Seniors (65 and Older)


In 2014 over 46 million people were over the age of 65 in the United States with Florida having the highest proportion of people in this age bracket. Not surprising, the percentage of seniors with a disability grew with each decade of age, making a total of 21% of the 65+ age group having some sort of disability. Because of the growing number of seniors, this group is now subdivided into age groups based on their level of healthiness. The ‘young-old” are people in their 60 and 70s who continue to be active and healthy. The next group “old” are ages of 70 and into their 80s. This group has more signs of aging with symptoms of chronic illnesses which are slowing them down. The “oldest-old” group are frail and nearing death. More and more people with developmental disabilities are living well into the senior years. One in ten adults in the “old” group has a child with a disability who is also within the older adult age range. Many seniors have chosen to be the primary caretaker of their adult child with significant disabilities. Having an “Old” or “oldest-old” senior caring for a “young-old” senior with disabilities may bring about many challenges. During this time, the parent of a person with a significant disability will more likely be dealing with their own health conditions and aging. Additionally the person with the significant disability may be taking on the role of caretaker for the parent. It’s important to be able to understand the difference between the effects of natural aging with a disability and the characteristics of more serious debilitating diseases.


Because of advances in medical care, changes in healthy living, level of education, socio-economic status, and the use of assistive technology more people are living well into their 80s. We all go through the same physical changes as we age but research from National Institute on Health (NIH) shows that disease and disability are not part of aging (National Institute of Health. Fact Sheet – Disability in Older Adults, October 2010). As a caregiver it is important to be aware of the age related changes that occur naturally. This will help in managing risk factors and making informed decisions about care.

Sensory impairments increase with aging and can decrease level of independence. For some these impairments will increase depression and vulnerability. Vision impairment is defined as a vision loss that cannot be corrected by glasses or contact lenses. Cataracts, age-related macular degeneration, glaucoma and complications of diabetes which affect the eyes are the main causes of vision impairments and blindness. Hearing loss can impair social interaction and cause cognitive decline. While elderly will have vision exams, fewer will have their hearing checked. The sensory system which helps with balance and spatial orientation changes slowly. Dizziness and the inability to coordinate movement with balance is the main cause of many elderly falling.

There is a decline in muscle mass and bone density in seniors. Strength and muscle tone start decreasing after the age of 40. Bones become more fragile and there is an increase chance of breaking bones in older adults. With higher risk of falling due to the sensory loss for balance and low bone density, the chances of bone fractures increases.

The respiratory, circulatory, and digestive systems are less efficient. The arteries harden, blood vessels shrink and the capacity of the heart pumping blood slows down. Become aware of the signs for stroke and heart attacks. Click Here for The American Heart Association website

The making of the enzymes needed to digest food slows down and some medications can also cause problems with digestion. This means it takes longer for food to digest and there is a higher potential for digestive diseases. Signs to watch for include frequent stomach aches, heartburn or gas, regurgitation, diarrhea, and blood in the stool. These can all be signs of serious problems which need medical attention.

All of these physical changes may be intensified when physical or developmental disabilities are present.

Cognitive Changes:

For most, cognitive changes with aging do not interfere with daily functioning. Learning and creativity can still take place. Cognitive changes related to aging include memory loss, slower processing speed, depression, and other diseases related to degenerative diseases of the brain. It is a natural aging occurrence to have a decrease ability to retain short-term memories and learn new information.

Verbal skills are maintained in the elderly. The major slowdown in language may be found in word retrieval or what is considered “tip of the tongue experience” when there is a delay in recalling a familiar word or name. If there is progressive difficulty in finding the right word for familiar objects, consider a referral to a certified speech-language pathologist or a general physician for an evaluation to determine if dementia is present.

Dementia is a broad category of brain diseases  that cause a long-term decrease in the ability to think  and remember to the extent that a person’s daily functioning is affected. Dementia is not a normal part of aging. Approximately 5 percent of individuals in the young-old group and 37 percent of the old-old age group, will be affected by neurocognitive impairments.

Most commonly affected are memory, visual-spatial ability, language, attention, and executive function (e.g., judgment and problem-solving). The DSM-V (Diagnostic Statistics Manual Version 5) has renamed dementia to neurocognitive disorders with three categories for the degree of severity.

