aging with a developmental disability -...

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Aging with A Developmental Aging with A Developmental DisabilityDisability

Old age is like everything else. To make a Old age is like everything else. To make a success of it, you’ve got to start young. success of it, you’ve got to start young.

Theodore RooseveltTheodore Roosevelt

Each Individual Ages DifferentlyEach Individual Ages Differently

�� Genetics, injuries, nutrition and life styleGenetics, injuries, nutrition and life style

�� Psychological outlookPsychological outlook

�� If we want to age gracefully and gradually If we want to age gracefully and gradually with our mental faculties intactwith our mental faculties intact

�� Our today's will influence our tomorrowsOur today's will influence our tomorrows

Aging in PlaceAging in Place

�� Many individuals with DD live with aging Many individuals with DD live with aging parents who are also agingparents who are also aging

�� The needs of these individuals must be metThe needs of these individuals must be met�� We need to increase our knowledge of the We need to increase our knowledge of the

aging process so we can be proactive not aging process so we can be proactive not just reactive to their needsjust reactive to their needs

�� All people deserve to age with dignity and All people deserve to age with dignity and respectrespect

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Effects on Health During the Effects on Health During the Aging ProcessAging Process

•• Normal aging Normal aging

processprocess

•• Lifestyle choicesLifestyle choices

•• Genetic effectsGenetic effects

•• EnvironmentEnvironment

Aging With a Developmental Aging With a Developmental DisabilityDisability

Person with a Disability

Normal effects of aging

Negative attitudes about people with disabilities

Lifestyleeffects

Limited access to quality

health careLack of knowledge

about aging for people with DD

Decreased Quality of Life

Inadequate fundingfor health care

Effects of the disability

and its treatment

Support During the Aging Support During the Aging Process Process

•• Need to document current level of function.Need to document current level of function.

•• Recognition of changes that need attention, Recognition of changes that need attention,

especially in nonespecially in non--verbal residents. verbal residents.

–– e.g., dementia vs. more treatable problemse.g., dementia vs. more treatable problems

•• Agency plan for aging in place or alternative Agency plan for aging in place or alternative

care.care.

•• EndEnd--ofof--life planning.life planning.

•• EndEnd--ofof--life care.life care.

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Vision Changes of Aging Vision Changes of Aging

•• Loss of acuity.Loss of acuity.

•• Loss of accommodation (presbyopia).Loss of accommodation (presbyopia).

•• Decrease in light transmission.Decrease in light transmission.

•• Changes in color perception (esp greens, blues, Changes in color perception (esp greens, blues,

violets).violets).

•• Decrease in dark adaptation.Decrease in dark adaptation.

•• Less able to adapt to glare.Less able to adapt to glare.

•• Decreased visual field.Decreased visual field.

Symptoms of a ProblemSymptoms of a Problem

•• Rubbing eyes.Rubbing eyes.

•• Squinting.Squinting.

•• Shutting or covering one eye.Shutting or covering one eye.

•• Tilting or thrusting head forward. Tilting or thrusting head forward.

•• Redness of eye or area around eyes.Redness of eye or area around eyes.

Changes in FunctionChanges in Function

•• Stumbling.Stumbling.

•• Hesitancy on a step or curb.Hesitancy on a step or curb.

•• Holding page or object closer to eyes.Holding page or object closer to eyes.

•• Refusing to participate in previous Refusing to participate in previous activities.activities.

•• Sitting close to TV.Sitting close to TV.

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Eye DiseasesEye Diseases•• Dry eyes Dry eyes -- scratchy, irritatedscratchy, irritated

•• Blepharitis Blepharitis -- red, itchy lids, person may rub too much.red, itchy lids, person may rub too much.

•• AgeAge--related macular degeneration (ARMD).related macular degeneration (ARMD).

•• Cataracts Cataracts -- gradual clouding of lens.gradual clouding of lens.

•• Diabetic retinopathy Diabetic retinopathy --damage to retina leading to damage to retina leading to blindness.blindness.

•• Glaucoma Glaucoma –– gradual tunnel vision, then blindness.gradual tunnel vision, then blindness.

•• Keratoconus Keratoconus –– disease of eye surface (cornea). More disease of eye surface (cornea). More common in persons with Down Syndrome.common in persons with Down Syndrome.

Types of Vision LossTypes of Vision Loss

•• Loss of central visionLoss of central vision

––Blind spot for central fieldBlind spot for central field

––Unable to see faces, read. Unable to see faces, read.

