ConnectABILITY Homepage

Aging: Changes in Hearing

Supporting people with an intellectual disability through the “Normal” Aging Process

Introduction

Aging Persons with an intellectual disability will:

  • Likely affect the daily rhythms of our homes and the community as a whole.
  • Push us to focus even more on building upon, reinforcing and developing their strengths so that their quality of life is enhanced.
  • Have frequent changes in support and residential location and their health records are often inadequate. Consequently, it may take some time to piece together an accurate picture of the individual’s health status.
  • Challenge us to find creative ways for people to continue to do the things they like to do and to continue to have a role in the home.

Other Considerations:

  • Aging takes place earlier with individuals who are intellectually disabled than the general population.
  • In the 21st century, the life expectancy has increased to 66.1 years of age.
  • Individuals who are intellectually disabled account for 3% of older adults.
  • Health needs change as they individual gets older.

Hearing

Changes in Hearing expected as the person ages:

  • Sensitivity to loud noises.
  • Difficulty locating sound.
  • More prone to wax build up that can affect hearing.

Strategies for supporting people with changes in hearing:

  • Reduce extra noise when trying to have a conversation.
  • Place yourself so the person can see you and fairly close. Increased volume is not always helpful.
  • Speak slowly.
  • Make sure you have the person’s attention before speaking.
  • Have doctor check for and remove wax if needed.
  • Arrange for hearing assessment and provide support to use a hearing aid if needed.
  • Use simple language and at a slower pace to help the individual distinguish words.
  • Encourage lip reading.
  • Do not shout on their faces.
  • Stand near the unaffected ear.
  • Check the battery of the hearing aid.
  • Before initiating the conversation convey your presence by moving closer where you can be seen or by gently touching the person.
  • Reduce background noises (i.e. radio) before speaking.
  • Talk at moderate rate and normal tone of voice.
  • Address the person directly. Do not turn away in the middle of the story. Make sure the person can see your face easily and in good light.
  • Avoid talking when something is in your mouth and avoid covering your mouth.
  • Always speak as clearly and as accurately as possible. Articulate consonants with particular care.
  • Do not ‘over articulate’. Mouthing or overdoing articulation is just as troublesome as mumbling.
  • Write ideas, use sign language or finger spelling, as appropriate.
  • Use simple words and short sentences. Word choice is important. Say ‘half a dollar’ instead of ‘fifty cents’.
  • Make reference to the name for easier understanding.
  • Change to a new subject at a slower rate.

Summary

  • Not every person will experience all of these changes.
  • Organizations concerned with a particular syndrome or condition may be helpful in providing information helpful for certain individuals.
  • Aging is a spiritual and psychological journey as well as a physical one.

Don’t Forget

  • If we believe that people can continue to grow and to share their gifts as they age we will support them to do so.

Information is compiled from the following:

  • McCracken Intervention Matrix –McCracken -College of Nursing and Health, University of Cincinnati and Lotteman Children, Inc. Covington, KY
  • A Focus on Geriatrics Sharing the Learning St Vincent Hospitals part of Providence Health Care
  • Age Changes and what to do about it Phyllis Kultgen and Peggy Hotz
  • Management Guidelines Development Disability Version 2, 2005.

Original material compiled by Jane Powell of L’Arche Ontario
Adapted with permission from http://www.aging-and-disability.org

Palliative Care and Symptom Management

“Palliative care aims to improve a person’s quality of life through improved symptom management while addressing psychosocial, emotional and spiritual issues. It is care that is appropriate at all stages of a person’s illness. An interdisciplinary care team may involve medical oncologists, radiation oncologists, family physicians, palliative care physicians, social workers, dietitians, nurses, spiritual care workers and other health professionals” CANCER CARE ONTARIO

Palliative care can be separated into three stages. These stages enable the caregiver to plan and work with expected outcomes. A palliative performance scale tool was developed by Victoria Hospice Society, and is available at Cancer Care Ontario web site. Use of this tool gives the caregiver information to support and anticipate level of care required.