The first category is delusional, which means that the loss of memory was sudden and is typically related to a medical condition such as a serious infection, a reaction to a medication, or a drug overdose. Delusional can often be treated and the person can return to living independently.

The second, Mild Cognitive Impairments. A person may show signs of mild memory problems that do not interfere with everyday activities. Individuals with minor cognitive impairments are often aware that they are forgetful. The third category is Major Cognitive Impairments. This includes many diseases that affect cognitive skills, such as Parkinson’s, Alzheimer’s, Vascular Cognitive Disorders, and Traumatic Brain Injury. Significant problems with memory and attention which interfere with everyday activities are exhibited and progressively worsen. Individuals are often not aware of their forgetfulness. (“DSM-V: Renaming Dementia” Ron Petersen, M.D., Ph.D. — Mayo Clinic)

Most of the Major Cognitive Impairments are slow and progressive. Alzheimer Disease is one of the progressive irreversible brain disorders. Symptoms of Alzheimer’s disease includes unusual forgetfulness, trouble recalling specific words during conversation, loss of recent and then older memories. Eventually those with Alzheimer’s lose the ability to speak intelligibly, don’t recognize family and friends and get confused frequently. Another chronic and progressive neurocognitive disease is Parkinson Disease. Parkinson’s is characterized by muscle tremors, slowing of movement and facial paralysis. Drs. Lynn McMunn and Peter Tolisano summarized the national research on the difference between dementia and natural aging memory loss by stating, “Individuals with age-related memory problems may forget parts of experiences, often remember parts of the experience later and can usually follow directions and care for themselves. Whereas, individuals with dementia forget the whole experience, rarely remember it later and are eventually unable to follow directions or care for themselves.” About 5% of individuals between 70 to 79 and 37% over 90 will be affected by some form of dementia.

Some individuals with developmental disabilities, such as Downs Syndrome, may have up to four times higher risk of developing Alzheimer’s disease due to genetic factors. Of concern is 35% of people with Downs Syndrome have early onset Alzheimer’s between 35 and 40. Approximately 80% will have some form of dementia in their 60s. Signs and symptoms of neurocognitive impairments for individuals with Downs Syndrome include loss of daily living skills, difficulty completing familiar tasks, confusion with time or place, trouble understanding visual images and spatial relationships, problems with choosing words in speaking and writing, onset of seizures or an increase of seizure activity, and withdrawal from social activities. More can be read about Alzheimer’s and Downs Syndrome Click Here.

Mental Health:

When we think about mental health often mental illness comes to mind. But in fact mental health is about keeping our mind healthy.   Mental health includes being able to maintain fulfilling relationships with others, coping with stress, and the ability to complete activities of daily living.   It doesn’t mean that a person is always happy. It means a person is able to experience all levels of emotions such as happy, joyful, silly, sad, angry, or disappointed and that the person has the ability to accept these emotions as part of life, but not letting the emotion overpower one’s life. Mental illness on the other hand, are conditions that affect a person’s mood, thinking, and behavior that can interfere   with a person’s ability to relate to others and function every day. Everyone has the potential of developing a mental illness at some point in life.   It is estimated that 1 in 5 Americans experience mental health problems each year and 1 in 17 having a serious mental illness such as schizophrenia or bipolar disorder.   Mental disorders are one of the leading causes of disability in the United States (C. Nordqvist, Medical News Today 2017). When a person has a mental illness it affects more than just them.   It affects everyone in that person’s life. It affects their family, friends and their community.

Mental Health for seniors – The numbers:

  • 18% of older adults affected by depression
  • 12% over 50 heavy drinkers; 3% binge drinkers, 2% use illicit drugs
  • 25% of older adults use prescription drugs that have abuse potential
  • 1 in 5 older adults adversely affected by a combination of alcohol and medication misuse
  • 16% of suicide deaths in United States over age 65.
  • 5.4 to 9.7% over 85 and 18.6 – 25.2% projected population for Palm Beach County will be over 65 In 2020 USF Florida Policy Exchange Center on Aging

Personality traits remain the same through the aging process. If a person was outgoing or an extrovert during youth, then more than likely the person will be outgoing later in life. The majority of seniors have good mental health. However one in four older adults experiences a mental health problem such as depression, anxiety, schizophrenia or dementia. Significant changes in personality can be signs of other issues that need to be addressed by professionals.

