Chapter 10- Life Span- Older Adults

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What Are the Main Points in This Chapter?

The number of older adults (age 65 and older) has risen significantly because of increasing life expectancy. Older adulthood is a time of transition. Most health problems experienced by older adults are chronic in nature and often affect the person’s ability to live independently. Most older adults live independently. Aging can be examined from a life expectancy, percentage of total population, or life-span perspective. Aging in place means that as they age, persons live in their own elder-friendly residences and receive supportive services for their changing needs, rather than moving to another location or alternative type of housing. Retirement communities are planned and built specifically to provide elder-friendly dwellings and environments for independent living and allow older adults to "downsize" their dwelling. Continuing care retirement communities (CCRC) offer a wide range of living accommodations, including residential living, assisted living, skilled nursing care, rehabilitation, and dementia care on a large campus-like setting. Assisted-living facilities (ALFs) are congregate residential settings that provide or coordinate personal services, 24-hour supervision and assistance, activities, and health-related services. Nursing care facilities, or nursing homes, provide skilled and unskilled nursing care for older adults and adults with disabilities. The stages of older adulthood are typically referred to as the young-old (age 65 to 74), middle-old (age 75 to 84), and oldest-old (age 85+). The fastest growing segment of older adults is the oldest-old, some of whom are the frail elderly and centenarians (people over 100 years old). Older adults learn new material more slowly. However, there is no loss of intelligence as a person ages. Disengagement theory and activity theory attempt to explain the psychosocial development of older adults. Dementia, a loss of cognitive ability, is not a normal result of aging. It is important to differentiate dementia from depression, acute confusion, or delirium that may be precipitated by dehydration, infection, or a medication side effect or overdose. Developmental differences result in each age group’s having specific health problems requiring specific assessment techniques. Data from these assessments are used to plan and provide care and anticipatory guidance that are developmentally appropriate. Older adults should have an annual physical examination, including a focused assessment of functional status. Frailty is a set of characteristics that describe a heightened state of vulnerability for developing adverse health outcomes. Abuse of adults is common. Assess all patients for signs of abuse. Suspicion of elder abuse must be reported to adult protection services and/or the authority designated by law in each state.

Which of the following age groups is one of the fastest growing segments of the American population?
(a) babies and children under age 5
(b) children aged 15 to 19
(c) people over age 85

Answer: (c) people over age 85 Rationale: The fastest growing age group in the United States is the population aged 85 and older.

You can be too old to exercise.

Answer: False Rationale: Exercise can be simple, involving basic movements appropriate to level of fitness, age, and health status. The body does change with age; however, at any age, exercise strengthens the heart and lungs, lowers blood pressure, improves muscle strength, lessens bone loss, and improves mental and emotional health.

Diet and exercise reduce the risk for osteoporosis.

Answer: True Rationale: Women are at particular risk for osteoporosis. They can help prevent bone loss by eating foods rich in calcium and exercising regularly throughout life. Foods such as milk and other dairy products, dark green, leafy vegetables, salmon, sardines, and tofu promote new bone growth. Activities such as walking and bikin, and simple exercises for strengthening the upper body also can be effective.

Heart disease is a much bigger problem for older men than for older women.

Answer: False Rationale: Heart disease is the most common cause of death in older adult women and men. During their reproductive years, women experience less heart disease than do men of the same age. However, the risk of heart disease for women increases after menopause. By age 65, the risk for sudden death related to heart disease for both is equivalent.

Screening older people for cancer is not beneficial because they can’t be treated.

Answer: False Rationale: Over half of all cancers occur in people aged 65 and older, which means that screening for cancer in this age group is especially important. Older adults can be treated successfully most of the time. One exception is that screening for prostate cancer in men aged 75 and older is not recommended because the potential treatment is believed to be more harmful than "watchful waiting"; the usual growth of prostate cancer is slow; and cause of death will most likely not be related to prostate cancer, given the major health risks and the life expectancy of men. Be aware that screening recommendations vary among professional organizations and physicians, and that they may change depending on new research.

Everybody gets cataracts.

Answer: False Rationale: Not everyone gets cataracts, although a great many older people do. Some 18% of people aged 65 to 74 have cataracts, and more than 40% of those aged 75 to 85 experience the problem. Cataracts can be treated very successfully with surgery; more than 90% of people say they can see better after having the procedure.

