Vartes Io-A2 Final Version

VIRTUAL & AUGMENTED REALITY TOOLKIT TO ENGAGE ELDERLY BRAIN
WITH INTER-GENERATIONAL UNDERSTANDING
ERASMUS+ PROJECT
Intellectual Output 1-A2:
CARE AWARENESS GUIDE
Version 1 (2020): 27-11-2020
PROJECT NUMBER – 2020-1-ES01-KA204-082270

Project information
Project title: Virtual & Augmented Reality Toolkit to Engage Elderly Brain with Inter-
Generational Understanding
Project acronym: VARTES
Funding European Commission, Erasmus+ Programme, Key Action 2
Grant agreement: 2020-1-TR01-ES204-082270
Project dates 01-09-2020 - 31-08-2022
Coordinator: STUCOM SA
Date of publication: 30.04.2021
Document version: 1
Disclaimer
"Funded by the Erasmus+ Program of the European Union. However, European Commission and
Spanish National Agency cannot be held responsible for any use which may be made of the
information contained therein”.
PROJECT NUMBER – 2020-1-ES01-KA204-082270 2

Contents
INTRODUCTION ......................................................................................................................... 5
CARE AWARENESS GUIDE ...................................................................................................... 6
1. Common Facts about Health in Elderly ............................................................................. 8
References................................................................................................................................ 11
2. Changes That Occur In Their Body and Mind .................................................................. 13
2.1. Cardiovascular System ............................................................................................. 13
2.2. Respiratory system................................................................................................... 15
2.3. Gastrointestinal System ........................................................................................... 15
2.4. Urinary System ......................................................................................................... 16
2.5. Endocrine System..................................................................................................... 17
2.6. Nervous System ....................................................................................................... 17
2.7. Immune System ....................................................................................................... 19
2.8. Musculoskeletal System........................................................................................... 20
2.9. Sensory Changes ...................................................................................................... 21
References................................................................................................................................ 23
3. How to Empower Elderly with Cognitive Skills ................................................................ 26
3.1. Preserving and Maintaining Physical Health............................................................ 27
3.2. Management of High Blood Pressure ...................................................................... 28
3.3. Healthy Nutrition ..................................................................................................... 28
3.4. Being Physically Active ............................................................................................. 29
3.5. Keeping the Mind Active .......................................................................................... 29
3.6. Participating in Social Activities ............................................................................... 29
3.7. Stress Management ................................................................................................. 30
3.8. Reducing Cognitive Health Risks .............................................................................. 30
References................................................................................................................................ 31
4. How Important Safety Measures Are For Elderly ............................................................ 34
4.1. Safety List ................................................................................................................. 35
4.2. In-House Arrangements ........................................................................................... 36
4.3. Kitchen ..................................................................................................................... 37
4.4. Bedroom................................................................................................................... 38
4.5. Living Room .............................................................................................................. 38
4.6. Bathroom and Toilets............................................................................................... 39
4.7. Laundry Room / Basement and Garage ................................................................... 39
4.8. Ensuring Home Security ........................................................................................... 40

References............................................................................................................................ 40
5. How Cultural / Learning Issues Can Improve the Life and Health of Elderly ................... 42
5.1. Cultural Issues .......................................................................................................... 42
5.2. Learning Issues ......................................................................................................... 45
5.3. The Effects of Cultural/Learning Issues to Life and Health of Elderly ..................... 47
5.4. The Positive Effect of Using VAR in the Work with the Elderly and Good Practices48
References................................................................................................................................ 51
6. Intergenerational Strategies to Interact With Elderly ..................................................... 55
6.1. Embedding Intergenerational Activities in the Educational Work .......................... 58
6.2. Involving in the Process of Developing Intergenerational Learning Programs ....... 61
6.3. Developing a Series of Courses ................................................................................ 63
References................................................................................................................................ 66
7. Important Points in Elderly Care ...................................................................................... 69
7.1. Physiological Changes, Problems, and Care Practices in Elderly People ................. 69
7.2. Geriatric Assessment ............................................................................................... 75
7.3. General Care of The Elderly ..................................................................................... 76
Reference ................................................................................................................................. 80
8. How Conditions Elderly Face As They Age Should Be Taken Into Account When Creating
VAR Content for Them ............................................................................................................. 85
8.1. Ageing of Societies ................................................................................................... 85
8.2. The Housing Situation of Elderly People .................................................................. 88
8.3. Types of Care ............................................................................................................ 89
8.4. Pensions ................................................................................................................... 90
References................................................................................................................................ 93

INTRODUCTION
Technological change and population ageing are affecting how we work, and many adult
learning systems are poorly prepared for the challenges ahead so, adult learning systems
need to face the changing needs of the labour market and society. The share of elderly
people in the EU continues to increase. The elderly population is known to play an
essential role in the world economy and society on a global scale but they tend to be
"excluded” from several opportunities. Therefore, the European Commission defined as
part of its inclusion policy, the goal of fostering ‘active ageing’ to contribute to the
economy and society.
(VR) and (AR) technologies are finding applications to help the elderly improve their
lives. There is thus a need that both VR and AR are exploited within the EU to help elderly
citizens to live longer, healthier, and independently. This combination of health and ICT
tools is currently not covered in the key competencies of adult education and to get future-
ready, we must anticipate these skills to design of a better adult learning policy.
“Virtual & Augmented Reality Toolkit to Engage Elderly Brain with Inter- Generational
Understanding-VARTES” Project, funded by Spanish National Agency under the
Erasmus+ Program Key Action 2 Strategic Partnerships, aims to empower adult trainers
and trainees in Care Attendance and IT with skills that will help to improve elderly' lives,
using a peer cooperative approach. They will help each other to co-create joint solutions
involving VAR (Virtual and Augmented Reality) that will enhance the elderly life and
memory by using an intergenerational approach. It also wants to foster an entrepreneurial
spirit in Adult learners and to motivate them to exploit further content addressed to the
needs of more elderly using VAR. Participants will implement the VAR content on more
elderly and will get the tools for acquiring entrepreneurial skills related to the topic. For
more info about VARTES project, the partnership, its outputs, and other activities, you
can visit VARTES project website.

CARE AWARENESS GUIDE
The potential co-presence triggered by VR and AR are playing an increasingly significant

role and especially in the world of the elderly. Because of this, VARTES project prepared
the Intellectual Output 1 called “Digital Guidelines For Adult Training in
Intergenerational Understanding Using VAR”. These Digital Guidelines aim to help adult
students and trainers learn about how to achieve the cognitive rehabilitation training and
knowledge stimulation of the elderly population by using Virtual and Augmented reality
tools. The Digital Guidelines of VARTES project will also help to improve the curricula
of the participants on fields not previously designed for them. At the same time, they will
contribute to helping to support and understand a social sector that needs to be more
included in society.
The Digital Guidelines have three parts:
• VR and AR Empowerment Guide

• Care Awareness Guide
• Training Videos
Care Awareness Guide offers complete information and guidelines related to elderly care
in eight sections. In the first section, common facts about health in the elderly, the
definition of ageing and classification of ageing, and healthy ageing will be explained and
detailed information will be given. In the second section, changes that occur in the
elderly’s body and mind will be explained detail. Especially changes in the cardiovascular
system, respiratory system, gastrointestinal system, urinary system, endocrine system,
nervous system, immune system, musculoskeletal system, and sensory changes will be
clarified.
After giving information about the common facts about health in the elderly and the
changes that occur in the elderly’ body and mind, the ways and techniques to empower
the elderly with cognitive skills will be discussed in the third section. In this section,
detailed information will be given about preserving and maintaining physical health,
management of high blood pressure, healthy nutrition, being physically active, keeping
the mind active, participating in social activities, stresses management, and reducing
cognitive health risks. In the fourth section, the importance of safety for the health of the

elderly will be explained, and a list of safety, which should be posted in a corner of the
house to raise the awareness of the elderly and those around them, will be given.
In the fifth section, how cultural / learning issues can improve the life and health of the
elderly will be explained. In the sixth section, intergenerational strategies to interact with
the elderly will be discussed. After giving detailed information about these issues,
important points for care in the elderly will be discussed in the seventh section.
Finally in the eighth section, how conditions the elderly face as they age should be taken
into account when creating VAR content for them will be discussed. Thus, caregivers,
families, and the elderly will know how to use VAR to increase the life quality of the
elderly.
This guide will be essential to learn the difficulties the elderly face when creating
customized VAR tools for them and learn about the methodology needed to empower
them to share their knowledge and to acquire a new one.

1. Common Facts about Health in Elderly
The world’s population reached 7.7 billion in mid-2019, by having added one billion
people since 2007 (World Population Prospects 2019). People worldwide are living
longer and getting older (Ageing and Health, 2018; Buskens et al., 2019). The number of
people aged 60 years and older in the population is increasing. In 2019, the number of
them was one billion and it is estimated that this number
will increase to 2.1 billion by 2050 (Preston & Biddell, QR Code 1:
World Population
2020). While life expectancy at birth for the world’s Prospects 2019.
population reached 72.6 years in 2019 and it is estimated
that the average length of life globally of around will be
77.1 years in 2050 as a result of further improvements in
survival (World Population Prospects 2019). For more
information on World Population Prospects, scan QR
Code 1).
Ageing is a lifelong process and it is a natural, ongoing, universal, and heterogeneous

phenomenon (Buskens et al., 2019; del Pilar Díaz-López, López-Liria, Aguilar-Parra, &
Padilla-Góngora, 2016). It is classified as biological ageing, psychological ageing, social
ageing, chronological ageing, and functional ageing (Chalise, 2019).
• Chronological ageing is defined as “the number of years a person has lived so

far”.
• Biological ageing is defined as “involves the loss of cells over time”.
• Psychological ageing is defined as “involves changes in memory, learning,
intelligence, personality, and coping”.
• Social ageing is defined as “the changes in roles and relationships as we age”.
• Functional ageing is related to how people compare psychologically to others of
similar age (Chalise, 2019).
Life expectancy throughout the world has increased dramatically over the past century
(Chia, Egan, & Ferrucci, 2018). Improved health care, hygiene, appropriate medical care,
and healthier lifestyles have contributed to this advantage (Borras et al., 2020). The
ageing population presents opportunities, such as a chance to pursue new activities –
education, a new career, etc. ("Ageing and Health," 2018). The vast majority of elderly

live in the community and adapt well to the changes (Bonder & Dal Bello-Haas, 2017).
Many of them continue to participate in meaningful occupations that contribute to the
quality of life (Bonder & Dal Bello-Haas, 2017). Furthermore, it contributes to the
intergenerational transferring of cultural knowledge and values.
Increased life expectancy also brings about some challenges related to physical, social,
and cognitive changes by ageing (Rodrigues, Herdeiro, Figueiras, Coutinho, & Roque,
2020). Complex physiological, social, economic, and psychological challenges often
present themselves by age (Mauk, 2018). Many of the alterations are characterized by a
decline in physiological reserve (Boltz, 2016). While every elderly is different from each
other, as it is known physical and mental capacity tend to decline during ageing (Gemma,
2020). Age-related changes are strongly impacted by genetics as well as by long-term
lifestyle factors, such as diet, alcohol consumption, tobacco use, and physical inactivity
(Boltz, 2016).
The changes with age often cause to decline in bodily functions (Chalise, 2019). The
elderly often have multiple conditions that interact to affect function (Bonder & Dal
Bello-Haas, 2017). However, a decline in function is different from the loss of function
that results from diseases (Chalise, 2019). Age-related changes predispose the elderly to
selected diseases (Boltz, 2016). The major population burdens of disability and death in
people over 60 arise from age-related losses in hearing, seeing, and moving, and
conditions, such as dementia, heart disease, stroke, chronic respiratory disorder, diabetes,
and osteoarthritis (World Health Organization, 2017).
Changes that occur with age strongly affect the health and functional status of the elderly
(Boltz, 2016). Some of these will be chronic, such as osteoporosis, arthritis, and diabetes,
superimposed may be acute illnesses, such as urinary tract infections of influenza (Bonder
& Dal Bello-Haas, 2017). At the biological level, ageing results from the impact of
molecular and cellular damage over time (Ageing and Health, 2018). Physical changes
due to ageing can occur in almost every organ and can affect the elderly health and
lifestyle. Physical injuries, mobility and balance impairments, dental problems are
particularly common among older adults (Ástvaldsdóttir et al., 2018; Bobić Lucić &
Grazio, 2018). Beyond biological changes, ageing is also associated with other life
transitions, such as retirement, and the death of relatives (Ageing and Health, 2018). As
people get older, physiological changes occur in their bodies as a natural part of ageing