Depression and anxiety disorders are among the most common mental health problems in older people. A higher rate of depression in older adults is mainly due to other chronic health conditions or life changes which limit independence. Often depression can be believed to be a natural reaction to these natural changes as we age. Symptoms of depression are feelings of sadness or anxiety that last for over two weeks. There may also be feelings of hopelessness, helplessness, irritability, loss of interest, appetite changes, from overeating to not eating or thoughts of suicide. If you notice these signs for more than two weeks, seek help by a mental health or medical professional.

While older adults over the age of 65 are approximately 12% of the US population, 16% of all suicides are people over 65. The risk of suicide increases significantly with age especially among white males. The American Foundation for Suicide Prevention reported that in 2016 the second highest suicide rate occurred in those 85 years or older.

Additionally, the number of older adults with substance abuse problems is expected to double to five million by 2020. Problems with drinking alcohol and taking psychoactive medications, such as antidepressants, anti-psychotic medications, or mood stabilizers, are the most common types of substance use problems. As many as 25% of older adults take prescriptions that have abuse potential. Misuse of medications can cause serious injury, delirium or death. If you suspect your loved one may show signs of depression or drug abuse symptoms, contact your primary care physician or a mental health professional. This fact sheet Click Here from the National Alliance on Mental Illness provides information on depression in older adults including statistics on prevalence, symptoms, risk, diagnosis, and treatment.


Community Inclusion:

The first and most important tip for helping an older person with disabilities is to have a plan of care and a plan for financial support. If the parent is still taking care of the older person with a disability, a plan needs to be in place as to where this person will live when the caretaker/parent needs move into assistive living or passes away. This planning is an on-going process and should begin before there is a crisis.

Independent Living:

Many seniors want to continue to live independently well into the old-old age group. However, there may come a time when the person needs additional supports to live on their own or need to move to assisted living. As the caregiver of a person in their senior years taking care of a person with a disability, there is a need to make sure that they do not need assistance to do every day activities. Some questions to ask when visiting the home of an elderly person with a disability are:

  • Can the person take care of their personal hygiene? Is it difficult for them to wash their hair? Do they have difficulty dressing, such as pulling a shirt or dress overhead or grasping to button or zip clothing?
  • Is the person eating healthy meals? Are the foods in the kitchen fresh or have the food items past the expiration date? Is the person able to use the stove and other electrical appliances safely?
  • Is the person able to move about the home safely without falling or bumping into things? Are supports in place, such as a handrail by the toilet and in the shower?
  • Is the person using safety precautions, such as keeping the doors to the house and car locked?
  • Is there a need for assistance with household responsibilities like housecleaning, yard work, grocery shopping or laundry?
  • Is the person taking their medications as prescribed? Is the person able to manage the money in their bank accounts? Are the bills being paid on time?
  • Is the person able to interact with friends, family in a variety of activities or is the person isolated?

These questions and more can be found on the National Institute on Aging website, “Aging in Place: Growing Old at Home,” Click Here. “The National Aging Institute’s Website is an institute of the NIH, a U.S. Federal Government agency that provides accurate, up-to-date information about aspects of aging research, information about clinical trials, educational materials and resources about aging for the general public, and information for researchers and health professionals.”

Living options for the elderly range from living independently in one’s own home to a nursing assisted living facility. Watch the below video to find out more about the different types of housing options.

Housing options for those with developmental or significant disabilities is limited. For some when the caregiver passes away, the person with the cognitive disability is left alone without supports or is often placed to a county nursing home. Senior services may not have an understanding of or availability of wrap around services. It is important to establish living options for the person with a significant disability before the death of a caretaker. David Lyn, of Palm Beach Habilitation Center, explains that the senior with a developmental disability is often relegated to the county nursing home. He recommends families to attend life planning seminars. In Palm Beach County, Jewish Family & Children’s Services provides as part of their community outreach to all residences of Palm Beach County, a series of seminars which guide families of adults with special needs in planning for the future. The workshops cover topics such as financial planning, housing options, securing benefits, employment and independence and communication with medical and psychiatric doctors. Click Here for more information.