People who are older than 80 years should stop driving a car.

Answer: False Rationale: Driving helps older adults stay mobile and independent. There is no specific age at which it is no longer safe to drive. In general, drivers over age 65 are safe drivers. Many drive fewer miles and avoid risky behaviors, such as speeding, drinking and driving, or driving at night and in heavy traffic. However age-related changes, such as reduced reaction time and impaired fields of vision, affect the older person’s ability to make safe turns (especially left-hand turns) and to change lanes; passing becomes more troublesome for those older drivers who have reduced sensory acuity and are more cautious. The risk of injury or death in a motor vehicle crash does increase for older adults.

Most older people are depressed.

Answer: False Rationale: Yes, in general older people do experience more loss than do younger adults. But most are not depressed. Depression is not common among older adults, nor is it increasing. Most likely this is because older adults with depression are receiving appropriate treatment. Depression at any age should be treated.

The older you get, the less you sleep.

Answer: False Rationale: The quality of sleep declines, but as a rule, the total time slept does not. Older adults are more likely to nap during the day and sleep less at night. The quality of sleep changes with aging, including the REM and non-REM cycles. Other health disorders can reduce the restfulness of sleep, such as restless leg syndrome, sleep apnea, nocturnal enuresis (getting up at night to urinate), chronic pain, and many other conditions. However, waking up tired every day is not normal and a healthcare provider should investigate.

Everyone becomes confused or forgetful if they live long enough.

Answer: False Rationale: Confusion and serious forgetfulness are signs of pathology. These symptoms may be caused by drug reactions, depression, poor nutrition, and many other treatable causes. They may also be signs of Alzheimer’s disease or other neurological conditions. Patients exhibiting these symptoms need prompt medical attention.

If your parents had Alzheimer’s disease, you will inevitably get it.

Answer: False Rationale: The overwhelming numbers of people with Alzheimer’s disease have no family history of the disorder. In a few families, scientists have seen an extremely high incidence of the disease and have identified genes that may account for the high incidence.

Older people take more medications than younger people.

Answer: True Rationale: Older people are more likely to experience a chronic disease that requires medication for treatment. Almost three-quarters of people over age 65 take at least one prescription drug; less than 40% of people aged 19 to 54 require pharmacological treatment.

People should control their weight as they age.

Answer: True Rationale: Most people increase body weight as they age. Usually, this increase is coupled with a decrease in physical activity. Adequate exercise and an appropriate low-calorie, low-fat diet can help maintain a healthy weight as people age.

People begin to lose interest in sex around age 55.

Answer: False Rationale: Many older people lead an active, satisfying sex life. A slowing of sexual response is a normal part of growing older. When problems develop, they may be caused by illness or medication side effects.

Older adults do not need to worry about HIV/AIDS.

Answer: False Rationale: About 10% of all people with AIDS in the United States were 50 or older when first diagnosed. As do younger people, older adults need to make sure their partners are HIV negative, and to use a latex condom during sex. If they use illicit drugs, they should not share needles.

Families do not take responsibility for care of their older relatives.

Answer: False Rationale: Most older adults live with their spouses or in family settings. Only 5% of older adults live in nursing homes. Less than 4% of people over age 65 live in nursing homes. This percentage rises to 15% for those over age 85.

As your body changes with age, so does your personality.

Answer: False Rationale: Research has found that, except for the changes that can result from Alzheimer’s disease and other forms of dementia, personality has long been considered one of the few constants of life. That is, you are likely to behave with age in much the same way as you have since becoming an adult. Recent research suggests that personality may change somewhat even during old age. It is possible that an older adult could become more conscientious and agreeable and less neurotic as he grows older (or vice versa). However, major changes in personality are unlikely. Changes in behavior, such as becoming confused or grouchy, can be a sign of a condition such as heat stroke or hypothermia.

Older people can accept urinary accidents as a fact of life.

Answer: False Rationale: Urinary incontinence is a symptom, not a disease. Usually, it is caused by specific changes in body function that can result from infection, diseases, pregnancy, or the use of certain medications. There are many treatment options available for people who seek medical attention.

Falls and injuries "just happen" to older people.