(Gemma, 2020). Some of the challenges of elderly are losing friends, grappling with the
meaning of life, maintaining the quality of life during increased disability, adapting to the
retirement process, and contemplating death (Mauk, 2018). In this way, depression, social
isolation, and loneliness are particularly common among older adults who are susceptible
to the effects of those (Dury, 2014; Wiederhold, 2018).
Health is a key determinant for not just adding more years to life, but adding more life to
years (Mauk, 2018). In other words, living longer does not always mean we will also have
a better or a good quality of life in later years (Chalise, 2019). Although once thought of
as merely the absence of disability and chronic disease with longevity, the term healthy
ageing has evolved to mean much more (Marsman et al., 2018). World Health
Organization (WHO) defines healthy ageing as “the process of developing and
maintaining the functional ability that enables wellbeing in older age.” Functional ability
is about having the capabilities that enable all people to be and do what they have reason
to value. This includes a person’s ability to: meet their basic needs; learn, grow and make
decisions; be mobile; build and maintain relationships; and contribute to society (Ageing:
Healthy ageing and functional ability, 2020).
Healthy ageing is the focus of WHO’s work on ageing

QR Code 2:
between 2015 – 2030 ("Ageing: Healthy ageing and The Decade of Healthy
Ageing.
functional ability," 2020). The Decade of Healthy Ageing
(2021-2030) was endorsed by the 73rd World Health
Assembly on 3 August 2020 (For more information on the
decade of healthy ageing, scan QR Code 2). The United
Nations General Assembly welcomed the Decade proposal
and decided to proclaim 2021-2030 the United Nations
Decade of Healthy Ageing on 14 December 2020 ("Decade of Healthy Ageing," 2020).
In light of the current situation, it supplies an opportunity to bring together governments,
civil societies, international agencies, academia, the media, and collaborative action to
improve the lives of older people, their families, and the communities in which they live.
The interest in ageing has progressed from understanding its origins, mechanisms, and
processes, to studying how to reduce, delay, or reverse its effects (Marsman et al., 2018).
Declining health and cognitive or physical functioning may necessitate moving to
supportive care environments for the elderly (Mauk, 2018). Being able to live in

environments that support and maintain the elderly intrinsic capacity and functional
ability is key to healthy ageing (Ageing: Healthy ageing and functional ability, 2020). For
this purpose, countries are supposed to plan for population ageing and ensure the well-
being of older persons by ensuring access to age-appropriate health care services, lifelong
learning opportunities, and formal and informal support networks (World Population
Prospects 2019). To sum up, designing interventions, educating patients and caregivers
about the age-related alterations, and sharing information with the healthcare team will
all serve to ensure optimal care for the elderly (Boltz, 2016).
References
Ageing and Health. World Health Organization. Available at: https://www.who.int/news-

room/fact-sheets/detail/ageing-and-health. Accessed 12.12.2020.
Ageing: Healthy ageing and functional ability. World Health Organization Available at:
https://www.who.int/westernpacific/news/q-a-detail/ageing-healthy-ageing-and-
functional-ability. Accessed 24.12.2020, 2020.
Ástvaldsdóttir Á, Boström A-M, Davidson T, et al. Oral health and dental care of older
persons—A systematic map of systematic reviews. Gerodontology.
2018;35(4):290-304.
Bobić Lucić L, Grazio S. Impact of Balance Confidence on Daily Living Activities of
Older People with Knee Osteoarthritis with Regard to Balance, Physical Function,
Pain, and Quality of Life – A Preliminary Report. Clinical Gerontologist.
2018/08/08 2018;41(4):357-365.
Boltz M, Capezuti, E., Fulmer, T. T. & Zwicker, D. Evidence-based geriatric nursing
protocols for best practice. . 5th Edition ed. Springer Publishing Company.:
Springer Publishing Company.; 2016.
Bonder BR, Dal Bello-Haas V. Functional performance in older adults. Forth Edition ed.
FA Davis. FA Davis.: FA Davis.; 2017.
Borras C, Ingles M, Mas-Bargues C, et al. Centenarians: An excellent example of
resilience for successful ageing. Mechanisms of Ageing and Development.
2020;186:111199.
Buskens E, Vogt TC, Liefbroer AC, et al. Healthy ageing: Challenges and opportunities
of demographic and societal transitions. Older people: Improving health and
social care: Springer; 2019:9-31.
Chalise HN. Aging: basic concept. Am J Biomed Sci & Res. 2019;1(1):8-10.
Chia CW, Egan JM, Ferrucci L. Age-related changes in glucose metabolism,
hyperglycemia, and cardiovascular risk. Circulation research. 2018;123(7):886-
904.
Decade of Healthy Ageing. World Health Organization. Available at:
https://www.who.int/initiatives/decade-of-healthy-ageing. Accessed 15.12.2020.

del Pilar Díaz-López M, López-Liria R, Aguilar-Parra JM, Padilla-Góngora D. Keys to
active ageing: new communication technologies and lifelong learning.
SpringerPlus. 2016;5(1):768.
Dury R. Social isolation and loneliness in the elderly: an exploration of some of the issues.
British Journal of Community Nursing. 2014;19(3):125-128.
Gemma H. World Health Organization launches new app to improve care for ageing
population. British Journal of Healthcare Management. 2020;26(1):48-49.
Marsman D, Belsky D, Gregori D, et al. Healthy ageing: the natural consequences of good
nutrition—a conference report. European journal of nutrition. 2018;57(2):15-34.
Mauk KL. Gerontological nursing: Competencies for care. . Jones & Bartlett Publishers.:
Jones & Bartlett Publishers.; 2018.
Preston J, Biddell B. The physiology of ageing and how these changes affect older people.
Medicine. 2020.
Rodrigues DA, Herdeiro MT, Figueiras A, Coutinho P, Roque F. Elderly and
Polypharmacy: Physiological and Cognitive Changes. Frailty in the Elderly-
Physical, Cognitive and Emotional Domains: IntechOpen; 2020.
Wiederhold B. K. (2018). Virtual reality enhances elderly' health and well-being. New
York: Mary Ann Liebert, Inc.
World Health Organization. Integrated care for older people: guidelines on community-
level interventions to manage declines in intrinsic capacity. 2017.
World Population Prospects 2019. United Nations, Department of Economic and Social
Affairs, Population Dynamics. Available at:
https://population.un.org/wpp/Publications/Files/WPP2019_DataBooklet.pdf.
Accessed 12.12.2020.

2. Changes That Occur In Their Body and Mind
Ageing is an unavoidable and irreversible process in human beings (Jaul & Barron, 2017;
Marotta, Zampini, Tinazzi, & Fiorio, 2018). While individuals differ from one another in
the timing, rates, and shape of life-span trajectories of physical and cognitive change, all
organ systems are exposed to physiological ageing albeit at different rates
(Navaratnarajah & Jackson, 2017; Tucker-Drob, 2019). It is well known that ageing is an
important risk factor for most diseases and conditions that limit health span (Franceschi
et al., 2018). The ageing body experiences several changes that may increase vulnerability
to disease (Chun, 2020). Oxidative stress and protein modifications have been forwarded
as significant etiological factors of ageing-related changes (Larsson et al., 2019).
2.1.Cardiovascular System
Cardiovascular disease remains the most common cause in death

of older adults (Jaul & Barron, 2017). Cardiac reserve declines in
normal ageing (Boltz, 2016). Ageing decreases the heart rate,
cardiac output, maximum exercise level and elevates systolic
blood pressure (Nagaratnam, Nagaratnam, & Cheuk, 2016b).
Ageing heart cells cause to diminish capacity to use oxygen that
may cause decreased tolerance for physical work (Linton, 2015).
Decreased functional reserves result in reduced exercise
tolerance, fatigue, shortness of breath, and tachycardia (Boltz,
2016). In the elderly, there may be some changes in the cardiac cavity, the response of
receptors, valves of the hearth, and coronary arteries.
Combined right and left ventricular failure is most common in the elderly
(Nagaratnam et al., 2016b). The left ventricular wall thickens, left atrium
hypertrophies, valves calcify and the heart fills with blood more slowly (Duque,
2016; Nagaratnam et al., 2016b).
The sympathetic response in the heart is blunt in the elderly because of decreased
beta-adrenergic responsiveness (Boltz, 2016; Nagaratnam et al., 2016b).
Baroreceptor function is impaired with age (Boltz, 2016). Impaired baroreceptor
sensitivity results from chronic hypertension and reduced arterial compliance

(Hechtman, 2020). After prolonged bed rest, dehydration, and cardiovascular drug
use, postural hypotension symptoms can occur (Boltz, 2016).
Valvular heart disease increases with age (Boltz, 2016). Age-related changes
include sclerosis of atrial and mitral valves. Because of these alterations, valves’
tight closure impairs and the risk of dysfunction occurs (Boltz, 2016). Aortic and
pulmonic valves become stiffer and if they do not close completely, murmurs
result (Linton, 2015). The number of pacemaker cells in the sinoatrial node
decreases. This increases the risk of atrial fibrillation of elderly (Boltz, 2016)
With ageing the heart and blood vessels become stiffer, thicken (Duque, 2016).
By age 20, thickening and calcification or the intimal layer of the aorta and
coronary arteries are evident (Linton, 2015). Age-related thickening of the arterial
wall and inflammation play an important role in atherogenesis (Chun, 2020;
Nagaratnam et al., 2016b). An increase in the wall thickness and stiffness of the
aorta and carotid arteries diminish vessel compliance and greater systemic
vascular resistance (Boltz, 2016). Arteries lengthen, dilate, and become more rigid
(Linton, 2015). Isolated systolic hypertension is the most common form in the
elderly because of arterial stiffness (Nagaratnam et al., 2016b). By 70 years of
age, the systolic blood pressure commonly increases to approximately 150 mm
Hg, and the diastolic blood pressure increase to approximately 90 mm Hg (Linton,
2015). Vascular changes, hypertension, and atherosclerosis increase the risk of
heart disease, myocardial infarction, stroke, and renal disease (Chun, 2020;
Linton, 2015).
The carotid disease results from atherosclerosis leading to plaque formation, plaque
ulceration, narrowing of the vessels in the thromboembolism, and carotid embolic disease
(Nagaratnam et al., 2016b). Many older adults have a blunted baroreceptor response such
that the body is not able to adapt to decreases in blood pressure (Chun, 2020). So that
many daily activities, such as excretion, postural changes, and eating may cause syncope
in the elderly (Nagaratnam et al., 2016b).

