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Lifespan Development for Allied Health Professionals

1.5 Contact Hours
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This peer reviewed course is applicable for the following professions:
Athletic Trainer (AT/AL), Occupational Therapist (OT), Occupational Therapist Assistant (OTA), Physical Therapist (PT), Physical Therapist Assistant (PTA)
This course will be updated or discontinued on or before Friday, January 16, 2026

Nationally Accredited

CEUFast, Inc. is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation. ANCC Provider number #P0274.


BOC
CEUFast, Inc. (BOC AP#: P10067) is approved by the Board of Certification, Inc. to provide education to Athletic Trainers (ATs).

FPTA Approval: CE24-1153764. Accreditation of this course does not necessarily imply the FPTA supports the views of the presenter or the sponsors.
Outcomes

92% of participants will know the general developmental differences, assessment needs, and common safety issues of infants, children, adolescents, adults, and older adults.

Objectives

After completion of this course, the learner will be able to:

  1. Outline typical motor, cognitive, and emotional developmental milestones of infants and children under 12.
  2. Outline typical motor, cognitive, and emotional developmental milestones of adolescents.
  3. Outline typical motor, cognitive, and emotional developmental milestones of adults.
  4. Outline typical motor, cognitive, and emotional developmental milestones of adults over 65.
  5. Explain at least one safety issue for each age group.
CEUFast Inc. and the course planners for this educational activity do not have any relevant financial relationship(s) to disclose with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

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Lifespan Development for Allied Health Professionals
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To earn of certificate of completion you have one of two options:
  1. Take test and pass with a score of at least 80%
  2. Reflect on practice impact by completing self-reflection, self-assessment and course evaluation.
    (NOTE: Some approval agencies and organizations require you to take a test and self reflection is NOT an option.)
Authors:    Divya Desai (OTD, MS, OTR/L) , Cindy Endicott (PT, DPT, FAAOMPT, ATC, Cert Dn)

Case Study

Martha is a physical therapist visiting her friend Rita from high school. She is excited to see Rita after almost three decades and looks forward to spending time with her children.

When visiting Rita, Rita shares some of her struggles with Martha. Rita works as a librarian in a local library. She has a teenage daughter who seems too aloof. The daughter spends too much time on her cell phone and rarely communicates with Rita. One day, Rita found her daughter’s phone and could not help but read the messages. She read some concerning texts indicating that her daughter may be experiencing bullying at school. She is unsure about how to approach her daughter.

Rita recently lost her father, and her mother has moved in with her. Her mother has early-stage dementia, and she is not sure what her mother can and cannot do safely. The mother has also had a few near-falls in the past few weeks, and Rita is unsure about the cause.

Overall, she feels overwhelmed by the new responsibility of caring for her mother with dementia and her teenage daughter, who is possibly being bullied. She has no time left for any recreation or exercise. She also admits she has no energy to exercise because she is always tired.

What age-related challenges are Rita, her mother, and her daughter experiencing? Are these changes typical?

Introduction

Significant developmental and cognitive differences exist between infants, children, adolescents, adults, and aging adults. While most allied health professionals and parents know some of the milestones, the developmental milestones checklist has been updated for the first time since 2004 (Bracho-Sanchez, 2022).  This course will discuss the differences between infants, children, adolescents, adults, and older adults and how they influence the healthcare needs of these specific populations, especially as it applies to therapy professionals.

Infants and Children: Ages 1 month to 12 Years

Anatomical and Physiologic Differences in Infants and Children from Adults

The anatomy and physiology of infants and children differ from an adult in many ways other than height and weight, and clinical interventions must be applied with these factors in mind. These differences are more pronounced in infants through preschool age, and most changes are complete by 18 years of age (Kosif & Keilan, 2020).

Physiologically, infants and children are at higher risk for respiratory difficulty and are more susceptible to airway obstruction than adults. Compared to oral cavities, this is vastly secondary to their relatively large heads, short necks, and large tongues. Infants are also obligatory nose breathers, so nasal obstruction can lead to respiratory distress. Children are more susceptible than adults to heat loss because they have proportionally larger heads and a greater surface-area/body-mass ratio than adults. Infants are more vulnerable to ear infections due to the external auditory canal being directed upward and backward rather than curving downward and forward in children three years and older (Kosif & Keilan, 2020).

Skeletally, infants’ and children’s bones are immature and softer than adults. The bones are still forming, growing, and becoming more calcific as a child grows. In infants, the sutures of the skull are not solidified, and in the area of the fontanel, not touching, creating susceptibility of injury to the underlying fragile brain tissue. The epiphysis, or growth plates of the bones, fuse at different rates and ages, depending on whether the child is male or female. Because the bones are softer and more cartilaginous, infants and children are more susceptible to joint injury, dislocations, and subluxations. Fractures on bony tissue can occur, however. Fractures in infants often cannot be visualized if the fracture occurred in the epiphysis. These are termed Salter-Harris fractures (Kosif & Keilan, 2020). An unfused epiphysis can sometimes be mistaken for a fracture in an older child.

