Addressing the Needs of

Older Persons
MOBILITY
Where are the world’s
older persons?
In Asia

3
Projected Number of People 65+, 1997-2050
according to WHO Regions (in Millions)

4
Mobility in Older Persons

• Mobility as affected by architectural design

and assistive technology
• Mobility as affected by physical ability

5
Mobility and architectural design
• Circulation of individuals
within/to/from a structure
must be ensured

• For most structures

accommodating older
persons, the wheelchair
becomes a basic design
consideration

6
Mobility and architectural design
How to design?
• Circulation in the horizontal
plane
– Sufficient space to turn a
wheelchair around
– Doors must be at least 3 ft
wide
– Thresholds must be
eliminated at doorways
– Glossy floors and scatter
rugs must be avoided

7
 Mobility and architectural
design

How to design?
• Circulation in the
vertical plane
– Ramps for access
– Stairs for access

8
9
 Mobility and architectural
design

How to design?
• Reaching
– Access to
essentials
– Clearance
– Vertical reach

10
Physical ability
• 1/3 of persons over 65 y/o fall every year (US
statistics)
• ¼ of all falls result in severe soft tissue and
bone injury
• Falls result in:
– Increased caution and fear of falling
– Loss of confidence in independent function
– Reduced motivation and activity
– Increased risk of recurrent falls
11
Mobility and physical ability
• Physical ability affects functionality at home
and in the community
• Age-related changes in the different body
systems
• Address risk for falls in older persons

12
FALLS AND INSTABILITY
Falls are multifactorial in nature

• Intrinsic factors
• Extrinsic (environmental
1. physiological factors factors)
2. psychosocial factors
• Activity – related factors

13
 FALLS AND INSTABILITY
Falls are multifactorial in nature
• Intrinsic – physiological factors • Extrinsic – environmental
factors
– Age
– Institutionalized or
– Sensory/Musculoskeletal/N
community-dwelling?
eurologic/CV changes
– Surfaces and lighting
– Drug intake
– Bedroom and bathroom
• Intrinsic – psychosocial factors
– Depression
• Activity – related factors
– Denial of aging
– Normal daily activities
– Fear of falling
associated with falls
– Relocation
– Improper assistive device
use

14
 Mobility Enhancement &
Fall Prevention
• Assess for fall risk and eliminate if possible
– FALL RISK ASSESSMENT
• Improve functional mobility
• Strength and flexibility training
• Sensory compensation strategies
• Balance and gait training
• Functional training
• Environmental modification

15
Nutrition in
the Later
Years…
Outline

• The Later Years

• Nutrition in the Later Years
• Energy and Activity
• Carbohydrates and Fiber
• Fats
• Protein
• Vitamins, Minerals and Water
• Other interesting issues
The Later Years

• The life span of human beings is now 130 years.

The Later Years
• One caution: to date, scientists who study
the aging process have found no specific
diet or nutrient supplement that will increase
longevity, although there are hundreds of
unproven claims to the contrary.
Nutrition in the Later Years

Should be highly
individualized!
Nutrition in the Later Years
Examples of Physical Changes of
Aging 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 food
avoidance or reduced intake
Examples of Physical Changes of
Aging 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.
Examples of Physical Changes of
Aging that Affect Nutrition
• Sensory Organs
– Diminished sight can make food shopping and
preparation difficult; diminished senses of smell
and taste may reduce appetite.
• Body Composition
– Weight loss and decline in body mass lead to
lowered energy requirements. May be
preventable or reversible through physical
activity.
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 uphold a healthy
immune system.
Benefits of Physical Activity
• Greater flexibility and
endurance
• Greater lean body mass
• Better sense of balance
• Greater blood flow to the
brain
Benefits of Physical Activity

• Stronger immune
systems
• Suffer fewer falls and
broken bones
• Enjoy overall better
health
Carbohydrates & Fiber

• 6-11 servings of breads,

grains and pasta
• Fiber is necessary to
prevent constipation
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
Protein