2.2. Respiratory system
The normal ageing process changes the pulmonary system and decreases its structural,
physiologic, and immunologic reserve (Tran, Rajwani, & Berlin, 2018). Respiratory
function slowly and progressively deteriorates with age. Normal lung function begins to
decline after the third decade of life (Tran et al., 2018). Several age-related changes
combine to impair the functional reserve of the pulmonary system (Boltz, 2016). With
ageing, respiratory muscles lose strength, lung tissues lose elasticity, the alveolar surface
area diminishes, and lung capacity is reduced (Knight & Nigam,
2017). While tidal volume is relatively stable with ageing,
residual volume increases (Linton, 2015). Changes in the lung
parenchyma, airway, chest wall, and respiratory muscles cause
functional decline (Tran et al., 2018). The net result of these
changes is a decrease in the alveolar surface area because of the
reduced efficient gas exchange (Bonder & Dal Bello-Haas,
2017).
It is known that cough reflexes and ciliary action are less effective during ageing (Linton,
2015). Reduced coughing reflex and a decline in ciliary activity the respiratory system is
less able to expel inhaled irritants and pathogens in the elderly (Knight & Nigam, 2017).
Pulmonary secretions are handled less effectively (Linton, 2015). The ventilatory
response to either a hypoxic or a hypercapnic stimulus is blunted in the elderly
(Navaratnarajah & Jackson, 2017). The modifications in ventilator capacity with age are
reflected in changes in pulmonary tests measuring lung volumes, flow rates, diffusing
capacity, and gas exchange (Boltz, 2016). Because of these age-related changes in the
respiratory system, both community and hospital-acquired respiratory tract infections are
a major risk factors for them (Knight & Nigam, 2017).
2.3. Gastrointestinal System
Age-related alterations in the oral cavity can affect the nutritional status of the elderly
(Boltz, 2016). The elderly complains about dry mouth due to decreased saliva secretion
(Akdeniz, Kavukcu, & Teksan, 2019). Decrease in saliva secretion, decrease in muscle
strength in jaw muscles and tongue, loss of teeth, decrease in sense of smell and taste
make feeding the elderly difficult (Akdeniz et al., 2019). Deterioration in the strength of

muscles of mastication, tooth loss, medications, and xerostomia because of dehydration
may reduce food intake (Boltz, 2016)
Age-related changes occur in esophageal function (Akdeniz et al., 2019). Swallowing

becomes slower and less efficient with age (Boltz, 2016). Pharyngeal muscle weakness
and reduced peristalsis of the esophagus lead to an increased risk of reflux and aspiration
(Preston & Biddell, 2020). Secretion of hydrochloric acid and pepsin decrease and an
associated small rise in gastric pH (Navaratnarajah & Jackson, 2017). Chronic atrophic
gastritis is more common in the elderly and is associated with helicobacter pylori infection
(Gao, Zhang, & Brenner, 2017). An increased prevalence of atrophic gastritis and delayed
gastric emptying cause to increased susceptibility to mucosal damage (Preston & Biddell,
2020).
Ageing is associated with several changes in gastrointestinal physiology and function,

which can impact the amount and types of nutrients delivered to the small intestine and
colon (An et al., 2018). The colon is the gastrointestinal organ most affected by ageing.
Stool storage capacity and transit time are prolonged due to mucosal changes, decreased
motility, and weakening of muscle structure (Akdeniz et al., 2019). Prolonged transit time
associated with ageing can result in constipation (Navaratnarajah & Jackson, 2017).
Moreover, there is an alteration of the hepatic metabolism of medications (Preston &
Biddell, 2020). Associated with changes in the hepatic system, clearance of a range of
medications, such as benzodiazepines declines to result in increased dose-dependent
adverse reactions (Boltz, 2016).
2.4. Urinary System
In the ageing population, there is a reduction in the number, size, and functions of
nephrons, sclerosis of the glomeruli, and thickening of the glomerular basement
membrane (Akdeniz et al., 2019; Preston & Biddell, 2020). The
glomerular filtration rate is impaired (Navaratnarajah & Jackson,
2017). Moreover, the activity of regulatory hormones diminishes by
age. Age-related changes of the kidney decrease the ability to adapt to
acute ischemia and heighten susceptibility to acute and chronic kidney
diseases (Akdeniz et al., 2019; Navaratnarajah & Jackson, 2017;
Preston & Biddell, 2020).

Age-related changes in the lower tract include reduced bladder elasticity and innervation
that cause decreases in urine flow rate, voided volume, and bladder capacity (Boltz,
2016). In older men, benign prostatic hyperplasia can result in urinary urgency hesitancy
and frequency (Boltz, 2016). Besides changes in the urinary tracts, such as increased
vaginal pH and decreased antibacterial activity of urine contribute to the development of
bacteriuria (Boltz, 2016).
2.5. Endocrine System
The certain effects of ageing on the endocrine system are not clear. The endocrine system
has not been implicated as the direct cause of ageing (Goodman & Fuller, 2020). While
the endocrine glands atrophy to varying degrees, they can still maintain normal function
in the absence of stressors (Hechtman, 2020). Age-related cellular damage and chronic
wear and tear might contribute the endocrine gland dysfunction or alterations in the
responsiveness of target organs (Goodman & Fuller, 2020).
The thyroid gland becomes smaller and fibrotic. Both hypo- and hyperthyroidism are
more common in the elderly (Preston & Biddell, 2020). The parathyroid gland has tissue
changes by age however the parathyroid hormone level has no major change (Goodman
& Fuller, 2020). However parathyroid hormone levels are increased with ageing and this
is implicated in the development of osteopenia and osteoporosis (Hechtman, 2020).
2.6. Nervous System
It is well known that there are pervasive changes throughout various regions of the brain
across age (Juan & Adlard, 2019). Some of the age-related changes in the brain are
decreased intracerebral blood flow, changes in neurotransmitter levels, cognitive
impairment, and reductions in the neuron population (Duque, 2016). Ageing produces a
decrease in neural density and there is an age-related deficiency of important central
neurotransmitters, including catecholamines, serotonin, and acetylcholine in the elderly
(Navaratnarajah & Jackson, 2017). Mild short-term memory loss, word-finding difficulty,
and slower processing speed are the normal processes of ageing (Jaul & Barron, 2017).
There is a significant reduction in signal transduction rate within the brainstem and spinal
cord (Navaratnarajah & Jackson, 2017).

Human cognitive function changes throughout the life span, from infancy through old age
(Tucker-Drob, 2019). In the general population, average levels of cognitive function
increase across childhood, peak in adulthood, and decline into old age (Tucker-Drob,
2019). It is important to note that the rate and degree of cognitive decline vary widely
across individuals (Harris & Korolchuk, 2019). For example, some 70 years olds have
better memory than other 60 year olds. This may be caused by biological, psychological,
health-related, environmental, and lifestyle factors and mechanisms. Cognitive function
is an umbrella term that encompasses many different distinct cognitive abilities, such as
fluid reasoning, processing speed, spatial ability, working memory, episodic memory,
learning, crystallized knowledge, procedural knowledge (Tucker-Drob, 2019).
Although cognitive decline is inevitable, the extent to which it occurs and the rapidity of
onset varies among individuals. There is much evidence that cognitive decline is not
uniform among people. The symptoms of cognitive decline associated with aging include:
Slower inductive reasoning / slower problem solving, diminished spatial orientation,
declines in perceptual speed, decreased numeric ability, losses in verbal memory, and few
changes in verbal ability.
Figure 1 shows how these functions decline with age. It can be seen in the Figure 1 that
there are almost no changes in verbal ability with age, but spatial orientation has a severe
drop with age.
Figure 1. Cognitive Decline with Ageing (Source: The biology of aging.

https://sphweb.bumc.bu.edu/otlt/MPH-Modules/PH/Aging/mobile_pages/Aging5.html)

A variety of risk factors can cause cumulative damage to the brain with age and give rise
to cognitive impairments (Murman, 2015). These factors include damage to the brain due
to cerebral ischemia, head trauma, alcohol, excess stress hormones, or the development
of degenerative dementia, such as Alzheimer’s (Murman, 2015).
Cognitive impairment and dementia may be associated with depressive symptoms. People
with dementia often present with complaints of mood or behavioral problems, such as
apathy, loss of emotional control, or difficulties carrying social activities (Organization,
2017).
Alterations of cognitive function result in age-associated reduction in speed of processing

and memory (Navaratnarajah & Jackson, 2017). The term “memory” is usually used the
describe various types of memory including sensory memory, short-term memory,
working memory, long-term memory, and prospective memory (Bonder & Dal Bello-
Haas, 2017).
Ageing is an important risk factor for the development of neurodegenerative diseases

including Alzheimer’s disease (AD), Parkinson’s disease, and Huntington’s disease (Juan
& Adlard, 2019). However, not all brain functions decline with age (Jaul & Barron, 2017).
Cumulative knowledge and experiential skills are well maintained into advanced age
(Murman, 2015).
The population of the elderly is unique and requires a thorough understanding of the life
span including healthy cognitive ageing (Bonder & Dal Bello-Haas, 2017).
Understanding the complex pattern of cognitive ageing can facilitate the development and
implementation of training programs and interventions (Bonder & Dal Bello-Haas, 2017).
2.7. Immune System
There are a wide variety of age-related changes in the immune system, some mediated by
chronic inflammation and a chronic pro-inflammatory state (Jaul & Barron, 2017). Loss
of lymphoid tissue and related decrease in immune functions during ageing is called
immune ageing (Akdeniz et al., 2019).
These age-related changes of the immune system can cause severe viral and bacterial
infections because vaccination efficacy declines with age (Boltz, 2016). The

