55 and Older

Although we like to think of 60 as the new 40 and 40 as the new 20, the reality is that time marches on – especially regarding physiology. With common issues such as extended healing timeframes, susceptibility to secondary infections and mobility problems, motor vehicle accident (MVA) clients who are 55 and older benefit from a specialized approach to rehabilitation. Treating them as if they are from a younger population group does not address their unique needs and, as a result, decreases effectiveness.  

Age increase = unique medical history issues

There is just no avoiding it: With longevity comes history. Consequently, although medical history is important for all clients, it is especially relevant regarding those 55 and older. Common medical histories for those 55 and older include:

• Previous hip or knee pathology/dislocation (affecting prior mobility and conditioning)
• Degenerative changes in lumbar and cervical spine (causing pain in the neck, shoulders and lower back)
• Diabetes mellitus (a contributing factor to numbness and tingling)
• Decreased healing properties of tissue due to previous pathology or systemic disease
• Depression (anti-depressants may cause motor dysfunction, visual impairment, and cognitive and attention decline)

Age increases = unique physiological issues

Younger population groups are not yet affected by a range of physiological changes and barriers that are common for those 55 and older. As we age, common physiological changes include:

• Decreased skin sensation, larger adhesions and tissue shortening due to diminished extensibility of muscles
• Susceptibility to secondary infections
• Extended healing timeframes
• Memory issues. A 2001 Statistics Canada survey notes, “Activity limitations related to memory problems are often associated with aging. Among adults aged 65 and over, 153,000 persons reported being limited by memory problems or periods of confusion, representing 4.3 per cent of Canadian seniors.”¹

A consequence of the unique medical history and physiology of the 55 and older population is that they have a range of specialized needs. In addition, this age group often has a range of unique lifestyle issues that also translate into a variety of distinct needs. 

Age increases = unique lifestyle issues

Increasingly the 55 and older population aims to live independently as long as possible. This goal is becoming a reality for many, making access to community support networks more important than ever.

In addition, a focus on support is also important. Although people are working longer and living independently longer, as people age there is still a trend toward social isolation. This is due to a range of factors like mobility, geography, and longevity of family and peers. “While seniors generally have good social support networks, compared to other Canadians, they are more likely to be socially isolated: 8% of seniors reported having no close relatives; 14% having no close friends; and 13% having no “other” friends,” according to Seniors in Canada 2006 Report Card.²

Trends also reveal that many people are now working into their seventies often in work arrangements that include contract and part-time work assignments.

As a result, vocational planning may also be a requirement of the rehabilitation plan. However, any vocational planning must address this population’s unique issues. Standard return-to-work programs and functional abilities evaluations must carefully monitor any pre-existing limitations and modifications that were present prior to the motor vehicle accident.

Tailoring rehabilitation to meet specialized needs

To help guide file management, there are a number of questions to consider when working with a client who is 55 and older. If any of the following issues are present, consider an approach specialized for this age group.

Medical history and physiology:

Does the 55 and older client:

• have extensive pre-MVA medical history? Before initiating treatment, it is especially relevant to address medical history for those 55 and older.
• Show signs of pre-MVA de-conditioning? According to a Health Canada report, “More than four out of five seniors living at home suffer from a chronic health condition, this proportion being slightly higher among senior women than senior men. The most common chronic health problems reported by seniors are arthritis and rheumatism, followed by high blood pressure, allergies, back problems, chronic heart problems,” making assessment of prior de-conditioning critical as it may negatively impact recovery.³
• Have pre-existing mobility issues? According to a Statistics Canada 2001 survey, 23.3 per cent of adults aged 65 to 74 reported mobility problems with the rate climbing to 42.9 per cent for those 75 and older, making comprehensive assessment of pre-accident mobility status critical.⁴
• Suffer from complex or multiple injuries? Expertise of professionals experienced with this population to ensure the use of assessment tools especially relevant for this population.

Lifestyle:

Does the 55 and older client:

• Require assistance with re-integration to home and community through discharge planning and other support services? Longer healing timeframes and range of pre-existing conditions makes early intervention critical.
• Have responsibilities as a primary caregiver? The client could be the primary caregiver for a partner aged 55 and older. Or perhaps has the dual responsibility of caring for elderly parents as well as children, making the need to assess additional assistance requirements increasingly important.
• Live in a remote geographic location? Early intervention is especially critical for this age group. However, remote locations often don’t have immediate access to the range of healthcare professionals that may be required.
• Lack medical, family, and/or community support? Trend toward living independently as long as possible makes the assessment of community, social and medical support increasingly relevant for this age group.
• Show signs of psychosocial changes since the MVA? Addressing psychosocial functioning pre- and post-MVA, and relating the information to an overall rehabilitation plan facilitates timely recovery.
• Needs vocational issues assessed? Vocational assessment may be required since the largest percentage of today’s workforce is 45 years or older.
• Resides in a convalescent or adult living environment? Issues like transportation and disruption of regular routine may need to be taken into consideration.

Specialize the approach

A range of unique issues related to everything from medical history to physiology to lifestyle, makes early intervention especially critical for the 55 and older population. Recognizing that this population has special needs – and matching these needs with a rehabilitation approach that is tailored to these needs – is the best way to make sure that your 55 and older clients receive intervention as early as possible. This will consequently mean the client will receive the best start toward maximum recovery.

Judi Farrimond is the supervisor of complex and catastrophic services and Angela Veri is the national director of customer relations at Sibley & Associates LP.

1. A Profile of Disability in Canada, Stats Canada, 2001
2. Seniors in Canada 2006 Report Card, National Advisory Council on Aging, Government of Canada, 2006
3. Canada’s Aging Population, A report prepared by Health Canada in collaboration with the Interdepartmental Committee
on Aging and Seniors Issues, 2002
4. A Profile of Disability in Canada, Stats Canada, 2001