• Needs remain about the

same through adult life,
but choosing low-fat
fiber-rich protein foods
may help control other
health problems.
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
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
 Foods/Supplements and
Alzheimer’s 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.
Foods/Supplements and
Alzheimer’s 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.
Obstacles to Adequacy
• Living alone may bring about problems in
poor quality diets.
• Tooth loss or lost taste sensitivity
• Medical conditions can also affect nutrition.
• Unintentional weight loss, followed by illness
or death
• Multiple medications and alcohol abuse
Source: Irwin, D., Milsom, I. et al. Impact of overactive bladder symptoms on employment, social inteactions and
emotional wellbeing in six European 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. Accessed
13.12.2006)
 ASIA (F) PERCENT
THAILAND 20.3
PHILIPPINE 13.9
S
MALAYSIA 13.1
WORLDWIDE PERCENT INDONESIA 5.8
(F) (%) SINGAPORE 11.8
ASIA 14.6 INDIA 6.2
JAPAN 32 PAKISTAN 24
US 37 TAIWAN 7.4
EUROPE 26 KOREA 22.6
HONGKONG 12
F - FEMALE
CHINA 11.6
 Women Living at Men Living at Home
Home Age 15 - 3%
Age 15 - 5% - 7% 44
44 Age 45 - 3%
Age 45 - 8% - 15% 64
64 Age 65 + 7% - 11-%
Age 65 + 10% - 20%
• 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 than
men
• Men more likely to suffer from urinary
retention
• Women are more likely to suffer interstitial
cystitis than men
• Urinary incontinence is a normal part of
aging

Many people at age 80 remain to be fully

continent despite the decline in bladder
elasticity and bladder tone
• Nothing can be done to treat UI in older
adults.

•Careful assessment of the older adult with UI is

required to determine cause of the symptom
•Use the most effective combination therapy, i.e.,
weight control, smoking cessation, pelvic muscle
exercises (PMEs) or Kegel exercise, assisted and timed
toileting, and medications.
• The only successful treatment for UI is
surgery
•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 promotes comfort and
enhances self –esteem.
•Educate the older person and the significant other about other
options which can allay their fears in seeking consultation.
• 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.
• The older person is having accidents on
purpose
•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.
• Absorbent products are the only option for UI
management for older people who are
homebound or in long-term care facilities

•Its convenience should never be used as an exclusive

solution: neither should it be used solely for the
convenience first-line staff caregivers or family.
•Patients should be thoroughly assessed to individualize
management options and find best interventions
appropriate for each person.
• Loss of Excess Weight
• Smoking Cessation
• Pelvic Muscle Exercises
– The first exercise is called a short contraction, and it
works the fast twitch muscles that quickly shut off the
flow of urine to prevent leakage. The muscles are
quickly tightened, lifted up, and then released. You
should contract as you blow out, or exhale, then
continue to breathe normally as you do the exercises.
• 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 are
gradually tightened, lifted up, and held for
several seconds.
– hold the contraction for 10 seconds before
releasing. Rest ten seconds between each long
contraction
• Dietary Changes
– Caffeine
– Alcohol
– Artificial sweeteners (sodium saccharine,
acesulfame K, and to a lesser degree
aspartame)
• Bladder retraining
• Use the toilet regularly - every 2½ to 3½
hours.
• 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 urine
in the bladder, stand up and then sit back
down again and lean forward slightly over
the knees. This is called “double voiding”
and may help you empty your bladder.
• Make the toilet facilities convenient and
safe. This may mean a bedside commode,
bedpan, or urinal placed conveniently near
or in the bed.
• Empty your bladder before you start on a
journey of an hour or more. Don’t try to
“wait until I get home to my own bathroom.”
• Avoid rushing or running to the toilet. This
actually increases the likelihood of an
accident and puts you at risk of falling.
MANAGING
STRESSFUL
MOMENTS

RGVTAMSE820
• What is caregiver
stress?
• What are the issues
related to caregiver
stress?
• What are the tell tale
signs of caregiver
stress?
• What can a caregiver
do to manage their
stress?
Mariel, 58, took care of her father
during 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
day—was to cut her hair very, very
short.
• Liza’s husband recently had myocardial
infarction and she was the sole
caregiver.
• She would often cry and had to rely on a
friend for decisions related to her
husband’s confinement.
• On the day her husband was confined
she refused to talk to anyone apart from
one friend.
• John is caring for her 83 year old father
who has memory problems and keeps
throwing fits wanting his way in every
thing. Makes messes all through the house.
He is not steady on his feet but is no longer
wanting to do anything but go to the SM.