–– Loss of acuity or clarityLoss of acuity or clarity

––Caused by macular diseaseCaused by macular disease

Types of Vision Loss (cont’d)Types of Vision Loss (cont’d)

•• Loss of peripheral visionLoss of peripheral vision

–– From glaucoma or retinitis pigmentosaFrom glaucoma or retinitis pigmentosa

–– Affects safe mobilityAffects safe mobility

•• Diffuse loss across visual fieldDiffuse loss across visual field

–– From diabetes, cataracts, keratoconus.From diabetes, cataracts, keratoconus.

–– Vision may fluctuate based on amount and Vision may fluctuate based on amount and

direction of light.direction of light.

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Support Strategies for VisionSupport Strategies for Vision

•• Get regular eye exams to check for Get regular eye exams to check for asymptomatic problems or unexplained asymptomatic problems or unexplained symptoms. symptoms.

•• Get professional explanation of the problem.Get professional explanation of the problem.

•• Modify the environment:Modify the environment:–– Use high contrast colors, nonUse high contrast colors, non--glare lighting and glare lighting and surfaces, large print.surfaces, large print.

–– Red, oranges, yellows better than blues, greens, Red, oranges, yellows better than blues, greens, violetsviolets

–– Provide increased lighting, use night lights.Provide increased lighting, use night lights.

–– Organize belongings and keep locations consistent.Organize belongings and keep locations consistent.

–– Keep eyeglasses clean and prevent scratches. Keep eyeglasses clean and prevent scratches.

Support Strategies for VisionSupport Strategies for Vision

•• Modify activities:Modify activities:

–– Engage in daytime activities.Engage in daytime activities.

–– Provide support for nightProvide support for night--time activities.time activities.

–– Allow time to adjust to change of light.Allow time to adjust to change of light.

–– Protect the “good” eye.Protect the “good” eye.

Hearing Changes of AgingHearing Changes of Aging

•• Loss of auditory nerve cells and fibersLoss of auditory nerve cells and fibers

•• Reduction of blood supply to auditory Reduction of blood supply to auditory nerve transmission areanerve transmission area

•• Thickening of eardrumThickening of eardrum

•• Increased ear waxIncreased ear wax

•• Presbycusis (loss for high pitched speech Presbycusis (loss for high pitched speech sounds)sounds)

•• Decreased tone discrimination, Decreased tone discrimination, localization.localization.

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Support StrategiesSupport Strategies

•• Reduce background noise and commotionReduce background noise and commotion

•• Hearing exams.Hearing exams.

•• Speak lower tones, face person.Speak lower tones, face person.

•• Hearing loss leads to social isolation and Hearing loss leads to social isolation and emotional concernsemotional concerns

Types of Hearing LossTypes of Hearing Loss

•• Conductive Conductive –––– Problem with the physical conduct of sound through Problem with the physical conduct of sound through the ear structures. the ear structures.

–– From earwax, infection, head trauma, damage to ear From earwax, infection, head trauma, damage to ear drum.drum.

•• SensoriSensori--neural neural –––– Problem with the conduct of the sound signal through Problem with the conduct of the sound signal through the nerve to the brain or the processing of the the nerve to the brain or the processing of the information in the brain. information in the brain.

–– From head trauma, drugs, diabetes, high blood From head trauma, drugs, diabetes, high blood pressure, heredity, kidney failure, coronary artery pressure, heredity, kidney failure, coronary artery disease.disease.

Possible SymptomsPossible Symptoms

•• Turning TV up loud.Turning TV up loud.

•• Speaking loudly.Speaking loudly.

•• Inappropriate response to questions.Inappropriate response to questions.

•• Confusion in noisy situations. Confusion in noisy situations.

•• Isolating.Isolating.

•• Self injurious behaviors.Self injurious behaviors.

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What Words sound like with What Words sound like with hearing losshearing loss

•• Tell me exactly what you want to keep”Tell me exactly what you want to keep”

•• “Ell me ezaly wha you wan oo ee”“Ell me ezaly wha you wan oo ee”

•• Decreased ability to hear high pitched Decreased ability to hear high pitched soundssounds-- some womensome women--

•• Can hear vowels (a,e,I,o,u) easier than Can hear vowels (a,e,I,o,u) easier than

“c,k,p,s,t“c,k,p,s,t

Support Strategies for HearingSupport Strategies for Hearing

•• Get regular exams with a hearing Get regular exams with a hearing professional to check for wax, disease, professional to check for wax, disease, gradual hearing losses.gradual hearing losses.

•• Hearing aid if indicated.Hearing aid if indicated.

•• Speak slower, with lower tones, clearly.Speak slower, with lower tones, clearly.

•• Reduce background noise.Reduce background noise.

