Module 2 - The Aging Process
This module provides basic information about the processes that occur throughout life, and particularly in the later years, that are considered normal aging. It also discusses common illnesses in later life and the effects of medications. Ombudsmen must be able to work with older individuals and avoid stereotypes. Ombudsmen should be alert to the difference between the effects of normal aging and the results of diseases that afflict some elderly persons.
Learning Objectives: At the conclusion of this module, LTCO will know:
- Normal age related changes;
- Myths and stereotypes about aging;
- Myths and stereotypes about care;
- Common illnesses and treatments; and
- The role of LTCO when poor care practices are encountered.
SECTION 1: What is Aging?
To better understand the population of long-term care residents who are an Ombudsman's primary focus, you need to understand the "big picture" of the senior population, defined here as persons of 65 years of age or older. This section provides a profile of the older population in America today.
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SECTION 2: Biological Aspects of Aging
Aging brings some changes in all people. These changes are continuous throughout life, from losing baby teeth to the loss of taste buds. The normal changes with advanced age have only recently been studied and are beginning to be understood. Some changes are obvious in the way they alter physical appearance or in their visible effect upon body systems. Other changes are less apparent, in that they affect internal body systems, such as the circulatory systems. These changes vary in degree and rate from individual to individual.
Hover your mouse over the images below to learn more about the biological changes brought about through aging.
The cumulative effect of these changes is minimal in everyday functioning. These changes occur gradually, which allows individuals to adapt to the changes. Normal, daily functioning continues. The impact of these changes is more apparent when an older person is in an unfamiliar environment or when an older person is subjected to physical or psychological stress. Exercise and diet significantly impact the rate of these changes by slowing down the processes. In spite of the normal, age-related changes, older people function well enough to maintain daily functioning.
SECTION 3: Psychological Aspects of Aging
Hover your mouse over the image below to learn more about the psychological aspects of aging.
SECTION 4: Sociological Aspects of Aging
As with individuals of any age, familial relationships are important to older people. With increasing age, family composition often undergoes some changes. Older men are much more likely to be married than older women. Almost half of all older women are widows. Divorced and separated older persons represent only 10% of all older persons. However, this percentage has increased since 1980.
Family connections extend into later life as reflected by living arrangements. Almost 60% of older women and 78% of older men live with a spouse or with another relative.
Relationship patterns which were established in earlier years prevail into later life. If a parent and child have always had personality clashes, they will continue to unless they learn new ways of dealing with each other. The parent who listened primarily to one child or turned to a child for advice will continue that pattern unless something intervenes.
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SECTION 5: Myths and Stereotypes
Within American society, there are some common generalizations that are thought to be truths about older people. Many elderly people, who may expect these behaviors of themselves, believe these stereotypes. The myths, stereotypes, and negative attitudes greatly influence interactions with older people. Expectations about the later years are formed very early and are reinforced throughout life.
The truth is that there is great variety among individuals in later life. Individuals are what they have always been. There is as much diversity in personalities among older adults as there is among younger individuals. Problems arise when people act on their assumptions about the older person. Family members may unconsciously “watch” their elderly relatives to see when they will begin to exhibit these characteristics. Some major myths and stereotypes are listed below.
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Ombudsmen Need to Know!
Stereotyping and myths also affect the medical treatment older individuals receive and the way caregivers treat them. Clinical expertise is beginning to challenge many commonly held perceptions about inevitable age-related declines and appropriate interventions. As an ombudsman, you need to know which conditions indicate a need for more assessment and/or consideration of different treatment interventions instead of assuming that the conditions are simply manifestations of the aging process.
Since your job will be working with individuals in long term care facilities, this section will focus on applications in that environment. The same principles are applicable to individuals in home settings or other residences. Click on the "Full Screen" button below to open the document and read more.
SECTION 6: Common Illnesses and Conditions Associated with Aging
This section is included to provide basic information about selected conditions and illnesses that you might hear about as you visit residents. This information is not to be used as a medical guide. Do not advise residents about treatment or make a diagnosis based on the following information.
Click on the links below to learn more about common illnesses and conditions associated with aging:
Tips for Ombudsmen
Regardless of the cause of confusion, or whether it is reversible or irreversible, there are positive ways to respond to individuals. The expectation for improvement needs to be present. Individuals sometimes rise to meet our expectations, in spite of confusion. Voice tones as well as words and actions convey much meaning. As an ombudsman, you must be aware of all messages you are giving.