• John would accompany his father even if

he is tired feeling guilty when unable
Melai complains that her grandfather would often
claim that there are “people “ who hides or
steals his money.
Melai would tell her grandfather that his
allegations are untrue but her grandfather would
not believe her but would insist that Melai is in
cahoots with the “thieves”.
Due to this concern, Melai harbors resentment
towards her grandfather and has become
irritable.
1. More than 7 million persons are informal
caregivers to older adults.
2. Caregivers include spouses, adult children,
and other relatives and friends.
3. Other surveys found that almost 26 million
family caregivers provide care to adults (aged
18+) with a disability or chronic illness, and
4. 5 million informal caregivers provide care for
older adults aged 50+ with dementia.
• The average amount of time that
caregivers spend on caregiving is about
20 hours per week.
• One third of all caregivers describe their
own health as fair to poor.
• Caregivers often worry that their care
recipient may outlive them
• There’s no question that Filipinos aside from
raising their children are also faced with
parenting their parents, too.
– squeezing in quick visits to assist with simple
daily tasks or providing actual caregiving
– the sacrifices and challenges of this balancing
act are taking a dramatic toll on those caught in
the middle.  
Caring or giving assistance to
anyone is rewarding …

Until . . .
• Feeling tired most of the time
• Feeling overwhelmed and irritable
• Sleeping too much or too little
• Gaining or losing a lot of weight
• Losing interest in activities you used to
enjoy
Mayo Foundation for Medical Education and Research (MFMER), March 2010
• Responses gathered through the Home
Instead Senior Care survey also showed
that 91 percent of family caregivers have
episodes of feeling anxious or irritable,
• 73 percent have disturbed sleep
patterns, and 56 percent seem to become
ill more frequently.
Emotional and physical strain of care
giving becomes evident
 It is what one feels when one have to
handle more than one is used to.
 Is normal and useful
 Is needed when one needs to work hard
or quickly
• Challenging demands on a caregiver’s
time
• Difficulty in balancing work and care
giving
• Feeling of being alone
• Fatigue
• Financial difficulties
• Relation to care recipient
A recent nationwide study by Evercare®,
“Caregivers in Decline” (2006), of
caregivers whose own health is at risk
because of their care giving duties found
that stress is their Number One issue.
• What is most alarming is that more than
half (53 percent) of the caregivers
surveyed say that this decline in healthy
behaviors has already affected their
ability to provide care.
The family caregiver typically is a 46-year-
old woman, according to Patricia
Volland, senior vice president of The
New York Academy of Medicine and
director of the Academy’s Social Work
Leadership Institute.
 
A survey done by Patricia Vollland women
ages 35 to 54, showed that
more than 60 percent of women concerned
about an aging relative’s health have difficulty
managing stress and
are about three times more likely than non-
caregivers to worry “a great deal” about
having enough time for family.
“Squeezed Between Children and Older Parents: A Survey
of Sandwich Generation Women.”
• According to a report from the National
Consensus Development Conference on
Caregiving, the most common psychological
symptoms of caregiver syndrome are
• depression,
• anxiety and anger.
Peter Vitaliano,, Professor of Geriatric Psychiatry
University 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
 Stress is recognized as the number one
proxy killer disease today.
 The American Medical Association has
noted that stress was the basic cause
of more than 60 percent of all human illness
and disease .
 It is estimated that American businesses
lose approximately $200-$300 billion dollars
per year to stress related productivity loss
and the treatment costs.
 Every week, 95 million Americans suffer
some kind of stress related symptoms for
which they take medication.  