•• When speaking, face person with light When speaking, face person with light on your face, not behind you. on your face, not behind you.

•• Keep hearing aid batteries fresh and aid Keep hearing aid batteries fresh and aid clean.clean.

Aging Effects on Mouth/TasteAging Effects on Mouth/Taste

•• Decrease in taste budsDecrease in taste buds

•• Recession of gums, Recession of gums,

•• Thinning of dental enamelThinning of dental enamel

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Be Alert For:Be Alert For:

•• Altered tasteAltered taste--may over season food or lose appetitemay over season food or lose appetite--watch for increased use of salt.watch for increased use of salt.

•• Mouth may be more susceptible to injury and dental Mouth may be more susceptible to injury and dental problems.problems.

•• Maybe more nosebleeds.Maybe more nosebleeds.•• Dentures may irritate or n o longer fit.Dentures may irritate or n o longer fit.•• May not be able to smell May not be able to smell –– safety, food odors, body safety, food odors, body

odor, fragrance use, smoke, gas.odor, fragrance use, smoke, gas.

•• Need dental and mouth examsNeed dental and mouth exams•• Attention to safety and hygiene issuesAttention to safety and hygiene issues

Abnormalities and Disease in Abnormalities and Disease in MouthMouth

•• Decreased saliva from drugs or diseases.Decreased saliva from drugs or diseases.

•• Dental caries.Dental caries.

•• Root caries and abscesses.Root caries and abscesses.

•• Periodontitis (gum disease).Periodontitis (gum disease).

•• Sores, especially with dentures.Sores, especially with dentures.

•• Infection of mucus membranes.Infection of mucus membranes.

•• Cancers.Cancers.

Support StrategiesSupport StrategiesMouth/TasteMouth/Taste

•• Regular dental checkups and good oral Regular dental checkups and good oral hygiene, even if no teeth.hygiene, even if no teeth.

•• Floss or use proxiFloss or use proxi--brush.brush.

•• Consider batteryConsider battery--powered toothbrush.powered toothbrush.

•• AlcoholAlcohol--free mouth wash.free mouth wash.

•• Ask dentist about chlorhexidine Ask dentist about chlorhexidine mouthwash to decrease bacteria and mouthwash to decrease bacteria and infections (prescription).infections (prescription).

•• Increase seasonings of food except salt.Increase seasonings of food except salt.

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Nose/SmellNose/Smell

•• Decrease in nerve fibers.Decrease in nerve fibers.

•• Drying of mucous membranes in nose. Drying of mucous membranes in nose.

•• Decreased sensitivity to odors.Decreased sensitivity to odors.

Support Strategies forSupport Strategies forNose/SmellNose/Smell

•• Use of smoke detectors. Use of smoke detectors.

•• Care if using propane stoves or water Care if using propane stoves or water heaters.heaters.

•• Discarding food after recommended time, Discarding food after recommended time,

check for spoilage.check for spoilage.

•• Assist with awareness of body odor or Assist with awareness of body odor or overover--use of fragrances.use of fragrances.

Skin/TouchSkin/Touch

•• Decrease sweat glands, subcutaneous fat, Decrease sweat glands, subcutaneous fat,

blood supply, elasticity, thickness of skinblood supply, elasticity, thickness of skin

•• Loss of pigmentLoss of pigment

•• Decrease skin cell production and hair Decrease skin cell production and hair

growthgrowth

•• Changes in nail matrixChanges in nail matrix

•• Decreased sensation of touch, painDecreased sensation of touch, pain

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Protecting SkinProtecting Skin

•• Minimize use of harsh soaps and rinse well.Minimize use of harsh soaps and rinse well.

•• Dry well and use moisturizers.Dry well and use moisturizers.

•• Reposition frequently if mobility is limited.Reposition frequently if mobility is limited.

•• Check skin frequently for problems.Check skin frequently for problems.

•• Label hot and cold water and monitor water Label hot and cold water and monitor water temperatures.temperatures.

•• Increased risk with Down Syndrome, immobility, Increased risk with Down Syndrome, immobility, poor nutrition.poor nutrition.

•• Use sun protection.Use sun protection.

Aging of the GI SystemAging of the GI System

•• Decreasing total calorie needs every Decreasing total calorie needs every

decadedecade

•• Less gastric juice may lead to increased Less gastric juice may lead to increased

indigestion and ulcersindigestion and ulcers

•• Decreased saliva production may lead to Decreased saliva production may lead to more gum diseasemore gum disease

•• Decreased smooth muscle tone, slower Decreased smooth muscle tone, slower

emptying and digestion, less absorption of emptying and digestion, less absorption of nutrients.nutrients.

