meeting the needs of aging persons with...

Meeting the Needs of Aging Persons with Developmental Disabilitieswith Developmental Disabilities

Cross Network Collaboration for Florida

Aging in Individuals with a Developmental DisabilityDevelopmental Disability

Module 3 Based on ADRC training developed by:

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Kathleen M. Bishop, Ph.D., and Ron Lucchino, Ph.D.

Purpose of Module 3

Understand aging as a normal processDi l th b t i dDispel myths about aging and developmental disabilitiesRecognize how aging may increase risk factors for disease

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Purpose of Module 3

Understand aging with developmental disabilities is the overlap of aging anddisabilities is the overlap of aging and disabilitiesRecognize how medications may affectRecognize how medications may affect adults with developmental disabilities

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Meeting the Needs of Aging PersonsMeeting the Needs of Aging Persons with Developmental Disabilities

Cross Network Collaboration for FloridaCross Network Collaboration for Florida

What Is Aging?

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Aging Factors

Determined by interaction of three factors

Life-long choices (diet, physical and mental exercise, self-esteem)Environment (physical cultural and social)Environment (physical, cultural and social)GeneticsSuccessful aging from positive genesSuccessful aging from positive genesNegative aging from life-long or late-onset gene

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gene

Aging Changes

Age related: Common to everyoneI t ti l d liInterventions may slow decline

Age associated: Not common to everyoneAssociated with disease, disorders, poor lifestyle choices, negative environmentControlled by individual choices

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Aging in Adults withDevelopmental Disabilities

Interaction of pre-existing disability with factors of aging may result in:g g y

Increased risk factors with earlier onset of symptomsIncreased risk for inappropriate medical treatmentIncreased vulnerability to a more restrictive environment

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Aging in Adults withDevelopmental Disabilities

Interaction of pre-existing disability with factors of aging may result in:g g y

Increased challenging behaviors due to communication difficultiesIncreased cost for treatment and interventionsIncreased staff/family frustration due to lack of communication and knowledge

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Meeting the Needs of Aging Persons with Developmental Disabilities


Myths About Aging and DevelopmentalMyths About Aging and Developmental Disability

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Myths - Aging and Developmental Disability

All individuals with developmental disabilities experience earlier onset of paging - FalseAll adults with Down syndrome will yexhibit the symptoms of Alzheimer’s disease - FalseMajority of adults with developmental disabilities live in supervised residential

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care facilities - False

Consequences of Myths

Affect quality of assessment and interventioninterventionInfluence attitudes of staff, family, and providersprovidersLimit available choices and resourcesAffect quality of life

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M th 1 Ea l Onset of AgingMyth 1 – Early Onset of Aging

Persons with mild to moderate developmental disabilities and thedevelopmental disabilities and the general adult population experience:

Same rate and age-related changesSimilar longevityIndividual aging influenced by genetics and lifestyle choices

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Myth 1 – Early Onset of AgingMyth 1 Early Onset of Aging(Continued)

The older adult with Down syndrome or cerebral palsy also experiences:

Same aging changes but earlier onsetSame rate of change but compressed due to shorter longevity

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Aging Curve

Maximum vitality

100

it lit

General aging curve

% vitality

vitality vitality

Aging DD curve% vitality

minimum

Aging DD curve

Down syndrome

0 30

deathminimum

vitalityand Cerebral Palsy

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0age

30conception

birth

Myth 2 – Down Syndrome and Alzheimer’s Disease

10%

<1%

60% of DS withAD by 6010% of DS withAD by 70<1% of DS withAD by 8060%

Janicki, M.P. & Dalton, A.J. (2000). Prevalence of dementia and impact on intellectual disability services Mental Retardation 38 277 289

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services. Mental Retardation,38, 277-289.

Myth 3 – Living SituationMyth 3 Living Situation

90% Living athome

10 %

10% Living inresidential care

90%90%

Braddock, D., Felce, D., Emerson, E. & Stancliffe, R.J. (2001). Mental Retardation and

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, ( )Developmental Disabilities Research Reviews, 7,115-121.

Meeting the Needs of Aging Persons with Developmental Disabilities


Aging in Individuals with a Developmental DisabilityDevelopmental Disability

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Differentiate “Normal” AgingDifferentiate Normal Aging Changes from DiseaseDetermine types of interventions to best meet needsDetermine appropriate servicesDevelop activities appropriate for age-Develop activities appropriate for agerelated cognitive/physical changesMaintain quality of health throughMaintain quality of health through increased awareness of changes

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Pre-existing Developmental ffDisability Aging Effects

Likelihood of “diagnostic over-shadowing”

Changes related to the disability result in inappropriate or no interventionsPre-existing cognitive challenges assumed to be symptoms of dementiaPre-existing disability may be misdiagnosed as disease

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Risk from Inappropriate Intervention

Reduced vitality and quality of lifeModified aging processIncreased misdiagnosis for other diseases c eased sd ag os s o ot e d seases(especially Alzheimer’s disease)Increased behavioral changesIncreased behavioral changes

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Meeting the Needs of Aging Persons g g gwith Developmental Disabilities


Age-Related Changes Everyone Experiences

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Sensory Changes Affect the Older Adult

Reduced sensory acuityIncreased masking of sensory impairmentsIncreased masking of sensory impairmentsReduced potential for quality of life and independenceindependenceIncreased social isolation

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How Is Hearing Affected by Aging?

Increased loss of high frequency sounds (children and females voices in(children and females voices in particular)Increased interference with hearingIncreased interference with hearing

Background sounds interfere with communicationcommunicationIncreased tinnitus – ringing in the ears

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How is Vision Affected by Aging?

