Case Managing Elderly Clients Kendra Peters, LMSW & Joyce Hefner, LMSW Family Eldercare Austin, TX TACAA Annual Conference, May 2019
Learning Objectives Objectives: 1. Learn about normal aging process. 2. Learn about problem issues or abnormal changes and how to address them when working with clients who are elderly. 3. Identify and learn about how to address critical issues: a) Basic Needs b) Social Isolation and Depression c) Substance Misuse 4. Resources and tips for navigating the system of services.
Aging in America • The demographics of aging: population boom • People are living longer. • Many older adults live with chronic but The sun shines different ways in not life-threatening illness that summer and winter. We shine different ways in the seasons of our contribute to disability and can lives. diminish quality of life. Terri Guillemets
Aging is part of the Life Cycle • A Physical Process • A Psychological process • A Social- Emotional Process • Older adults are an extremely unique group. They bring a lifetime of diverse experiences, behaviors, and health status.
Emotional Changes • Sadness and Grief over loss • Physical • Personal • Resiliency, humor, internal locus of control • Depression is common but not normal part of aging • Under diagnosed • Consequences of lack of treatment
Psychological/Brain Changes Change: Brain and spinal cord lose nerve cells. Things slow down, including production of neuro-transmitters. Normal Short-term memory loss More difficulty handling change Slower memory retrieval Problem/Abnormal Confusion Dementia (includes Alzheimer’s) Significant short-term and long-term memory loss Delusions
Brain Changes Cont’d Dementia is the general term for loss of memory and other intellectual abilities serious enough to interfere with daily life. -Dementia occurs in 6%-10% of adults 65+. Rises to 30% in those 85+. -Other things that cause memory problems: Depression, side effects of drugs, strokes, head injury, sodium imbalances, and alcoholism Most common types: Alzheimer’s: Key symptom: memory loss, includes inability to do familiar tasks, time/place confusion, misplace things, poor judgment, mood/personality change. Gradual onset. Lewy-Body Dementia: Generally requires an ongoing decline in thinking skills, along with two of the following: visual hallucinations, Parkinsonism, or fluctuating alertness. May include sleep disorder, effect blood pressure, heart rate, cause sweating. About half of these patients also have Alzheimer’s dementia. Vascular Dementia: Lack of blood flow & oxygen to brain. Linked to strokes, heart attacks, high blood pressure. Symptoms can be fairly sudden and depend on what part of brain affected. Can be memory loss, confusion, trouble with daily activities. Most treatable form. Korsakoffs (Alcohol related dementia): Memory problems, difficulty with daily tasks, psychiatric problems (depressed, irritable, resistant).
Physical Changes Changes in Hearing Changes in Vision Changes in Smell and Taste Changes in Mobility Changes in Fine Motor Skills
Hearing Loss Change: High pitched hearing and low pitched frequency reduced. Stats for those age 65 and above • 28% will experience some hearing loss • 8% will lose hearing in 1 ear • 5% will lose hearing in both ears • Rates increase with age- 48% of those over 85 will have some hearing loss. • The ear is connected to balance. Changes in the ear can impact balance. Presbycusis, or “old ear” is the 3 rd most common health problem of older adults and involves inability to hear high-pitched frequencies (it sounds like hands are cupped over both ears). Loss is gradual and impacts both ears.
Changes in Vision Change: Elasticity decreases, lens thicken, prone to disease, produce less tears Stats for those age 65 and above: • 95% wear glasses • 31% have difficulty seeing even with glasses • Total vision loss is seldom a problem Other factors: • May have an increase of problems with glare (includes indoor glare), adjusting to darkness or bright light. • Muscles less able to fully rotate eye. • Ability to distinguish blues and greens worsens. • Reduced peripheral (side) vision is common.
Vision Loss Cont’d Common Vision Problems: Presbyopia- most common, unable to clearly see or read things held close to the face. Cataracts- Causes fuzzy vision. Usually not significant problem, affects peripheral vision. Experienced by 90% of older adults. Macular Degeneration- decreases ability to see things in front of you. Does not impact side vision. Experienced to some degree by 30% of older adults. Retinopathy-Dark areas of vision. Diabetes common cause. Glaucoma: Glaucoma is an eye condition that develops when too much fluid pressure builds up inside of the eye.