Being able to get around the community is important for socialization of older adults. Often transportation leads to continued social participation. For older adults staying engaged in social activities improves both physical and mental health. Click Here for more information. A time will come when a senior will need to stop driving. Signs that the older person may need to have their driving ability evaluated include: having difficulty navigating to and from familiar places, drives too fast or too slow, has difficulty staying in their lane, or hits the curb when making right turns. Car insurance companies, AAA, and AARP all have information available on senior driving evaluations.

When a senior stops driving social isolation may increase; but, Palm Beach County has many resources for transportation. Click Here for Palm Tran, Click Here for Connections, Click Here for Brightline, Click Here for TriRail, Click Here for Uber, Click Here for Lyft. If the elderly person with disability has never used public transportation, Palm Tran provides travel training to help seniors and people with disabilities learn how to navigate the fixed route system.   Palm Tran also provides door to door service for those with significant disabilities. To learn more about Palm Tran Click Here. Many of Palm Beach’s small towns and also senior residences offer community outings with transportation. Senior resident communities often provide transportation for shopping and medical appointments.

Let’s Go – A Guide to Getting Around Your Community in Florida is a FDDC publication which provides county-by-county transportation information, including specific services available in each county, as well as contact information for the various transportation services in Florida. To download a copy Click Here


Many senior citizens choose to continue working past the age of 65. People over 65 represent over 15% of the work force and this number is growing each year. Seniors do face challenges in finding or maintaining work due to discrimination. Ageism or age discrimination still occurs in many forms in America. It may range from letting go of the oldest first when downsizing, to underusing the skills of an older worker or just not hiring older workers. The Age Discrimination Employment Act is a federal mandate that protects people over the age 40 or older, who work in companies with 20 or more employees. If a person feels they are being discriminated due to age, before pursuing a complaint take time to become familiar with the law Click Here  then talk with the company’s human resource person.

The Senior Community Service Employment Program is designed to respond to the needs of these older jobseekers with barriers to employment. Authorized by the Older Americans Act, SCSEP provides unemployed, low-income adults 55 years and older with part-time jobs working in local nonprofit, government, and faith-based agencies providing services in the community. Working in their community service assignments, SCSEP participants earn income while they build their self-confidence and learn skills valued by local employers. Click Here for the SCSEP Website.

Other options to consider when looking for work may include volunteering. There are many opportunities in our community to volunteer. It may be tutoring, being a foster grandparent, guardian ad litem, seniors helping seniors and helping with nonprofits. To find volunteer opportunities check with 211 Click Here or Your Aging Resource Center website at Palm Beach County Division of Senior Services website, Click Here.

Questions to Ask Yourself about Independent Living:

  • Have I considered what home adaptions or other living options are available to help an elderly person with disabilities to live independently in their home and in the community as they age?
  • What modifications are needed to be made to the home to accommodate barriers of aging?
  • How do I access senior services, like Meals on Wheels for the elderly person?
  • Is the elderly person driving skills impaired by their disability or medications?
  • Does the person know how to access public transportation?
  • Does the elderly person want to continue working or retire?
  • Does the elderly person interested in volunteering?
  • Do they have the funds or financial supports available to replace income when retiring?
  • Do I need assistance to vote? Does the person with a disability want to vote by absentee ballot?

Social and Family Life:


The CDC has a mobility planning tool on their website to help you or your loved ones have a plan to stay safe, mobile, and independent as you age? Many people make financial plans for retirement, but don’t consider how to plan for potential mobility changes. The mobility planning toolpdf icon can guide you to take action today to help keep yourself—or your loved ones—safe, mobile, and independent tomorrow. Click Here for the mobility plan.

Legal and Financial:

MetLife’s Mature Institute study, Broken Trust: Elders, Family and Finances, found that financial exploitation is the most common form of elder abuse. One out of every five seniors age 65 and older has been the victim of financial exploitation. Additionally, only a small fraction of financial exploitation is reported – Approximately one in 10,000 instances. Another way seniors are financially exploited is through phone scams. Every year, seniors are being scammed and lose a large percentage or all of their life savings. Scammers are always creating new ways to make easy money, the Federal Trade Commission has developed a booklet to help in decreasing phone scams.