immunological consequences of reduced B- and T-cell functions include the reduced
ability to generate immune memory to novel antigens. As a result of this, the reduced
vaccine efficacy and increased vulnerability to certain infections in the elderly (Titorenko,
2019). For instance, influenza vaccinations have a protection rate of only 56% in the
elderly (Boltz, 2016).
2.8. Musculoskeletal System
The musculoskeletal system performs many functions. The skeletal bones supply a
structure that gives the body its shape. The bone marrow produces erythrocyte,
leukocytes, and platelets. The muscles provide a power source to move the bones
(Williams, 2016). Because the amount of collagen decreases with age, the flexibility of
ligaments, tendons, muscles, and joints decline and this affects muscle function over time
(Harris & Korolchuk, 2019). Changes in bones, muscles, and joints and especially
degeneration in intervertebral discs cause neck shortening and posture disorders in the
elderly (Akdeniz et al., 2019).
Ageing reduces the density of cells in joint cartilages (Akdeniz et al., 2019). Age-related
changes in the joints are associated with pain and stiffness, which can affect mobility and
predispose to falls (Duque, 2016). As the number of chondrocytes and their ability to
repair tissue decreases with age, the cartilage hardens and shrinks and undergoes erosion
(Akdeniz et al., 2019).
Skeletal muscle is a vital organ to the body and muscle mass and strength decline starting
in the fourth decade of life (Jaul & Barron, 2017; McCormick & Vasilaki, 2018). The
ageing process is characterized by a decrease in muscle mass and strength (Akdeniz et
al., 2019).
Age-related muscle atrophy is associated with significant impairment of function, such

as slowing of movement and muscle weakness, and leads to the loss of independence of
the elderly (Larsson et al., 2019; McCormick & Vasilaki, 2018). The most prominent
morphological changes in muscles are a decrease in the number and size of muscle fibers,
a decrease in capillaries, increase in interstitial spaces and connective tissue (Akdeniz et
al., 2019). Postural changes can occur as a result of age-related loss of lower limb muscle
mass (Duque, 2016).

Insufficient calcium intake and excessive loss of calcium from bone may result in
osteoporosis. Osteoporosis makes the bones porous, brittle and fragile (Williams, 2016).
Loss of gonadal functions and ageing are two important factors contributing to the
development of osteoporosis (Akdeniz et al., 2019). People that have osteoporosis can
easily have fractures of the hip, ribs, clavicle, and wrist because of simple traumas or falls
(Williams, 2016).
2.9. Sensory Changes
The brain may be impaired in its integration of normal afferent signals on vision,
smelling, and hearing (Duque, 2016). Impaired sensory functioning impacts the quality
of life of older people. The effect of sensory impairments in the elderly includes not only
bodily functions and capacity for action, but also depression and social isolation (Tseng,
Liu, Lou, & Huang, 2018).
2.9.1. Hearing
Hearing disorders are most common in the elderly (Löhler et al., 2019). The most
common hearing disorder in the elderly is peripheral presbycusis (Fioretti, Poli,
Varakliotis, & Eibenstein, 2014). Changes within the cochlea, increased earwax
production with ageing and presbycusis, contribute to difficulty hearing (Fioretti et al.,
2014; Jaul & Barron, 2017). On the other hand, in the inner ear, changes, such as the loss
of elasticity of the eardrum with age, calcification in the middle ear ossicles, the loss of
elasticity of the vessels leading to the ear, and the inability to carry enough blood is
observed (Akdeniz et al., 2019). Changes to the vestibular system of the inner ear cause
balance problems in the elderly (Knight, Wigham, & Nigam, 2017).
2.9.2. Vision
Eye and vision are affected both structurally and functionally by ageing (Akdeniz et al.,
2019). Age-related changes of eyes are first noticed as problems with near work due to
loss of accommodation and later as decrease in visual acuity due to changes in the lens
and retina (Rizzo, Anderson, & Fritzsch, 2018). Glaucoma and corneal dryness are the
most common problems in the elderly.

Another age-related change in the eye is glaucoma
as a result of increased lens thickness (Rizzo et al.,
2018). Glaucoma is initially characterized functionally
by loss of peripheral vision (Rizzo et al., 2018).
With age, the lacrimal glands produce fewer tears
and the wetting efficiency and stability of the tear are
reduced (Knight et al., 2017). Corneal dryness,
secondary abrasion, redness, and irritation may develop
as the eyelids cannot completely close the eye during
sleep due to the loss of strength in the eye muscles
(Akdeniz et al., 2019). Age-related visual impairments
predispose to some problems, such as falls by limiting
the capacity to perceive and interact with stimuli from
the environment (Duque, 2016).
2.9.3. Taste and smell
Glandular atrophy is the most common change in the nose during ageing. Atrophy of
goblet cells and submucosal serous glands causes its density to increase while decreasing
the amount of mucus produced (Akdeniz et al., 2019). Alterations related to taste and
smell may lead to poor appetite and weight loss in the elderly (Ogawa, Annear, Ikebe, &
Maeda, 2017). A decreased appetite also may result in a side effect of medications.
2.9.4. Skin
Although some structural and functional changes that occur in the skin with ageing do
not threaten life, they may adversely affect the quality of life (Akdeniz et al., 2019).
Ageing skin shows greater sensitivity to excessively dry skin (xerosis) and irritant
dermatitis (Akdeniz et al., 2019). With age, thinning of the epidermis and reduction of
fibroblasts, mast cells, subcutaneous tissue, and vascular structure lead to increased
susceptibility to shearing and friction skin breaks, as well as pressure damage (Akdeniz
et al., 2019; Preston & Biddell, 2020). Reduced vitamin D synthesis in the skin leads to
decreased calcium absorption and predisposes to osteopenia and osteoporosis (Hechtman,
2020).

2.9.5. Sleep Disturbances
Ageing is associated with a reduced ability to initiate and maintain sleep (Mander, Winer,
& Walker, 2017). Melatonin release secreted by the brain during sleep, especially at night,
decreases due to changes in the sleep cycle in the elderly (Ağar, 2020). Chronic diseases,
which are more common with age, depression, anxiety, and fear of death, pain, nocturia,
and some medications can cause insomnia, and elderly patients often express that they
cannot sleep due to decreased sleep quality (Ağar, 2020).
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Duque G. Age-Related Physical and Physiologic Changes and Comorbidities in Older
People: Association with Falls. In: (eds) Medication-Related Falls in Older
People. . Adis, Cham. : Adis, Cham. ; 2016.
Fioretti A, Poli O, Varakliotis T, Eibenstein A. Hearing Disorders and Sensorineural
Aging. Journal of Geriatrics. 2014/01/22 2014;2014:602909.
Franceschi C, Garagnani P, Morsiani C, et al. The Continuum of Aging and Age-Related
Diseases: Common Mechanisms but Different Rates. Frontiers in medicine.
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Gao X, Zhang Y, Brenner H. Associations of Helicobacter pylori infection and chronic
atrophic gastritis with accelerated epigenetic ageing in older adults. British
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Goldstein BJ, Müller-Wieland D. Type 2 diabetes: principles and practice: CRC Press;
2016.
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Physical Therapist: Elsevier Health Sciences; 2020.

Harris JR, Korolchuk VI. Biochemistry and Cell Biology of Ageing: Part II Clinical
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3. How to Empower Elderly with Cognitive Skills
Cognitive health is the ability to think, learn, and remember, and an important component
of performing daily activities (U.S Department of Health
QR Code 1:
U.S. Department of and Human Service National Institute of Aging, 2020) (For
Health and Human
more information about cognitive health, scan QR Code 1).
Service National
Institute of Aging. People experience both physical and cognitive changes as
they age (Rut, Jose, & Antonieta, 2018). Active agieng is a
process in which a person continues to use and even
develops his strengths by focusing on them rather than his
losses. It is known that individuals experience deficiencies
especially in the areas of attention, memory, visual and auditory perception with ageing,
on the contrary, active elderly people have more internal memory strategies by
overcoming the average obstacles and they are less distracted (Ebaid et al., 2019; André
et al., 2018).
Older adults are more afraid of losing their mental abilities than their physical abilities.
Besides, it is suggested that new approaches arising from a better understanding of risk
factors for cognitive impairment are much more promising than current drug therapies
(Kueider, Krystal, & Rebok, 2014).
Cognition is the combination of processes such as attention, learning, and reacting to

surrounding objects, using language and memory. If cognition becomes weak, the person
may have difficulty performing daily tasks. In a study done by Sala et al. (2019), it has
been found that the participation of elderly people in leisure activities (playing shogi,
practicing tai chi, and going to a public bath) contributes to three basic dimensions of
successful ageing (i.e. cognitive function, physical function, and mental health). This
study supports the view that an active lifestyle in elderly people is a universal and
culturally independent tool that does not change between different countries and cultures
and contributes to successful ageing (Rebok et al., 2014).
Structural and functional changes in the brain are related to age-related cognitive changes,
including changes in neuronal structure without neuronal death, loss of synapses, and
dysfunction of neuronal networks. Age-related diseases accelerate the rate of neuronal
dysfunction, neuronal loss, and cognitive decline, and cause severe cognitive disorders

that disrupt daily life activities in many people. However, it is stated that healthy lifestyles
can reduce the rate of cognitive decline seen with age and help delay the onset of cognitive
symptoms in cases of age-related diseases (Murman, 2015). Although it is thought that
the loss of cognitive functions (memory, attention, maintaining social relationships,
coping with diseases) is inevitable with ageing, human and animal studies show that the
brain can be shaped in every period of life (Kueider, Krystal, & Rebok, 2014). It is stated
that engaging in mental stimulation activities can increase cognitive reserve (Cheng,
2016). In a study done by Kouzuki et al. (2020), it has been found that physical exercise,
cognitive training, and education on lifestyle habits improve cognitive and physical
function in elderly individuals with suspected mild cognitive decline.
Protecting the physical health of the elderly can help maintain cognitive health. In
addition to characteristics such as genetics, personality, and mood, it is also important to
adopt and implement healthy lifestyles and to carry out mental activities in the protection
of cognitive functions in old age and preventing or delaying impairments. It has been
stated that there is a link between the protection of physical health in the elderly,
controlling high blood pressure, healthy eating, being physically active, keeping the mind
active, participating in social activities, stress management, and reducing risks to
cognitive health and cognitive health (U.S Department of Health and Human Service
National Institute of Aging, 2020).
3.1. Preserving and Maintaining Physical Health
• Recommended health screening should be done.

• Chronic health problems, such as diabetes, high blood pressure, depression, and
high cholesterol, should be managed.
• Healthcare professionals should be consulted about the drugs used and the
possible side effects of these drugs on memory sleep and brain function.
• The risk of brain injuries caused by falls and other accidents should be reduced.
• Limiting alcohol use (some drugs can be dangerous when mixed with alcohol).
• Smoking should be quit.
• Adequate sleep (seven to eight hours) (U.S Department of Health and Human
Service National Institute of Aging, 2020).