Aging LiverAging Liver

•• Decrease in sizeDecrease in size

•• Becomes less efficient in processing Becomes less efficient in processing medications, their effect lasts longer and medications, their effect lasts longer and dosage needs to be decreaseddosage needs to be decreased

•• Less efficient in absorbing nutrientsLess efficient in absorbing nutrients

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StrategiesStrategies

•• Promote elimination through fluids, fiber Promote elimination through fluids, fiber and physical activity.and physical activity.

•• Observe for constipation.Observe for constipation.

•• Encourage slower eating, smaller, more Encourage slower eating, smaller, more

frequent meals.frequent meals.

•• Avoid empty calories.Avoid empty calories.

Urinary and Reproductive Urinary and Reproductive --GenitourinaryGenitourinary

•• Bladder capacity and muscle tone Bladder capacity and muscle tone

decreasedecrease

•• Kidneys become less efficientKidneys become less efficient

•• Enlargement of prostate commonEnlargement of prostate common

•• Relaxation of pelvic musclesRelaxation of pelvic muscles

•• Effects of decreased hormonesEffects of decreased hormones

Observe ForObserve For

•• Incontinence of urineIncontinence of urine

•• Urinary leakage, frequencyUrinary leakage, frequency

•• Medications more difficult to clearMedications more difficult to clear

•• Swelling in extremities or signs of Swelling in extremities or signs of dehydrationdehydration

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•• Observe for voiding patternsObserve for voiding patterns-- increased or increased or decreased frequency, changes in decreased frequency, changes in continence.continence.

•• Observe for signs of infectionObserve for signs of infection-- frequency, frequency, urgency, accidents, discomfort, unusual urgency, accidents, discomfort, unusual odor, color or bleeding. There may be no odor, color or bleeding. There may be no fever or usual symptoms.fever or usual symptoms.

•• Regular screening tests and examinations.Regular screening tests and examinations.

•• Good hygiene practices. Good hygiene practices.

Heart and Blood VesselsHeart and Blood Vessels

•• Decreased responsiveness to stress, leading to Decreased responsiveness to stress, leading to difficult breathing, fatigue.difficult breathing, fatigue.

•• Heart rate decreases due to slower contraction Heart rate decreases due to slower contraction of muscle fibers.of muscle fibers.

•• Slow return to normal HR after elevation.Slow return to normal HR after elevation.

•• Build up of calcifications and fat in arteries.Build up of calcifications and fat in arteries.

•• Decreased elasticity of arteries leads to heart Decreased elasticity of arteries leads to heart

needing to pump faster.needing to pump faster.

Protecting the HeartProtecting the Heart

•• Encourage regular, moderate exerciseEncourage regular, moderate exercise

•• Slow the pace of activitiesSlow the pace of activities

•• Watch for signs of decreased endurance Watch for signs of decreased endurance --distress, dizziness, confusiondistress, dizziness, confusion

•• Change position slowly to prevent dizzinessChange position slowly to prevent dizziness

•• Reduce or stop cigarette smokingReduce or stop cigarette smoking

•• Healthy, low sodium diet, blood pressure Healthy, low sodium diet, blood pressure checks.checks.

•• Decrease fat and trans fatty acids from diet.Decrease fat and trans fatty acids from diet.

•• Learn signs and symptoms of a heart attackLearn signs and symptoms of a heart attack

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Signs of a Heart AttackSigns of a Heart Attack

•• Chest discomfort that lasts more than a few Chest discomfort that lasts more than a few minutes or goes away and comes back.minutes or goes away and comes back.

•• Discomfort in other areas of the upper body, Discomfort in other areas of the upper body, including one or both arms, neck, jaw, back, including one or both arms, neck, jaw, back,

stomach.stomach.

•• Shortness of breath with or without chest Shortness of breath with or without chest

discomfort.discomfort.

•• Other symptoms: nausea, lightheadedness, Other symptoms: nausea, lightheadedness, breaking out in a cold sweat.breaking out in a cold sweat.

Endocrine SystemEndocrine System

•• Thyroid function may decrease, Thyroid function may decrease,

metabolism slowsmetabolism slows

•• Increase incidence of diabetes Increase incidence of diabetes

•• Menopause for womenMenopause for women

Lungs Lungs -- Pulmonary SystemPulmonary System

•• Lungs become less elastic, less able to Lungs become less elastic, less able to

take in oxygentake in oxygen

•• Breathing becomes less efficient, tolerance Breathing becomes less efficient, tolerance for exercise decreasesfor exercise decreases

•• Decreased cough reflex.Decreased cough reflex.

