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Chapter 9
Functional Performance in Later Life:

Basic Sensory, Perceptual, and Physical Changes Associated with Aging

Objectives (1 of 3)

List at least four recommendations for healthcare professionals who work with people who have diminished visual skills.

Define perception and describe how perceptual skills may change as one ages.

Describe compensatory measures related to decreased perceptual functioning.

Describe how sensory systems tend to change over the course of aging, impacting function.

Objectives (2 of 3)

List compensatory measures for each of the sensory changes related to aging.

List at least four recommendations for healthcare professionals who work with people who are hard of hearing.

Describe the basic physical changes of aging related to range of motion, strength, motor control, and endurance.

Objectives (3 of 3)

Discuss how physical changes affect performance in various life skills, including self-care and work.

Describe how sleep patterns change with age.

Describe the components of interventions related to sleep disorders, including cognitive behavioral therapy.

Vision (1 of 8)

  • Begins to deteriorate around age 30
  • Older adults can maintain near 20/20 vision with corrective lenses until about age 88
  • Aging eye is vulnerable to diseases that can permanently damage the ability to see

Vision (2 of 8)

Vision (3 of 8)

  • Other visual skills that decline with age:
  • Visual processing speed
  • Sensitivity to light
  • Ability to see well in dim light
  • Near vision
  • Upward gaze without moving head
  • Contrast sensitivity

Vision (4 of 8)

  • Other visual skills that decline with age (continued):
  • Color sensitivity
  • Dynamic vision, which includes
  • Smooth visual pursuits of a moving target
  • Visual tracking or saccades

Vision (5 of 8)

  • Visual skills preserved with age:
  • Basic color vision
  • Ability to maintain fixation on a target
  • The healthcare professional can offer several simple compensatory measures for older persons with decreased eyesight

Vision (6 of 8)

Vision (7 of 8)

  • Visual perception
  • Brain’s ability to make sense of visual data
  • Does not uniformly decline with age
  • Older adults may:
  • Become more proficient at inferring meanings from less sensory input
  • Have difficulty distinguishing novel items
  • Be slower at processing the information
  • Take in less visual information per unit of time

Vision (8 of 8)

  • Decreases in perceptual skills are not usually associated with typical aging
  • Problems are usually related to a disease process or psychiatric disorder
  • Rehabilitation specialists can work with individuals with perceptual difficulties in adapting the environment and daily tasks to promote functional performance

Hearing (1 of 5)

  • Presbycusis (hearing loss)
  • Occurs in both genders
  • Older adults tend to:
  • Have more difficulty distinguishing higher-pitched consonant sounds
  • Not be able to recall earlier conversations when the number of words spoken per minute is high

Hearing (2 of 5)

  • Older women are more likely to:
  • Report hearing loss
  • Compensate by searching for nonverbal cues
  • Seek treatment
  • Older men are more likely to:
  • Have hearing loss
  • Deny a problem and not seek treatment

Hearing (3 of 5)

  • Mild hearing loss
  • Doubles for every decade past the age of 50
  • Worsened by repeated or ongoing exposure to high-intensity sound
  • Older adults have more difficulty tuning out background noise in noisy social gatherings
  • May lead to social isolation

Hearing (4 of 5)

  • Older adults with hearing loss report:
  • Feelings of loneliness and anxiety due to social isolation
  • Fewer friends in their social network
  • Social isolation can lead to mental decline
  • Hearing loss is associated with a higher risk for being diagnosed with dementia

Hearing (5 of 5)

  • Recommendations for working with older adults with hearing loss:
  • Speak in a tone that can be heard
  • Face people so they can see you speak
  • Speak at an appropriate rate of speed
  • Avoid elderspeak
  • Keep background noise to a minimum
  • Do not verbally jump between ideas quickly

Smell

  • Ability to detect smells and correctly identify differing odors decreases with age
  • High prevalence of hyposmia and anosmia
  • Sense of smell declines insidiously with age
  • Can constitute a serious safety issue
  • Compensatory strategies are recommended
  • Decreased sense of smell can contribute to decreased pleasure in eating

Taste (1 of 2)

  • Ability to detect salty, bitter, and sour tastes decreases with age
  • Threshold of salty flavor needed for detection increases
  • Ability to taste sweets does not change
  • Thirst sensation declines with age
  • Increased risk of dehydration

Taste (2 of 2)

  • Inadequate dietary intake can cause a loss of taste perception
  • Number of taste buds can be reduced due to malnutrition or as side effects of medication
  • Appetite can decrease due to the sense of fullness and early satiation from age or disease-related changes in the GI tract

Physical Changes (1 of 11)

