Helping Relationships With Older Adults. Adelle M. Williams

all burners after use to be certain they are turned completely off and marking the date food is placed in the refrigerator to prevent eating spoiled food (Talbot & Hogstel, 2001). Changes in the ability to smell negatively impacts quality of life for older adults as does changes in sensation with aging.

      Sensation

      Changes in sensation common to older adults include the peripheral nerve function that controls the sense of touch declines slightly with age and the ability to perceive painful stimuli is preserved in aging; however, there may be a slowed reaction time for pulling away from painful stimuli with aging (Cacchione, 2005). Consequences of decreased sensations include the possibility of falls due to inability to recognize position sense or inability to ascertain where feet are on the floor and development of calluses or serious foot lesions. Older adults who fall may develop a fear of falling, which will negatively impact all activities of daily living and social endeavors. Older adults may become anxious and depressed, which may warrant psychological interventions. Mental health practitioners can facilitate coping mechanisms with their older clients, coordinate service providers, provide psychosocial interventions, and facilitate social interaction, which is essential if the older client has become withdrawn.

      Sensations may be diminished or changed in older adults. Peripheral nerve function that controls the sense of touch declines slightly with age. Two-point discrimination and vibrating sense both decrease with age. The ability to perceive painful stimuli is preserved in aging; however, there may be a slowed reaction time for pulling away from painful stimuli with aging (Cacchione, 2012). The sense of touch may decrease, and a firmer touch may be needed to elicit a response. Many older adults respond positively to touch; perhaps it indicates a special sense of caring by another person. However, sensations are also compounded by disease, and most older adults will have at least one or more chronic diseases. Diabetic patients will have difficulties in the area of pain sensation. Osteoporosis can produce a sense of being off-balance when ambulating.

      The sensation of pain varies considerably in older adults. It may be more difficult to evaluate acute pain because of an older adult’s reduced ability to locate the source of pain. The autonomic response to pain, such as rapid pulse, elevated blood pressure, pallor, and nausea, may not occur in older adults. Every person exhibits learned behaviors in response to pain, and older adults may have experienced chronic discomfort for such a long time that they fail to respond to a new stimulus. Also, the inflammatory response is often reduced or delayed, resulting in a decreased stimulus for pain. A combination of assessment skills to detect the presence of pain is necessary. It is essential to differentiate acute from chronic pain because the cause and treatment may be quite different.

      Typically, painful disorders are often less or not at all painful in elders. In the cortex, populations of neurons continuously receive input from upstream neurons, integrate it with their own ongoing activities, and generate output destined for downstream neurons. Such cortical information processing and transmission is limited, and pain sensation appears to decline with age. The brain has a neural (relating to the nervous system) circuit and endogenous (developing from within) substances to modulate pain and as individuals age endogenous pain inhibition is reduced with aging. Some pain thresholds show age-related changes. Although sensitivity to heat pain decreases with age, sensitivity to pressure pain is enhanced. Sensory nerves lose myelin, which is a layer of tissue that surrounds the nerve fibers (axons) selectively, and perhaps predisposing individuals to neuropathy (problem with the nerves). Vibration sensation perception diminishes with aging, especially in the legs (Besdine & Wu, 2008). Changes in sensation may negatively impact older adults and create an unsafe environment, while issues with balance pose similar safety issues within the environment.

      Balance

      Having good balance means being able to control and maintain your body’s position, whether you are moving or remaining still. An intact sense of balance helps you walk without staggering, get up from a chair without falling, climb stairs without tripping, and bend without falling (NIH Senior Health, 2014). Good balance is important to help elders move around, maintain independent functioning and carry out daily activities. As individuals get older, many people experience problems with their sense of balance. They feel dizzy or unsteady, or feel that their surroundings are in motion, and usually disturbances of the inner ear are a common cause (NIH Senior Health, 2014).

      Balance problems in older persons can result in falls. Falls and fall-related injuries, such as hip fracture, can have a serious impact on an older person’s life. If the older person falls, it could limit his or her activities or make it impossible to live independently. Many persons often become more isolated after a fall. Additional consequences of balance are disruptions in normal sleep patterns, a cause for excessive fatigue, and balance disturbances can shorten your attention span and cause major disruptions in routine activities, social activities, and work and/or leisure activities. These limitations diminish the quality of life for older adults, and mental health practitioners can provide education, referral, and counseling to older clients. They can encourage older clients to obtain a comprehensive physical examination from their primary care provider, refer client for services as needed (e.g., occupational therapist), educate clients on their condition, conduct an assessment of the environment (identify potential environmental hazards), and support their clients in their efforts to cope with their condition.

      Balance function declines with increasing age, but it is rarely the sole cause of falls in older persons. A person’s sense of balance is controlled by the vestibular (sensory) system that is affected by many diseases (e.g., diabetes, stroke, Parkinson’s disease) and is also sensitive to various combinations of medications, both prescription and over the counter (Besdine & Wu, 2008). In a normal healthy individual, our senses of touch (feet, ankles, and joints), sight (eyes), and inner ear motion sensors work together in harmony with the brain. A person with a balance disorder, however, may have a problem in any one of these systems or in multiple systems. The risk of developing one or more of these problems increases with age as our senses or brain centers are exposed to degenerative or infectious diseases or the effects of injuries accumulated over a lifetime. The natural aging process produces changes in our bodies as we grow older, but these changes do not necessarily result in a loss of balance control or mobility (Natus Balance & Mobility, 2015).

      The response to both vestibular and kinesthetic stimuli (sensation of muscle contraction) is reduced in very old people. Vestibular sense receptors are located in muscles and tendons and relay signals to the central nervous system concerning joint motion and body position in space. Because both of these senses help maintain equilibrium, coordination, and body position, a diminution in their effectiveness produces a general unsteadiness, a lack of coordination in movements, and an increase in the amount of body sway. Because a longer time is required for stimuli to reach the central nervous system and be interpreted, and for messages then to be sent to the periphery, there is a great need for older adults to move slowly, have a wide stance, refrain from rapid body or head turning to maintain balance and prevent falls, and perhaps use a cane for support when walking. Older people should be instructed not to make quick changes in direction because such movements may cause loss of balance (Talbot & Hogstel, 2001). Maintaining good balance is critical for all older adults, and no living organism can exist without a fully functioning respiratory system.

      Respiratory System

      The major function of the respiratory system is the delivery of air to sites in the lungs where gas exchange can occur between the air and circulating blood (AAHF, 2015). The lungs have two main functions. One function is to get oxygen from the air into the body, and the other function is to remove carbon dioxide from the body. The body needs oxygen to work properly, and carbon dioxide is a gas the body produces when it uses oxygen (Martin, 2014). During breathing, air enters and exits the lungs. When you breathe in (inhale), air flows through the airways into the lungs. The airways are made of stretchy tissue and bands of muscle, and other support tissue wraps around each airway to help keep it open. Air keeps flowing into the lungs until it fills tiny air sacs, and blood circulates around these sacs through tiny blood vessels. Oxygen crosses into the bloodstream at the place where the vessels and air sacs meet, and this is also where carbon dioxide crosses the bloodstream