3.2. Management of High Blood Pressure
Preventing or controlling high blood pressure can help not only your heart but also your
brain (U.S Department of Health and Human Service National Institute of Aging, 2020).
Hypertension is a risk factor that can be modified by antihypertensive therapy, which
reduces the risk of stroke and potentially slows down cognitive decline. However, optimal
blood pressure levels have not yet been determined
to maintain ideal age-related mental performance
(Tadic et al., 2016). Regularly taking a drug, stress
management, a diet without a salt, healthy diet,
regular exercise, and regularly monitoring blood
pressure are important for optimal blood pressure
level.
3.3. Healthy Nutrition
Healthy nutrition can help to reduce the risk of many chronic diseases, such as heart
disease and diabetes, and keep the brain healthy. Researchers are investigating whether
healthy nutrition can help preserve cognitive function and reduce Alzheimer's risk (U.S
Department of Health and Human Service National İnstitute of Aging, 2020). For
example, it has been found that there is some
evidence that people who consume the
Mediterranean diet have a lower risk of developing
dementia. Moreover, the researchers have
developed another diet called the Mediterranean-
DASH Intervention for Neurodegenerative Delay
(MIND) (U.S Department of Health and Human Service National Institute of Aging,
2020). Research observing changes in the thinking of people consuming the
Mediterranean or MIND diet suggests that this may help the brain. There are several
studies done on healthy nutrition by Mosconi et al., (2018), Berti, Walters, Sterling, &
Quinn, (2018), Morris et al., (2016), and Keenan et al., (2020).

3.4. Being Physically Active
It is stated that being physically active by doing regular exercise, household chores, and
performing other activities has many benefits. It is also stated that physical activities;
• Preserve and develop strength,

• Cause more energy,
• Provide a healthy balance,
• Prevent heart disease, diabetes, and other
concerns,
• Help stay mentally healthy and reduce
depression (U.S Department of Health
and Human Service National Institute of
Aging, 2020).
Present studies show that although a strong relationship between physical activity and
prevention of Alzheimer’s disease has not yet been determined, there is a positive
relationship between sustained physical activity and brain and cognition. (U.S
Department of Health and Human Service National Institute of Aging, 2020). There are
several studies done on the effects of physical activity for better cognitive skills by
Dougherty et al., (2017) and Andre et al., (2018).
3.5. Keeping the Mind Active
People who engage in personally beneficial activities such as volunteering or hobbies

report that they feel happier and healthier. Learning new skills can improve thinking
ability (U.S Department of Health and Human Service National Institute of Aging, 2020).
There are several studies done on how to keep mind activity for better cognitive skills by
Park, et al, (2014) and Tennstedt and Unverzagt, (2014).
3.6. Participating in Social Activities
Connecting with other people through social activities and community programs can keep
the brain active and help you feel less isolated and more engaged with the world around
us. There are several studies done on the benefits of participating in social activities for
better cognitive skills by Cacioppo et al., (2016) and Fu, Li, & Mao, (2018).

3.7. Stress Management
Stress is a natural part of life. Short-term stress can focus our thoughts and motivate us to
act. However, over time, chronic stress can alter the brain, affect memory and increase
the risk of Alzheimer’s and related dementia (U.S Department of Health and Human
Service National Institute of Aging, 2020). In a study, it has been stated that there is a
decrease in the levels of depression, anxiety, and stress in the elderly who are included in
the Orientation Program Based on Daily Living Activities (Piadehkouhsar, Ahmadi, &
Khoshknab, 2019). Things to do to reduce stress are as follows:
• Keep a diary, writing down the thoughts or concerns, can help to solve a problem
or come up with a new solution.
• To practice relaxation techniques. Practices such as breathing exercises can help
your body relax. These practices can help lower blood pressure, reduce muscle
tension, and reduce stress.
• Staying positive. It is suggested to let go of things beyond your control, feel
grateful or slow down to enjoy simple things such as the comfort of a cup of tea,
the beauty of the sunrise (U.S Department of Health and Human Service National
İnstitute of Aging, 2020).
3.8. Reducing Cognitive Health Risks
As the population ages, risks of cognitive decline threaten independence and quality of
life for older adults (Fu et al., 2018). Genetic, environmental, and lifestyle factors are all
thought to affect cognitive health. Some of these factors can decrease thinking skills and
affect the ability to perform daily activities such as driving, paying bills, taking medicine,
and cooking (U.S Department of Health and Human Service National Institute of Aging,
2020). Genetic factors are inherited from a parent and cannot be controlled. However,
many environmental and lifestyle factors can be changed or managed. These factors are:
• Some physical and mental health problems, such as high blood pressure or
depression
• Brain injuries, such as those caused after a fall or accident
• Some drugs or improper use of certain drugs
• Lack of physical activity

• Malnutrition
• Smoking
• Drinking too much alcohol
• Sleep problems
• Social isolation and loneliness (U.S Department of Health and Human Service
National Institute of Aging, 2020).
By providing elderly people with the ability to manage their health, their cognitive well-
being can be maintained.
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Cognitive Health and Older Adults. Retrieved December 19, 2020, from
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4. How Important Safety Measures Are For Elderly
One of the important goals for society is to create suitable home conditions for the elderly.
For this reason, the quality of life of the elderly should be increased by adapting to the
environment and living conditions of the elderly, not by adopting to the elderly to the
environment. (T.R The Ministry of Health Public Health General Directorate, 2017;
Grazuleviciute-Vileniske, et al., 2020).
It is seen that the majority of injuries caused by falling and accidents in old age occur at
home. When the causes of accidents are examined, it is seen that most of them are caused
by preventable human errors, such as ignorance, recklessness, and negligence. There are
several studies done on home accidents and injuries done by Dağhan et al. (2017),
Haagsma et al. (2019), Mortazavi et al., (2018), Romli et al., (2016), and Şahin & Erkal
(2016).
Moreover, it is found in the researches that most of the fall injuries occur in bathroom,
bedroom, and kitchen. Figure 1 shows the room/location in home where geriatric fall
injuries occur.
Fall Injuries
Proch/patio, 4.8
Doorway, 3.6
Living room, 5.7
Bathroom, 37.5
Other, 13.5
Kitchen, 15.3
Bedroom, 21.3
Bathroom Bedroom Kitchen Other Living room Proch/patio Doorway
Figure 1. Room/Location in Home Where Geriatric Fall Injuries Occur

(Adatped from: Abraham & Cimino-Fiallos, 2021)

Dangers at home in the elderly are generally unwanted health problems, injuries, and loss
of independence (Rowe & Kahn, 2016). However, it has been stated that small
arrangements and supports in the environment where the elderly life can significantly
reduce accidents and related injuries (T.R The Ministry of Health Public Health General
Directorate, 2017; Grazuleviciute-Vileniske, et al., 2020). In elderly individuals, sensory
changes, such as vision, hearing, smell, taste, touch, balance problems, drug use, and
cognitive status changes increase the risk of accidents and injuries. In this context, the
risk of poisoning due to food and harmful substances, traffic accidents, falls and burns is
quite high. To prevent these, precautions and arrangements should be made to prevent
falls and other accidents at home, in the institution, in the environment where they live
(Karadakovan, 2014).
The elderly and the individuals they live with may not be aware of the risk factors which
cause a fall in the living environment. It is important to prepare safety lists to raise
awareness of the elderly on this issue. The safety list should be posted in a corner of the
house to raise the awareness of the elderly and those around them, and it should be
ensured that the security list is periodically reviewed (T.R. The Ministry of Health Public
Health General Directorate, 2017; Bilgili & Birimoğlu Okuyan, 2017).
4.1.Safety List
As it is mentioned above, it is important to prepare safety lists to raise awareness of the

elderly on risk factors. An example of a safety list can be seen in Table 1.
Table 1. An Example of Safety List
No Safety Measures
1 Emergency phone numbers (ambulance, fire, etc.) should be affixed to each phone.
2 Phones with easily selected numbers should be preferred.
3 If possible, telephones should be placed in each room. It should be at a distance from the
ground in case of a fall.
4 Door handles should be opened easily from inside and should not allow easy opening
from outside for security reasons.
5 Medicines should be kept in safe, cool places without direct light and in their boxes.
6 Various warnings should be written on the medicine boxes to prevent the wrong drug use.
7 Carpet, rug, etc. that can slide should not be laid on the floor.
8 The edges of carpet, rug, etc. should not be twisted or in a way that could cause to fall or
slip.
9 Tools used for lighting must be clean and in good condition.
10 The cables of electricity, telephone, etc. should not be exposed and in a way that could
cause tripping or falling.

11 No items that will cause abrasion and damage should be placed on the electrical cables
that may cause a fire risk.
12 Electrical plugs and sockets (grounded) should be easily visible (radiated, illuminated,
etc.) at night in emergencies.
13 Electricity cables should have a feature to prevent electric shock in areas where water is
used, such as kitchens and bathrooms.
14 If possible, fire alarms should be used in home or work areas.
15 Once a year the smoke detector batteries should be replaced. A date, such as a birthday
should be chosen to replace them.
16 Home floors, especially wet areas, should not be made of material that can easily slip.
17 Materials that can cause rolling easily and slipping, such as children's toys, should not be
left around.
18 Unused, excessive, or messy items should be reduced as much as possible.
19 Smoking of the elderly in bed should be prevented.
20 Ashtrays must be deep and very little water should be put inside.
21 Slippers or shoes that do not slip the soles of the feet should be worn.
22 There should be fire escape or emergency exit doors. Besides, warning signs can be
placed to protect against falls. Falling generally happens while getting stuck on an object,
leaning on an object from the ground, trying to reach, losing balance, and slipping on an
item.
Source: Eriksen, Greenhalgh-Stanley, & Engelhardt, (2015), Fagerstro, Home Care
Assistance (2020), T.R. The Ministry of Health Public Health General Driectorate (2017),
Home Instead Senior Care, (2020).
4.2.In-House Arrangements
It is important to arrange inside of the houses. Examples of the in-house arrangements

can be seen in Table 2.
Table 2. Examples of the In-House Arrangements

Place The Arrangements
General • The door width should be at most 100 cm and at least 80 cm. All doors
must be without thresholds. There should be easy-to-grip handles on the
door. The apartment entrance must be sufficiently lit.
• All kinds of buttons and sockets for mailbox, doorbell, and electrical
equipment should be at most 90-100 cm above the ground.
• Phosphoric buttons which can be seen in the dark should be preferred.
• The elevator cabin should be at least 110 x 140 cm in size and easily
accessible places.
Lightening • Burnt out bulbs should be replaced.
• New lighting fixtures should be installed.
• Motion detection lighting should be placed inside and outside the house.
• All lighting should be tested by standing in a corner of a room and
looking across the room. "Can everything be seen clearly?" If not, the
interior of the house should be illuminated with more light
Entree • Furniture should be placed along the walls and in the corner of the area
to reduce the risk of elderly people falling and knocking.
• There should be a seat placed close to the door to allow the elderly
person to rest.