Answer: False Rationale: Falls are the most common cause of injuries among people over age 65. Regular vision and hearing tests and good safety habits can help prevent accidents. Alcohol use also is a major contributor to falls in older adults. Older adults should be made aware of any medications that may affect balance and coordination.

"You can’t teach an old dog new tricks."

Answer: False Rationale: People at any age can learn new information and skills. Research indicates that older people can obtain new skills and improve old ones.

Extremes in environmental heat and cold can be especially dangerous for older people.

Answer: True Rationale: The body’s thermostat tends to function less efficiently with age, making the older person’s body less able to adapt to heat or cold.

Suicide is most often a risk among teens.

Answer: False Rationale: Suicide is most prevalent among people aged 65 and older. An older person’s concern with suicide should be taken very seriously, and professional help should be sought quickly.

About what percentage of people over age 65 live in nursing homes?

Answer: Only 3.3% of people 65 and over live in nursing homes.

What percentage of people over 85 years old live in nursing homes?

Answer: Fifteen percent of those over 85 years live in nursing homes.

Who has the longer life expectancy, women or men?

Answer: Women. For infants born in 2009, the average total life expectancy for females is 80.9 years. For males it is only 76 years. This difference is especially noticeable in the ratio of women to men in the 85-plus-year-old population, in which women greatly outnumber men (National Center for Health Statistics, 2012).).

What is the difference between a retirement community and a continuing care retirement community (CCRC)?

Answer: A retirement community is a housing development planned to provide elder-friendly dwellings and environments for independent living and allow older adults to "downsize" into a house that has less than 2,000 square feet in single-level, livable space. A CCRC is also planned and purchased; however, it offers a wider range of living accommodations (e.g., cottages, cluster homes, apartments). A CCRC also offers assisted living, skilled nursing care, rehabilitation, and dementia care on a large campus-like setting, whereas a retirement community does not.

Name and give the age ranges for the four stages of older adulthood.

Answer: Young-Old: age 65 to74 Middle-Old: age 75 to 84 Old-Old: age 85+ Centenarians (You may have included this separately from the old-old. Either way is correct.) Frail Elderly: Frailty is more likely in the older age groups; however, it can occur at any age. It is a set of characteristics that describes a heightened state of vulnerability for developing adverse health outcomes; or the point at which the human organism is believed to have its least capacity for survival capacity

Name and briefly describe four theories of aging.

Answer: 1. Wear-and-tear theory. The wear-and-tear theory of aging proposes that repeated insults and the accumulation of metabolic wastes eventually cause cells to wear out and cease functioning. 2. Genetic Theories. Genetic theories of aging state that cells have a preprogrammed, finite number of cell divisions. Hence, the time of death is determined at birth. The genetic messages within the various cells of the body specify how many times the cell can reproduce, thus defining the life of that cell. 3. Cellular Malfunction. Cellular malfunction theories hypothesize that a malfunction in the cell causes changes in cellular DNA, leading to problems with cell replication. The cellular malfunction can be the result of a chemical reaction with the DNA (cross-linking theory), an abundance of free radicals that damage cells and impair their ability to function normally (free-radical theory), or a buildup of toxins over time that cause cell death (toxin theory). 4. Autoimmune Reaction. Autoimmune reaction theory hypothesizes that cells change with age. Over time, the changes result in the immune system’s perceiving some cells as foreign substances and triggering an immune response to destroy the cells.

Name two age-related changes seen in older adults.

Answer: A multitude of answers are possible. For a complete listing, go to Table 10-2, Age-Related Changes and Areas for Assessment, in Chapter 10, Volume 1.

According to Erikson, what is the developmental stage of the older adult?

Answer: According to Erikson, the developmental stage of older adults is known as ego integrity versus despair.

What are the top two causes of death among older adults?

Answer: Among older adults, the top two causes of death are heart disease and cancer.

Match the following theories of aging with the description of their theory.

Description of Theory
1. The time of death is determined at birth because it is programmed into cellular reproduction.
2. As the cells change over time, the immune system begins to perceives some cells as foreign substances and triggers a response to destroy them.
3. An abundance of free radicals damage the cells and impair their ability to function normally.
4. Repeated trauma and accumulation of metabolic waste eventually cause cells to become exhausted and stop functioning.

