Mobility and Sensory Disabilities

Original Air Date: May 29, 1998; Repeated June 28.

Arthritis

What is arthritis?

  • "Arthritis" means inflammation of the joints. It results in pain and loss of mobility, strength and function. There are about 100 types, but the common ones in seniors are:
    • osteoarthritis: caused by degeneration of the cartilage (wear and tear); it's local to the joints; diagnosed through examination or x-ray. Will not show up on blood test.
    • rheumatoid arthritis: a systemic inflammatory disease. Can be diagnosed via blood test.
  • It's not just a disease of the elderly. It can strike at any age.

How common is arthritis?

  • 3-4 million Canadians are affected by arthritis; 600,000 are disabled.
  • osteoarthritis: caused by degeneration of the cartilage (wear and tear); it's local to the joints; diagnosed through examination or x-ray. Will not show up on blood test.
  • 1 in 10 has osteoarthritis; 1 in 100 has rheumatoid arthritis.
  • It's not just a disease of the elderly. It can strike at any age.
  • More common in women.

Can you do anything to prevent it?

  • We don't know what causes arthritis, so there isn't really advice on how to prevent it.

How is it treated?

  • Once you've been diagnosed, treatment is focused on managing/minimizing the impact of the symptoms, and teaching people how to manage pain at home.
  • Acetaminophen/Tylenol is often used to treat the pain of arthritis. If the pain and inflammation are really bad, a doctor may prescribe anti-inflammatories.
  • A lot of treatment involves applying heat or ice on affected joints.
  • If the joint is hot and swollen, an ice pack (or a bag of frozen peas) is applied.
  • When joints are damaged and aching, moist heat is applied.
  • Education is an important part of treatment, as well. Arthritis sufferers need to be educated re joint protection and energy conservation.

How important is exercise?

  • Exercise is a "natural remedy" for arthritis.
  • Thirty minutes a day (it can be cumulative) is enough.
  • Gentle exercise and activity are very important to stretch joints and maximize mobility.
  • Depending on the person's balance and coordination, good exercises include walking, treadmill, exercise bike, exercises with low weights (or just against the pull of gravity) with a lot of repetition, "chair" exercise classes, aquatic exercise (very good if the water is warmat least 84F).
  • If a person is housebound, even getting up and walking around the house for 5 or 10 minutes is better than nothing.
  • If motivation is a problem, arrange to do things with other people.

What are the psychological ramifications for people?

  • Social isolation, and loss of confidence and self-esteem, can lead to depression.
  • When first diagnosed, some people go through a grieving process: their body is no longer the body it once was. They go through a roller coaster of anger and denial.
  • This grieving process is normal, but if they're "stuck," she'll recommend they seek help.
  • Support groups are a great help, as they make people realize they're not alone.

What can caregivers do to help?

  • Be understanding and give encouragement.
  • Be patient and sensitive to their pain. Realize that the person perhaps can't move as quickly or do as much as before. Don't have unrealistic expectations.
  • Find solutions (i.e. assistive devices) to support their independence; let them do what they are still able to do.
  • Motivate them to be active (and join in yourself).

Hearing Impairment

Will everyone's hearing deteriorate with age?

  • It's estimated that 60-65% of people over 60 will have some degree of loss. That increases to 90% of those over 80.
  • It's difficult to get accurate statistics, because many seniors with hearing loss will deny it.

What are the most common causes of diminished hearing in seniors?

  • Deterioration of the little hairs in the inner ear. They wear down over time, or are damaged by accumulated exposure to loud noise. As a result, impulses are not transmitted as effectively, and hearing declines.
  • Secondly, as we age, there are changes in the way the brain processes sound. Our ears may actually "hear" the same, but the message doesn't get through as well.
  • Drugs (particularly arthritis and cancer medications).
  • Head trauma.
  • Heredity.

What are the psychological ramifications for people?

  • Because most hearing loss is a slow process, it's often not a psychological "crisis" for people. Instead, they may gradually withdraw from activities, becoming isolated. For example, someone who has always enjoyed playing bridge finds he/she is having trouble hearing bids. If it turns into too much of a struggle or becomes embarrassingor if others lose patience with themthe person may just quit.
  • Some people who lose their hearing may become paranoid, feeling people are talking about them or keeping things from them.
  • In couple/family situations where one person loses hearing, it can cause problems if the non-hearing-impaired individual(s) feel(s) the other just isn't listening or is choosing not to respond.
  • "Bluffing behaviors" (where the hearing-impaired person pretends to understand what others are saying) can cause problems, especially if they miss instructions for medication or some other such important information. (Misunderstood questions, and resulting inappropriate answers, can lead to some seniors with hearing loss being inaccurately diagnosed with dementia.)
  • Some seniors put themselves in danger. Afraid they'll miss important things like home care or Meals-on-Wheels if they don't hear a doorbell or knock, they'll leave the door open, making them vulnerable to intruders.