  • PPS level — 100% – 70% — Stable stage
  • PPS level — 60% – 40% — Transitional stage
  • PPS level — 30% – 0% — End of life stage

In each of these stages symptom management is required, the following pages cover the most common symptoms.

Pain

Pain is a common symptom in palliative or end of life care. Pain has several origins.

  • Due to the disease itself
  • Due to the investigation and treatment of the disease
  • A result of a complication of the disease or treatment
  • Unrelated to the cancer(2)

The origin of pain is not limited to the physical body, pain may be a combination of emotional and spiritual suffering, this is referred to as “total pain”. To effectively manage pain the whole person must be assessed.

A pain score, greater than 5 on a 0-10 scale requires the use pain medication, in conjunction with relaxation techniques, massage and any other therapeutic techniques that the patient and caregiver find effective. Pain medication combines opoids, anti-inflammatories, and a group of medications referred to as adjuncts in order to maintain a pain score of less than 5. In order to create a safe and effective pain relief cocktail there will be a need to involve a prescriber (Nurse Practitioner or Doctor) and a Registered Nurse to ensure effective outcomes and assess for side effects, intolerance and complications.

Emotional and spiritual pain can be a result of isolation, unresolved family and personal issues, feelings of loss, grief, alterations to independence and other changes that come with the end of life. The caregiver, should encourage communication of painful or positive thoughts and feelings, talk about contributions to life, victories in life, encourage the participation family and friends. If appropriate ask the patient how she/he wants life to end. Grief counselors are also available through palliative support groups. www.cancer.ca has links to support groups.

Spiritual pain is harder to assess as we all have varying spiritual beliefs and concepts. In the developmentally delayed population this concept may be vague therefore difficult to discuss. All humans have a concept of something greater than ourselves, understanding this concept and accepting our powerlessness to change the outcome of the life cycle may complicate pain until acceptance is achieved.

Touching, holding hands, singing and music can initiate a spiritual experience when words cannot, this connection may promote a sense of peace and serenity.

Bowels

Constipation, in palliative care is a condition that requires preventative therapies and maintenance. All cancer or palliative care patients must be on or have access to a bowel routine which includes use of laxatives and stool softeners.

Complications: unresolved constipation will lead to bowel obstruction which will require medical intervention. Constipation can occur even with reduced food intake.

Some signs of bowel obstruction:

  • Nausea and vomiting
  • Abdominal pain and distention
  • Unable to pass gas

Common signs of constipation:

  • No bowel movement after 3 days or no movement 1-2 days longer than the individual’s normal routine
  • Difficulty passing stools
  • Feeling the need to go and only producing watery stools without relief
  • Stomach distention, with stomach pain or cramping
  • Reduced appetite in conjunction with the above signs

Good bowel management starts with knowing the risks or causes. Examples of risk and causes:

  • Reduced fluid intake especially water
  • Inappropriate use or poor use of laxatives and stool softeners
  • A side effect of medications (especially opoids/pain meds)
  • A side effect of some treatments (for example chemotherapy)
  • Reduced activity
  • Part of the disease process (mechanical bowel obstruction related to a tumour)

Recommendations:

  • Daily use of laxatives and stool softeners
  • Maintain a bowel chart (frequency, type, difficulty/ease)
  • Consult with a community nurse through your GP or CCAC
  • Consult with the attending doctor or nurse practitioner

Nausea

Nausea, (and vomiting) can be caused by medications, therapies (chemotherapy/radiation), constipation and bowel obstruction. “The prevalence of chronic nausea in patients with advanced cancer varies from 20%-70%” (Alberta Hospice Palliative Care Resource Manual p.59). An accepted tool to gage the intensity of the nausea is called the Visual Analogue Scale (VAS).

