Helping Relationships With Older Adults. Adelle M. Williams

the lungs to be breathed out (exhaled) (Martin, 2014).

      As a result of aging changes in the body, older people are at increased risk for lung infections (i.e., pneumonia, bronchitis), shortness of breath, low oxygen level, and abnormal breathing patterns resulting in problems such as sleep apnea (episodes of stopped breathing during sleep) (Martin, 2014). Mental health professionals can create a supportive environment to provide health education to encourage the older client to decrease or eliminate smoking (if appropriate) and to encourage an exercise to improve lung function. Lying around for long periods of time allows mucus to collect in the lungs and places the older adult at risk for lung infections. Mental health practitioners will address concerns, fears, and psychological issues, which may impede the recovery process. Coordination of services and arranging access to obtain needed equipment (if required) will be an essential component of the therapeutic process.

      Aging changes in the body that affect the lungs include changes to the bones and muscles of the chest and spine. Bones become thinner and change shape, and this can change the shape of your ribcage, and as a result, the ribcage cannot expand and contract as well during breathing. The muscle that supports your breathing (diaphragm) becomes weakened and may prevent the older adult from breathing enough air in or out. These changes in your bones and muscles may lower the oxygen level in the body, and less carbon dioxide may be removed from the body. Symptoms such as tiredness and shortness of breath can result (Martin, 2014). Changes to lung tissue include muscles and other tissues that are near the airways, which may lose their ability to keep the airways completely open, and this causes the airways to close easily. Aging also causes the air sacs to lose their shape, and these changes in lung tissue can allow air to get trapped in the lungs. Too little oxygen may enter the blood vessels and less carbon dioxide may be removed, which makes it hard to breathe (Martin, 2014). Changes to the nervous system involve the part of the brain that controls breathing, which may lose some of its function. When this happens the lungs are not able to get enough oxygen, and not enough carbon dioxide may leave the lungs, which makes breathing more difficult. Nerves in the airways that trigger coughing become less sensitive, and large amounts of particles (smoke/germs) may collect in the lungs and may be hard to cough up (Martin, 2014). Changes to the immune system include weakening of the immune system, which means the body is less able to fight lung infections and other diseases, and the lungs are also less able to recover after exposure to smoke or other harmful particles (Martin, 2014).

      The respiratory system becomes more restrictive with age (Whitbourne, 2000). As a person ages, the elastic component in the lungs becomes smaller, resulting in the collapse of the peripheral airways while a person breathes out intensively. This is intensified due to a reduction in the maximum vital capacity of the lungs. The maximum breathing capacity is believed to reduce by 40% in older people. It can progress to the extent that this problem can arise during normal breathing. This leaves an older person feeling tired or results in shortness of breath caused by exertion. Furthermore, coughing becomes weaker with age, which is very problematic for older people, who are more susceptible to illness. Without the proper strength to cough, secretions in the lungs build up, and this can lead to aspiratory pneumonia (Weber, 2010).

      It is very important that older people quit smoking because smoking greatly increases the chances of developing a respiratory disease. Diseases such as emphysema and chronic obstructive pulmonary disease are sometimes the natural effects of aging on the lungs. This is intensified in smokers, and these diseases impair respiratory functioning. Exposure to environmental pollutants is also linked to these diseases associated to the elderly because the effects are cumulative.

      Older people who exercise consistently have less decrease in lung function. The major decrease in lung function occurs when the older adult requires maximal breathing for a period of time. The respiratory system is usually able to meet the needs of a normal older adult, but when illness or stress precipitates a need for increased respiratory function, the reserve capacity may be inadequate to meet the need. For most people, the reserve capacity is greater if they have remained active throughout life. Alterations in the respiratory system may require adjustments as one ages, as does changes to the cardiovascular system.

      Cardiovascular System

      Issues related to the cardiovascular system in older adults may negatively impact their psychological well-being. They may become depressed and anxious if they have been diagnosed with any accompanied heart disorders (e.g., angina, congestive heart failure, high blood pressure). The heart works harder due to medications, emotional stress, physical exertion, illness, infections and injuries (Hurd, 2014). These factors might interfere with daily activities, engaging in social relationships and activities, employment and a host of routine activities that bring meaning to the lives of older persons. Mental health professionals are in a position to educate their older clients on their condition and the impact it has had on their lives, provide support in their adjustment to their condition, and empower them to make decisions that will support a healthy lifestyle. Mental health professionals will need to encourage their older clients to eat a heart-healthy diet, encourage physical exercise, maintain appointments with health care providers, and comply with their identified treatment regimen as prescribed by their primary care physician. Mental health practitioners will need to address the cardiovascular issues as they impact daily activities and be certain to conduct sessions with the older patient and available family members. Encouraging family support or initiating new supports is essential in this treatment process.

      Changes and diseases associated with the cardiovascular system can be attributed to aging, genetics, and also lifestyle choices. The cardiovascular system is responsible for having the heart pump an adequate amount of blood to the cells throughout the body. Aging, however, limits the heart’s functionality (Whitbourne, 2010). The heart has more difficulty pumping out blood so, in older adults, strenuous activities can become problematic at times. It is difficult to pinpoint the exact cause of the decline in functionality because major studies are not able to control the amount of a person’s physical activity throughout their life as well as other lifestyle choices such as drinking and smoking that have profound effects on the system (Whitbourne, 2010). For example, disease rates in older adults are significantly higher for people who smoke. Studies also show that change in body compositions in seniors are probably caused both by the process of aging and those external factors like physical inactivity (Weber, 2010).

      A person’s age cannot be accurately defined by examining a heart; however, studies show a strong correlation between a person’s age and an increase in coronary artery disease (Arking, 2006). This is a severe problem because about half of the elderly population shows symptoms of cardiovascular disease, which is the leading cause of death. There is approximately a 30% increase in the thickness of the left ventricle wall among older adults (Arking, 2006).

      Some of the problems associated with the cardiovascular system result from the loss in mass of muscle cells within the heart due to aging (Whitbourne, 2000). The left ventricle wall becomes thicker because of an increase in fat and connective tissue buildup caused by muscle mass decreasing. This makes the heart produce fewer functional contractions that pump the blood. During the diastolic phase (relaxation and dilation of the ventricles), the heart muscle stretches and the ventricles fill up with blood. Pressure builds in the blood as it is released into the aorta. During a condition known as diastolic dysfunction, the capacity of the walls of the heart is decreased, which reduces and delays filling up the left ventricle with blood. This impairs blood flow to various arteries throughout the body.

      Another problem for older adults is that the cardiac muscle becomes less responsive to neural stimulation (activation/energizing of a nerve). The “pacemaker” cells in the heart are responsible for starting each contraction but become less responsive as a person ages. In addition, the heart muscles become less flexible, and the buildup of plaque forms in the inner linings of the arteries. This causes the arteries to become narrower, impeding the flow of blood through them. There is a natural age-related change that stiffens and narrows these arteries called vasculopathology of aging. The walls of the aorta are less flexible, which causes resistance for blood trying to travel far into the arteries. The main way to stave off these various cardiovascular problems is a healthy diet with exercise (Whitbourne, 2000). The purpose of Guided Practice Exercise 1.2 is to provide the opportunity to view the