•• Decrease in cilia lining respiratory tract. Decrease in cilia lining respiratory tract.

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Protecting the LungsProtecting the Lungs•• Avoid smoking and secondAvoid smoking and second--hand smoke.hand smoke.

•• Encourage deep breathing, physical activity.Encourage deep breathing, physical activity.

•• For persons with difficulty, slow pace of For persons with difficulty, slow pace of activity, allow rest.activity, allow rest.

•• Help alleviate stress.Help alleviate stress.

•• Proper diet and enough fluids.Proper diet and enough fluids.

•• Immunizations for lung diseases (flu and Immunizations for lung diseases (flu and pneumonia).pneumonia).

•• Watch for signs of infection (increased Watch for signs of infection (increased coughing, shortness of breath, colored sputum, coughing, shortness of breath, colored sputum, increased confusion).increased confusion).

Protecting the Lungs (cont’d)Protecting the Lungs (cont’d)

•• Observe for signs of reflux:Observe for signs of reflux:

–– Heartburn, discomfort after meals or at Heartburn, discomfort after meals or at

night.night.

–– Difficulty or painful swallow.Difficulty or painful swallow.

–– Swallowing or excessive salivation when Swallowing or excessive salivation when not eating.not eating.

–– Coughing during night. Coughing during night.

Nervous SystemNervous System

•• Loss of nerve cells and fibers with Loss of nerve cells and fibers with

decreased conduction.decreased conduction.

•• Decreased blood flow and oxygen to Decreased blood flow and oxygen to brain.brain.

•• Less REM stage of sleep.Less REM stage of sleep.

•• Altered pain responseAltered pain response

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Aging NervesAging Nerves

•• Reflexes slowReflexes slow

•• After age 60 the number of cells in the After age 60 the number of cells in the spinal cord decreasespinal cord decrease

Behavior and CognitiveBehavior and Cognitive

•• Intelligence, ability to learn, don’t Intelligence, ability to learn, don’t

necessarily changenecessarily change

•• More difficulty processing, organizing new More difficulty processing, organizing new

information, recalling old informationinformation, recalling old information

•• Mental illness more prevalent in those Mental illness more prevalent in those with I/DD than in general population with I/DD than in general population --

depression most common.depression most common.

Intellectual HealthIntellectual Health

•• The 9 elements of cognitive health are: The 9 elements of cognitive health are: language, thought, memory, executive language, thought, memory, executive functions, perception, judgment, functions, perception, judgment, attention, remembered skills (such as attention, remembered skills (such as driving), and the ability to live a driving), and the ability to live a purposeful life. Preserving these functions purposeful life. Preserving these functions can literally make the difference between can literally make the difference between leading an independent or a dependent leading an independent or a dependent life. life.

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Emotional HealthEmotional Health

•• Emotional health is just as important as Emotional health is just as important as cognitive health. Like cognitive health, cognitive health. Like cognitive health, emotional health is not simply the absence emotional health is not simply the absence

of psychiatric illness, but the ability to of psychiatric illness, but the ability to control one's emotions and emotional control one's emotions and emotional

intelligence (the ability to use and identify intelligence (the ability to use and identify emotions constructively)emotions constructively)

Emotional HealthEmotional Health

•• Emotional health comprises personal traits Emotional health comprises personal traits

that promote successful adaptation, such that promote successful adaptation, such as resilience, mastery, selfas resilience, mastery, self--efficacy, and efficacy, and

wisdom. Selfwisdom. Self--efficacy and the ability to efficacy and the ability to engage with others may ward off the engage with others may ward off the

sadness and depression that often sadness and depression that often characterize old age and speed cognitive characterize old age and speed cognitive

declinedecline

Risk FactorsRisk Factors

•• Advancing age is the most important risk factor Advancing age is the most important risk factor for cognitive decline, cognitive impairment, and for cognitive decline, cognitive impairment, and dementia.dementia.

•• There are strong associations between cognitive There are strong associations between cognitive decline and both physical inactivity and vascular decline and both physical inactivity and vascular disease. disease.

•• The link between hypertension in midlife and The link between hypertension in midlife and later cognitive decline is particularly strong. later cognitive decline is particularly strong. Cardiovascular disease increases the risk for Cardiovascular disease increases the risk for severe and permanent neurologic deficits. severe and permanent neurologic deficits.

