Aging with a Disability©
Many individuals have a disability present from birth and others have a disability that is acquired during childhood or adulthood. Many of these individuals have a normal life span and live into older adulthood. One consequence of having a disability is a smaller margin of health or safety when it comes to health issues. As a result, it is important to anticipate the effect of aging on a person’s disability and the effect, in turn, of a person’s disability on the aging process. The interaction of aging and disability is an issue that nurses and other health care professionals need to consider in providing care to individuals with disabilities. Many individuals with a disability experience changes related to aging earlier in life than individuals without a disability.
Physical Consequences of Aging in People with Disabilities
Aging in any individual often results in decreased sensation and balance, thinning of the skin, decreased muscle strength, flexibility and endurance, loss of bone density, decreased lung volume, and increased incidence of urinary and bowel problems. It is important for all health care providers to realize that people with disabilities: 1) are at risk for and experience the same health issues that people without disabilities experience with aging (e.g., heart disease, arthritis, osteoporosis as well as normal physiologic changes associated with aging), 2) need the same age-appropriate periodic preventive health screening that is indicated for anyone, and 3) may be at risk for secondary conditions related to having a disability or due to their specific disability, and those secondary conditions may lead to other health issues.
Although aging typically does not cause major medical and functional problems until after age 70-75, people with disabilities may experience problems associated with aging at a much younger age. This is due in part to the number of secondary conditions that may occur because they have a disability. Secondary health conditions, which are conditions related to the presence of a disability, increase the patient’s risk for skin breakdown, respiratory compromise, renal failure, bowel and bladder problems, injuries due to falls, infections, and depression. An important role of the nurse caring for a patient with a disability is prevention of preventable secondary conditions, such as pressure ulcers. The nurse and other members of the health care team need to be aware of the existence of secondary conditions a patient has and assess for and manage secondary conditions to prevent them from compromising the patient’s health status. It is also important for an individual as well as health care providers to avoid attributing all symptoms (such as increasing fatigue) to a patient’s disability or the aging process without evaluating those symptoms.
Because of the effect of weight gain on mobility, it is important for all individuals with disabilities, especially those whose disability affects their mobility, to maintain a normal weight. Transferring with or without assistance from others will likely become more difficult if an individual with a disability becomes overweight. Physical activity and exercise are important to avoid overweight and obesity, to maintain muscle strength and muscle tone, to preserve range of motion of the joints, and to reduce bone loss. When possible, exercises should be weight-bearing in order to slow bone loss, which can result in osteopenia, osteoporosis and fractures. Exercise can also improve mood and sleep and increase one’s ability to take care of daily activities. Further, exercise can reduce the risk of falls. Because an exercise program may need to be tailored to the patient’s ability and mobility limitations, consultation with other health care providers, including physical or occupational therapists, can help to ensure that an appropriate exercise plan is developed and that assistive devices are appropriate and safe for the patient.
People with certain types of disabilities (e.g., spinal cord injury, spina bifida, cerebral palsy, post-polio syndrome and others) often use manual wheelchairs or scooters, crutches, canes, or walkers to enable them to move from place to place. If an individual has used such devices for years to move around, overuse of the upper extremities and shoulders may result in overuse, rotator cuff injuries, joint stress, muscle pain or arthritis.
Psychological Consequences of Aging in People with a Disabilities
In addition to the physical changes associated with aging and aging with a disability, individuals with disability often fear becoming more dependent on others as they age and fear the loss of the independence that they have had. Additionally, they may experience changes in their roles in society and their support systems may change. These changes may produce psychological changes and concerns about their well-being and future. It is important to note that depression should not be considered a “normal” consequence of disability or of aging.
Resources for Nursing Providing Care Related to Aging in People with Disabilities
The National League for Nursing’s Advancing Care Excellence for Seniors (ACE.S) is an excellence resource for issues of aging that are shared by many people with or without an existing disability. The following table includes examples of physical changes that are specific to individuals with disabilities and discusses age-related changes that may occur in patients with selected disabilities along with actions that are indicated.
Examples of Selected Physical Changes in Disability with Aging
and Nursing Actions/Assessments Indicated
Decrease in muscle mass and strength; thinning of skin
Assess patient’s skin at site of amputation; consult with health care team members to assess fit of prosthesis to ensure stability and lack of abrasion or skin breakdown; assess for risk of falls; monitor for safe use of assistive devices
Recurrence of symptoms experienced with initial acute attack of polio as children: increased muscle weakness and fatigue
Consult with health care team about symptoms and their management, the need for use of assistive devices or change from a cane or walker to wheelchair or scooter; assess for risk of falls; monitor for safe use of assistive devices
Spinal cord injury
Overuse of arms and shoulders if manual wheelchair user; thinning of skin; changes in bowel and bladder function
Consult with physical or occupational therapist to identify strategies to reduce overuse; assess and initiate changes to reduce risk of pressure ulcers; assess effectiveness of bowel and bladder programs; assess for risk of falls; monitor for safe use of assistive devices
Overuse of arms and shoulders due to use of crutches or manual wheelchair
Consult with physical or occupational therapist to identify strategies to reduce overuse; assess fit of splints; assess for risk of falls; monitor for safe use of assistive devices
Increasing symptoms: spasticity, loss of strength and decreased mobility, fatigue, pain, risk of falling, difficulty eating and swallowing
Consult with physical and occupational therapist for assessment of needed changes in assistive devices or splints, pain management, physical therapy for exercise program; assess for risk of falls; monitor for safe use of assistive devices
Selected References and Resources:
1) University of Washington. (n.d.) Provider’s Guide to Using Aging Well with A Physical Disability Factsheets. Retrieved from: http://agerrtc.washington.edu/info/factsheets
2) Sheets, D. (2010). Aging with Physical Disability. In: JH Stone, M Blouin, editors. International Encyclopedia of Rehabilitation. Available online: http://cirrie.buffalo.edu/encyclopedia/en/article/288/
3) United Cerebral Palsy Foundation. (2015). Cerebral Palsy: https://ucp.org/resource-guide/health-and-wellness/
4) National Institute of Neurologic Disorders and Stroke (2015). Post-polio syndrome. Retrieved from: https://www.ninds.nih.gov/Disorders/All-Disorders/Post-Polio-Syndrome-Information-Page
5) Web MD (2016). Spinal cord injury: Retrieved from: http://emedicine.medscape.com/article/322713-overview#a2
6) Advancing Care Excellence for Seniors (ACE.S) http://www.nln.org/professional-development-programs/teaching-resources/ace-s
Copyright: Suzanne C. Smeltzer, Bette Mariani & Colleen Meakim of Villanova University College of Nursing June 24, 2016
Users are asked to cite the source for this Villanova University developed resource as developed by the Villanova University College of Nursing and retrieved on the NLN website.