Therapy professionals must understand fundamental anatomic and physiologic differences between infants, children, and adults when planning rehabilitation and care activities. This is especially important when considering stresses going through developing joints, bones, and other musculoskeletal tissues. Often, therapy needs to promote proper stresses and encourage weight bearing through specific body parts to promote appropriate developmental patterns while protecting other parts.

Growth and Development of Infants and Children

The period between 1 month and 12 years of age is one of rapid change. Infants and children should be routinely assessed to determine if they are growing typically, and periodic physical, cognitive, language, and social-emotional development evaluations are crucial for this population. This developmental monitoring will aid healthcare professionals in determining if the infant/child is developing in a typical manner or if more specific screening or in-depth testing is required (CDC, 2023a). The Center for Disease Control and Prevention (CDC) recently updated the developmental surveillance milestones checklist, also known as “CDC’s Developmental Milestones” (CDC, 2023b). It is worth noting that the checklist is not a replacement for in-person assessment and evaluation but serves as an adjunct to initiate conversations around the child's development.

These assessments compare the patient to developmental milestones, defined as abilities and behaviors typical for a specific age group. In younger infants, developmental milestones are dependent on the actual strength of the infant in various motor groups, as well as the presence and subsequential integration of primitive reflexes, such as the ATNR (asymmetric tonic neck reflex) and the STNR (symmetric tonic neck reflex). As the infant ages, the development of more mature postural reflexes, balance control, and sensory-motor skills. If a primitive reflex is not integrated as the infant ages, it can cause difficulties and contribute to motor delays, difficulty with coordination, or various processing disorders.

Notice that cognitive, language, and hand/finger motor abilities are assessed in infants and young children, but visual and perceptual abilities are not.

The Infant from 2 to 3 Months

Motor development of the 2 to 3-month-old infant should show the ability to raise their head while lying on their stomach and to open and close their hands briefly (CDC, 2023c).

Cognitively, a two-to-three-month-old infant will typically start to be able to follow a moving object with their eyes. They are making sounds other than crying and will also respond to a voice or turn their head toward the direction of a sound. They also start to look at a toy for several seconds (CDC, 2023c).

Social and emotional development wise, an infant 2 to 3 months of age will attempt to mimic facial expressions and begin to smile in response to people. Facial expressions become more numerous and complex. Most babies at this age will look at your face, seem happy to see their parents when they walk up to them, and calm down when spoken to or picked up (CDC, 2023c).

photo of baby on blanket showing head

Infant lifting head

The Infant from 4 Months to 6 Months

Infants in this age group gradually reach milestones like pushing themselves onto elbows and forearms when on their stomach and pushing up onto fully straight arms by six months. They can now sit while leaning on their hands for support and hold their head steady without support. By six months, they can typically roll from their tummy to back (CDC, 2023e).

photo of infant pushing onto upper extremities

Infant Pushing Onto Upper Extremities

They learn to explore attractive toys, put them in their mouth for further exploration, and experiment with the properties of the toy by shaking it or hitting it against another toy. They learn to hold toys with two open hands, then a fist, and progress to a precise grasp. As the grasp becomes more mature, the infant progresses from raking small bites of food, such as Cheerios, to holding food in their hands, such as a soft banana.

Regarding communication and social development, 4 to 6-month-old infants will coo, chuckle, and make sounds back when talked to. They will turn, smile, move, or make sounds to keep someone’s attention (CDC, 2023d). By six months, infants like to look at themselves in a mirror, laugh, blow raspberries, and stick their tongues out (CDC, 2023e).

The Infant from 6 Months to 12 Months

During these months, most children develop a strong attachment to their caregiver. Separation anxiety develops and peaks close to the first birthday. Depending on the opportunity for socialization, children at this age learn to communicate with others. Babies initially learn to communicate their needs, such as hunger, sleep, and discomfort, with sounds, babbling, and then with the first few words. The environment greatly impacts the language development of infants and toddlers. By one year, an infant will usually wave hello and goodbye and can call a parent by simple names such as mama or dada.

Cognitively, the infant will be able to understand the word and meaning of “no” and play simple games (CDC, 2023f). This is an excellent time to enjoy such games as patty cake! Remember, you are your baby’s first teacher, and the child will often begin to mimic what they are seeing. Using positive words and physical affirmations when the infant performs a desired behavior will help reinforce their learning and encourage continued performance. Typically, by now, the infant understands to look for things they have seen you hide and can put large items inside other things, like placing wooden toys into a bucket or toy wagon. They still lack fine motor skills to manipulate smaller objects and toys but may be starting to pick items up between their thumb and index fingers(CDC, 2023f).

photo of three infants playing with toys

Infants playing with toys

Physically, an infant in this age range can start to pull to stand, cruising around furniture while holding on, and may even start walking. As the infant becomes more mobile, proper home childproofing becomes crucial.

