Helping Relationships With Older Adults. Adelle M. Williams

precipitate falls, injuries, and subsequent hospitalizations. Mental health practitioners may serve the role of a coach to encourage older adults to maintain their health, maintain appointments with health providers, and recommended tests and encourage healthy behaviors. They can teach coping strategies for dealing with stress and the consequences associated with any abnormalities within the digestive system. Mental health practitioners must also assist in the coordination of care and provide appropriate referrals. They must also encourage older adults to separate their personal experience of the aging process from the disease or illness that they may be experiencing. Mental health practitioners may also need to address issues of social withdrawal, isolation, fear, and depression. These psychological issues will definitely decrease the overall functioning for older adults. The psychological well-being of older adults can be enhanced by the supportive and trusting relationship with the mental health practitioner.

      The gastrointestinal (GI) system is the digestive system of the human body. The major functions of this system are the processing of food and the absorption of nutrients, minerals, vitamins, and water (AAHF, 2015). Aging has relatively little effect on GI functioning because of the large functional reserve capacity of most of the GI tract. The digestive system is made up of the mouth, teeth, tongue, salivary glands, pharynx, esophagus, stomach, pancreas, liver, gall bladder, and both the large and small intestines. Essentially normal digestion and absorption occur in the elderly; however, there are many changes in the digestive system that parallel age-related changes seen in the other systems. Like other systems, the rate of new cell growth declines and tissues become more susceptible to damage (AAHF, 2015).

      The elderly face changes to their digestive systems. Though the digestive system suffers little from changes related directly to aging, psychological and social strains threaten the system’s functionality (Whitbourne, 2000). The digestive system is a series of tubes and glands that run all the way from the mouth to the rectum. It is responsible for extracting nutrients from food and then eliminating the remaining waste. Anxiety and stress are key components to problems linked to the digestive system. Stress inhibits saliva and gastric juice secretion, which makes swallowing foods and eliminating waste difficult. Saliva secretion is important for lubricating food, making it easier to move down the esophagus (p. 127).

      One change associated with aging and the digestive system is known as presbyesophagus. This particular condition is characterized by a weakening of the esophagus muscles. It reduces food movement down the esophagus and leads to difficulty swallowing. Another challenge for older people is maintaining a healthy appetite. A condition known as anorexia of aging is when older adults fail to eat a sufficient amount to satisfy his or her nutritional needs. This can be made worse by poor teeth and taking multiple prescription medications that reduce appetite. Psychological changes, such as anxiety, also affect this system. Anxiety and stress can lead to a loss of sensory functioning such as taste and smell, further ruining a person’s appetite and causing disturbances to the digestive system (Whitbourne, 2000).

      Aging causes a slight decrease in the amount of pancreatic enzymes, which further decreases digestion and the absorption of nutrients. Thus digestion is slowed but remains fairly adequate until an advanced age. Slowed peristalsis (involuntary contraction and relaxation of the muscles of the intestine or another canal), reduced abdominal muscular strength, inadequate exercise, and reduced food and fluid intake are responsible for a high prevalence of constipation. Some older adults may have problems related to relaxation of the anal sphincter because of cold environments or ulcers or hemorrhoids that lead to constipation (Talbot & Hogstel, 2001).

      The digestive system remains a cause of concern among older adults. They fear that they may lose control of or not be able to have bowel movements. Constipation is problematic because they cannot eliminate waste, which could build up in the system to toxic levels and has been linked to cancer of the gastrointestinal tract. The loss of control of defecation is often linked to more advanced stages of Alzheimer’s disease, which is becoming an increasing problem for older people (Whitbourne, 2000). Changes in the digestive system of older adults can negatively affect their overall well-being, as does changes in the musculoskeletal system.

      Musculoskeletal System

      Psychological changes will accompany the natural changes in the musculoskeletal system of older adults. The changes will affect their emotional well-being, sense of security, living environments, self-esteem, and ability to function in all aspects of daily life. Older adults may fear falling due to loss of muscle mass and difficulty ambulating as a result. They may become isolated and fearful of having to move to an unfamiliar environment, which facilitates dependence on others. Older adults may perceive themselves in a negative manner because of any limitations imposed by the changes in the muscles and bones. Self-care and activities such as grocery shopping, driving, and handling financial transactions may not be managed by older adults. Fearfulness, anxiety, depression, social isolation, and low self-esteem are just some of the issues counselors will need to address to improve the quality of life for elders. Counselors must also evaluate the environment or make a referral for a home assessment to decrease any possibility of falls or other injuries. They must teach older adults how to cope with the consequences and/or diseases that they have developed. They must always focus on the strengths and abilities while providing the required resources to improve their quality of life.

      There are three types of muscles in the musculoskeletal system: skeletal, cardiac, and smooth muscles. Skeletal muscle is a collection of striated muscle fibers connected at either or both extremities with the bony framework of the body. Cardiac muscle is an extremely specialized form of muscle tissue that has evolved to pump blood throughout the body. Smooth muscle fibers form the supporting tissues of blood vessels and hollow internal organs, such as the stomach, intestine, and bladder. The skeletal muscles make up most of the muscle content in the body and lose the most mass with aging. Muscle tissue and strength begin to decrease around the age of 30 and continue throughout the life span (Arking, 2006). With proper precautions, most older people retain enough muscle mass and strength to carry out everyday tasks. Lean muscle is the amount of weight you carry on your body that isn’t fat. When lean muscle mass decreases, it is caused by muscle atrophy. The decrease in hormones and testosterone that stimulate muscle development is a reason why muscle mass declines with age. Disuse and disease, as in many systems, are major confounders of age effect. One hypothesis is that disuse atrophy occurs, arguing for a “use it or lose it” construct. Age-related changes include loss of muscle mass, though strength loss can be relatively preserved by exercise (Besdine & Wu, 2008).

      The size and number of muscle fibers decreases with age, which causes the muscle to respond more slowly. The muscles cannot contract as quickly because there are more muscle fibers in fast-contracting muscles than compared to the slow-contracting muscles. Sprinters require short but intense bursts of energy and therefore need more fast-contracting muscles, while postural muscles of the back are composed of slow-contracting muscles, and long-distance runners require more slow-contracting muscles (Aging Changes in the Bones, Muscles, and Joints, 2012). As the muscle mass decreases, fat content increases, which affects the body’s metabolic rate. This can make it harder to maintain a healthy weight and good cholesterol level (Arking, 2006). The change in the metabolic rate is the reason why older people do not metabolize medications as well.

      The human body is a complex network of symbiotic systems. The skeletal system and the muscular system work together as the framework for the body as well as providing the pieces that allow for movement. The human skeleton consists of 206 separate bones that provide a solid frame to support the body, as well as protection for internal organs. The bones come together at joints, which allow for movement of individual limbs as well as movement of the entire body in conjunction with skeletal tissue and the muscular system. The muscular system is composed of over 600 muscles, which include involuntary muscles of the heart and the smooth muscle of the internal organs. The skeletal muscles connect to the bones and work with connective tissue at the joints to allow for movement. The muscles connect to the nervous system and allow initiation of movement through nerve signals to and from the brain (Hurd, 2014). The skeletal system gives strength and support to the body. It is also affected by age. As a person ages, the amount of cells present in cartilage decreases, and it loses its translucence. One of the most notable changes with the skeletal system is that of calcification