We all recognize that the demographic is becoming older, yet did you realize that nearly half of all adults aged 65 and up in the U.S. live with some form of disability? The Americans with Disabilities Act (ADA) defines a disability as any “physical or mental impairment that restricts one or more major life activities” or a history of such impairment.
Consequently, disabilities encompass: physical restrictions like mobility challenges, pain, and fatigue; sensory difficulties such as hearing loss or deafness, or low vision or blindness; chronic health issues (including cancer or diabetes); cognitive or intellectual challenges (like dementia, or a prior brain injury or stroke); and mental health disorders, such as depression, PTSD, or anxiety disorders.
Given this extensive definition, I find it surprising that the rate of elderly adults with disabilities isn’t even higher.
The ADA, naturally, prohibits discrimination against individuals with disabilities. Nevertheless, I suspect that much of our healthcare workforce is ill-equipped to address the needs of older adults with disabilities. This primarily stems from insufficient training and experience with this diverse group, along with a lack of awareness of their challenges. Regrettably, this unpreparedness poses considerable obstacles for these patients in obtaining quality healthcare.
Concerns include not only the physical accessibility of spaces but also the necessity for assistive devices and adjustments or modifications to the evaluation or treatment sessions. While “compliant” office furnishings and restrooms are generally met, numerous other factors must be considered.
– Does your workspace provide a portable amplifier and magnifier for patients with hearing or vision impairments?
– Is the examination room adequately quiet?
– Is the lighting sufficient?
– Can appointments be scheduled at the patient’s preferred time of day?
– Is there a need to involve a family member, with the patient’s approval, if the patient has cognitive difficulties?
– Are educational materials or some form of reminders necessary?
– Should you provide the patient with additional time to complete tasks or respond to questions?
– Is there a need to consult with or refer the patient to speech therapy or occupational therapy or physical therapy for strategies or equipment?
– In a mental health session, should you suggest that the patient take notes, something you may not typically do?
– Are transport services or prescription deliveries needed to be organized?
These are merely some examples of recommended practices essential for more equal and accessible services.
Beyond accessibility, accommodating the disabilities of our patients also helps to ensure their autonomy is not unduly restricted. I instruct my students that, when evaluating a patient’s cognitive abilities or decision-making capacity, we must first enhance their functional capabilities. This may involve ruling out reversible factors of dementia or delirium (such as a UTI). It also includes providing aids such as confirming the patient has their glasses or hearing aids with batteries, or offering enlarged written materials or a sound amplifier. Verifying that the patient isn’t suffering from acute pain, hunger, or sleep deprivation is also crucial. Sometimes, rest periods or extra time is necessary, or an assessment needs to be delayed until their depression is managed or blood sugar levels are stabilized.
In essence, it is imperative that information is conveyed clearly, but also that it is actually comprehended and processed, ensuring that the patient understands before any examination can be conducted. This way, capacity can be first restored or optimized, and then assessed (or reassessed) to avoid inaccurate results.
Years ago, my grandfather was hospitalized in the telemetry unit. He had significant hearing loss and typically used hearing aids. One day I visited him during my break while my aunt was out obtaining new batteries for his hearing aids. Until her return, we had to communicate by writing notes back and forth.
During this time, a resident entered, greeted my grandfather, and explained the procedure he would undergo the following day. My grandfather nodded, she departed, and I wrote him a note inquiring, “Why did you just nod and say ‘OK’ when you couldn’t hear anything she said?” He replied that he was trying to be courteous. I quickly followed the resident to inform her that he could not hear her at all. She was astonished. She assured me she would return after my aunt came back to review everything again, but I couldn’t help but reflect on patients who may not have an advocate with them. What if he were evaluated alone and deemed cognitively impaired, when in reality, he simply had profound hearing loss?
In conclusion, the population of older adults with disabilities is set to increase, and clinicians, no matter their specialty, will need to offer services that cater to the needs of patients with these diverse identities and their associated lived experiences. This is a subject that is seldom addressed; articles exist on older adults and aging, and some on disability, but very few delve into the intersection and interrelation of these conditions.
Thus, there is