The infant from 12 months to 2 years

There is significant growth and development between one and two years of age. Infants are getting taller, their muscular system is strengthening to support mobility, and cognitively, they are developing rapidly. These are the times when the infants’ unique personalities start to show. Within these years, an infant will progress from pulling themselves to standing to cruising along furniture while holding on, learning to walk without support, and being able to climb onto and off a chair or couch independently (CDC, 2023g). By age two, a toddler can run and kick a ball (CDC, 2023h).

photo of baby taking first steps

Babies First Steps

Hand motor skills are also rapidly improving, and the toddler will progress from trying to use their fingers to feed themselves (CDC, 2023i) to being able to use a spoon. During this time, toddlers can manipulate switches, knobs, and buttons on toys or activity boards and scribble with a writing device (CDC, 2023h). They understand how to play with toys like cars and trucks and can play with more than one toy at a time (CDC, 2023h).

Language skills expand drastically during these two years. Progressing beyond their first few words, such as mama and dada, the child will start to apply simple words to other objects, such as “Da” for a dog or “Ba” for a bottle, around 15 months (CDC, 2023i). By 18 months to 2 years, they can put three or more words together (CDC, 2023g).

Cognitively and emotionally, the infant of 18 months starts to move away from their parent in a sense of independence but will check to ensure their parent is still nearby (CDC, 2023g). By two, the toddler begins to notice the feelings of others and will express concern if someone else is hurt, sad, or crying (CDC, 2023h).

The Child at 3 Years

Children at three years should be physically able to walk unassisted up a flight of stairs one step at a time, pedal a tricycle, throw a ball overhand, and turn a doorknob. They are developing enough fine motor skills to string beads, use a fork, dress with loose clothing, and draw simple shapes like a circle (CDC, 2023j).

The social and emotional development behaviors considered normal for this age group include expressing a wide range of emotions, copying adult behavior, and describing what others are feeling.

The cognitive and language abilities of the 3 to 4-year-old child should include an increasingly sophisticated sense of time, the ability to follow a short series of instructions, speak in short sentences, and be understood most of the time. When asked, they can name familiar objects and friends and state their first names. Asking questions involving who, what, where, and why is typical for this age (CDC, 2023j).

photo of young child riding tricycle

Young Child Riding Tricycle

The Child from 4 to 5 years

Preschoolers, 4–5-year-olds, are very active. Motor skills are improving; they can catch a large ball and hold crayons between their fingers and thumb (not just as a fist) (CDC, 2023k). You can encourage your child to develop these fine motor skills by encouraging them to turn pages in a book and play with puzzles. Cognitively, they begin using symbols and improving their memory. They can count to 10 and start to recognize letters. They begin to develop an understanding of time, such as yesterday and day/night, and can start to recognize letters. They have vivid imaginations, which may cause unseen fears. A dress-up box may be helpful in activities such as tea parties and pretending to be someone else, like a teacher or doctor (CDC, 2023k).

photo of child playing dressup

Child playing dress-up

In these years, they will also be able to start telling stories with at least two events, sing, dance, and hold a conversation with more than three exchanges (CDC, 2023l). The preschooler is starting to develop independence, which means they may begin to talk back and test the boundaries of behavior (CDC, 2023l).  Try to encourage their independence by taking notice and praise for good behavior. The preschooler is starting to notice and become sensitive to other people’s feelings and will try to comfort others who are sad or hurt (CDC, 2023k).

School-aged children from 6 to12

School-aged children between 6-12 years grow more slowly now until puberty. Cognitively, they are active and eager learners who can understand cause and effect. Building self-esteem is an important task during this period. The school-age child develops a greater sense of self and independence and wants to fit in with his peers. The school-age child is beginning to make lifestyle choices and may act with poor judgment. Peer pressure, alcohol, sex, drugs, and smoking need to be discussed with this age group.

photo of strong school aged girl

Strong school-aged girl

The Assessment and Examination of Infants and Children

An infant or child's assessment and examination process must be adapted to the appropriate behavioral, emotional, and intellectual development level.

Infants and Toddlers

Approach an infant or toddler calmly, gently, and slowly. Have the caregiver hold the patient during an assessment or treatment if possible. If the child has to lie down, let the parent stay next to the child (Treitz et al., 2018). Try to make the assessment or treatment into a game to reduce fear. Use your imagination and involve the toddler using storybooks, dolls, or puppets. Since infants and toddlers have a short attention span, remember to change activities frequently. Provide reassurance during the assessment or intervention. Praise the child for doing well. Early intervention can be of great benefit to a child who may be slower in their development or those who may be significantly behind their developmental milestones. Physical, occupational, and speech therapy can be influential in improving a child’s motor, cognitive, and language skills.

Preschoolers (4-5)

Speak at the language level the child can understand. Explain what you are doing to and with the child using sensory terms whenever possible. Use games and imagination to gain cooperation. Allow the child to handle the equipment if possible. Enlist the child’s help and allow him to express his feelings. Preschoolers need praise, rewards, and easy-to-understand rules.