What can caregivers do to help?

  • Be patient. It will take longer to communicate effectively with a hearing-impaired person.
  • Ask, "What can I do to help you communicate?"
  • Before speaking to a hearing-impaired person, get their attention by tapping their hand, saying their name, making sure you're facing them. Speak slowly and clearly. Turn off background noise like TV or radio. Don't talk with a hand or paper in front of your mouth.
  • If appropriate, use facial expressions or gestures to make a point clearer.
  • When you're changing the topic in a conversation, announce to the person that you're about to do so.
  • If you're not sure a hearing-impaired person understands or has heard you, ask. Have them repeat what you've said back to you.
  • If the person is having trouble hearing you, rephrase rather than repeat.
  • If the information is really important (i.e. medical instructions), write it down so there's no room for misunderstanding.

What should caregivers not do?

  • Don't overload the person. Make visits short. It can be fatiguing for a hearing-impaired person to spend a long time in conversation.
  • Don't have unreasonable expectations. A hearing aid or other device won't cure everything.

Sight Impairment

Will everyone's sight deteriorate with age?

  • Up to 95% of us will experience some changes in the ocular lens by the time we're 65. As a result, less light enters the eye, and we develop problems with glare and color perception.
  • Overall, though, most of us retain relatively good vision as we age.

What are the most common causes of diminished sight in seniors?

  • macular degeneration: By far the most common cause of visual disability in the elderly. The central area of the retinathe maculadegenerates, and a "blind" spot develops in the central vision, making reading and recognizing faces very difficult. Peripheral vision remains unaffected. The cause of macular degeneration isn't really known.
  • glaucoma: Second most common cause. Defects in the eye's drainage system result in a buildup of fluid, causing increased pressure in the eye. It results in limited side vision or "tunnel" vision, as well as problems with low light ("night blindness"). Glaucoma is treated with medication or eye drops.
  • cataracts: Clouding of the lens of the eye, resulting in blurred or dim vision. In advanced cases, the lens is removed and replaced in a fairly routine operation.
  • diabetic retinopathy: A complication of diabetes in which blood vessels in the retina weaken and hemorrhage. Affecting only a small percentage of diabetics, the condition may change from day to day, with sight fading and sharpening unpredictably. Can be controlled by laser treatment.

What are the psychological ramifications for people?

  • The more sudden the onset of the disability, the more likely the person will have trouble coping.
  • The big thing is the loss of independence. Having to give up driving, or depending on someone else to read things to you can be very devastating.
  • It really depends on the individual. If the person has led a very active lifestyle all along, he/she may be more devastated by the onset of a disability and may suffer shock, disbelief and depression. Other people just "roll with it."
  • When they develop a vision impairment, some people isolate themselves, losing confidence in their ability to get around.

What can caregivers do to help?

  • If you suspect the person is having a problem, encourage him/her to get help as soon as possible.
  • Support groups can be tremendously helpful.
  • Be patient and non-judgmental. It may take the person longer to do something, but let them do it. Don't rush them or grab things from them.
  • Little things can be extremely helpful:
    • use brighter lighting around the home;
    • when writing notes or labeling items, large printing using a thick black marker
    • helps;
    • don't leave doors half open where the person could walk into them;
    • say hello as soon as you encounter the person; many can't recognize faces
    • immediately;
    • if you're serving a meal, tell the person how the food is laid out on the
    • plate: "The meat is at 6 o'clock; vegetables are at 3 o'clock."

What should caregivers not do?

  • The more sudden the onset of the disability, the more likely the person will have trouble coping.
  • Don't assume what the person needsask what will be helpful. Allow the person to express their concerns in their own way.
  • Don't be overprotective. Many people with visual disabilities are still quite self-sufficient. Allow them to use what vision they still have.
  • Avoid using visual cues like "over there" to convey information.
  • Don't move furniture or things out of place, even if you think you're tidying up for them. You could cause confusion or, even worse, an injury.

Top of page