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Control Risk FactorsControl Risk Factors

•• Controlling the risk factors for heart Controlling the risk factors for heart disease (hypertension, smoking, obesity, disease (hypertension, smoking, obesity, lack of exercise) may slow the process of lack of exercise) may slow the process of

cognitive decline, but it is not yet known cognitive decline, but it is not yet known whether such changes can actually whether such changes can actually

improve cognitive function improve cognitive function

Balance and Balance and Protective ResponsesProtective Responses

•• Sense of balance decreases due to loss of Sense of balance decreases due to loss of

hair cells in middle ear. hair cells in middle ear.

•• Slow movement and less sensation lead to Slow movement and less sensation lead to

slower reaction time and decreased slower reaction time and decreased protective responses. protective responses.

AgeAge--related Musculorelated Musculo--skeletal skeletal ChangesChanges

•• Decrease in muscle mass, strength and Decrease in muscle mass, strength and

tonetone

•• Decrease in joint mobilityDecrease in joint mobility

•• Increased porosity and fragility of bonesIncreased porosity and fragility of bones

•• Shortening of the spinal cordShortening of the spinal cord

•• Increased likelihood of developing arthritisIncreased likelihood of developing arthritis

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Protecting theProtecting theMusculoMusculo--skeletal Systemskeletal System

•• Encourage independent movement and selfEncourage independent movement and self--care.care.

•• Promote regular exercise.Promote regular exercise.

•• Implement safeguards to prevent falls.Implement safeguards to prevent falls.

•• Promote safe use of mobility aids.Promote safe use of mobility aids.

•• Provide seating that is comfortable, firm, and Provide seating that is comfortable, firm, and not too deep.not too deep.

•• Ask health care provider about calcium and Ask health care provider about calcium and vitamin D supplements, weightvitamin D supplements, weight--bearing exercise, bearing exercise, hormone replacement therapy.hormone replacement therapy.

Down SyndromeDown Syndrome

•• Longer lifespan than in the pastLonger lifespan than in the past

•• More rapid aging at the cellular levelMore rapid aging at the cellular level--affects all body systemsaffects all body systems

•• Normal aging processes occur earlier than Normal aging processes occur earlier than in persons without Down syndromein persons without Down syndrome

•• Poor function of immune systemPoor function of immune system

Aging with Down SyndromeAging with Down Syndrome

•• Great increases in early childhood survival related to Great increases in early childhood survival related to heart surgery, general health management.heart surgery, general health management.

•• Deinstitutionalization led to fewer communicable Deinstitutionalization led to fewer communicable diseasesdiseases

•• Extra chromosome 21 means extra proteins it codes for Extra chromosome 21 means extra proteins it codes for and leads to increased production of tangles and plaques and leads to increased production of tangles and plaques defective repair of oxidative damage to DNA; increased defective repair of oxidative damage to DNA; increased rate of programmed cell deathrate of programmed cell death

•• Increased heart and vascular disease, leukemia, immune Increased heart and vascular disease, leukemia, immune deficiencydeficiency

•• Increased frequency of osteoporosis, especially in males; Increased frequency of osteoporosis, especially in males; increased prevalence of thyroid disease.increased prevalence of thyroid disease.

•• Increase in vision and hearing issuesIncrease in vision and hearing issues

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•• Increased incidence of Alzheimer’s Increased incidence of Alzheimer’s DementiaDementia

–– Early onset type of ADEarly onset type of AD

–– Begins at age 40 instead of 50s or 60sBegins at age 40 instead of 50s or 60s

–– First noticed in daily function rather than First noticed in daily function rather than memory loss.memory loss.

–– Progresses more rapidly (8 years not 20)Progresses more rapidly (8 years not 20)

–– Affects about 25% of DS population.Affects about 25% of DS population.

–– May have new onset of seizure disorder.May have new onset of seizure disorder.

Behavioral changes in DementiaBehavioral changes in Dementia

•• Changes in normal routines of ADLSChanges in normal routines of ADLS

•• Eating and sleeping habits changeEating and sleeping habits change

•• Difficulty making choicesDifficulty making choices

•• Lose possessionsLose possessions

•• Loss of enjoyment in normal activitiesLoss of enjoyment in normal activities

•• Increase in anxiety and confusion may Increase in anxiety and confusion may

lead to aggressionlead to aggression


•• Dry skin, more fungal infections of nails.Dry skin, more fungal infections of nails.

•• Increased incidence lifelong risk of thyroid Increased incidence lifelong risk of thyroid dysfunction, usually hypothyroid.dysfunction, usually hypothyroid.

•• Earlier onset of visual and hearing Earlier onset of visual and hearing

problems of aging.problems of aging.

•• Increased incidence of sleep apnea.Increased incidence of sleep apnea.

•• Overweight, especially those living with Overweight, especially those living with

family.family.