• There should be easily accessible hangers of different heights to hang
clothes and walking sticks.
• Night light or rope lighting should be used. Night lights are an ideal
solution for dark corridors. Rope lighting is a good option for corridors
connecting the bathroom to the bedroom.
Staircases • There should be switches at the beginning and end of the stairs. If
possible, lamps sensitive to moving objects (with sensors) should be
used.
• The steps should be at equal spacing and height, and there should not be
protrusions that may cause tripping and improper step applications
(spiral stairs).
• There should be a landing for resting on handles and long stairs.
• The step height of the stairs should not exceed 14 cm and the length of
the steps should not exceed 28-30 cm.
• Non-slip materials should be used in the steps.
• Patterned floors, carpets, and rugs which will cause visual disturbances
in the depth of vision should not be used.
• Stairsteps can be painted in different colours to be visible and
noticeable, or the steps can be made visible with different colour tapes.
Sources: Bilgili & Birimoğlu Okuyan (2017), Eriksen et al., (2015), Home Instead Senior
Care (2020), T.R. The Ministry of Health Public Health General Directorate (2017).
4.3.Kitchen
It is important to arrange the kitchen. Examples can be seen in Table 3.
Table 3. Examples of the Arrangements in Kitchen

No Arrangements
1 Good lighting and ventilation/chimney facilities should be available.
2 The workbench must be in a sufficient height and length.
3 The shelf height of the kitchen cabinet should be a maximum of 150 cm, ideally 140 cm
to reach without putting anything underneath. The minimum shelf height of the lower
cabinets should be 40 cm. For elderly people using wheelchairs, the place under the
counter must be empty for the chair to enter.
4 The belongings should be placed on the closest shelves or the counter, which is easiest to
reach for an elderly person.
5 Hooks should be attached to the walls for pots and pans which are frequently used by the
elderly.
6 There should be a fire extinguisher in the kitchen.
7 It is important to wear comfortable shoes or socks with non-slip soles. The flooring should
be replaced with one that has a less slippery surface.
8 Table legs should not protrude to prevent falls and tripping. Tables should not have sharp
edges.
9 The on and off positions of the buttons of the tools such as; stoves and water heaters
should be distinct and easily visible.
10 Cables of electrical equipment used in the kitchen should not be close to the sink or stove.
There should be no easily ignitable objects near stoves and ovens.
11 If natural gas is used, there must be an automatic gas cutting system in case of flame or
failure.

Sources: Bilgili & Birimoğlu Okuyan (2017), Eriksen et al., (2015), Home Care
Assistance (2020), Home Instead Senior Care (2020), T.R. The Ministry of Health Public
Health General Directorate (2017).
4.4. Bedroom
It is important to arrange the kitchen. Examples can be seen in Table 4.
Table 4. Examples of the Arrangements in Bedroom

No Arrangements
1 Good lighting and ventilation should be available.
2 (If possible) Bedroom, bathroom, and toilet should be planned close to each other.
3 Frequently used clothes and items should be located inaccessible places, and these items
should be easily accessible without getting on the stool/chair.
4 A sturdy chair with armrests should be available to sit while dressing.
5 On the doors of the wardrobes, auto-lighting lamps and handles which are easy to grasp
should be preferred.
6 Bedroom furniture should be arranged in such a way that the elderly can easily walk
around with a wheelchair, crutches, or walking stick.
7 There should be a small fixed table/nightstand which can be easily accessible from the
bed so that the elderly can put important items, such as bedside lamps, phones, glasses,
medicines on it.
4.5. Living Room
It is important to arrange the living room. Examples can be seen in Table 5.
Table 5. Examples of the Arrangements in Living Room

No Arrangements
1 Furniture should be placed in a way that the room can be wide and spacious.
2 Furniture upholstery should be made of non-combustible, non-slippery fabrics and
vibrant colours should be used.
3 Chairs and sofas should be strong and secure, not too high or too deep, and suitable for
easy sitting.
4 Electric cables should not be in walking areas, they should be fixed at the edges.
5 Coffee tables should not be in the middle area but should be placed between the seats.
6 Carpets should not be slippery, the edges should not be upturned and curved in order not
to cause falling, and carpets should not have mixed patterns that would mislead the depth
of vision.
Sources: Eriksen et al., (2015), Home Instead Senior Care (2020), T.R. The Ministry of
Health Public Health General Directorate (2017).

4.6.Bathroom and Toilets
It is important to arrange the bathroom and toilets. Examples can be seen in Table 6.
Table 6. Examples of the Arrangements in Bathroom and Toilets

No Arrangements
1 There should be handlebars near the toilet, shower, and bathtub. Handlebars should be
well fixed on the wall on the horizontal axis. Handlebars should be 4-5 cm in diameter
and placed 90-100 cm above the ground.
2 The bathtub should be avoided as it may cause falls in the entry and exit. A shower system
with seats should be preferred.
3 Armatures should have an easy opening and closing feature.
4 Electrical gadgets must be unplugged when not in use.
5 The ventilation system and hot water source (boiler/stove) must be safe in the bathroom.
6 Bathroom cabinets and ventilation systems should be at an accessible height.
7 The bathroom door should be opened to the outside in order not to narrow the space.
8 The bathroom floor should be made of non-slip, non-glowing material and the floors
should not be left wet.
9 A night lamp should be placed in the bathroom. This will help the elderly who may go to
the toilet frequently at night. One or two night lights should be installed in the route to
the bathroom so that the elderly can find their way.
10 The tiles should be non-slip and rust-proof.
11 The floor and the wall should be painted in different colours.
12 Non-slip slippers should be used.
Care (2020), Home Instead Senior Care (2020), T.R. The Ministry of Health Public
Health General Directorate (2017).
4.7.Laundry Room / Basement and Garage
It is important to arrange laundry room, basement, and garage. Examples of the

arrangements can be seen in Table 7.
Table 7. Examples of the Arrangements in Laundry Room/Basement and Garage

Place The Arrangements
Laundry • There should be appropriate lighting, wall lighting should be used if
room/ necessary.
Basement • Ideally, at least one guardrail should be added along the wall, although
there is a guardrail on both sides.
• It is important to paint the last step of the basement in a different colour to
distinguish it better.
• Laundry detergents should be put into smaller containers.
• The elderly should clean the spills immediately in the laundry and they
should wear non-slip soled shoes or socks.
Garage • Steps leading up from the garage (like basements and entrances) should
have at least one or ideally two solid guardrails.
• Make sure that there is enough litter box. Litter should be kept right
outside the garage to avoid attracting insects and mice.

• Electrical gadgets and toxic turf chemicals can be fatal for some elderly,
especially those with dementia, as they may be confused about how to
use them safely. If necessary, these items should be removed from the
garage.
4.8.Ensuring Home Security
Ensuring home security is also so important for the elderly. Examples of the arrangements
can be seen in Table 8.
Table 8. Examples of the Arrangements for Ensuring Home Security

No The Arrangements
1 There should be a peephole in the front door of the houses where the elderly live.
2 The elderly should be informed not to open the door to strangers when they are
alone at home. On the wall next to the front door, reminders, such as “Do you
know this person? If not, don't open the door" should be placed.
3 Windows and doors must be kept locked at all times.
4 The elderly should not accept any phone offers. They should not believe the
caller when they assert that a family member is in danger. They should not share
their financial information or social security numbers on the phone. They should
not forget that if someone is really in danger, a police officer will come to visit
the elderly person to report. In this context; they should be warned of swindlers
targeting the elderly and loved ones.
Sources: Home Care Assistance (2020) and Home Instead Senior Care (2020).
References
Abraham, M. K. & Cimino-Fiallos, N. (2021). Falls in the Elderly: Causes, Injuries, and
Management. Medscape. Retrieved from
https://reference.medscape.com/slideshow/falls-in-the-elderly-6012395#22
Bilgil, N., Birimoğlu Okuyan, C.(2017). Home accidents and falls in elderly people. N.
Bilgili, Y. Kitiş (Ed.) in Elderly and elderly health, for professionals in elderly
care(p.430-449). Ankara: Vize Publishing
Eriksen, M. D., Greenhalgh-stanley, N., & Engelhardt, G. V. (2015). Home safety,
accessibility, and elderly health : Evidence from falls. JOURNAL OF URBAN
ECONOMICS, 87, 14–24. https://doi.org/10.1016/j.jue.2015.02.003
Dağhan, Ş., Arabacı, Z., & Hasgül, E. (2017). Yaşlilarda Ev Kazalarinin Bilişsel Durum
ve İlişkili Faktörlere Göre İncelenmesi. Sosyal politika çalışmaları dergisi, 17(39),
75-95.
Grazuleviciute-Vileniske, I., Seduikyte, L., Teixeira-Gomes, A., Mendes, A., Borodinecs,
A., & Buzinskaite, D. (2020). Aging, Living Environment, and Sustainability: What
Should be Taken into Account?. Sustainability, 12(5), 1853.
Haagsma, J. A., Olij, B. F., Majdan, M., Van Beeck, E. F., Vos, T., Castle, C. D., ... &
Roberts, N. L. (2020). Falls in older aged adults in 22 European countries: incidence,

mortality and burden of disease from 1990 to 2017. Injury prevention.26:i67–i74.
doi:10.1136/injuryprev-2019-043347
Home Care Assistance. (2020). 10 Tips on Home Safety for Elderly. Retrieved December
18, 2020, from https://homecareassistance.com/blog/home-safety-tips-for-elderly
Home instead senior care. (2020). Home Safety Checklist Reference Guide. Retrieved
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home-safer//
Karadakovan, A. (2014). Healthy Living Needs of the Elderly. In Elderly Health and
Care (pp. 100–174). Ankara: Academician Medical Press.
Mortazavi, H., Tabatabaeichehr, M., Taherpour, M., & Masoumi, M. (2018). Relationship
Between Home Safety and Prevalence of Falls and Fear of Falling Among Elderly
People: a Cross-sectional Study. Materia Socio Medica, 30(2), 103.
https://doi.org/10.5455/msm.2018.30.103-107
Romli, M. H., Mackenzie, L., Lovarini, M., & Tan, M. P. (2016). Pilot study to investigate
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Halk Sağlığı Genel Müdürlüğü]. (2017). Yaşlı Sağlığı Güvenli Çevre. Retrieved
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sağlığı-güvenli-çevre.html
World Health Organization. (2020). Ageing. Retrieved December 20, 2020, from
https://www.who.int/health-topics/ageing#tab=tab_1

5. How Cultural / Learning Issues Can Improve the Life and Health of Elderly
It has been functioning in the public opinion over the years a stereotype of an elderly man,
who is in the group of people, who needed social assistance and help. The stereotypical
cultural pattern of the elderly man presents sad, ill, and most often the lonely person who
is useless to society. He is contrasted with the image of young, strong, and attractive
people, willing to work. Such stereotypical thinking leads to the elimination of the aged
from society, even though their experience and wisdom should be regarded as great assets
(Ageism & Stereotyping the Elderly: Definition and Examples, 2014; Sztompka, 2002).
5.1.Cultural Issues
When people retire and end their professional activity, it means that they have more free
time. A survey of pensioners carried out in Poland in which they were asked about their
free time, presents that 43.5% of men and 36.9% of women complained that they had too
much free time (Po co seniorom kultura? Badania kulturalnych aktywności osób
starszych, 2012). Active elderly did not complain that they had too much free time (op.
cit).
For the elderly, it is important not only to help with their daily activities but also to
organize their free time. Appropriate selection of activities can improve physical and
intellectual fitness (Cohen et al., 2006). In the subject, literature functions the term
"successful ageing". The term was first originated by scholars John Rowe and Robert
Kahn. It consists of three elements: low probability of disease and disease-related
disability, high cognitive and physical functional capacity, and active engagement with
life (Rowe & Kahn Robert, 1997; Po co seniorom kultura? Badania kulturalnych
aktywności osób starszych., 2012, p.19).
The cultural activity of people in the third age, elderly and retired people takes very
different forms and concerns various areas. There are several types of human behaviour
after retirement (Neugarten, 1976):
• reorganization of one's own life to maintain a high and diverse activity different,
however, from the current one;
• activity devoted to only one field of interest (e.g. collecting);

