Ageing and Adults with Developmental Disabilities Catholic Community Services Patricia Auerbach, R.N. September 2005

Goal of Class Talk about ageing Talk about ageing in adults with developmental disabilities Talk about aspiration, ageing and our residents Talk about our feelings about ageing in ourselves and in our residents Talk about death

Instructor Who I am Why I have this passion

Objectives of class Describe normal ageing Describe ageing in our clients Describe how aspiration affects the ageing process Express our feelings about the ageing of our clients Express our feelings about the dying process of our clients

Limitations Cannot give a comprehensive review about ageing –So many factors come into play with a limited time to address the subject Examples are limited to our current clients

Ground Rules Encourage discussion Encourage questions Respect for everyone’s feelings and opinions

Definition of ageing Definition of ageing General definition –Chronological age of 65 years –“any change in an organism over time” Ageing in adults with developmental disabilities –Chronological age of mid-50s –Dependent upon changes in functional status

Usual Changes in Neurological System Brain size decreases Slowing of movement and reaction time Decrease in ability of senses: hearing, sight, smell

Usual Changes in Gastrointestinal System Difficult in swallowing Gastric juices diminish Constipation increases Potential decrease in weight

Usual Changes in Respiratory System Decline in elasticity of the bony thorax Loss of muscle mass with weakening of the muscles of respiration and reduced mechanical advantage Decrease in alveolar gas exchange surface Decrease in CNS responsiveness

Usual Changes in Musculoskeletal system Loss of flexibility Osteoarthritis Loss of strength 25-43%

Usual Changes in Psychiatric System Cognitive function declines Depression is a common ailment Dementia can be side effect of medications “Many changes in mental health are difficult to attribute to ageing per se: they are often the result of disease”

Similarities of ageing in normal population compared with DD population Numbers are growing Similar prevalence (12% of population) Die from similar causes

Differences of ageing in normal population compared with DD population Earlier ageing trends Average life expectancy is less Adults with DD have not been exposed to same ageing influences: –Not had same stress, tobacco, alcohol exposure as general population –Have had uneven health care

Neurological Changes in DD Population Decrease in sensory systems Seizure disorders are associated with a higher frequency of cardiovascular diseases and infectious diseases

Gastrointestinal changes in DD Population Long term problems with constipation lead to more problems Esophagus lining thickening leading to difficulty swallowing Decreased production of saliva Fewer calories needed Decreased smooth muscle tone which leads to problems with moving food through tract

Respiratory changes in DD Population Age-related change in joint function and bone density is added to immobility Inactivity accelerates loss of bone density and mass AED link with osteoporosis Arthritis is noted at an earlier stage than in “normal” people DD population have increased pain, soreness, weakness of muscles and energy decline

Psychiatric considerations in DD population “Alzheimer’s Disease represents a major health concern for adults with DD.” More difficulty processing, organizing new information, recalling old information Mental illness more prevalent in those with developmental disabilities than in general population

Effects of Aspiration Effects of aspiration on our clients Risk of our clients How aspiration risk changes with age

Feelings about ageing and death

Normal feelings about death Shock Denial Emotional release Depression, loneliness, sense of isolation Physical symptoms Panic

Normal feelings about death (continued) Guilt Hostility Inability to resume usual activities Glimpse of hope Acceptance

Deaths at CCS

Stages of Grieving

Ending…or Beginning?