SECTION 7: Drugs and Their Side Effects in the Elderly
Most nursing home residents are on five or more drugs at any time. Ombudsmen, in visiting in nursing homes, will notice the side effects these drugs can have on residents. This section familiarizes ombudsmen with common drugs in nursing homes and the side effects many residents experience. Ombudsmen should be familiar with this basic terminology of drugs so that when residents’/families’ complaints involve drugs, ombudsmen recognize the terms. Ombudsmen can thus refer or investigate the complaint reliably.
Over a four year period, two-thirds of nursing facility residents have adverse drug events (ADEs) and one out of seven of these results in hospitalization. Ombudsman should be aware of the Beers Criteria that identify 48 commonly used individual drugs or classes of drugs to avoid in older adults and 20 diseases or conditions and medications to be avoided in older adults.
NOTE: In order to access the Beers Criteria you will need to register on the AGS website. The link to the document is on the right side of the web page.
Misuse of Antipsychotic Medications
Residents of long-term care facilities are increasingly being placed on antipsychotic medications despite having no proper diagnosis to warrant their use.Twenty-six percent (26%) of all nursing home residents are given antipsychotic medications. Use is even higher (nearly 40%) among residents with dementia - the very individuals that the Food and Drug Administration (FDA) warns are at serious risk of medical complications and death from taking antipsychotics. In addition, far too often the dangers of these medications are not even discussed with residents and their families and are administered without consent.
CMS has launched a National Partnership to Improve Dementia Care and Reduce Unnecessary Antipsychotic Medication Use in Nursing Homes to improve dementia care through the use of individualized, comprehensive care approaches. The partnership calls for a systematic process to evaluate each person and identify approaches that are most likely to benefit that individual. The goal of the partnership is to continue to reduce the use of unnecessary antipsychotic medications, as well as other potentially harmful medications in nursing homes and eventually other care settings as well.
The Consumer Voice, along with several groups, has provided input and feedback to CMS on the National Partnership and has created a toolkit for advocates on the misuse of antipsychotic medications among nursing home residents. This toolkit contains take-away resources for consumers, family members and advocates describing how to recognize symptoms of the improper use of antipsychotics; the rights of residents under federal nursing home laws and regulations; and what consumers, family members and advocates can do to combat this problem. The contents of the toolkit include the following:
- Misuse of Antipsychotics Status Update
- Misuse of Antipsychotics Issue Sheet
- Promising Practices to Reduce the Use of Antipsychotic Medications
- The Interpretive Guidelines: A Tool for Advocates
- Information About Inappropriate Drug Use for Long-Term Care Consumers (Postcard)
- Sample Letter to the Editor
- Resource List
Additional Advocacy Resources:
- Long Term Care Community Coaliation (LTCC) Brochure on Antipsychotic Drugs
- LTCCC Report: Federal Requirements & Regulatory Provisions Relevant to Dementia Care & The Use Of Antipsychotic Drugs
- CANHR Releases New Guide to Fighting the Misuse of Psychoactive Drugs in Nursing Homes
- LTCCC Report on Informed Consent Rights in U.S. Nursing Homes
For more information and resources, visit the Consumer Voice Misuse of Antipsychotics Among Nursing Home Residents issue page.
The decision on prescribing appropriate drugs is the domain of the physician. Advance Practice Nurses (Nurse Practitioners and Clinical Nurse Specialists) and Physician Assistants in some states also have prescriptive authority. Pharmacists in nursing homes should review the drug regime of residents on a monthly basis to ascertain if there are adverse drug reactions, allergies, contraindication, or ineffectiveness.
Remember: your role is not to second guess a medical decision regarding medications. You are to listen, observe, ask appropriate questions, and suggest that an individual ask his/her physician for additional review or more information. Ombudsman should know that all drugs given to the elderly should be started at a low dose and raised slowly. This is especially true for individuals who have a dementia.
If more specific information related to medications is needed, call the State Long Term Care Ombudsman. You can also consult the following document for excellent information about geriatric conditions, medications, and alternative treatments.
Click on the links below to learn more about drugs and their side effects in the elderly:
Click on your state or territory in the list below to take the Review Quiz.