• cultural activities - participation in artistic forms (theatre, cabaret, choir, poetry,
prose, etc.);
• focus on social and self-help activities and volunteering.
There are many activities offered by various institutions working with the elderly, such
as NGOs, cultural centres, libraries, nursing homes. The most popular are: Reading,
listening and playing music, dance, doing arts and crafts, going to a place of worship,
visit museums, watching or being involved in theatre, intellectual discussions (about
books, films, etc.), using a range of media, memoir writing (presentation the results during
the meetings with others, exhibitions, on web sites, etc.), collection the local and family
histories, photography (for example -creating a family or personal digital albums), textile
crafts, wood crafts or knitting, jewellery making, enjoy cuisine, IT activities (how to use
a computer, internet, mobile, etc.) (Swindell, 2002).
Social and cultural activity can play a therapeutic role (Fabiś, 2008). Based on research
(Zelazny, 2011) it was noticed that playing instruments helps in the treatment of arthrosis
in the elderly. (reported that therapeutic instrumental music playing helped hand
rehabilitation in older adults with osteoarthritis).
Many cultural institutions offer offers elderly to participate in amateur theatres. It can be
a form of therapy for elder people, too. Drama Therapy is based on using dramatic
techniques to aid individuals in personal growth and increase emotional wellbeing. There
are many forms of theatrical interventions including role-play, theatre games, group-
dynamic games, mime, puppetry, performance, and other improvisational techniques
(Erasmus+ Project Results Platform Explained; European framework for action on
cultural heritage, 2019; Fatyga, Nowiński, & Kukułowicz, 2009).
Research carried out over 12 months on a group of 166 respondents showed that cultural
activity improved health. Participants in artistic activities used the doctor's advice less
often, felt better, and were more satisfied with life (Cohen et al., 2006).
Another study carried out in a group of 124 elderly aged 60-86, found that their cognitive
skills and well-being improved after four weeks of drama (Noice, et al., 2004).
Participation in culture meets the needs of the elderly, such as fighting loneliness, the
need to become involved in social life, the need to be appreciated, need for social life,

and the need for contacts with the younger generation (source:
https://cpe.ckzamek.pl/media/files/CPE_-_uzyteczny_poradnik.pdf).
The choice of the type of cultural activity is influenced by gender, which can be seen in
Figure 1.
Cultural Activities
73 69 68
100 81
71 67
80 37
46 25
60 36 16
40 24
Men (%)
20
Women (%)
0
Women (%) Men (%)
Figure 1. The Choice of the Type of Cultural Activity Influenced by Gender (Adapted
from Age UK Policy and Research Department, Creative and Cultural Activities and
Wellbeing in Later Life, 2018)
The frequency of cultural activity is influenced by many factors: health, transport, being
a carer for another person, friends, place of residence (urban or rural area), and finance
(Age UK Policy and Research Department, Creative and Cultural Activities and
Wellbeing in Later Life, 2018).
Various activities can help to break down barriers for the elderly. These can be discounts
in galleries, museums, and cinemas, discounted transport tickets, open concerts, elderly
clubs, activities organized by non-governmental organizations (Butler, 2019).
According to Leon (2021), the benefits for health centre programs to engage in cultural
and linguistic competence services can be listed as follows:
• Expand quality and effectiveness of care,

• Improve health outcomes and well-being,
• Increase the effectiveness of the older patient-provider communications,
• Expand provider knowledge and skills,

• Foster mutual respect and shared-decision making,
• Strengthen patient and provider satisfaction.
It is worth encouraging and developing hobbies such as cooking. Cooking and eating
together strengthens bonds, it can be an opportunity to meet friends or make new ones.
Moreover, it is an occasion for discussion. Cooking can be a teaching tool. Collecting and
creating new recipes requires mental activity. The preparation of dishes influences
encouraging fine motor skills. Cooking workshops for the elderly are an opportunity to
talk and learn healthy eating habits (Mobility Choice Cultural Activity of Older People).
Creating a cookery book can be an attractive activity for the elderly who like photography
and using IT (text editing, presentations, internet). It is not only a way of spending free
time but also due to the development of modern technologies opportunity to learn new
skills (Active Seniors Learn, Educate, Communicate and Transmit Active Seniors Learn,
Educate, Communicate and Transmit - Towards a better participation of seniors in
education and culture, 2018; What Every Teacher Should Know about Reaching Older Learners;
Swindell, 2002).
Learning a new skill is a great way to keep one’s memory active (6 Easy Ways to Improve
Memory for Seniors). Lifelong learning is important for keeping the mind and memory
working as we age. Ongoing education and learning activities can compensate for age-
related degenerative brain diseases like Alzheimer’s, encourage the elderly to develop and
maintain social connections, improve their self-confidence and quality of life, and prevent
depression due to social isolation (Fergusson, 2018; Schaie, 1990).
Researchers investigating older adult primary care patients pointed out those elderly with
a cat or a dog were less likely to report discomfort and a sense of isolation (Branson, et
al. 2017). Therefore, having pets, exchanging information about pets, walking, and
meeting other owners can have a positive effect on the well-being and physical health of
older people.).
5.2. Learning Issues
There are many benefits of studying for older learners, such as increased self-confidence,
increased feelings of health and well-being, reduced feelings of isolation, and increased
engagement in the community (Kieran, 2015).

In all the countries, libraries are the places of lifelong learning. It is not only the place
where you can borrow books. They have Open Educational Resources and Massive Open
Online Courses. They are free for anyone to use. This is one of the reasons why many
elderly are their clients. Lifelong learning, non-formal education let the elderly follow
their interests. Some libraries are using VR to allow the clients to visit places and see and
hear what they could never experience otherwise (Active Seniors Learn, Educate,
Communicate and Transmit Active Seniors Learn, Educate, Communicate and Transmit
- Towards a better participation of seniors in education and culture, 2018; Saxon, Etten,
& Perkins, 2014).
Unfortunately, the libraries in rural areas are less have as many services as libraries in
urban and suburban areas. Libraries are a good place to organize educational activities
for elderly because they are usually more active in the morning, and then there are fewer
school-age or adult clients in the libraries (10 Free Entertainment Activities for Seniors).
For the elderly one of the opportunities to learn is to be a

QR Code 1:
member of the University of the Third Age. Universities of the University of the
Third Age are educational institutions where the elderly acquire Third Age in UK.
knowledge and new skills. The main aim of these institutions is

intellectual and physical activation of old people and
researching on ageing. The first was created by Pierre Vellas in
Toulouse in 1973 (Formosa, 2009). The first Third Age
University in Poland was created in 1975 (Fabiś, 2008).
This form of activity is becoming more and more popular. In 2018, there were 640 Third
Age Universities in Poland (universities_trzeciego_wieku_w_polsce_w_2018_r. pdf).
We can recognize two models of 3rd Age Universities: French and British. French was
associated with universities and its costs were borne by the university. The UK is self-
help and does not benefit from external funding (Swindell & Thompson, 1995). For more
information about 3rd Age University of UK, scan QR Code 1.
Now, Universities of the Third Age teach about the many ways in which to keep the aged
people active and to introduce gerontological preventive measures; they also make it
easier to adapt to psychological and physical changes, as well as to adapt to the ever-

changing environment, and they give the older people a chance to keep on being active
and creative. (Hebestreit, 2008).
Another possibility to learning is active involvement in civil society organizations. The

organizations can take part in EU programmes like Erasmus+. The Erasmus + program
gives the opportunity to study the situation of older people and organize activities for
them, exchange experiences in this field (Some projects are Active Seniors Learn,
Educate, Communicate and Transmit; Social Inclusion through Digital Skills and
Intergenerational Learning; Mobility choice. Cultural activity, SEAL). The advantage is
that the results of the projects (studies, brochures, guides) are available free of charge
from Erasmus+ Project Results Platform.
The elderly, despite their commitment, willingness, and good instructors, can learn at a
slower pace. Especially in the case of people with dementia or Alzheimer's, the learning
methods must be very well suited to the patient's condition. They are mainly based on
repeating and recording what the patient already knows and can do. Logic games, sudoku,
bingo, word puzzles, luminosity are very helpful in these cases (6 Easy Ways to Improve
Memory for Seniors).
5.3. The Effects of Cultural/Learning Issues to Life and Health of Elderly
Older people want to be active and participate in

cultural life. This has a positive effect on their
health and well-being. They should also
participate in educational activities. This activity
keeps their mind working for longer. They also
want to have contacts not only with their peers but
also with the younger generation. Most of them
would like to participate in intergenerational
activities (Mott, 1999). The effects of active
ageing can be assessed by asking what is
important to them (Katz, et al. 2011). Figure 2 also
presents expectations, values, and obstacles. Figure 2. Expectations, values, and
obstacles. (Source: Katz, Holland,
Peace, Taylor, 2011)

New friendships made while participating in various forms of cultural activities increase
their self-esteem, allow them to relax, and the sense of achievement makes them feel part
of the community. Moreover, older people want to feel in control of
QR Code 2:
10 Free their own lives as long as possible. Learning, participation in
Entertainment organizations, cultural events gives them such an advantage. The
Activities for
Seniors. activity and contacts with people provided by science and cultural
life create a safe environment. A sense of security is very important
for the health of older people. For more information about free
entertainment activities for seniors, scan the QR Code 2.
Research shows (Creative and Cultural Activities and Wellbeing in Later Life, Age UK
Policy, and Research Department Retrieved, 2014) that despite health problems, older
people want to actively participate in various forms of social life. In their case, the Internet
and VR Technology take on special importance, because thanks to it, physical disabilities
do not interfere with being active.
Creating and encouraging the elderly to take part in educational and cultural activities
sometimes faces barriers in the form of stereotypes. Older people sometimes think they
are no longer good for anything, they feel that at their age certain things are no longer
appropriate to do (such as dancing) (Active Seniors Learn, Educate, Communicate and
Transmit - Towards a better participation of seniors in education and culture, 2018).
However, the positive effects of activity should encourage people working with the
elderly and the elderly's families to overcome these stereotypes. Many leisure activities
may be available to older people (Mobility Choice Cultural Activity of Older People).
You can find those that will match the interests and health condition of the elderly
(Hutsch, Dixon, 1990; Zielińska-Więczkowska, 2010).
5.4. The Positive Effect of Using VAR in the Work with the Elderly and Good
Practices
There are many researches done on the effect of VAR usage on the improvement of the
elderly’s cognitive health and overall life conditions. Soltani (2019) reviewed some of the
applications of virtual reality (VR) for seniors by using SWOT (Strengths, Weaknesses,