Increased glare (light reflection) sensitivitysensitivityIncreased difficulty adjusting to reduced lightinglightingIncreased difficulty with busy visual patternspatterns

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Effects of Hearing and Visual gImpairments on Older People

Increased risk of fallsDecreased social interactionDecreased social interactionIncreased inappropriate behavior Decreased verbal communication Increased misdiagnosis of dementiag

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Other Age-related Changes in g gOlder People

Reduced muscle mass by 15%Increased risk of fallsIncreased risk of fallsDecreased ability for physical activities

Decreased thyroid functionDecreased thyroid functionDecreased body temperatureIncreased symptoms of acute dementia

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Other Age-related Changes in g gOlder People

Reproductive system (male)Enlarged prostate - reduced flow of urine g pand reduced ability to urinate

Reproductive system (female)Decreased estrogen - menopauseIncreased bone lossIncreased risk of depressionIncreased risk of heart disease

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Increased short-term memory impairment

Lesser Age-related Changes in g gOlder People

IQ remains the same or increasesPersonality remains the samePersonality remains the same Ability to learn new skills remains the samesameLong-term memory remains the sameLittle change in memory recall

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Meeting the Needs of Aging Persons with g g gDevelopmental Disabilities


Early Aging Changes Experienced by Adults with Down Syndrome and Cerebral PalsyDown Syndrome and Cerebral Palsy

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Early Aging Down Syndrome andy g g yCerebral Palsy Risk Factors

Increased early symptoms Increased severity of symptoms y y pIncreased symptoms may be:

OverlookedOverlookedAssumed to be “normal” agingMisdiagnosed as dementiasd ag osed as de e t a

Note: An individual with Down syndrome must also have a diagnosis of retardation to be eligible for APD services

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diagnosis of retardation to be eligible for APD services.

Early Aging in Down SyndromeEarly Aging in Down SyndromeAdultsShorter longevity Reduced cognitive and physical functionReduced cognitive and physical functionIncreased behavioral problemsChanges may mimic or mask diseases or disorders

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Early Aging in Down SyndromeAdults

Slowing of the thyroid (hypothyroidism) increases risk for:increases risk for:

Increased feelings of cold, tiredness, lethargy Decreased appetiteDecreased appetiteIncreased need for sleepIncreased short term memory impairmentIncreased short-term memory impairment

Increased confusion

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Early Age-related Changes inCerebral Palsy Adults

Decreased muscle strength after many years of no changeIncreased risk for urinary tract infections and incontinenceIncreased difficulty in swallowingReduced staminaReduced staminaIncreased fatigue

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Meeting the Needs of Aging Persons g g gwith Developmental Disabilities


Adverse Drug Reaction Risk Factors in

Adults with Developmental Disabilitiesp

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Medication Risk Factors in Older Adults

Increased levels of medications in the blood for longer timesgIncreased use of multiple medications Little understanding of medicationLittle understanding of medication interaction I d d d tiIncreased adverse drug reactions (ADRs) masking or mimicking dementia

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Medication Risk Factors in Older Adults

Increased dosages of medicationsFew studies of medication use in olderFew studies of medication use in older adults with developmental disabilitiesFew health care providers trained toFew health care providers trained to identify adverse effects of medications

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Additional Risk Factors Affecting Drug Reactions in Older AdultsPopulation variations due to gender, race, ethnicity

Increased side effects from anti-depressants Prozac & Paxil are twice that in Caucasions than in Hispanicsthan in HispanicsIncreased Tardive Dyskinesia from anti-psychotic drugs in African-Americansp y gIncreased response to anti-psychotic drugs by Asians

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Additional Risk Factors Affecting gDrug Reactions in Older Adults

Individual variations in responseAge-related differencesAge related differences

Disability specific variations in responseOld d l i h d l lOlder adults with developmental disabilities will “age into” medications

ith l twith long-term use

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Adverse Drug Reactions Affect Bod F nctionBody Function

Examples of biological changesIncreased/decreased blood pressureIncreased/decreased blood pressure

Increased urine retention or incontinence

Examples of behavioral changesIncreased risk for depressionIncreased risk for depression

Increased risk for paranoia

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Adverse Drug Reactions Affect Bod F nctionBody Function

Examples of neurological changesIncreased change in sleep patternsIncreased change in sleep patterns

Increased risk for seizures

Examples of decline in muscle coordinationIncreased risk for muscle tremors

Decreased coordinated muscle movement

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Adverse Drug Reactions That Mimic Dementia

Increased agitationIncreased anxietyIncreased anxietyIncreased behavioral changesIncreased decline in cognitive functioning

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Decreased communication skillsIncreased disorientation to personIncreased disorientation to person, place or timeIncreased loss of interest in normalIncreased loss of interest in normal activities

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Increased risk for confusionIncreased risk for delusionsIncreased risk for delusionsIncreased risk for depression, sadnessIncreased risk for unexplained excitabilityIncreased risk for restlessness, wandering

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g

Summary of Module 3

Myths may affect how services are appliedA i i i d bAging is experienced by everyone

Aging is an individual processInfluenced by genetics and lifestyleDisabilities over-lay influences on aging

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Summary of Module 3

Increased risk of mimicking or masking diseases or disorders from early aging indiseases or disorders from early aging in adults with Down syndrome and cerebral palsypalsyIncreased risk for adverse drug reactions that mimic or mask diseasesthat mimic or mask diseases

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Group Discussion

Questions

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