School-Aged Children (6-12)

Because of developing independent and cognitive understanding, the school-aged child needs to be allowed to help make decisions when feasible and within reasonable bounds. Provide privacy during assessment or treatment and explain all procedures at the child’s level of understanding. Be prepared to listen and be honest. Tell the child how they can be involved or assist in their care, if possible. Reassure the child that their therapy care is not a punishment but something that can help them, is fun, and something to look forward to.

Common Safety Issues of Infants and Children

The primary safety issues of infancy and childhood are accidental injury, poisoning, and child abuse.

Accidental Injury

Accidental Injury is the number one cause of death for children in the US, with 1 in 5 child deaths due to injury. Accidental injuries like burns, drowning, poisoning, falls, suffocation, and automobile accidents are prevalent in children; most injuries are preventable (CDC, 2020).

Infants and children are naturally curious, and exploration is part of their growth. They are much more likely to use hand-to-mouth behavior to determine the nature of an object, and they lack the caution of older children. Serious harm and death caused by pediatric exploratory behavior are unusual; however, because of the risks of choking and poisoning, infants and children need to be monitored carefully. Because of their body weight, children are especially vulnerable to the effects of medications and hazardous substances, and even one dose of certain medications can cause serious harm or death in a child.

Physical and Occupational therapists can help educate parents on these safety issues by teaching parents safe handling skills with their child while dressing, changing, or carrying their child. They can work with parents to prevent falls, on home safety considerations such as baby-proofing techniques and safety with bathing to prevent burns and drowning risks. Proper car safety is crucial, and healthcare professionals should teach parents how to get their child into a properly installed car seat safely.

Therapy professionals can play a key role in keeping children safe by helping to improve proper motor and muscular development to improve strength, range of motion, and balance to prevent falls or other musculoskeletal injuries.

Child abuse

The incidence of child abuse is difficult to ascertain, but it is a prevalent social issue that has serious short and long-term consequences. The CDC estimated that 1 in 7 children in any year are abused, and 1750 children died in 2020 of abuse and neglect (CDC, 2022a). In addition, child abuse statistics can be deceiving because a child who is abused would be considered one case, but that child is likely to be abused many times.

Child abuse can be physical, sexual, emotional, psychological, or in the form of neglect. Munchausen syndrome by proxy is another form of child abuse in which the caregiver fabricates illnesses or makes the child sick (Kaneshiro, 2021). The CDC identifies many risk factors for child abuse (CDC, 2022b), including individual characteristics, caregiver and family risk factors, and community risk factors.

There are many characteristic signs, symptoms, and patterns of injury associated with the physical abuse of a child, such as bruises, burns, specific fractures, and head trauma, all of which may be indicators of child abuse (Colbourne, 2020). For screening and detection purposes, clinicians should also keep in mind that the emotional and psychological condition of the child and the history surrounding possible incidents of child abuse are important. When considering the possibility of child abuse, consider these three issues.

  1. Child-caregiver interaction: Is the child agitated, fearful, or emotionally or psychologically upset when interacting with the caregiver? What are the caregiver’s attitudes and behaviors towards the child? Are they attentive, concerned, cold, disinterested, and harsh?
  2. Frequent or suspicious injuries: Does the caregiver’s story of how and why the injury occurred make sense? Did the caregiver delay getting help for an injured child? Has the child had previous injuries or the same injury before? Are the injuries increasing in frequency and severity? Does the child have an injury or a medical condition that could not happen to a child, like genital trauma, a sexually transmitted disease, or physical trauma that could not happen to a child, given their age, body weight, and level of physical activity? Does the child have bruises or fractures that are days, weeks, or months old, but the caregiver claims that the child was recently injured?
  3. General well-being of the child: Is the child well nourished? Do they have frequent illnesses or injuries? Is the child withdrawn, apathetic, or fearful?

Healthcare professionals must report child abuse according to professional ethics codes, the standards of healthcare facilities, and state and local statutes. In the United States, mandatory reporting laws vary by state and will describe what populations are covered and under what situations. Typically, this will include children, the disabled, and the elderly, including neglect and abuse (Thomas & Reeves, 2023). State reporting laws will also indicate which individuals are mandated to report, such as childcare providers, clergy, coaches, counselors, healthcare providers, lay enforcement, and educational staff such as principals and teachers.

The CDC’s publication Preventing Child Abuse and Neglect: A Technical Package for Policy, Norm, and Programmatic Activities, 2016, provides guidelines, plans, and resources for preventing child abuse (Fortson et al., 2016). The publication can be accessed using this link. Other information from the CDC on this topic is on their website.

Adolescents: Age 13 to 20 Years

Growth and Development of Adolescents

Adolescence is a time of significant physical, sexual, cognitive, and social change (Allen & Waterman, 2019). Physically, adolescents grow in spurts, with the female growth spurt peaking between 11-16 and the male growth spurt peaking between 13-18 (Kaneshiro, 2023). Skeletal maturity is complete when the epiphyseal plates close, which may continue (especially in males) into early adulthood. For these reasons, it is more reliable to determine skeletal age through radiological morphologic changes over chronological age (Sanders et al., 2017).