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•• Joint problems of neck, knee, and hip and Joint problems of neck, knee, and hip and more likely to develop bunions.more likely to develop bunions.

•• Lower peak bone density and earlier risk Lower peak bone density and earlier risk

for osteoporosis.for osteoporosis.

•• Many born with heart abnormalities.Many born with heart abnormalities.

•• Increased risk of heart valve disease later Increased risk of heart valve disease later in life.in life.

•• Decreased risk of atherosclerosis.Decreased risk of atherosclerosis.


•• AtlantoAtlanto--axial Instability axial Instability

–– Spinal column instabilitySpinal column instability--about 14%.about 14%.

–– May compress cord leading to neck pain, May compress cord leading to neck pain, poor posture and gait, loss of upper body poor posture and gait, loss of upper body

strength, abnormal neurological reflexes strength, abnormal neurological reflexes and changes in bowel and bladder and changes in bowel and bladder

emptying. emptying.

–– Treatment controversialTreatment controversial-- ask health care ask health care provider.provider.

Cerebral PalsyCerebral Palsy

•• Amount of decrease in life expectancy Amount of decrease in life expectancy

related to degree of severity of condition.related to degree of severity of condition.

•• Abnormal muscle toneAbnormal muscle tone

–– Muscular and joint painMuscular and joint pain

–– Hip and back deformitiesHip and back deformities

–– Worsening bowel and bladder functionWorsening bowel and bladder function

–– Orthopedic surgeries Orthopedic surgeries

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•• Abnormal movement of food through the Abnormal movement of food through the throat and stomach: throat and stomach: –– Dysphagia (abnormal swallowing)Dysphagia (abnormal swallowing)

–– Reflux of stomach acid into throat (GERD Reflux of stomach acid into throat (GERD gastrogastro--esophageal reflux disease)esophageal reflux disease)

–– Delayed emptying of the stomach.Delayed emptying of the stomach.

–– All contribute to dental erosion, irritation of All contribute to dental erosion, irritation of the esophagus, anemia, feeding problems, the esophagus, anemia, feeding problems, aspiration and pneumonia.aspiration and pneumonia.


•• Abnormal movement of food and waste Abnormal movement of food and waste

through the small and large intestine.through the small and large intestine.

–– High incidence constipation, fecal impactionHigh incidence constipation, fecal impaction

–– Increased risk of death from bowel Increased risk of death from bowel

obstruction and intestinal perforationobstruction and intestinal perforation


•• Feeding and digestion problems worsen.Feeding and digestion problems worsen.

•• Joint pain and deterioration worsens.Joint pain and deterioration worsens.

•• Breathing difficulties worsened by above Breathing difficulties worsened by above problems. Speaking more difficult.problems. Speaking more difficult.

•• More susceptible to pressure sores due to More susceptible to pressure sores due to decreased mobility and thinning of skin.decreased mobility and thinning of skin.

•• Nutritional deficits, limited movement and Nutritional deficits, limited movement and medication usage increase risk of medication usage increase risk of osteoporosis.osteoporosis.

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•• Get at least 7 hours rest each nightGet at least 7 hours rest each night

•• Avoid cold and high humidity as this Avoid cold and high humidity as this increases spasticityincreases spasticity

•• Avoid stress and relaxAvoid stress and relax–– hot bathshot baths

•• Avoid caffeineAvoid caffeine-- increases spasticityincreases spasticity

•• Keep body weight within normal rangeKeep body weight within normal range

•• ExerciseExercise--keep movingkeep moving

PraderPrader--Willi SyndromeWilli Syndrome

•• HypogonadismHypogonadism-- low hormonal levels.low hormonal levels.

•• Problems related to uncontrolled Problems related to uncontrolled obesityobesity

–– CardiovascularCardiovascular

–– DiabetesDiabetes

Fragile X SyndromeFragile X Syndrome

•• Increased rates of mitral valve prolapseIncreased rates of mitral valve prolapse

•• MusculoMusculo--skeletal disordersskeletal disorders

•• Early menopauseEarly menopause

•• EpilepsyEpilepsy

•• Visual impairments.Visual impairments.

•• Earlier osteoporosisEarlier osteoporosis

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Seizure DisordersSeizure Disorders

•• Change in seizure frequency, increase or Change in seizure frequency, increase or decreasedecrease

•• Cumulative effects of long term use of Cumulative effects of long term use of

seizure medications seizure medications

•• Decreased bone density and increased Decreased bone density and increased trauma and falls due to seizures may lead trauma and falls due to seizures may lead

to fracturesto fractures

What Is Dementia?What Is Dementia?

