Helping Relationships With Older Adults. Adelle M. Williams

process from the perspective of an older family member.

      Guided Practice Exercise 1.2

      Interview your grandparent or other older adult in your family and inquire regarding the changes they noticed as they aged. Ask them how they felt regarding the changes and how they adjusted to them. Share this information with peers and colleagues.

      Integumentary System

      Older adults may be negatively affected by the changes to the integumentary system. They may have difficulties with adjusting to the aging process and the outward changes that affect their physical appearance. In a youth-oriented culture within the United States, many elders might adjust to the changes; however, others may suffer from low self-esteem, being depressed, and may result to alterations to their bodies to communicate a more youthful appearance. Mental health practitioners are positioned to counsel older adults to help facilitate an adjustment to the outward changes, which may be inconsistent with how they feel inside. They may need to teach coping strategies, educate them on the natural and inevitable processes of aging, and they may need to advocate for them if they feel they have been discriminated against based on their appearance. Empowering older adults to learn to embrace themselves, which might include some wrinkles and gray hair, is important. Counselors will need to remain open and receptive to older adults who have always given a great deal of attention to their physical appearance. However, all changes must be kept in a perspective as just one component of the aging process. Getting the older person to focus on intrinsic factors versus extrinsic factors will be helpful. Educating older adults on the benefits and risks associated with procedures that modify one’s appearance may prove beneficial, if presented objectively. Counselors working with older clients are in an excellent position to assist with the emotional and psychological adjustments to the physical manifestations of the aging process.

      Several changes occur in the integumentary system, which consists of skin, hair, and nails, with aging. Obvious changes are the graying of hair and wrinkling of the skin that lead to the loss of self-esteem in many Americans as these changes are noticeable to others and are not respected in our culture (Cash, 2001; Yaar & Gilchrest, 2001). As melanocyte (pigment-producing cell) activity declines, this causes the hair to turn gray or white. Hair loss (alopecia) in men begins between the late teens and the late 20s, and by the time they reach their 60s, 80% of men are substantially bald (Stough, Stenn, & Haber, 2005). There are two types of male hair loss: bitemperol hair loss is universal, constant, gradual, and does not respond to treatment. Male pattern baldness (androgenetic alopecia) accounts for the majority of all hair loss and can be treated with oral medications (Scheinfeld, 2012). Inherited or pattern baldness affects many more men than women, and male pattern baldness is the most common type of baldness in men, especially older men, and the hair loss is gradual. In men, the hair loss usually starts with a receding hairline, while in women, it manifests a diffuse thinning of hair on the crown (Scheinfeld, 2012). Female baldness tends to be associated with more diffuse hair loss than it occurs in men. Most women develop widening partings and thinning of the hair all over the scalp with age, and this process starts in the teens or early 20s, and it affects 50% of women by the age of 50 (Price, 1999). After menopause, thinning of the hair is more pronounced. Guided Practice Exercise 1.3 examines feelings regarding premature graying of the hair.

      Guided Practice Exercise 1.3

      Imagine you are 23 years old and just noticed your first gray hair. Over the next year, your entire head has turned gray. What are your feelings regarding your premature change in hair color? How are you perceived by others? Do you feel you look older with gray hair and will you accept the change or dye your hair? Explain your response in detail.

      Changes in the skin are the most obvious, especially on the top layer, known as the epidermis. This layer thins with age (Aging Changes in the Skin, 2014). As the body ages, the effects of nutrition, environment, genetics, and especially sun exposure begin to manifest through this system. The overall number of melanocytes, or pigmented cells, decreases. However, heavily sun-exposed areas, such as the hands, arms, and face, will show an increase in pigment called lentigo senilis. These areas are sometimes called liver spots, although they have no relationship to the liver, or age spots. They are harmless but may result in feelings of self-consciousness. Additionally, skin will droop and sag with age, which is due to the loss of elasticity, also known as elastosis (Aging Changes in the Skin, 2014).

      The middle layer of the skin, known as the dermis, is the site of blood vessels and oil glands. In younger years, the blood vessels here are strong, but as one gets older, they weaken and may occasionally break, causing bleeding within; cherry angiomas are commonly what result (benign blood vessel skin growths). Sebaceous glands decrease oil production with time, making it more difficult for the skin to stay hydrated. This can cause problems, including dryness, itchiness, and peeling. This condition can be partially overcome by using tepid rather than hot water when bathing, using less soap or an oily soap, eliminating the use of powder, and applying an emollient lotion after the bath.

      Below the dermis is the subcutaneous fat layer, containing fat and sweat glands. This layer thins just as the epidermis does, resulting in difficulty maintaining a reasonable body temperature (homeostasis). This may explain why older adults chill easily and are at an increased risk for hypothermia in cold weather. However, in the warmer months, older adults are at risk for heat-associated conditions due to decreased functioning of sweat glands. The thinning of this subcutaneous layer also limits the normal functioning of nerve receptors associated with touch, pain, and pressure (Aging Changes in the Skin, 2014).

      Wrinkling is caused by the loss of subcutaneous fat and water in epidermal layers and exposure to the sun over many years. Highly pigmented skin is less prone to wrinkling and sun damage, which causes thinning of the epidermis. With the thinning of the epidermis, the skin is easily injured and healing is slow if the blood flow to the dermis is impaired. Because of the changes in the skin, prolonged bed rest can cause major problems such as pressure ulcers. Special beds, mattresses, and lotions should be used to help prevent skin breakdown.

      Changes in the thickness, shape, color, and growth rate of the nails occur with age. Vascular supply to the nail bed decreases resulting in dull, brittle, hard, and thick nails, with a slowed growth rate. The fingernails may flake and become brittle or develop ridges. The toenails may become discolored or abnormally thickened. The nails of older adults may be thick and easily split. It is imperative that nails be soaked in warm water before being cut or shaped to prevent splintering and to avoid possible trauma leading to infection. The condition of an older person’s toenails may help to indicate whether the person is capable of living alone and caring for personal hygiene needs. Older persons may develop bunions, which are misaligned bone at the base of the big toe, and eventually the big toe may bend abnormally toward the small toes. They may develop calluses and corns, which are dead, yellowish, thickened skin on toes. Hammertoes may develop, which are toe joints that curl up or under, either rigidly or with some flexibility, often resulting in a permanently dislocated joint (Health in Aging, 2012). Finally, ingrown toenails may develop. These foot problems may impede mobility and may necessitate admission to a supervised living facility. Also these problems will make it difficult for these older adults to ambulate to take care of their activities of daily living and instrumental activities of daily living. An older adult client should be encouraged to seek professional care for their feet from a podiatrist at periodic intervals to prevent trauma, especially if the client has a severe visual deficit, vascular problems, and diabetes, or if the client’s body is no longer flexible enough to allow them to care for their feet. It is essential to address all changes in the integumentary system of older adults and also the gastrointestinal system, which undergoes changes as one ages.

      Gastrointestinal System

      Gastrointestinal issues can have a negative effect on the psychological well-being of older adults. Problems in this area can also adversely affect the ability of older adults to maintain good nutritional habits, which might lead to malnourishment that can precipitate a host of other problems (e.g., susceptibility to illnesses/diseases, hospitalizations, increased use of medications). Another example is problem with the absorption of calcium required for bone growth and maintenance can be disrupted, which may lead to osteoporosis