 A 20-year study conducted by the University

of London concluded that unmanaged
reactions to stress were a more dangerous
risk factor for cancer and heart disease than
either cigarette smoking or high cholesterol
foods.
• stress is how we respond to events, not the
events themselves
• stress is inescapable - trying to avoid it will create
it
• not all stress can or needs to be controlled: we
need positive high energy stress - it gives us
motivation and challenge; we need to control
negative, emotional, and physical stress
• false perceptions often cause stress; find out the
facts before you get stressed
 EMOTIONAL AND
PHYSICAL
STRAIN OF CAREGIVING

FRUSTRATION
FRUSTRATION

EXHAUSTION/ ANGER/
BODY PAIN RESENTMENT

LONELINESS/
ISOLATION
GUILT

Sara Rom, MSW, MSG

Director of Education and Training
RGVTAMSE820 Southern Caregiver Resource Center
• TWO EXTREMES
– some people can
handle major
upsets without
batting an eye
– others become
distressed at the
slightest deviation
from their normal
routine

RGVTAMSE820
• Excessive anxiety and tension
• A general feeling of exhaustion
• Persistent anger or guilt
• Overreactions and emotional outbursts
• Difficulty concentrating
• Increasing isolation
• Trouble sleeping
• Depression
• avoid 
• suffer
• manage
Severe stress that is sustained over a
long period of time can take a major
toll
on both mental and physical well-
being.
• The First Step:
– Recognizing What You Can and Cannot
Change

• Step 2
– Learn everything you can
– Accept the inevitable.
– identifying sources of help
– Validate
• Breathing Exercises

• Mini-Meditation
– Get into a comfortable position
– Close your eyes.
– Clear your head.
– That’s it. Keep letting go of any thoughts
that may pop into your mind,
• Aromatherapy – light a candle or incense

• Quick Burst of Exercise

• HUMOR!
– Read comics
or joke books
– Laugh with
Friends
Watch funny
Movies

Comedy
clubs
• Humor is a wonderful stress-reducer
and antidote to upsets. It is clinically
proven to be effective in combating
stress,
• . Experts say a good laugh relaxes
tense muscles, speeds more oxygen
into your system and lowers your
blood pressure.
• A research published in 2005 by Dr
Michael Miller of the University of
Maryland in Baltimore :
– stress caused blood flow to slow by around
35%,
– laughter increased it by around 22%.

RGVTAMSE820
 Take single days
or even a week’s
vacation.
Talk about different
things, read that
book you haven’t
been able to get to,
take naps,
whatever relaxes
you and makes
you happy.
 “yes-sir” stretch.
 Place the index finger
on the eyebrow, and
middle finger lightly on
the eyelid.
 In a slow circular
motion, gently massage
the eyeball and eye
socket. Be careful to
place no pressure on
the eyeball, and if you
use contact lenses, only
massage the eye
socket.
 Stress
Management Plan
1. Adopt a
Wellness
lifestyle
Nutrition
2. Physical
fitness
Focus on
Positive
Emotionality
 Love yourself
 Communicate
 Get organized
 Prioritize
 Schedule wisely
 Laugh and
share
 Eat wisely
• Surrender
Dr. Peter Vitallano and the Family
Health Physicians in the US says
that due to the enormous concerns
experienced by caregivers and the
kind of stress symptoms there is
now a new condition “ Caregiver
Stress Syndrome”
• Try to do something you enjoy
• Do one thing at a time
• Maintain your sense of humor.
• Make lists
• Don’t shut out the good moments.
• Don’t try to cope alone.
• Mary Kay Morrison. Stress Survival Strategies. Humor Quest.
2008
• Promoting Positive Mental Health. Health Promotion Agency.
Ireland.October 2008
• Randy Pausch, Time Management. Carnegie Mellon
University.2000
• Running on Empty: Family Caregiver Stress .Home Instead
Senior Care Dallas
• Texas, 2007
• Stress Management. Canadian Society Of Intestinal
Research.