Normal Aging Changes, Contracture Prevention, and Rehabilitation Goals

Normal Aging Changes by Body System

Aging brings predictable changes to every body system. Knowing what is normal helps the CNA recognize what is NOT normal and report it.

• Integumentary (skin): Skin thins, loses elasticity, and produces less oil (dry, itchy). Wound healing slows. Wrinkles and age spots appear. Sweating decreases, raising risk of burns and hypothermia.
• Cardiovascular: The heart pumps with less force at maximum effort; arteries stiffen (higher systolic BP is common); heart rate response to stress slows.
• Respiratory: Lungs lose elasticity; cough weakens; oxygen exchange decreases — higher pneumonia risk.
• Gastrointestinal: Less saliva, slower peristalsis (constipation common), reduced taste and smell — appetite often decreases.
• Genitourinary: Bladder capacity decreases; urinary frequency, urgency, and incontinence risk rise; kidney filtration slows.
• Musculoskeletal: Muscle mass decreases; bone density decreases; joints stiffen — fall risk rises.
• Neurological: Reaction time slows; some short-term memory recall slows (NOT dementia); sleep becomes lighter with more awakenings.
• Sensory: Vision changes include presbyopia (trouble focusing close), cataracts, macular degeneration, and glaucoma risk. Hearing loss (presbycusis) affects high-pitched sounds first. Taste and smell decline.
• Endocrine: Glucose tolerance decreases (diabetes risk rises); thyroid function slows.

TRAP: Normal aging means slower recall, NOT dementia. Slower reaction time and slower memory retrieval are normal — confusion, disorientation, and sudden personality change are NOT normal aging. Report new confusion immediately; it may signal infection, stroke, medication effect, or dehydration.

Contracture Prevention

A contracture is a permanent shortening of muscle, tendon, or ligament that limits joint movement. Once a contracture is established it is very hard to reverse — prevention is essential.

Causes

• Immobility (bedrest, weakness, paralysis)
• Lack of ROM exercises
• Poor positioning
• Spasticity (stroke, cerebral palsy)
• Pain that limits movement

Prevention

• Reposition every 2 hours (q2h) — never leave a resident in one position longer
• ROM exercises (active if possible, passive if needed) at least twice daily
• Proper body alignment using pillows, wedges, trochanter rolls, and hand rolls
• Splints or orthotics as ordered by the therapy team
• Encourage ADL participation — even partial movement prevents contractures
• Report early signs: decreased ROM, stiffness, resistance to movement, pain on movement

TRAP: The single most effective contracture prevention is q2h repositioning combined with daily ROM. A resident who is repositioned every 2 hours and ROM'd daily is far less likely to develop contractures. Bedrest alone causes contractures — it does not prevent them.

Common contracture sites: fingers (claw hand), wrists, elbows, hips (flexion contracture), knees, and ankles (foot drop — use a footboard or high-top sneakers to prevent).

Rehabilitation Goals

Rehabilitation aims to:

• Maintain current function — prevent loss of ability
• Prevent further decline — stop deterioration
• Restore lost function where possible
• Promote independence and dignity
• Prevent complications — contractures, pressure ulcers, blood clots, pneumonia, urinary tract infections

CNA role in rehabilitation

• Carry out the care plan / therapy program BETWEEN PT and OT sessions
• Encourage the resident to do as much as possible independently
• Use assistive devices as ordered
• Document progress and report any setbacks or changes
• Be patient — progress may be slow, especially in older adults
• Reinforce teaching from PT, OT, and speech therapy

TRAP: Rehabilitation is planned by PT/OT, but the CNA carries it out between therapy sessions. CNAs spend the most time with residents and are best positioned to encourage practice, observe setbacks, and reinforce the therapy plan.

Common Diseases — CNA Considerations

TRAP: Three rules appear on nearly every CNA exam: (1) For stroke, dress the weak/affected side first, undress the strong side first. (2) For diabetes, the CNA never trims the resident's nails — podiatrist only. (3) For arthritis, never force a joint through pain. Memorize all three.