Adolescence is the time when teens enter puberty, creating hormonal puberty-related changes. Body changes include menstruation, genitalia enlargement, hair growth on the face, armpits, and genital region, deepening of the male voice or voice cracking, and skin changes such as acne become prominent (Allen & Waterman, 2019). By the middle of adolescence, they are fully able to reproduce.

Cognitively, adolescents become more abstract thinkers, can consider many options, can develop their moral philosophies, and can challenge authority. Adolescents are developing their own identities and building close relationships. Adolescents are self-conscious and concerned about how they fit in with peers and social groups.  In early adolescence, most peer groups consist of non-romantic relationships; however, in mid to late adolescence, this may start to include romantic relationships (Kaneshiro, 2023). They may start to pull away from their parents and adult authority figures.

photo of a bullied teen

Bullied Teen

The Assessment and Examination of an Adolescent

The adolescent's assessment should focus on how development in these areas affects them at home, school, and in society. When assessing an adolescent in the clinic, ensure that the assessment is completed privately with an adult present. If an adult is not immediately present, treatment and evaluations should be conducted in a public area or with an additional healthcare provider present. This reduces the risk of accusations regarding misconduct by the provider and ensures the safety of the adolescent patient.

Parents still have full authority in early adolescence regarding medical issues related to their teens; however, adolescents need to feel heard and understood. While the parent needs to be informed about and provide permission for interventions, the teen should be included in the education about what they will be experiencing. If possible, give them choices in exercises and try to include particular areas of interest to them as an individual. Make the interventions as relatable as possible. For instance, if the teen is in physical therapy for an ankle injury sustained in basketball, have them hold, drill, or pass a ball while performing balance and proprioceptive exercises. Talking about things the adolescent is interested in keeps them engaged, builds their trust in you as a healthcare provider, and makes it more likely that they will comply with their treatment.

Common Safety Issues of an Adolescent

Adolescents strongly need peer approval so they may participate in risky behaviors (Kaneshiro, 2023). The teen, parent, and healthcare provider must openly discuss good decision-making. Risky behavior is common during adolescence. The Youth Risk Behavior Surveillance, 2017, reported that 5.9% of adolescents never or rarely wore a seat belt, 16.5% had ridden in a car driven by someone who had been drinking, 15.7% had carried a weapon, and 13.8% did not use any contraceptive method while having intercourse (Kann et al., 2018). Healthcare providers, especially rehabilitation professionals, spend significant time with their patients. As a physical or occupational therapist or an athletic trainer, you may be the first to notice safety concerns in a young person.

Unintentional Injury

Unintentional injuries continue to be the leading cause of death of adolescents between 15-19 years old, followed by homicide and suicide (CDC, 2023m). Motor vehicle safety needs to be emphasized with this population, with education centering on the importance of safety belt use, the risks of substance abuse while driving, and speed-related risks. Adolescents should not be allowed to drive until they demonstrate the physical and cognitive skills to do so safely (Kaneshiro, 2023).

Sports participation significantly increases in adolescence and can become a large component of a teen’s personal and social identity. With sport comes an increased risk of injury. A teen’s musculoskeletal maturity is often incomplete, so they must be educated about the risk of overuse or overload injury. An adolescent athlete needs to be educated on the importance of a proper warm-up, limiting the number of repetitions (such as for youth baseball pitchers), and should be encouraged to participate in multiple sports. An adolescent should be encouraged not to participate in year-round sports competitions. Youth with early single-sport specialization, before the age of 14, or those with high training volumes have been shown to have an increased history of injury, have sustained a greater total number of injuries, and had a higher incidence of injuries requiring surgery (Ahlquist et al., 2020). Intensity and exercise load must be considered when developing rehabilitation programs for this population. The cumulative amount of time the athlete spends on strength and conditioning, rehabilitation, and practice training sessions should also be considered.

Proper preparticipation examinations should include a general health checkup, a check of organs and systems, a thorough screening of the musculoskeletal system for muscle, bone, and joint health, and neurocognitive baseline testing. Establishing baselines for these systems will ensure that the adolescent is healthy enough to participate in sports and indicate the healing trajectory if an injury occurs, such as a concussion. Proper cardiac screenings should be considered to identify the risk of cardiac events. Adolescents must be informed about the importance of proper techniques and safety equipment. In addition, physicians, athletic trainers, and physical therapists can play a key role in keeping an adolescent healthy.

Depression and Suicide

Major depression in adolescents is a common and serious problem, and it is associated with acute and chronic morbidity and mortality (Zuckerbrot et al., 2018). According to the American Academy of Pediatrics (AAP), approximately 1 in 11 adolescents have had a major depressive event (AAP, 2021). Major depression in adolescents also frequently goes unrecognized, and it is recommended that depression screening start at age 12(Zuckerbrot et al., 2018). The AAP recommends using the Patient Health Questionnaire-2 (PHQ-2), as seen below.