Recommendations:

  • observe for nausea trends, when does the nausea occur?
  • Avoid spicy, greasy, odorous foods
  • Provide calm meal times, and small portions of food
  • Use anti-nausea medication as prescribed
  • Check for constipation, and provide good oral hygiene
  • If nausea does not improve have doctor or CCAC send in a nurse to assess

Appetite

Anorexia is a common symptom in cancer care especially in the palliative stages. There is not usually one identifiable cause, “Cancer anorexia/cachexia occurs in 80%-90% of patients with advanced cancer.” (Alberta Hospice Palliative Care Resource Manual p.55.)
Anorexia is harder on the family/caregiver than the patient. Families feel that if only their loved one will eat he/she will feel better, get stronger, live longer, support is needed to move away from these beliefs and embrace quality of life.

Recommendations:

  • Avoid forcing food. This can lead to complications such as aspiration, vomiting, abdominal distention due to poor food digestion and absorption
  • Consult with prescriber, there may be a case for an appetite stimulant
  • Encourage favorite foods in small frequent amounts
  • Use soft, pureed foods or liquid meals for easier swallowing and digesting
  • Provide good mouth care and observe mouth for evidence of thrush or ulcerations

Hydration

Hydration in palliative care is not a standard procedure or therapy. Usually there has to be a specific indication such as delirium or opoid toxicity. “Patients who develop delirium or opoid toxicity may benefit from parenteral hydration if the oral route is not feasible.” (Alberta Hospice Palliative Care Resource Manual P.48.) If hydration is ordered the most suitable route for the patient is subcutaneous, also called hypodermoclysis. Hypodermoclysis is the insertion of a tiny needle into the fat of the skin. The benefits of this method include:

  • Easier access, veins may be difficult and painful to access
  • Less invasive than IV
  • Can be given easily and safely at home
  • Site can last up to 7 days, IV sites need to be changed every 3 days
  • Less risk of systemic overload with saline (Alberta Hospice Palliative Care Resource Manual p.47)

Mood disorders

Mood disorders can include depression, anxiety, confusion, insomnia and some forms of dementia.

Shortness of Breath (Dyspnea) Cough & Fatigue

Shortness of breath (SOB) is a very distressing symptom, combined with cough and fatigue it becomes more difficult to manage and promotes anxiety in the patient and family. Mild SOB can be tolerated and may have minimal effect on the patient’s ability to be involved in day to day activities. When SOB is distressing to the individual, caregivers must engage in managing activities to promote rest and energy conservation. Often the patient’s perception of SOB is different than the observer.

“Dyspnea is an uncomfortable awareness of breathing. Like pain, it is a subjective sensation, involving both the perception of breathlessness and the patient’s reaction to it.” (Alberta Hospice Palliative Care Resource Manual p.51)

If oxygen is prescribed and available then it should be used in conjunction with rest, calm and energy conserving activities. Cough suppressants can be used (as prescribed) to reduce the cough and provide rest intervals between coughing sessions. If the cough is producing blood tinged, yellow or green sputum, there will be a need for a medical assessment as there may be a lung infection that is contributing to the SOB.

“Maintaining high fowler’s position, bed rest, good oral hygiene, and increased ventilation are all easy measures to decrease perception of dyspnea” (Alberta Hospice Palliative Care Resource Manual p.51.)

Increasing fatigue and SOB with activity and a PPS score above 50% may be an indicator of reduced hemoglobin. A PPS score of below 50% in conjunction with increasing fatigue and SOB at rest may indicate impending death. The involvement of a Registered Nurse will provide the support required to communicate with a prescriber to meet the needs appropriately.

References

    1. Cancer Care Ontario, https://www.cancercareontario.ca/en
    2. Managing Cancer Pain, The Canadian Healthcare Professional’s Reference, Copyright 2005, Perdue Pharma
    3. Alberta Hospice Palliative Care Resource Manual, 2001

Written by Aakilah Ade RN Certified Hospice and Palliative Care Consultant, 2012 aakilahade@hotmail.com

“Me in Motion” – Exercise Tips for Everyday Healthy Living

When we hear the word “exercise”, the first thoughts or images that come to mind are Health clubs, weight training and huffing and puffing our way to fitness.