Theory
A. Autoimmune reaction
B. Cellular malfunction
C. Genetic theories
D. Wear-and-Tear Theory

Answer: 1 – C 2 – A 3 – B 4 – D

What is the fastest growing segment of older adults: young-old, middle-old, or oldest-old?

Answer: The fastest growing group is the oldest-old (age 85+). This group includes centenarians.

On a normal day, which of the following activities would you find the most young-old adults engaging in?

A. Spending time with friends
B. Participating in sports, exercise, or other active recreation
C. Reading and talking with family
D. Watching television

Answer: D On an average day, young-old persons spend most of their time (55%) watching television; 18% in solitary activities of reading, relaxing, and thinking; 11% socializing and communicating; 4% participating in sports, exercise, and recreation; and the remaining time in other activities, including related travel (Federal Interagency Forum on Aging Related Statistics, 2010).

For the middle-old, why is physical activity so important?

Answer: In middle-old adulthood, life tends to become increasingly solitary and sedentary. By this time, many have chronic conditions such as hypertension, arthritis, and diabetes. Without physical activity, the risk of disability associated with chronic conditions increases.

List four developmental challenges of the oldest-old.

Answer: The developmental challenges of the oldest-old are sensory impairments (e.g., hearing and vision), oral health, inadequate nutritional intake, and functional limitations.

Compare the number of older adults (all groups) who live independently to the number of centenarians that live independently.

Answer: Twelve percent of centenarians live independently compared with one in three persons aged 75 or older who live alone.

An older adult is worried that her memory may fail. She says she sometimes forgets where she puts things. Which of the following would you advise her to do to help slow memory loss? Choose all that apply:

A. Do regular mental exercises (e.g., crossword puzzles).
B. Cut back on group activities, to prevent overstimulation.
C. Have a glass of wine with dinner each day.
D. Try to get adequate sleep and rest.
E. Eat a nourishing diet.

Answer: A, D, E. Regular mental exercises appear to stimulate the brain and enhance memory. Other factors that slow memory loss are adequate sleep and rest, a nourishing diet, avoidance of drugs and alcohol, and adequate social stimulation. Research indicates that an active social life with complete engagement and participation in the community delays memory loss with aging (Ertel, Glymour, & Berkman, 2008).

Which of the following would be an abnormal assessment finding for an older adult that the nurse would document and report to the primary care provider? Decreased:
1) Reaction time
2) Short-term memory
3) Intellectual ability
4) Cognitive processing speed

Answer: 3) Intellectual ability Rationale: There should be no loss of intellectual ability. An elderly person can learn, although learning takes longer. Reaction time slows as we age, and it is also normal to have a decline of short-term memory, although long-term memory loss is not as common. Cognitive processing speed declines with age. This includes slower computational skills and reduced speed for problem-solving, but this does not imply that intellect is impaired.

Which of the following should you advise a frail older adult to do to slow the spiral of frailty? Select all that apply.
1) Participate in a fall-preventive moderate-intensive group exercise program.
2) Eat a balanced diet, including enough protein, fiber, and fluids.
3) Keep the mind active (e.g., by reading and socializing).
4) Walk, as tolerated, for aerobic fitness and joint flexibility.

Answer: 2) Eat a balanced diet, including enough protein, fiber, and fluids. 3) Keep the mind active (e.g., by reading and socializing). 4) Walk, as tolerated, for aerobic fitness and joint flexibility. Rationale: Available research suggests that the frail elderly do not appear to benefit from fall-preventive moderate-intensity group exercise programs, although they have positive effects on older adults before frailty occurs. Maintaining good nutritional status is also thought to be important in preventing or delaying frailty (Bartali, Semba, Frongillo, et al., 2006). Keep the mind active by socializing, working puzzles, reading, or playing games ("Frailty in Older Adults," 2006). Engage in daily physical activity to the extent possible: walking and weights to build aerobic fitness, build muscle, and improve joint stiffness and pain (Bartali, Semba, Frongillo, et al., 2006).

Which of the following is the primary goal for the oldest-old?
1) Maximize function
2) Prevent falls
3) Promote good nutrition
4) Prevent heart disease

Answer: 1) Maximize function Rationale: The goal of interventions for the oldest-old is to maximize function and prevent loss of function or disability, thus ensuring independence for as long as possible. Supportive environments and conditions that allow a person to function are vital.