Table 1: PHQ2
The Patient Health Questionnaire-2 (PHQ-2)
Patient Name:Date of Visit:
Over the past 2 weeks, how often have you been bothered by any of the following problems?Not At AllSeveral DaysMore Than Half The DaysNearly Every Day
1. Little interest or pleasure in doing things0123
2. Feeling down, depressed or hopeless0123

Suicide is the second leading cause of death in 15 to 24-year-olds (AACAP, 2021). Most adolescents who attempt or commit suicide have a serious psychiatric disorder, most commonly depression. Other factors that put adolescents at risk for suicide include but are not limited to, anxiety disorders, emotional problems, a history of physical or sexual trauma, family conflict, feelings of hopelessness, or stressful life events (AACAP, 2021).

Bullying

Bullying is an unwanted and aggressive behavior among school-aged children involving a power imbalance that may be perceived or real (Stopbullying.gov, 2023a). Examples of bullying include teasing, name-calling, pushing, hitting, or making sexually inappropriate gestures.

Who is at risk?  (Stopbullying.gov, 2023b).

  • Children who appear different from their peers
  • Those who are perceived as weak, depressed
  • Those with low self-esteem
  • Those who have a sexual and gender orientation not fitting the ‘traditional norms”
  • Those who are overweight or underweight
  • Those with visible (or invisible) disability

Signs of Bullying include (Stopbullying.gov, 2023c)

  • Unexplainable injuries
  • Destroyed/ damaged books
  • Altered eating habits
  • Faking illness to skip school
  • Declining school grades
  • Attempting to harm themselves or talking about suicide

You can find additional information on bullying here.

School and Sexual Violence

According to the CDC (2021), school violence is described as violent “acts that disrupt learning and have a negative effect on students, schools, and the broader community.” School violence can include bullying, fighting, weapon use, gang violence, and sexual violence. The Youth Risk Behavior Surveillance, 2019, reported that 7.0% of students had been threatened or injured with a weapon, 8.0% had been in a physical fight, and 9% of high school students had not gone to at least one school day because of safety concerns.

The CDC’s program, STOP SV: A Technical Package to Prevent Sexual Violence, is not designed explicitly for adolescents, but it provides essential information on the topic (Basile, et al. 2016). The STOP SV program can be accessed by using this link.

 

Adults: Ages 21 to 64 years

Growth and Development of Adults

Adulthood is a period of independence and responsibilities. Most body systems have matured by this time. For example, the musculoskeletal system is fully mature, visual and hearing are fully functional, and the integumentary system is well functioning (unless one has an established diagnosis that causes faulty development of these systems). The prefrontal cortex matures around age 25, which means most adults who just entered this stage of their lives are still refining their skills regarding higher-level cognitive challenges.

Jeffery Arnett described emerging adulthood as a phase of life from 18-25 years where this group's challenges differ from the later parts of adulthood (Arnett, 2016). This is partly because many decisions of emerging adulthood (such as purchasing a car, moving to a different state, etc.) are made without much experience. Many adults in this age group stay with their parents much longer, may return to pursuing education after taking a break, and explore many employment opportunities before identifying a career path. Arnett also points out that transitioning from emerging adulthood to established adulthood varies from culture to culture (Arnett, 2016).

Adults are sexually and physically mature. Their nutritional needs are for maintenance, not growth. Chronic illnesses are either evident at this time of life or have yet to develop, so the adult faces the threat of illness or death from the impact of unhealthy lifestyles. Mentally, they learn new skills and information to solve problems. They are very concerned about affiliation, love, and intimacy. Personal identity and self-acceptance allow young adults to form their own independent decisions. Major stress factors occur as this individual establishes a career and family. Their fears include losing their jobs and status in established social relationships. The young adult chooses a lifestyle and career to fulfill goals, seeks closeness with others, and may commit to starting a family and becoming an active community member.

The middle-aged adult develops physical changes and (possibly) chronic health problems. Some body structures start a gradual decline towards the end of this period. For example, production of some of the digestive enzymes decreases, making it challenging to digest certain foods. Cholesterol deposition slowly begins and worsens unless the adult takes special measures (such as a healthy diet, exercises, and medications). The visual and hearing systems gradually decline, and women experience osteoporosis, especially close to their menopausal age.

Cognitively, they use experience to learn, create, and solve problems. People of this age are concerned about staying productive, and they hope to contribute to future generations and strive to balance dreams with reality. They start planning for retirement and may end up taking care of parents and children, which is why this generation is also known as the sandwich generation.

Common Safety Issues of Adults

Safety considerations of adults can be similar to those of other age groups, including suicide, transportation safety, and gun safety. More unique to this age population are safety issues in the workplace.

Workplace Safety

Compared to other age groups, workplace injuries are more prevalent in the age group than others, as these are the years in which most adults focus on their careers and work toward building their retirement funds. In 2020, the top 3 causes of occupational injuries involving days away from work were the following (NSC, 2021):

  1. Exposure to harmful substances or environments
  2. Overexertion, bodily reaction (most common site: back injury)
  3. Falls, slips, trips

“ Work-related medically consulted injuries totaled 4.26 million in 2021 (NSC, 2021)”.

