aging intellectual and developmental disabilities
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Aging Intellectual and Developmental Disabilities. Presented by: Rita J. Murphy RN,BSN,CDDN Cathy N. Shaffer RN Jody Thomas RN. Why are People Living Longer ?. Life expectancy is unpredictable Remarkable advances over the past 50 years Public Health Sanitation Immunizations - PowerPoint PPT PresentationTRANSCRIPT
Presented by:
Rita J. Murphy RN,BSN,CDDN
Cathy N. Shaffer RN
Jody Thomas RN
AgingIntellectual and Developmental
Disabilities
Why are People Living Longer ?
Life expectancy is unpredictableRemarkable advances over the past 50 years
Public Health Sanitation Immunizations Antibiotics Nutrition Social policy Environment
Historic group of individuals
Define: Developmental Disability
A condition that occurs prior to , at birth or during childhood which affects normal growth and development Depends on the functional capabilities of the individual and
affects on physical and /or cognitive abilities Condition may interfere with:
Mobility Speech ADL’s Learning Making life decisions Living independently
Life Expectancy
Leading cause of increased life expectancy: Moving out of institutions Receive better medical care
Life expectancy is now closely approaching that of the general population
May have related conditions that affect life expectancy Severe Impairments include:
Cerebral Palsy Down Syndrome Epilepsy
Dr. William Thomas & Normal Aging
“Aging is not a chaotic mechanical breakdown rather…Aging can be thought of as a symphonic
physiological developmental process that extends across the decades”
The Process
Older individuals with ID may exhibit relatively higher rates of: Mobility Issues Fractures Osteoporosis Visual Hearing Mental health Poly-pharmacy Depression
Older individuals with IDD may not have built reserves to support their aging and wellness- body, mind and spirit
Older individuals with IDD/DD may have lead a sedentary life style and have not been encouraged to exercise
Maximum Vitality
Reach maximum vitality at an earlier ageThe body responds to stressorsMaximum vitality in the general population:
Age 30
Common Factors –Aging and IDD/DD
The aging process /factors of aging, can further alter function that has already been affected by a developmental disability.
Down Syndrome, Epilepsy and CP Layering of Issues due to IDD/DD:
Hearing Vision Mobility Self-care skills
Communication and understanding Further complicates the aging process and an accurate diagnosis
Difficult to differentiate disease vs. aging process for the severely impaired
May have fragmented care with little medical and family history
Lifespan
According to studies, causes of death are similar to those of the general population
Causes of death include: Cardiovascular disease Respiratory disease Cancer
(Janicki, Dalton, Henderson,& Davidson,1999)
Identifying Changes
Observe facial expressions Alert Sleepy Confused Anxious Painful
Observe response Usual response or off?
Individuals may be poor reporters
It is important to know: How they have
presented throughout their life
Their storySupport and honor the
Direct Support Professionals who know our individuals
The Integumentary System (SKIN)
Our bodies first line of defense and the system that you notice first with age
Individuals with IDD/DD have a higher risk for: Immobility
Loss of thickness Less insulation Skin tears and breakdown
Inability to report pain and discomfort Possible bowel or bladder issues Diminished or elevated sense of touch Difficulty healing No access to water on their own or complain of thirst Poor hygiene skills
HEARING, VISION AND ORAL
GI /GU
VACCINES
ASPIRATION PNEUMONIA
SENSORY PROCESSING
FALLS
Specific Issues
Hearing, Vision and Oral
Individuals may experience: Impaired vision due to a neurological deficit Unable to voice changes in vision Improper use bifocals and hearing aides Higher incidence of hearing issues (wax build up) Misplace or refuse to wear assistive devices Unable to open their mouth Oral changes due to medications
Poor oral hygiene Lack of adequate dental care
Ill fitting dentures Problems with choking, aspiration and food consistency
Small group of Dentists who understand and can work these individuals
GI/GU
Individuals with IDD/DD have higher risk for: Bowel obstruction GERD Slower stomach emptying
Poor hygienePossible gluten intolerance
Wheat sensitivity Full Celiac disease
Problems with incontinence
Vaccines
Who should get a pneumococcal vaccine, flu shot and possibly a shingles vaccine? Individuals age 65 or older Those prone to respiratory problems, including:
Myotonic Dystrophy Down Syndrome
Those who are medically frail Those with severe IDD/DD
Individuals with Down Syndrome: Carefully watch for signs and symptoms of an upper respiratory
infection, it may lead to pneumonia Antibiotics should be prescribed early on to prevent full blown
pneumonia. Pneumonia is the leading cause of death in this population.