In general, for young-old clients with no special problems, which of the following would you recommend for exercising? Select all that apply.
1) Walk 10 minutes a day and increase minutes and intensity slowly.
2) Perform muscle-strengthening activities on 2 or more days a week.
3) Participate in yoga and tai chi exercises.
4) See an exercise therapist for an exercise program.

Answer: 2) Perform muscle-strengthening activities on 2 or more days a week. 3) Participate in yoga and tai chi exercises. Rationale: Clients should perform moderate or high-intensity muscle-strengthening activities on 2 or more days a week. The weight-bearing and toning exercises should involve all major muscle groups. Muscle-strengthening activities can include use of exercise bands; handheld weights; digging, lifting, and carrying as part of gardening; carrying groceries; and some yoga and tai chi exercises. Inactive older adults or those with a very low level of fitness should begin with 10 minutes of walking and increase minutes and intensity slowly with subsequent walks. Others should engage in 150 minutes a week of moderate-intensity aerobic exercise. Only those with chronic conditions may need to see an exercise therapist for help in making adaptations that allow them to exercise.

When assessing an older adult patient, which of the following should the nurse recognize as a normal age-related change? Select all that apply.
1) Urinary incontinence ("dribbling")
2) Frequent loss of balance
3) Diminished acuity of near vision
4) A decline in short-term memory

Answer: 3) Diminished acuity of near vision 4) A decline in short-term memory Rationale: Urinary incontinence is not the result of usual age-related changes. It may signal a urinary tract infection, a prostate problem, excessive urogenital drying, or the need for in-home assistance. Frequent falls or loss of balance is not the result of normal age-related changes but could signal a neuropathology such as Parkinson’s disease or early symptoms of dementia and should be reported to a healthcare provider. With aging, the lens of the eye thickens and there is increased glare sensitivity and decreased visual acuity. Reaction time slows in older adults, and short-term memory declines; it takes longer to respond to a stimulus, and it takes more time to process incoming information. However, there is no loss of intelligence as a person ages.

Which of the following is the best test of functional ability?
1) Geriatric Depression scale (GDS)
2) Katz Index of Independence in Activities of Daily Living
3) Client’s heart rate after 2 minutes on a treadmill
4) Bone density scan to identify osteoporosis

Answer: 2) Katz Index of Independence in Activities of Daily Living Rationale: Functional status is the ability to perform self-care and other activities of daily living (ADLs) and instrumental activities of daily living (IADLs). The Katz Index of Independence in Activities of Daily Living allows you to rate a client’s independence in bathing, dressing, toileting, transferring, continence, and feeding. The Geriatric Depression Scale (GDS) is a 30-item questionnaire that screens for depression. Although depression and decreased bone density might indirectly affect functional ability, they are not good tests of functional ability because they do not necessarily result in loss of ability to perform ADLs. They do not screen for overall functional ability.

The nurse would expect a client with early Alzheimer’s disease to have problems with:
1) Balancing a checkbook.
2) Self-care measures.
3) Relating to family members.
4) Remembering his own name

Answer: 1) Balancing a checkbook Rationale: In the early stage of Alzheimer’s disease, executive functions or complex tasks (such as balancing a checkbook) would be the one of the first cognitive deficits to occur. The loss of self-care ability, problems with relating to family members, and difficulty remembering one’s own name are all areas of cognitive decline that occur later in the disease process.

An 86-year-old patient had prostate surgery 2 days ago. Which nursing action best meets his developmental needs?
1) Perform a spiritual assessment and make referrals as needed.
2) Provide a complete bed bath and other hygiene needs.
3) Encourage the patient to perform self-care as much as possible.
4) Administer pain medications to keep the patient comfortable.

Answer: 3) Encourage the patient to perform self-care as much as possible Rationale: An important nursing goal for all older adults should be to maintain the person’s ability to function independently for as long as possible. Encouraging self-care will help to achieve that goal. A spiritual assessment is appropriate, but is not a need of older adults any more than of other age groups. Providing hygiene needs does not promote independence. Administering analgesics is appropriate, but does not encourage functional independence.

A client tells the nurse, "I can’t see well enough to read any more. I have new glasses, but it’s still hard." What should the nurse advise her to do first?
1) Go back to the eye doctor and have him check your glasses.
2) Buy some audio books and listen to those.
3) Adapt to reading less and find a new leisure activity.
4) Install a bright but glare-free light near where she reads.