Allied health professionals often perform ergonomic evaluations at worksites to decrease the risk of workplace-related injuries. A physical therapist may also be contracted to perform “back classes,” during which employees are taught proper lifting techniques and how to use proper body mechanics when performing the tasks related to their job. This can be especially important in repetitive jobs.

Older Adults: Aged 65 and Older

Physiologic Differences of the Older Adult

The later years are a time of significant physical and physiological changes for adults 65 years and older. These physical and physiological changes, the increased prevalence of and risk for acute and chronic diseases, and the emotional, psychological, and social issues particular to aging adults require assessment and screening specific to this age group.

The physiological, physical, and cognitive aging-related changes are particularly interesting. Some of the physiological and physical changes associated with aging are (Kane et al., 2018):

  • Atrophy of sweat glands
  • Decreased bladder muscle tone
  • Decreased bone density
  • Decreased immune system function
  • Decreased liver size
  • Decreased muscle mass
  • Decreased production of skin oils
  • Decreased renal mass and loss of glomeruli
  • Decreased sensitivity of baroreceptors
  • Decreased strength of respiratory muscles
  • Decreased visual acuity
  • Hearing difficulty
  • Loss of muscle strength 

Cognitive changes in aging adults are universal and individual. The cognitive decline that is noticeable and problematic is not an inevitable consequence of aging. However, cognitive ability does change with aging, and clinicians would do well to remember these when assessing an older patient (Kane et al., 2018).

  • Memory of recent events may not be as good.
  • Divided attention, the so-called multi-tasking, is less easily done by older adults.
  • Verbal ability is preserved, but it may take an older adult more time to recall a word or name.
  • Problem-solving that requires a new and unfamiliar approach may take longer.
  • Information processing slows down with age.

The Assessment and Examination of the Older Adult

The assessment of an aging adult should focus on the issues specific to this age group. A commonly used approach is the Comprehensive Geriatric Assessment (CGA). Ward and Rueben (2018) state that the CGA is “a multidisciplinary diagnostic and treatment process that identifies a frail older person's medical, psychosocial, and functional limitations.” The CGA can be structured in different ways, but it typically includes an assessment of the abilities and health status parameters. This includes parameters such as functional capacity, fall risk, cognition, mood, polypharmacy, social support, financial concerns, goals of care, advanced care preferences, nutrition, continence, sexual function, vision/hearing, dentition, and living situation. It may include spirituality (Ward & Reuben, 2018).

Assessment and examination are processes of information gathering and information exchange, and with this in mind, they must be adjusted to accommodate the aging adult. A family member may well accompany the aging adult, and evidence indicates that this improves patient satisfaction with the assessment and examination and improves the amount and quality of information retained by the patient.

When considering the physiological and anatomical changes associated with aging, these are areas in which rehabilitation specialists are experts: improving strength and muscle mass, improving balance, encouraging exercise to improve bone density and lung capacity, decreasing frailness, maintaining or improving independence and quality of life. It is important to consider proper resistance, rest, and activity dosage to create challenging activities for strength, balance, endurance, and improved overall function. However, studies suggest an overall underdosing of exercise in older adults.

Common Safety Issues of Older Adults

Multiple safety issues affect older adults, with falls and burns being the most common causes of unintentional injury (Healthinaging.org, 2019). The healthcare professional needs to screen for these safety issues when treating an older adult, as older adults live alone and independently longer than previously. Older adults sometimes do not make changes needed for safety and continue to do things the way they always have until an accident occurs. Small changes can make a big difference in preventing unintentional injuries.

Falls

graphic listing injuries related to falls in the elderly

Falls in the Elderly

A simple fall can cause serious injury in the older adult, such as breaking a bone, leading to expensive medical costs and the possibility of more serious health problems or long-term disability (NIAb,nd). Falls are a common event in older adults, and it has been estimated that more than one in four people over 65 years fall annually (NIAb,nd). Multiple risk factors contribute to falls in the elderly, including (but not limited to):

  • Decreased eyesight, hearing, or reflexes
  • Medical conditions like dementia or stroke, diabetes, neuropathy
  • Adverse effects of medications
  • Orthostatic hypotension
  • Age-related loss of muscle mass or problems with balance and gait
  • Safety hazards in the home
  • History of past falls

A fall risk assessment is recommended for all older adults, at least once a year, and more frequently for at-risk patients. Screening involves questioning about fall history, gait, and balance. A formal fall assessment can be done if the patient or caretaker reports positively to the questions. Several well-validated screening tests for fall assessment include the Timed Get Up and Go, Berg Balance Scale, Falls Efficacy scale, Activity-Specific Balance Confidence scale, Five Times Sit to Stand Test, and the Tinetti Performance Oriented Mobility test. In addition to the performance-based balance assessment tests, additional screening should be performed on strength, range of motion, vision, cognition, and vestibular functions.