  • Range of motion (ROM)
  • Ability of a joint to move through its natural pattern of movement
  • Every joint has a typical range
  • Declines in joint ROM in the shoulder, hip, and wrist occur with age
  • Some age-related conditions can restrict smooth movements and limit maximum range of motion

Physical Changes (2 of 11)

  • Non-resistive, repetitive ROM exercises may:
  • Be able to maintain or improve current range
  • Slow down the progression of disease processes such as osteoarthritis
  • Regular movement is important if the individual is able

Physical Changes (3 of 11)

  • Joint contractures
  • Stiff muscles and tendons leading to joint rigidity
  • Being sedentary or immobile puts an individual at a higher risk for contractures
  • Joints typically affected include the hips, shoulders, fingers, and knees
  • Prevention is the best treatment
  • Remedial treatment should involve a passive, active-assisted, or active ROM program

Physical Changes (4 of 11)

  • Strength
  • Slight decline in middle age
  • 15% loss per decade after age 50
  • Some individuals may not get progressively weaker with age
  • If physically capable, older adults can still be involved in, and improve in, sports requiring practice

Physical Changes (5 of 11)

  • Older adults who exercise can:
  • Reduce pain caused by arthritis
  • Restore balance to reduce fall potential
  • Strengthen bones
  • Maintain ideal weight
  • Improve glucose control for diabetes management
  • Improve heart health

Physical Changes (6 of 11)

  • Encouraging physical activity is almost always appropriate, although:
  • The level of exertion and duration of activity need to be determined by the primary healthcare provider(s)
  • Goals related to physical fitness need to be clearly discussed with the older client

Physical Changes (7 of 11)

  • Endurance
  • Ability to sustain involvement in a physical activity
  • Lack of physical reserve and ability to resist stressors can lead to frailty
  • As muscle power decreases, frailty level increases

Physical Changes (8 of 11)

  • Combination of endurance and strength training has been found to:
  • Have a positive impact on heart and pulmonary function
  • Improve muscle function
  • Increase functional capacity
  • Improve cognition

Physical Changes (9 of 11)

  • Physical exercise
  • Long-term aerobic exercise training programs for older adults are associated with improved physical endurance
  • Can improve:
  • Range of motion
  • Strength
  • Endurance
  • May slow the course of physiologic aging

Physical Changes (10 of 11)

  • Praxis
  • Ability to carry out purposeful motor actions
  • Dyspraxia
  • Decreased ability to plan and/or execute purposeful movements
  • Apraxia
  • Complete inability to carry out motor plans

Physical Changes (11 of 11)

  • Frequent repetition of routine goal-directed activities throughout the day enables the conversion of once novel actions into established habits and routines
  • When there is a decline in function, an overarching rehabilitation goal is often to:
  • Help people regain lost skills
  • Learn to work with their remaining abilities

Physical Performance (1 of 5)

  • Age-related performance can be measured in several domains:
  • Reaction time
  • Gross motor coordination
  • Strength
  • Endurance
  • Work-related performance

Physical Performance (2 of 5)

  • Reaction time
  • Older people are not able to react as quickly as they were able to in their younger years
  • Particularly important in regard to driving
  • Other factors relevant to driver safety:
  • Physical strength
  • Mobility
  • Cognition
  • Perception

Physical Performance (3 of 5)

  • Motor coordination
  • Falls affect the older population more than any other age group
  • Falling once increases the risk of falling again
  • Repeated falls are often associated with declines in balance, coordination, and/or strength
  • Impaired ambulation may be cause for a referral to a physical therapist

Physical Performance (4 of 5)

  • Fine motor coordination
  • Hand-based skills such as writing, self-feeding, buttoning, and working with tools
  • Often impaired in old age due to arthritis, stroke, or other skill-robbing disease
  • Older adults aging typically without limitations from disease are just as capable as their younger counterparts in completing fine motor tasks

Physical Performance (5 of 5)

  • Important to address significant decreases in level of functioning occurring either suddenly or over the course of a few weeks or months
  • Abrupt behavioral changes may warrant a call and visit to the primary care provider

Work Performance (1 of 3)

  • General work performance of older adults is not inferior to that of younger counterparts
  • Older adults are:
  • Considered more dependable
  • Less likely to be absent from work
  • Less frequently injured in the workplace
  • Less likely to demonstrate workplace aggression and substance abuse

Work Performance (2 of 3)

  • Changes in cognition, sensation, perception, and physical performance do not make a substantial impact on older adults’ comprehensive work performance or essential daily living skills
  • Most older adults can do very well in the workplace with minimal modifications

Work Performance (3 of 3)