Vision Problems MACULAR DEGENERATION CATARACTS GLAUCOMA DIABETIC RETINOPATHY
Smell and Taste Change: Number of taste buds and sense of smell decrease • Less satisfied with food, decreased appetite • By age 80, over half of taste buds are lost. Loss of salty and sweet most significant. Lead to over-salting food, using too much sugar. • Olfactory (smell) nerve endings affected-changes with age and by disease. • Illness and medications can affect taste and smell. Other factors: A person with reduced ability to smell may not notice body odor. A person may be less likely to detect danger from gas leaks, smoke, etc.
Mobility Change: decreased bone & muscle mass, sensory changes, heart and lung changes Stats for those age 65 and above: • 25% have difficulty walking 10 steps • 19% have difficulty walking ¼ of a mile • Increases with age. At age 85+, 48% have difficulty walking 10 steps and 36% have difficulty walking ¼ of a mile Other factors: • Common diseases such as arthritis & osteoporosis. • Heart enlarges and pumping capacity decreases. • Ability to take in oxygen decreases 40% between ages 20 and 70.
Fine Motor Skills Change: related to common diseases found in elderly Stats for those age 65 and above: • 8% need help with bathing, 7% need help with dressing, 6% with phoning, 5% with cooking • Need increases with age. Of those age 85+, 23% need help with bathing, 18% with dressing, 18% with phoning, 8% with cooking, and 10% with toileting. Other factors: • The impact is not significant unless disease condition is present. • Common diseases include Arthritis, Diabetes, Parkinson’s, Alzheimer’s or an occurrence of a stroke.
Identifying Needs Medication Veterans Affairs Counseling Housing Safety Medicaid Health Care Social Security Medicare Food Financial Plans Transportation
Geriatric Assessment • Designed to address common issues faced by older adults. • Multi-dimensional-need to address complex needs. • Emphasizes Functioning and Quality of Life.
Elements of Assessment Mental & Cognitive Social Well-Being Physical Functional Emotional Well- Environment Financial Status Abilities Health Abilities Being
What do we learn? Mental & Physical Cognitive Emotional Well- Health Function Being Risks Resiliency Memory Adapt & Respond to Age Related Life Changes Change Changes Depression, Anxiety, Chronic Conditions Competency Substance Abuse
What do we learn? Functional Social Well- Financial Environment Ability Being Resources Accessibility of Choice and Resources ADLs Housing Values Ability to Accessibility of Self- IADLs Manage Services Determination Support Safety Safety Exploitation Network
Critical Issues: Poverty and Limited Resources • Older adults are the only population group to experience an increase in the number of people in poverty (US Census Bureau Data). • There are more older adults who work full time but live in poverty than there are older adults who are unemployed. More than 13.2 million older adults who are still working are classified as low-income Americans. (AARP Foundation) • The average monthly Social Security benefit for retired workers is just over $1,300/month. About 46 percent of unmarried people over age 65 and nearly 25 percent of married older adults rely on Social Security for 90 percent or more of their income. (AARP)
Poverty and Limited Resources For every unit of Almost half of the poorest seniors 16% (10,000,000) of Section 202 housing (a (those earning less than 50 percent older adults face hunger federal-assisted of the area median income) pay each year. housing program more than half of their income for targeted to seniors) housing that becomes available, ten seniors are waiting. Of low income elders living in poverty, 63% choose to pay for food instead of medical care .
Critical Issues: Social Isolation & Loneliness • Holt-Lunstad, Smith, & Layton (2010) found a strong association has been shown between objective/subjective isolation and morbidity. • Isolated individuals have been shown to have greater rates of re-hospitalization (Mistry et al., 2001; Curtis et al, 2006). • Tomaka et al. (2006) found both subjective and objective isolation connected to negative health outcomes for: • Diabetes • Hypertension • Arthritis • Emphysema
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