Helping Relationships With Older Adults. Adelle M. Williams

calcium deposits in joints and tendons, which sometimes contributes to inflammation, causing pain and limiting movement and sometimes causes soft tissues to harden. Calcium crystals can also contribute to the erosion of cartilage (Aging Changes in the Bones, Muscles, and Joints, 2012). The replacement of tissues like collagen decreases with age (Arking, 2006). Lipofuscin (an age-related pigment) and fat are deposited in muscle tissue. The muscle fibers shrink. Muscle tissues are replaced more slowly, and lost muscle tissue may be replaced with a tough fibrous tissue. This is most noticeable in the hands, which may look thin and bony (Hurd, 2014). Bone mass or density is lost as part of the aging process, and it is especially significant for women after menopause. The bones lose calcium and other minerals. The disks gradually lose fluid and become thinner in the spine, and vertebrae lose mineral content, which results in thinner bones. Foot arches become less pronounced contributing to a slight loss of height. Hip and knee joints, as well as finger joints, may begin to lose cartilage. Lean muscle mass decreases due partly to loss of muscle tissue (atrophy) (Hurd, 2014). Aging brings about changes in the musculoskeletal system that is essential for all movement, while the immune system is critical to fight against infections.

      Lymphatic System

      The major function of the immune system is defense against infection and disease. With advancing age, the lymphatic system becomes less effective at combating disease and fighting off infections. A compromised immune system leaves older persons vulnerable. Illnesses or diseases negatively impact the lives of older adults due to the potential social inactivity, isolation, decreased ability to perform activities of daily living, and increased financial expenses due to the need to purchase equipment supplies and medication and pay for any health care services. Older persons may become depressed and/or anxious. Mental health professionals can assist older persons by encouraging them to obtain flu vaccinations, eat nutritious meals, comply with their treatment regimen, and engage in physical activity. Mental health professionals can provide counseling around issues of stress and loss and medical issues that have arisen from the suppressed immune system. Mental health professionals can also encourage social interaction, teach stress reduction techniques, and educate older persons on various issues pertaining to their illness. A compromised immune system with any associated conditions does not need to impede the quality of life for older persons. Mental health practitioners are in an excellent position to assist older persons in developing coping mechanisms.

      As a person ages, the ability to fight off infections declines, and the risk of becoming ill increases. The cells within the immune system react more slowly. Specifically, T and B cells are associated with fighting off disease. The T cells, white blood cells that coordinate immune defenses, are responsible for cell immunity. They coordinate and regulate the immune system to allow it to fight off diseases. With age, the T cells become less responsive and make it harder to respond to pathogens. The B cells are responsible for producing antibodies. The antibody levels do not rise quickly enough after an infection enters the body with age (Aging Changes in Immunity, 2012).

      The decline in immune system functioning can explain several findings that are associated with aging (Whitbourne, 2000). The cancer rate increases with age because the cells of the immune system are not able to recognize the malfunctioning cells that cause cancer. Vaccines are less protective for older people because the body is not able to produce the antibodies needed. Older adults are more susceptible to common infections, such as pneumonia and influenza, which become more prominent and can cause death. Additionally, open wounds will not heal as fast because the cells responsible for healing act slower and are reduced in number. The lymphatic system provides protection for all human beings and without it, illness and death may occur. The emotional state of an older adult can either promote a healthy outcome or become detrimental to the recovery process.

      Emotions

      Emotions change with age; however, aging adults can improve in the area of emotional regulation (Kensinger, 2009). Healing emotions (serenity, gratitude, and reverence) bolster the immune system. They have been long understood in alternative medicine and are slowly coming to be accepted by the mainstream medical community as well. Since decreased immune function is common in later life, whatever can be done to strengthen it is good. Positive emotions boost two kinds of immune system cells: T cells and natural killer cells, large white blood cells that attack cancer cells and infected cells (Cohen, 1998). Immune function varies greatly, but people over 75 or 80 usually need longer to recover from a cold or from wounds, and their infections tend to be more serious than those of younger people.

      Older adults can develop healing emotions. Practitioners can teach stress reduction techniques to encourage relaxation. They can also encourage older persons to develop a spiritual connection (if one does not already exist), and they can empower elders to be assertive and take control of their health. Practitioners can also encourage older adults to embrace the aging process, focus on their strengths and abilities, and give of themselves (talents, knowledge, experience) to others. A common way serenity is cultivated is gardening. Nurturing new growth is calming, and gardeners seem to thrive in old age. The ability to feel and express gratitude is an important part of healthy aging. In the lives of most people, there are at least a few things to be grateful for. Sometimes this is just a matter of mindfulness, for example, promoting thinking like “I’m grateful that it is a clear night and I can see the stars.” Gratitude does not depend on external circumstances, and it helps to counter the message from industrial societies that we need more of everything (Macy, 2007). Reverence is more abstract than gratitude or serenity. The hard breathing that accompanies strenuous exertion or exercise can induce feelings of reverence. This emotion acknowledges the life force greater than our individual spark. It may make us feel small or exalted. A group experience may evoke it, or it may be solitary. People who see the northern lights report feelings of reverence. This emotion may come from a flash of understanding that all things are interconnected. Looking over one’s life may inspire reverence for the sheer doggedness of humans who live to be old (Cruikshank, 2009).

      Case Illustration 1.1 shows the natural physical changes that may accompany aging and the manner in which older persons can adapt to their environments with an adequate support system and stay actively engaged. The changes demonstrated include mobility issues, development of osteoporosis, decreased activities of daily living, loss of vision and hearing acuity, and digestive challenges.

      Case Illustration 1.1

      A 98-year-old elderly woman lives in her three-bedroom home with her adult daughter who is 75 years old. She drove until her early 80s, at which time she had an accident and was hospitalized. She ambulates with the assistance of a walker and an occasional arm to hold onto and is fearful of falling because of her recent diagnosis of osteoporosis. She attends church services regularly, watches television daily, and enjoys conversing with family and friends in her home and via telephone. Her daughter prepares her meals, washes her laundry, and manages her finances. She has one outside provider, a registered nurse, who comes to her home on a monthly basis and conducts a physical assessment. Overall, she is in good health and is thankful for every day she is alive. She doesn’t know if she will see age 99; however, she leaves it up to the “man upstairs.”

      This individual is living in her home, has the assistance of a loving daughter, and is visited regularly by friends and neighbors. She is able to attend church (which is very important to her) and engage in a few activities that bring her joy. Despite her limited mobility and slowness in ambulating, she is overall very satisfied with life. She is able to live at home because she has an excellent support system. Though she has difficulty with her vision, she wears bifocal glasses to help her see; her hearing is impaired, but she wears a hearing aid, which enhances her ability to hear. Her biggest complaint is that of constipation, which is not uncommon due to the slowing of the digestive system and more sedentary lifestyle, along with decreased daily fluid intake.

      Cognitive Changes That Accompany Aging

      In general, cognitive changes are much more subtle than physical changes. Cognitive abilities peak in young adulthood (Ericsson, 2000). Losses in midlife occur primarily during peak performances; in other words, declines in developmental reserve capacity are apparent when performance is pushed to its limits (Lindenberger,