BUT if you think of exercise as ‘me in motion’ what do you see—

  • Taking care of ourselves
  • Providing flexibility to prevent falls
  • Maintaining muscle tone
  • Ensuring a good blood flow to our brains
  • Boosting our moods
  • Providing a chance to meet new people and socialize with friends
  • When outdoors, providing a source of vitamin D and fresh air

As seniors, in addition to being persons with many different physical and intellectual limitations, our needs for exercise can be as individual as each of us is. Perhaps you use a wheelchair, or a walker. You might have bad knees or a knee replacement along with breathing issues, weight control issues or a pacemaker. It can really be hard for us to participate in ‘regular exercise’, so we need to look at imaginative ways to get the exercise we need.

But before we can do anything, there are a few important rules to follow.

  • Always check with your doctor. Remember to tell him what medications you are on.
  • Follow your doctor’s recommendations before starting any exercise, including checking with a physiotherapist or an occupational therapist
  • When exercising, remember to take a list of your medications and health issues so your instructor and friends know in case of any emergency.

Now that this is taken care of here are some ideas to get you ‘in motion’

  • We have many ways to get moving. We go for walks, ‘lift weights’ and do our stretches and bends.
  • A kid’s colourful parachute can be used inside or outside of the house. There are a number of websites with variations of games that can be played. This helps with our arms, stretching, breathing, and co-operation.
  • If you don’t have access to a parachute…then try things like folding pillowcases, towels, helping with bedding or folding laundry.
  • There are other chores that are part of every day living yet help with ‘me in motion’: Emptying the dishwasher (bending stretching and balance), sorting and putting away laundry, throwing folded socks into the drawer, collecting the garbage (again bending, stretching and walking.)
  • Mealtime is often a social time at home. Dinner can last a long time. It is not just about the eating. It is a time to laugh and talk about our day. It can also be a good time to get some exercise. Play a game of toss using empty medicine cups or a hacky sack ball. Don’t forget to clear the table first. This encourages stretching, arm and hand co-ordination and dexterity. Of course, there will be bouts of laughing and may require heavier breathing – both of which increases oxygen flow and relaxation).
  • During the summer months everyone can help with the gardening. If you use a wheelchair, you can help with the flowerpots (urns), hanging baskets and railing baskets. It starts with the annual trip to the nursery where everyone picks out the flowers and plants that each person wants to grow. This trip gets us a healthy dose of Vitamin D, sunshine, fresh air and walking.
  • In the cooler months and inclement weather we tend to stay indoors more. This doesn’t mean that you need to stay home though. There are plenty of malls to go to. A great chance to ‘people watch’ while you are socializing, walking and window shopping. Again, lots of exercise while having fun.
  • You do not need to buy expensive exercise equipment. There are so many things that can that be used as exercise equipment. Going to the dollar store keeps the cost down considerably. Small soft balls can be used for throwing into pails or to each other. There are many inexpensive toys available that help with co-ordination as well as stretching and bending. Those Velcro catching mitts are great for catching and throwing.

If you are not sure what activity to do, just think about all things you used to like to do. Or, you can make a list of some new activities you might like to try now.

  • But remember: be sure to wear the proper clothing and shoes for the type of exercise you choose.
  • Check to see if you need special equipment to do some activities
  • Check to see if a friend would like to join you… the buddy system makes it safer and more fun.
  • Check the area that you are using to ensure that it is well lit, clutter free and accessible to you.
  • Make sure you eat at least two hours before you exercise, drink plenty of water before and a little, if needed, during your exercise.
  • Rest when you feel the need – PAIN IS NOT GAIN!!
  • When exercising outside remember to check the weather and the air quality for your health.
  • STRETCH, STRETCH, STRETCH before and after to relax your muscles.

Here are some places to check out for ‘Me in Motion’ Links

  • Canada’s Physical activity Guide
  • Parks, forestry and recreation: Toronto parks
  • Malls for walking
  • Club 55+ in York and clubs in your neighbourhood
  • Libraries
  • Meet at the pool in your apartment building and have a group aqua fit with friends
  • Use the exercise room in the apartment building and if you need special equipment then talk to the superintendent or a committee in the building to see if they can help to get the safe equipment for you (check with ODSP too)
  1. Home
  2. 2012