Answer: 4) Install a bright but glare-free light near where she reads Rationale: With aging, there is decreased pupil accommodation, decreased tear production, and thickening of the lens of the eye. All of these contribute to impaired near vision (presbiopia). Decrease in pupil accommodation allows less light into the eye, so in order to read, the person needs a good light. However, there is also increased sensitivity to glare, so the light should have a glare-free bulb. The patient should try this first, since she already has new glasses. If this doesn’t help, then perhaps she should have the glasses rechecked. If her vision cannot be improved, then she could think about buying audio books and other ways to adapt to her difficulty reading.

A couple is planning to move to a housing development that has been built to provide elder-friendly dwellings and environments for independent living. The houses are smaller and on a single level. Their purchase includes home maintenance and repair, snow and trash removal, a pool, and a walking track. Only people 60 years and older qualify to buy a house in this community. Medical and nursing care are not a part of the purchase. How would their living situation be described?
1) Naturally occurring retirement community
2) Retirement community
3) Continuing care retirement community
4) Assisted-living facilities

Answer: 2) Retirement community Rationale: The scenario describes a retirement community. A naturally occurring retirement community is one in which the person ages in place, living in the same home as always and in a neighborhood where the neighbors have aged together and provided support for each other through the years. A continuing care retirement community is residential living (e.g., cottages, cluster homes, apartments) into which a person must move. The person pays an entrance fee and monthly fees. In return, the contract provides for assistance with activities of daily living, coordinated social activities, health monitoring, and so on. There is usually a health clinic on site. Assisted-living facilities (ALFs) are congregate residential settings that provide or coordinate personal services, 24-hour supervision and assistance (scheduled and unscheduled), activities, and health-related services. State regulations and level of services preclude residents from staying in an ALF when their needs become greater than the resources and services provided.

When interpreting a population pyramid, which of the following do you need to know? Select all that apply.
1) The youngest age group makes up the base of the pyramid.
2) Men are on the left side of the pyramid and women on the right.
3) The length of a bar indicates how many people are in that age category.
4) Adolescents are the youngest group on the pyramid.

Answer: 1) The youngest age group makes up the base of the pyramid. 2) Men are on the left side of the pyramid and women on the right. Rationale: Age distribution of a population is often illustrated in a pyramid with the youngest age group (0-4) at the base and the oldest age group (85+) at the peak, men on the left of the figure and women on the right. The shape of a population pyramid changes to a rectangle in developed countries with fewer births and increased life expectancy. The length of a bar does not indicate the absolute number of people in a category; it indicates the proportion of the total population represented by that category.

How can the nurse facilitate communication with an older adult? Select all that apply:
1) Assess for hearing deficit at the beginning of the interaction.
2) Speak more loudly than normal, and at a slightly higher pitch.
3) Pay special attention to cues from body language.
4) Speak slowly, allowing time for the patient to word his answers.

Answer: 1) Assess for hearing deficit at the beginning of the interaction. 3) Pay special attention to cues from body language. 4) Speak slowly, allowing time for the patient to word his answers. Rationale: The nurse should check for sensory deficits at the beginning of the interaction so he can allow for lipreading, as needed. Because older adults sometimes have difficulty expressing themselves, body language (e.g., wringing hands, fidgeting) is especially important. Because older adults process information slowly, the nurse should speak slowly, allowing them to formulate their answers. Speaking slowly does not mean the nurse should speak loudly or at a higher pitch. Many older adults have high-pitch hearing loss.

Which of the following would be the most important health assessment focus for older adulthood?
1) Cancer screening with the annual health examinations
2) Seeking information about consistent use of seat belts
3) Screening for eating disorders
4) A bone scan (DEXA test) for osteoporosis

Answer: 1) Cancer screening with the annual health examinations Rationale: Chronic diseases, including cancer, are major health problems for older adults. In fact, cancer is the second leading cause of deaths for older adults. Older adults should also have an annual physical exam; they should receive cancer screening at that time. Habits for seat belt use should have already been established; although it may be important to reinforce seat belt use, the most important assessment is cancer screening. Eating disorders are more common in adolescence and young adulthood. Although loss of bone density is fairly common in older adults and can be pathological, it does not assume the status of cancer with regard to mortality for older adults.

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