Most older adults live in and own their homes. Physical or economic problems may force some to relocate to a retirement center or an assisted-living facility. Family members and facility staff need to be aware that older adults need personal space in their new surroundings. They need to participate in deciding how the space will be arranged and what they can keep in their new home to help offset the feelings of powerlessness. Suggest that the client or family bring in personal items, such as pictures or relatives and friends, favorite clothing, and valued knickknacks to assist in making the new setting seem more familiar and comfortable.
This same intervention can be carried out in a hospital setting. Changes in vision, touch, and motor ability can create difficulties for older adults in any environment. For example, decreased vision in old age, especially the poor perception of distance, may make walking more difficult; the person is less aware of the location of each step. A reduced sense of touch decreases the awareness of body orientation ( e. g., whether the foot is squarely on the step ). The decreased reaction time that commonly results from age-related changes in the neurologic system may also impair the ability to recognize or move from a dangerous setting.
MENTAL HEALTH AND BEHAVIOR. Most older adults are mentally sound and competent. A few changes in cognition have been identified as age related and are linked to specific cognitive function rather than intellectual capacity. These changes include a decreased reaction time to stimuli and an impairment of memory for recent events. However, gross cognitive impairment, depression, hallucinations, and delusions are not part of the normal aging process. Two forms of competence exist: legal competence and clinical competence. A person is legally competent if he/she is:
18 years of age and older Pregnant or a married minor A legally emancipated ( free ) minor who is self-supporting Not declared incompetent by a court law If a court determines that a person is not legally competent, a guardian is appointed to make financial and health care decisions. A person is clinically competent is he or she is legally competent and has decisional capacity. Decisional capacity is determined by an individual’s ability to identify problems, recognized options, make decisions, and to provide the rationale supporting the decisions.
It is not surprising that mental illness does occur among the older population. Losses in income and physical health, a lack of comprehensive health care and social services, a loss of social roles, and the death of significant others may affect a person’s emotional stability. Older adults are often unaware of early symptoms of emotional or mental impairments. Their symptoms may go unnoticed by family and friends and thus progress until crisis results. The three most common cognitive problems among older adults are depression, dementia and delirium.