Home evaluations can include assessing the presence of stairs in the home, tripping hazards such as throw rugs or electrical cords, poor lighting, and proper footwear. Encourage the use of handrails whenever navigating stairs. Encourage the older adult to keep clutter on the floor to a minimum. Educate the older adult to turn on the lights and avoid walking in dark or dim lighting. Assessing the need for use or compliance with assistive devices, such as canes and walkers, is often necessary to improve safety. Install grab bars where needed, often in the shower or near the toilet. As part of a fall prevention program, an occupational therapist could evaluate and improve an older adult's ability to don and take off clothing.

Finally, assessment of risk-taking behaviors also needs to be evaluated, such as excessive alcohol consumption and adherence to medication schedules and dosages. Physical and occupational therapists are skilled at performing comprehensive evaluations to identify the root causes of falls and address them effectively.

Burns

According to the National Council on Aging, older adults are 3.5 times more likely to die in fires than the general population (Crosswhite-Chigbue, 2022). Common causes of fire in the age population result from cooking on the stove or oven, smoking, and using candles. Safety skills in the kitchen can be addressed by occupational therapists.

Elder Abuse

Elder abuse is a severe and pervasive safety issue for aging adults. According to the National Council on Aging, approximately 1 of every 10 Americans 60 years of age or older have experienced elder abuse, and it has been estimated that only 1 out of 14 cases of elder abuse are reported (NCOA, 2021). Elder abuse has been defined in different ways. Still, it is typically considered intentional actions that either cause harm or a risk of harm done by a caregiver or someone in a position of trust (NCOA, 2021). The types and definitions of elder abuse are (NCOA, 2021).

  1. Physical Abuse: Inflicting injury or pain.
  2. Sexual Abuse: Nonconsensual touching or sexual activities.
  3. Emotional abuse: verbal assaults, threats of abuse, harassment, or intimidation.
  4. Confinement: restraining or isolating an older adult other than for medical reasons.
  5. Passive Neglect: Failing to provide the necessities of life.
  6. Willful deprivation: denying an older adult medication, medical care, shelter, food, a therapeutic device, or other physical assistance and exposing the person to the risk of physical, mental, or emotional harm.
  7. Financial Exploitation: Failing to provide the necessities of life.

Signs of elder abuse vary depending on the type of abuse. Some signs to watch out for in older adults include the individual seeming withdrawn, isolated from family or friends, having unexplained bruises, burns/ scars, appearing dehydrated, dirty, or having not received needed medical care, and recent changes in their spending patterns(NIAa, nd). Several professional organizations recommend screening patients for elder abuse; many screening tools are available.

Case Study Follow-Up

Martha explains to Rita that her teenage daughter may struggle to ‘fit in’ with her peers. She suggested that Rita attempt a mother-daughter outing of some type and have an honest conversation about bullying in teenagers. Martha also shares with Rita the stopbullying.gov website that explains the prevalence of cyberbullying in teenagers. Rita understands that she needs to reassure her daughter that she is welcome to share all her feelings and issues with Rita.

Martha also recommends that Rita have her mother see a physical, occupational, and speech therapist. Together, These disciplines can help identify her mother’s current level of strength, balance, cognition, and activity tolerance- which will help develop a list of safe activities that her mother can engage in. In addition, an occupational or physical therapist can also assess her home environment and make suggestions on modifications that can reduce the risk of falls.

Finally, Martha recommends that Rita carve some time for herself and engage in outdoor recreation. This will slowly allow her to explore more opportunities for leisure, and she will feel energetic to exercise more. Martha explains to Rita that exercise is a way to relieve stress but is also beneficial in reducing the risk of osteoporosis.

Conclusion

Allied healthcare professionals need to be aware of the updated developmental milestones to treat patients optimally across their lifespans. Considering a person's age-appropriate motor, language, and cognitive capabilities when planning an assessment and developing treatment plans and interventions will improve trust and compliance between the patient and the healthcare provider. Allied healthcare providers must also be aware of common safety issues within each age population. Educating and improving the patient's safety can be of great value. Healthcare professionals must report child abuse according to professional ethics codes, the standards of healthcare facilities, and state and local statutes.

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Implicit Bias Statement

CEUFast, Inc. is committed to furthering diversity, equity, and inclusion (DEI). While reflecting on this course content, CEUFast, Inc. would like you to consider your individual perspective and question your own biases. Remember, implicit bias is a form of bias that impacts our practice as healthcare professionals. Implicit bias occurs when we have automatic prejudices, judgments, and/or a general attitude towards a person or a group of people based on associated stereotypes we have formed over time. These automatic thoughts occur without our conscious knowledge and without our intentional desire to discriminate. The concern with implicit bias is that this can impact our actions and decisions with our workplace leadership, colleagues, and even our patients. While it is our universal goal to treat everyone equally, our implicit biases can influence our interactions, assessments, communication, prioritization, and decision-making concerning patients, which can ultimately adversely impact health outcomes. It is important to keep this in mind in order to intentionally work to self-identify our own risk areas where our implicit biases might influence our behaviors. Together, we can cease perpetuating stereotypes and remind each other to remain mindful to help avoid reacting according to biases that are contrary to our conscious beliefs and values.

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