Questions to Ask about Social and Family Life:

  • Has a “road map” on how to best support my loved one with a disability after the caregiver has died?
  • Who will be there for the person with a disability once either parents or the caretakers have died?
  • Are extended family members knowledgeable of things important to the person with a disability?
  • Is my loved one at risk of falling?
  • Are there things happening such as dementia, adding to concerns for my safety?
  • Does my loved one know what to do in case of an emergency by practicing safety drills?
  • Is there a disaster plan in place that takes into account the needs of my loved one?
  • Do I know the legal rights and protections for a person who is aging?
  • Are supported decision making or other alternatives to guardianship in place to protect the rights of my loved one with a disability?
  • Do I have legal documentation of end of life wishes for myself and my loved one with a disability?
  • Who can I contact if I feel my loved one with a disability is being abused or victimized?
  • Is there assistive technology that will help the person with a disability stay safe as they age?
  • Who will emotionally support the person with a disability when a family member or close friend passes away?

Healthy Living:

Fitness and Nutrition:

Older adults who rate their health as good are twice as satisfied with life as older adults who rate their health as poor. Increase your chances of aging well by taking some of the following steps.

  • Exercise. Even a moderate amount each day can help one stay active, independent and maintain positive mood. It can make even the frailest older person stronger and fit.
  • Continue to maintain a healthy lifestyle and make adjustments for any changes in your function (e.g., hearing, vision, flexibility or strength).
  • Continue to engage in routine preventive health behaviors (e.g., get immunizations for flu and pneumonia).
  • Advocate for yourself and your family in health care settings or bring a knowledgeable representative with you. Do not be afraid to ask questions or get a second opinion.
  • If you feel anxious, depressed or are using alcohol or drugs to manage your mood, seek assistance. Untreated mental health problems are associated with poor physical health outcomes, including increased disability and illness as well as decreased quality of life
  • Be an interested person. Remain aware of new developments in the arts, sciences, politics and other areas of cultural and social interest.
  • Be an interesting person. Engage in something that matters to you and that you care passionately about.

Here in Palm Beach County we are fortunate to have at Florida Atlantic University the Louis and Anne Green Memory & Wellness Center . The Center’s programs help maintain functional independence, delay decline and promote the well-being and quality of life for individuals with memory decline and provide support for their families. Services include memory and wellness evaluation, neuropsychological testing, comprehensive driving evaluation, adult day care, counseling and psychotherapy, physical therapy, caregiver and community programs.

Asking questions from caregiver

Waiting Room: Ask questions

Mental Health:

Depression and anxiety disorders are among the most common mental health problems in older people. A higher rate of depression in older adults is mainly due to other chronic health conditions or life changes which limit independence. Often depression can be believed to be a natural reaction to these natural changes as we age. Symptoms of depression are feelings of sadness or anxiety that last for over two weeks. There may also be feelings of hopelessness, helplessness, irritability, loss of interest, appetite changes, from overeating to not eating or thoughts of suicide. If you notice these signs for more than two weeks, seek help by a mental health or medical professional.

While older adults over the age of 65 are approximately 12% of the US population, 16% of all suicides are people over 65. The risk of suicide increases significantly with age especially among white males. The American Foundation for Suicide Prevention reported that in 2016 the second highest suicide rate occurred in those 85 years or older.

Additionally, the number of older adults with substance abuse problems is expected to double to five million by 2020. Problems with drinking alcohol and taking psychoactive medications, such as antidepressants, anti-psychotic medications, or mood stabilizers, are the most common types of substance use problems. As many as 25% of older adults take prescriptions that have abuse potential. Misuse of medications can cause serious injury, delirium or death. If you suspect your loved one may show signs of depression or drug abuse symptoms, contact your primary care physician or a mental health professional. Click Here for a fact sheet.