Aspiration Pneumonia
Causes: Inhalation or the breathing in of fluids, vomit or foods Eat too fast, hoard and may fear the eating process Poor dentition - missing loose or decayed teeth
Increase the incidence of aspiration and poor fitting dentures The aging, both the general population and ID/DD population, are
prone to aspiration if they have difficulty chewing and swallowing Individuals with Down Syndrome
Tongue thrust Mouth breathers Dry mouth
Individuals with Cerebral Palsy & Myotonic Dystrophy Increased incidence of aspiration
Sensory Processing
The Senses Hearing Taste Vision Smell Touch Proprio-ception Vestibular
All 7 senses are needed and work together to help make sense of the environment
Senses determine responses to the environment
Information processed by senses can be changed by the process of aging
Vision and hearing affected earlier for IDD/DD
Preferred Senses: Everyone has one Possible loss due to aging
Design the environment to enhance our senses as we age
In order to minimize loss of our senses as we age: Continue to program pathways to the
brain
(Kathleen Bishop, PH.D.)
Falls
Individuals with IDD/DD… Are living longer May have a dual diagnosis (IDD,MH) Have underlying issues with mobility Increase risk of developing Osteoporosis, due to
medication Led sedentary lifestyles
This decreases bone density, increases prevalence of osteoporosis
Falls in the General Population
Environmental Slippery falls Poor lighting Throw rugs Cluttered walking
paths Uneven
sidewalks/broken curbs
Poor fitting shoes
Physical Change in balance control Vision and hearing changes Muscle weakness Osteoporosis /osteoarthritis Medication side effects Taking 3 or more
medications Diabetes (decreased
sensation in feet) Mental decline/confusion Seizures
AGING AND DOWN SYNDROME
WHAT CAN WE EXPECT?
DOWN SYNDROME & ALZHEIMER’S DEMENTIA
Down Syndrome
Aging and Down Syndrome
Disorder of chromosome 21Chromosomes are usually found in pairs
Trisomy of chromosome 21 Accelerated aging gene found on chromosome 21Aging and Down Syndrome not completely understood
(ndss 2013)
Appear to slow down in their 40s or 50s (ndss 2013)
Have an increased risk for age related visual and hearing disorders, depression, seizure and Alzheimer’s disease, skin, endocrine and upper respiratory infections /pneumonia, celiac disease and sleep apnea
Individuals with Down Syndrome Danny at the Ball
What Can We Expect?
Lifespan: Less than general
population and/or DD population
Living into their 50’s, 60’s and 70’s
Down Syndrome & Alzheimer’s Dementia
Risk of developing Alzheimer’s increases with age At age 50:
30% of individuals At age 60
50% of individuals Not all individuals will develop Alzheimer’s At age 30 and 40
Changes in brain matter may occur Will not develop clinical symptoms
Diagnosis: It is over diagnosed Cannot determine in one MD visit NTG is an early screening tool
Maximum environmental supports
AGING AND CEREBRAL PALSY
DR. MICHAEL HENDERSON
AS PEOPLE WITH CEREBRAL PALSY AGE. .
Cerebral Palsy
Aging and Cerebral Palsy
One time injury to the immature central nervous system Condition not a disease May or may not have an intellectual or developmental
disabilityAffects the central control of muscle function
Movement Balance
Life long neurologically induced motor impairmentAging is similar to general population
Timing of changes may vary
Dr. Michael
Henderson
Simple voluntary action or task may require increased effort
Difficulty with muscle movements• Poor coordination• Rapid muscle
movements• Weakness in their
muscles• Involuntary or
writhing muscle movements.
“Cerebral palsy (CP) is one of the most common developmental disabilities. About 65% of people with cerebral palsy have an Intellectual or Developmental Disability.
The majority of cases of cerebral palsy are caused by abnormalities of the developing
brain that took place prior to birth. Cerebral palsy refers to a variety of conditions that are characterized by
abnormal motor actions.” (movements of the muscles and corresponding limbs).
As People with Cerebral Palsy Age..
Individuals may experience Increased pain in muscles and joints
Arthritis Bursitis Tendonitis Pain due to fractures or sprains and osteoporosis
Possibility to opt out of walking Problems with skin integrity Depression due to losses in function Concerns with eating, swallowing, choking issues and GERD Increased body weight, obesity and deconditioning Constipation and bladder issues Spasms may cause pain and decrease function/mobility
Down Syndrome & Cerebral Palsy
Observed acute or chronic loss of function in an individual with CP or Down Syndrome(or general population for that matter): A change in the way the person walks Inability to use an arm Decrease in hand writing skills Feelings that hands do not function as they did before
Must be reported to a medical professional A prompt and thorough evaluation by an MD is essential to the
health and wellness of the individual.
CATHY WILL SHARE STORIES REGARDING THE IDD/DD POPULATION
FROM A MENTAL HEALTH STANDPOINT.
ENJOY PHOTOGRAPHS FROM ONTARIO ARC’S IDD/DD POPULATION.
Mental Health
Contact Information
Rita MurphyLearning & Development Specialist - RN [email protected]
Cathy ShafferCoordinator of Clinical Services - RN [email protected]
Jody ThomasManager of Aging Services - [email protected] 585-919-2161