•• Impaired brain function.Impaired brain function.

•• Problems with memory and judgment.Problems with memory and judgment.

•• Often accompanied by confusion.Often accompanied by confusion.

•• Loss of ability to use information once Loss of ability to use information once known or learned.known or learned.

•• Loss of basic abilities to think and Loss of basic abilities to think and understand.understand.

Types of DementiaTypes of Dementia

•• Alzheimer’s Dementia (AD or DAT).Alzheimer’s Dementia (AD or DAT).

–– Most common type.Most common type.

–– Gradual onset with stages of increasing severity.Gradual onset with stages of increasing severity.

•• Multiple Infarct Dementia (MID). Multiple Infarct Dementia (MID).

–– Second most common type.Second most common type.

–– Numerous tiny strokesNumerous tiny strokes--related to heart disease and related to heart disease and high blood pressure.high blood pressure.

–– Can have sudden onset.Can have sudden onset.

•• Other types.Other types.

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Stages of Alzheimer’s Stages of Alzheimer’s DementiaDementiaMildMild

(early (early stage)stage)

Confusion Confusion and and

memory memory loss.loss.

DisorienteDisoriented in space.d in space.

Problems Problems with with

routine routine tasks.tasks.

Changes Changes in in

personality personality and and

judgment.judgment.

ModerateModerate

(mid (mid stage)stage)

Difficulty Difficulty with ADL’swith ADL’s

Anxiety, Anxiety, paranoia,paranoia,

agitation.agitation.

Sleep Sleep difficulty.difficulty.

Difficulty Difficulty recognizinrecognizin

g familiar g familiar people.people.

SevereSevere

(late (late stage)stage)

Loss of Loss of speech.speech.

Loss of Loss of weight, weight,

appetite.appetite.

Loss of Loss of bladder/bobladder/bo

wel wel control.control.

Total Total dependencdependenc

e on e on others.others.

What Else Could Be Causing What Else Could Be Causing These Behaviors?These Behaviors?

•• Medical problemsMedical problems-- anemia, high blood anemia, high blood pressure, brain tumor.pressure, brain tumor.

•• Medication side effects.Medication side effects.

•• Hearing and/or vision problems.Hearing and/or vision problems.

•• Metabolic disturbancesMetabolic disturbances--diabetes or thyroid diabetes or thyroid dysfunction.dysfunction.

•• Alcohol or other substance abuse.Alcohol or other substance abuse.

•• Affective disordersAffective disorders--delirium or depression.delirium or depression.

•• Vitamin deficiencies. Vitamin deficiencies.

Get Medical EvaluationGet Medical Evaluation

•• Rule out other possible causes for Rule out other possible causes for

symptoms, behaviors.symptoms, behaviors.

•• Document a progressive decline from the Document a progressive decline from the person’s former or baseline status.person’s former or baseline status.

•• Possible or probable diagnosis by process Possible or probable diagnosis by process of elimination and characteristic pattern of of elimination and characteristic pattern of difficulties.difficulties.

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Documenting Baseline FunctionDocumenting Baseline Function

•• Use a standardized test.Use a standardized test.

•• Give periodically beginning before you Give periodically beginning before you anticipate problems.anticipate problems.

•• Include a video recording of the person’s Include a video recording of the person’s

functional abilities.functional abilities.

•• Compare change over time.Compare change over time.

•• The PCAD project (see sample handout).The PCAD project (see sample handout).

Service Delivery ModelsService Delivery Models

•• Aging in placeAging in place-- adaptation as client needs, adaptation as client needs,

abilities and behaviors change.abilities and behaviors change.

•• DementiaDementia--specific environmentspecific environment--specialized specialized

staff and setting.staff and setting.

•• Referral out, usually to longReferral out, usually to long--term care term care facility or other generic community facility or other generic community

programs.programs.

ReferencesReferences

•• Parts of this presentation were adapted from: Factor, Parts of this presentation were adapted from: Factor, A.R. (1997). A.R. (1997). Growing Older with a Developmental Growing Older with a Developmental Disability: Physical and Cognitive Changes and Their Disability: Physical and Cognitive Changes and Their ImplicationsImplications. Chicago: Rehabilitation Research and . Chicago: Rehabilitation Research and

Training Center on Aging with Mental Retardation,, Training Center on Aging with Mental Retardation,, University of Illinois at Chicago.University of Illinois at Chicago.

•• Many other resources at this website:Many other resources at this website:

http://www.uic.edu/orgs/rrtcamr/http://www.uic.edu/orgs/rrtcamr/

aging with a developmental disability -...

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