Changes in the Elderly: Pain, Temperature and Hunger
As we
consider sensory changes that occur throughout the aging process, it is
important to remember the subtle differences that will manifest and how they
might affect a patient's participation in therapy and daily activities, as well
as his or her quality of life. My colleagues and I often notice that while we are usually
warm, often uncomfortably so, in the treatment gym most of our residents
are asking for the heat to be turned up or to have another sweater. In the
summer, we want to turn up the A/C to full power while they want to sit in the
sunlight.
It has
been well documented that aging brings changes in touch, vibration and pain. It
can be difficult to determine which changes are due simply to the aging process
or to a disorder common amongst the geriatric population. Medications and
surgeries can interfere with sensation, as can nerve damage and the effects of
disease processes. A person might notice that water is hot, or that he is
experiencing pain, but may not rate the pain to be as intense. This places
elderly people at increased risk for burns, hypothermia, accidents or injuries,
and even weight loss or dehydration if they fail to recognize hunger pains or
thirst.
Weight, metabolism,
dress, and how a person was used to regulating temperature will all affect how
an individual interprets sensations of hot and cold. Family members may become
bewildered and worried when they notice grandma wearing several layers of
clothing, hats or gloves in the house, or even pulling blankets over her head.
On the opposite end, some patients will remove clothes, either because they are
too warm, or perhaps because their clothing now feels irritating. Patients may be
at an increased risk for pressure ulcers if they don't fully register the
discomfort of remaining in one spot for long periods of time, or fail to feel
the onset of skin breakdown. It's important to conduct frequent skin checks in
order to look for irritation, breakdown and bruising.
As speech therapists,
we need to develop strategies and intervention based on the individual
patient's strengths and needs. While some patients may constantly voice their hunger
or a drop in their core temperature, others will sit quietly for hours,
seemingly content and wanting for nothing. But this person may be ignoring - or
unable to identify - the pain from a shoe rubbing on a blister or the feeling of
thirst. A good functional maintenance plan and treatment plan of care should
cover the protocol for addressing these needs, including how the staff should
communicate and interact with the patient to avoid potential problems relating
to the reduced sensation of temperature, pain, pressure, touch, hunger and
thirst.
In
next week's post, I will highlight specific interventions and compensatory
strategies related to the sensory changes mentioned in this post.