  • Healthcare professionals need to help older workers remain on the job, even after the onset of disabilities
  • Can support older workers to return to, or remain at, work by encouraging accommodations and partial absences instead of permanent withdrawal from the workplace

Sleep (1 of 17)

  • Essential part of everyday life
  • Plays a central role in promoting good health and a high quality of life
  • Changes in sleep patterns can occur with age due to difficulty falling and staying asleep
  • Lack of sleep contributes to how one feels and acts during the day

Sleep (2 of 17)

  • Normal sleep
  • Circadian rhythm
  • Sleep-wake cycle
  • Light stimulates wakefulness
  • Melatonin is released with the fall of darkness
  • Many fall asleep between 9 and 11 at night
  • States of sleep include non-rapid eye movement (NREM) and rapid eye movement (REM)

Sleep (3 of 17)

  • Non-rapid eye movement (NREM)
  • N1—link between consciousness and unconsciousness; some awareness of surroundings
  • N2—loss of consciousness; light sleep
  • N3—deep sleep

Sleep (4 of 17)

  • Rapid eye movement (REM)
  • Sleep in which we dream
  • Brain is more active than when awake
  • Experience muscle atonia and loss of a degree of autonomic control
  • Sleep cycle consists of four to five periods of non-REM and REM sleep
  • Each lasts about 90 minutes

Sleep (5 of 17)

  • Impact of sleep on older adults
  • Adults need about 8 hours per day
  • Getting enough refreshing sleep may become more difficult with age
  • More time spent in lighter sleep stages
  • Many medications interfere with sleep
  • Depression, menopause, frequent urination, heart disease, and stress also lead to insomnia

Sleep (6 of 17)

  • Circadian rhythms change as people age
  • Melatonin released earlier in the evening
  • Leads to earlier sleep and wake-up times
  • Easiest way to delay the hour of sleep is exposure to bright light later in the day

Sleep (7 of 17)

  • Sleep disorders
  • Sleep-onset insomnia
  • Waking up often during the night
  • Waking up too early and not being able to get back to sleep
  • Waking up not feeling refreshed
  • Snoring (may be related to sleep apnea)
  • Unpleasant feelings in the legs

Sleep (8 of 17)

  • Insomnia
  • Most common symptom of more than 30 different sleep disorders
  • Acute insomnia lasts fewer than 30 days
  • Chronic insomnia lasts longer than a month
  • Onset may begin with an emotional event
  • New cycle becomes the norm
  • Can be difficult to resume the previous sleep routine

Sleep (9 of 17)

  • Sleeping pills
  • May be a good short-term solution
  • Other techniques preferable in the long run:
  • Sleep restriction
  • Stimulus control
  • Sleep hygiene
  • Cognitive behavioral therapy
  • Underlying health issues should be addressed

Sleep (10 of 17)

  • Obstructive sleep apnea (OSA)
  • Signs and symptoms:
  • Snoring
  • Witnessed apnea during sleep
  • Complaints of excessive sleepiness during the day
  • Caused by total or partial tracheal obstruction
  • Disruption of sleep pattern can occur up to 60 times per hour

Sleep (11 of 17)

  • Health conditions attributed to the presence of OSA:
  • High blood pressure
  • Heart disease
  • Stroke
  • Diabetes
  • Poor brain oxygenation

Sleep (12 of 17)

  • Addressing OSA
  • Repositioning to side-lying may help
  • Back-lying seems to exacerbate the problem
  • Leading therapy is the use of a CPAP device
  • Often prescribed after a sleep study is completed by a sleep specialist

Sleep (13 of 17)

  • Aspects evaluated during a sleep study:
  • Sleep state
  • Eye movement
  • Muscle activity
  • Heart rate
  • Respiratory effort
  • Airflow
  • Blood oxygen levels

Sleep (14 of 17)

  • Restless leg syndrome (RLS)/periodic leg movements of sleep (PLMS)
  • RLS is a neurologic disorder including:
  • Unpleasant sensations in the legs
  • Irresistible urge to move the legs while in bed
  • Symptoms of RLS lead to PLMS
  • May occur every 10 to 60 seconds
  • May last the entire night

Sleep (15 of 17)

  • Medications that have been able to offer some relief to PLMS sufferers:
  • Parkinsonian-type medications
  • Anticonvulsants
  • Benzodiazepines
  • Narcotics

Sleep (16 of 17)

  • Other strategies for addressing PLMS:
  • Avoid stimulants
  • Exercise
  • Leg massages
  • Warm packs
  • Leg compression devices

Sleep (17 of 17)

  • Treatment of sleep disorders
  • Effective strategies:
  • Sleep restriction
  • Stimulus control
  • Sleep hygiene
  • CBT
  • Relaxation techniques