The Effects of Aging and Cerebral Palsy 2
By: JessePaul

Page 3 of 3

One of the most pressing concerns is that physicians are incapable of effectively guiding and developing the most effective practices to treat their condition. Additionally, older adults with CP express a difficulty in locating doctors who are willing to provide care for them. Inadequate information on preventative care seems to be the underlying issue concerning the deficit in medical attention for adults with CP. One study used a representative population and revealed that an overwhelming proportion (90 per cent) of adults with CP do not receive periodic general health evaluations.

Lack of medical attention advances the onset of secondary conditions which will often produce greater need for specialized care. Secondary conditions which affect people who are aging with CP include: changes in mobility, increased fatigue, spasticity, increased pain, possibilities for developing arthritis, incontinence, and musculo-skeletal problems (Overeynder et al., 1994). Studies have examined the prevalence of other secondary conditions in older individuals with CP. Janicki (1989) revealed that aging is linked to increases in the rate of visual, auditory and ambulatory impairment, in addition to decreases in levels of independent functioning in the activities in daily living. A positive conclusion drawn from this study is that the occurrence of seizure disorders decrease with advancing age.

The results of a study of the medical and functional status of 101 adults with cerebral palsy aged 19-74 years conducted in the USA indicated that the people experienced infrequent general health problems. However, both males and females  experienced problems with urinary tract infections and incontinence.   

Some other responses included: Difficulty access to medical facilities including examination rooms and equipment. Further studies showed that pain occurred at a relatively young age and  was prevalent in subjects under the age of 50. There was a high frequency of hip and knee pain; painful joints were the reason given by subjects for cessation of walking. Murphy et al. (1995) concluded that in the USA preventative health care for adults with cerebral palsy was almost nonexistent and that the medical profession may be unaware of the problems experienced by adults with cerebral palsy.

The advice received from several health professionals was to concentrate on strengthening specific muscles. However, another highly recommended doctor had some very different advice regarding energy conservation, exercise and mobility aids. He felt muscle strengthening would not be that helpful because the unevenness in cerebral palsy comes from imbalance in the degree of damage in the brain motor    cortex. A person with cerebral palsy could strengthen muscles all he wanted, but eventually they would return to being unequal in strength. In his opinion, the time and energy spent exercising is not worth the temporary, if any, results.

Because medical technology is improving, people with cerebral palsy are living longer. In April, 1993, a group of professionals and people with cerebral palsy formed a task force to examine aging in people with cerebral palsy. The Task Force on Aging and Cerebral Palsy made recommendations in prevention and intervention, training and education, research and policy. Recommendations in research include advocating for the funding of selected projects focusing on prevention, as well as giving priority to projects with immediate and practical application for people with cerebral palsy. The policies recommended are: first, to include persons with cerebral palsy and their families in all aspects of evaluating and decision-making; and second, to ensure that health care reform provides adequate coverage for adults and older people with cerebral palsy.

Psychosocial Issues

The inadequacies of health professionals in the domain of aging and persons with cerebral palsy has had a direct impact on the psychosocial well-being of those affected. Inability to function at previous levels often result in a loss of motivation and desire to achieve goals, and may ultimately precipitate more detrimental health problems. The primary concerns of adults with CP include independence and employment. The decline in energy and daily life skills is first noticed when their life is occupied with activities that are directly linked to these concerns.

Independence.

Independence is a highly valued and respected attribute of people in our society. The achievement of an independent lifestyle for many people with CP is an even greater accomplishment. Loss of function that accompanies the aging process threatens independence. It is a factor which is part of the nature of involvement in many aspects of life. With the lack of support in the medical community, the struggle to maintain the current level of functioning and independence is an enormous undertaking. It is reasonable to hypothesize that, for people experiencing aging with CP, with the necessary resources and social support, the accelerated aging may be slowed, and consequently independence may be kept into old age. Janicki (1989) reported that "a great proportion of older individuals with cerebral palsy are institutionalized either in public residential or nursing facilities", which supports the conclusion that an early onset of aging leads to a subsequent loss in independence. For the psychosocial health of these individuals, steps must be taken to assist in the preservation of independence in older adults.

Employment.

It is widely accepted that employment is an important aspect of an adult's psychological health. As in the case of independence, employment is inherently associated with social status and self-worth. Discrimination and prejudice are often barriers to development of career opportunities, therefore attainment of secure employment is regarded as a great achievement. The physical effects of many of the secondary conditions may render the individual incapable of performing specific duties they once executed effortlessly.

In general, for all individuals, any decline in functioning has an enormous psychosocial impact. Depression and stress are words commonly used to describe the effects of growing old quickly, at a young age. The physiological stressors associated with aging, particularly in the later stages of life, may hasten the declines in functional ability (Overeynder et al., 1994). Deficiencies in social awareness regarding this matter reinforces the hopelessness and isolation many of these people feel.

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