Questions to ask about Healthy Living

  • Are emergency responders aware of the end of life wishes for my loved one with disabilities?
  • Who else understands the medical needs of the person with a disability? Who is available to if help is needed in communicating at appointments?
  • Are medical directives known?
  • Has a will, power of attorney, medical directive been created for the person with a disability?
  • Is the person with a disability preparing and eating healthy meals and snacks?
  • Is the person staying physically active as possible?
  • Is there a need for technology that can monitor sleep patterns, activity or other health related concerns?
  • Are there disability related aging and health issues I should be aware of?
  • What opportunities are available to make or maintain friendships?
  • Is there a senior center nearby for social activities?
  • Is extra support needed to participate in the faith community as the person ages?
  • Are the beliefs and spiritual wishes being considered and respected?

Education (Lifelong Learning):

Many seniors want to continue learning. Florida Atlantic University has the Life Long Learning Center, where seniors can take special courses each semester. If a person is over 60 years of age, a US citizen and resident of Florida, undergraduate courses are available tuition free on an audit basis if space is available. To learn more about auditing classes Click Here

Palm Beach State College, also allows seniors to audit 2 classes per semester for a discounted amount. The “Senior Citizen Fee Waiver Form” must be submitted to the Registrar’s Office prior to the audit deadline for the specific semester. Those wishing to audit courses must register in person on the specified date. To find out more contact the Registrar’s Office at 561-967-7222

Many of the public libraries in our community will offer classes to their community members. Additionally, the many public schools are Community Education sites. Each semester, the School District of Palm Beach County advertises online and in a mailed advertisement its course schedule. Click Here for more information.

Caring for Yourself:

You are not alone in being a caregiver of an elderly person with a disability. Johns Hopkins Bloomberg School of Public Health conducted a study on family caregivers and found there are about 14.7 million unpaid caregivers helping older mostly older adults with neurocognitive disabilities. As a caregiver of an elderly family member with a disability, we often forget to take care of ourselves. We will advocate for our loved one to make sure they are getting the help they need. We will fill our schedule with activities to help them make progress, but we tend to forget about ourselves. This can lead to exhaustion, depression, and isolation. It’s important to take care of your health as well as your loved one. If we neglect our own well-being we may risk our own health and the ability to be there for our children. There are three key points all parents should follow:

  1. Live a healthy lifestyle – eat nutritional meals, spend at least 30 to 45 minutes exercising each day, get adequate sleep. Develop good communication skills, consider using “When ___ happens, I feel ____” statements.
  2. Know your limitations. No one can do this alone! Be aware of what you can and cannot do. Ask friends, family, advocates, and agencies for help. Remember it takes a village to raise a child. Check the Parent Support section or call 211 to find resources to help you with the care of the elderly.
  3. Find ways to relax. It’s important to take time be yourself. This may be through meditation, participating in religious beliefs, taking a long bath, or reading a novel. Find time to interact with other adults with common interests. It may be doing the things you love such as hobby, going to the gym, or going out with your spouse or close friends.

Keeping these three key points in mind will help in managing the stress of parenting.

Other websites: Provides contact information for senior services in Palm Beach County. Click Here for the list. Aging in Place: Growing Old at Home. Click Here for more information. Tips [and Resources] for Healthy Living. Click Here for more information. Silver Sneakers is a wellness program designed for people over 65 years of age.  Some Medicare Advantage Plans provide the service at no charge.  The website provides information on exercise, nutrition, mental wellness and brain health. Click Here.


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McMunn, L., &  Tolisano, P. (2015, January). Aging, Dementia and Intellectual/Developmental Disabilities.

National Down’s Syndrome Society. Alzheimer’s disease & Downs Syndrome a Practical Guidebook for Caregivers.

Usacco, D. (1999, January/February). Normal Communication Changes in Older Adults. ASHA Let’s Talk No. 72.

Petersen, R. (2013, October 11). DSM-V: Renaming Dementia. Mayo Clinic

Center for Disease Control and Prevention (2018, January). Depression is Not a Normal Part of Growing Old Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion.

Wolff, J.L., Spillman, B., Freedman, V.A., & Kasper, J.D. (2016, February 15). A National Profile of Family and Unpaid Caregivers Who Assist Older Adults with Health Care Activities. Johns Hopkins University Bloomberg School of Public Health Public Release.

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