study by Evercare,
Caregivers in Decline (2006), ofcaregivers whose own health is at riskbecause of their care giving duties found
that stress is their NumberO
ne issue.
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DID YOU KNOW THAT
What is most alarming is that more thanhalf (53 percent) of the caregiverssurveyed say that this decline in healthy
behaviors has already affected theirability to provide care.
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PeterVitaliano,, Professor of Geriatric PsychiatryUniversity of Washington :
Chronic stress :
high blood pressure,
diabetes and
a compromised immune system.
In severe cases, caregivers can take on the symptoms
of the person that they care for
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EMOTIONAL AND PHYSICAL
STRAIN OFCAREGIVING
FRUSTRATION
FRUSTRATION
ANGER/
RESENTMENTEXHAUSTION/
BODY PAIN
LONELINESS/
ISOLATIONGUILT
Sara Rom, MSW, MSG
Director of Education and Training
Southern CaregiverResource CenterRGVTAMSE820
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THERE ARE THREE BASIC
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THERE ARE THREE BASICAPPROACHES PEOPLE USE TO
CO
PE WIT
HSTR
ESS
avoid
suffer manage
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DONTFORGET THAT
Severe stress that is sustained over a
long period of time can take a major
tollon both mental and physical well-
being.
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Watch funnyMovies
Comedyclubs
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TAKE A BREAK
Take single daysor even a weeksvacation.
Talk about differentthings, read thatbook you haventbeen able to get to,take naps,
whatever relaxesyou and makesyou happy.
EXERCISE 1 THE YES SIR
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EXERCISE 1 THE YES-SIR
STRETCH
yes-sir
stret h.
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ABDOMINAL EXERCISE
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EYE SOCKET SOOTHER
Place the index fingeron the eyebrow, andmiddle finger lightly onthe eyelid.
In a slow circularmotion, gently massagethe eyeball and eyesocket. Be careful toplace no pressure on
the eyeball, and if youuse contact lenses, onlymassage the eyesocket.
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IMPORTANT TOOLS TOMAKE YOU
SANE : Love yourself
Communicate
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Get organized
Prioritize
Schedule wisely
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Eat wisely
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TAKING STEPS TO
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TAKING STEPSTOREDUCE YOURSTRESS
Try to do something you enjoy
Do one thing at a time
Maintain your sense of humor.
Make lists
Dont shut out the good moments.
Dont try to cope alone.
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REFERENCES
Mary Kay Morrison.Stress Survival Strategies. HumorQuest. 2008
Promoting Positive Mental Health. Health PromotionAgency. Ireland.October 2008
Randy Pausch, Time Management. CarnegieMellonUniversity.2000
Running on Empty: Family CaregiverStress .Home InsteadSenior Care Dallas
T
exas, 2007 StressManagement. Canadian Society OfIntestinal
Research.