Opportunities, and Threats) analysis. Here are the some studies showing the opportunities
of VAR usage listed in Soltani’s research:
• Fernandes and Argyriou (2017) used VR as an affordable approach for creating e-

health screening AD diagnostic systems. They proposed VR tests that could
evaluate memory loss related to common objects, recent events, expressing and
understanding languages, and the ability to recognize abnormalities accurately
and similarly for the presence of AD. From their research, Plancher et al. (2012)
concluded that VR is better adapted for early diagnosis of AD compared to
traditional verbal memory tools.
• Manera et al. (2016) tested the feasibility of an image-based VR system in MCI
and dementia. Their patients reported high feelings of security and low
discomfort, anxiety, and fatigue. Although the VR task was more difficult, they
were also more satisfied with the VR condition and preferred it to the paper
condition.
• Lin et al. (2018) used means-end chain techniques to examine elderly’s awareness
and personal values regarding VR activities. Elderly population mentioned leisure
VR activities to be fun, safe, easy, and physically and mentally healthy. While
playing with VR, they were also seeking enjoyment, improved quality of life, and
a sense of belonging.
• Goršič et al. (2017) explored the role of competition while using VR. They
concluded that stroke patients (including elderly) who exercise with a peer in an
unsupervised situation (e.g. home) exhibit higher enjoyment and exercise
intensity compared to those who exercise alone.
• Brunner et al. (2017) explored the effectiveness of their upper extremity VR
rehabilitation system and showed that the improvements were similar to the
conventional therapy. They also suggested that the motivating nature of VR could
be a supplement to standard rehabilitation.
• Saldana et al. (2017) used HMD in VR to objectively assess balance by using
visual-vestibular conflict and by comparing the results of postural sway with a
force plate. Their preliminary results showed that the HMD is a valid, reliable,
and comparable to traditional mechanical perturbation approaches for measuring
balance. Popular HMDs allow easy navigation in life-size virtual environments
and provide required spatial requirements of non-immersive serious games,

exergames, and motor rehabilitation applications (Borrego et al., 2018). Such
interaction allows natural navigation and exploration and therefore, the improved
ecological validity of the task while facilitating skill transfer.
• Albiol-Pérez et al. (2017) designed a low-cost active balance rehabilitation system
and measured the performance of balance control during 15 sessions of virtual
rehabilitation. Although there were no statistically significant differences between
the left, central, and right positions, their results indicated a trend of improvement,
especially in the left and right sway which are important in avoiding risks of falls.
Tsang and Fu (2016) compared the efficacy of their VR balance system with
traditional balance training. They attributed the improvements in VR system to
the real-time performance feedback and cuing stimuli that supports error-free
learning.
• Paquin et al. (2016) used a VR rehabilitation program for fine motor recovery of
stroke patients. All of their subjects experienced a perceived increase in hand
function and that they would recommend the program to other stroke survivors.
McDonald et al. (2013) used a VR pain coach for the effects on the
communication of pain by older adults. They measured pain and depressive
symptoms before and one month after the intervention. Older adults shared a
significant amount of clinically important pain information with the pain coach
than the pain communication-only group. Pain intensity and depressive symptoms
reduction showed a non-significant trend one month after the intervention. The
VR pain coach shows a possible strategy for pain management discussions
between practitioners and older adults.
Finally, Soltani (2019) noted the opportunities and strength of VAR usage for the elderly
to improve their life conditions. It can be seen in Table 1.
Table 1. Opportunities and Strengths of VAR Usage in Elderly

Opportunities Strengths
-Ability to modify physics and -Short term overall psychosocial state improvements
scenarios according to the needs -Improved balance and decreased risks of falls
-Efficiency -Improved visual searching
-Affordable -Higher compliance to self-training
-Possible similar results to traditional -Similar validity to traditional memory tests
interventions -Enhanced ecological validity

Moreover, there are good practices of VAR usage in the work with the elderly. Here are
some of them (You can click the following headings and read more about the good
practices):
• How Virtual Reality Is Benefiting Seniors

• How to Launch a Strong VR Program in Senior Care
• How virtual reality is helping seniors breathe new life into old memories
• Reducing social isolation through the power of virtual reality and shared
experiences
• How Virtual Reality Is Providing Comfort To Elderly Hospice Patients And
Others
• VR helps seniors to re-engage with the world
Finally, it can be said that VR and AR tools have a positive effect in the work with the
elderly and should be used for them. VARTES project aims to be a good practice of
VAR usage in the work with the elderly.
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6. Intergenerational Strategies to Interact With Elderly
Two terms are sometimes used interchangeably: intergenerational and multigenerational.

Intergenerational means that members of different generations work together, share
common goals collaborate, and influence each other. Multigenerational means common
activities of a generation, but they may not influence one another, they do not interact
(Villar, 2007).
Intergenerational learning takes place when

people learn from each other. Knowledge is
passed down from generation to generation. It
happened in families. Nowadays scientists point
out that more and more often unrelated people,
from outside the immediate family, take part in intergenerational learning (Kaplan, 2002).
The definition of Intergenerational Learning, which can be found

QR Code 1:
on the ENIL platform (https://eaea.org/our-work/projects/enil- Learning for
european-network-for-intergenerational-learning/) states: “A Active Ageing
and
learning partnership based on reciprocity and mutuality Intergenerational
involving people of different ages where the generations work Learning. Final
Report.
together to gain skills, values, and knowledge.” Examples of
Intergenerational learning can be found at all stages of education
(European Commission, Learning for Active Ageing and
Intergenerational Learning: Final Report DG Education and
Culture. 2012):
• Pre-school - older people are encouraged to volunteer;
• Schools- Intergenerational elements can be compulsory learning modules for

young people (e.g. Apprenticeships), young people can work as volunteer’s people
for elderly people in various activities, subjects, programs, and projects;
• Vocational education - intergenerational learning is of particular importance in the

professions related to nursing and social work;
• Higher education - some universities propose intergenerational learning as an

educational offer for adults.

Schools can be places where intergenerational learning begins. It can be a subject or a
module of the family science curriculum. Schools can also be a precursor of changes,
where, in addition to theoretical learning, learning through experiments will be
conducted.
This can be done in two ways. Elderly people can be mentors, pass on their experience to
the younger ones. This can be especially valuable in the case of vocational education. The
second way is when students teach the elderly (e.g. new technologies). They will then
gain experience as trainers and educators. Such activities can be started already at the
level of the older grades of primary school (Janiszewska-Rain, 2005; Szarota, 2013).
An example of a program involving older people and primary school children is the
"Intergenerational Academy of Activity - Experiences Bind Generations" which was
carried out in 2012-2013 (Leszczyńska-Rejchert, 2014). Teachers and students of The
University of Warmia and Mazury in Olsztyn (a region in Poland) participated in the
program as volunteers. The program included separate activities: lectures for the elderly,
physical activities for children, and joint activities for both groups: culinary, music, art,
theatre, and literary activities. The meetings always ended with the presentation of the
works performed together. Based on the program analysis, a recommendation was given
for the creation of intergenerational educational programs. This:
• Proper interpersonal communication - creating conditions for understanding,

tolerance, and kindness so that the participants can establish an intergenerational
dialogue,
• Identifying resources inherent in people representing different generations,
• Getting to know each other by all participants,
• The subject matter offered to different generations should be of interest to young

and old,
• Activities should be planned so that each participant can be active (op. cit).
Another example of intergenerational cooperation is The Granddad Program in

Stockholm County Sweden (Newmann & Hatton-Yeo, 2008) which is a program
involving older people in primary education. Since most of the teachers in these types of
schools are women, the presence of older male volunteers (grandparents) serves to shape

the male model.
Examples of higher education programs are described by Newmann & Hatton-Yeo

(2008). The University of Valencia has been implementing the NUGRAN program since
1999. It enables older adults to enrol as university students. They can share their
experience with younger people and at the same time deepen and consolidate their
knowledge. It is not only important to exchange knowledge and experiences. Participation
in the program allows you to interact and communicate with younger and older students.
The University of Pittsburgh uses the expertise of retired engineers. Their hands-on
approach and practical understanding of the basic engineering principles helped freshmen
master the subject. Particularly good results of this program were visible in the case of
foreign students entering the University of Pittsburgh (op. cit).
Typically, people achieve a high level of professional skills in late adulthood (European
Commission, Learning for Active Aging and Intergenerational Learning: Final Report
DG Education and Culture. 2012). After retirement, they have more time. Sharing with
younger knowledge and experience gives them a sense of meaning in life and influences
future generations. For trainers and teachers, older volunteer tours can be a useful source
of information and help in working with young people.
Worth mentioning is the project Transfert de Competences Acquises et de Savoirs

Techniques, which was implemented under the Grundtvig 2007-2009 program. The idea
of the program was that older craftsmen, who were retired or about to retire, were teaching
young adepts their trade when they retired or just before retirement. It was an opportunity
to improve the skills of both groups and to consolidate these professions.
Another example of intergenerational cooperation is a program launched by The

University of Victoria in Canada where the tribal elders co-founded the education and
care programs for first nation communities. The curriculum was based upon what the
learners could bring to the curriculum from their culture and values because the aim was
to integrate while respecting the traditions and history of the nation (Newmann & Hatton-
Yeo, 2008).
It has been noticed (European Commission, Learning for Active Aging and
Intergenerational Learning: Final Report DG Education and Culture. 2012) that

intergenerational learning in the workplace motivates older people to stay in the labour
market and acquire new skills. This is especially important in the face of the ageing of
European societies. The importance of contact with older people (e.g. retired specialists
of various fields) is of great importance for the life choices of young people (Chusseau &
Hellier, 2011), especially those with low social status, such as in which certain dynasties
remain unskilled from generation to generation. Programs for cooperation with older
people should appear in compulsory primary schools. However, further education is the
choice of the individual. Children from families who do not pay attention to education,
through contact with retired specialists, may be more motivated to continue learning or
even a specific profession.
6.1. Embedding Intergenerational Activities in the Educational Work
European Parliament decides that 2012 will be The European Year for Active Ageing and
Solidarity between Generations (DECISION No 940/2011/EU). In the document, one of
the aims is: to promote social justice and protection (...) and solidarity between
generations. During the year, many organizations, institutions organized many activities
for the elderly and young people. Programs and actions are another way to promote
intergenerational integration. In 2012, around 600 schools across Europe took part in
intergenerational activities with the elderly (Eurostat, 2012).
At a time when young people are affected by a crisis of trust towards adults,
intergenerational contacts and activities can contribute to the development of young
people (Kaplan, et al. 2017). Vanderbeck Robert and Worth Nancy (2015) share the same
opinion. Taking into account the way of spending free time, types of activities can be
organized to activate both younger and older people. The proportion of the population
aged 15+ expressing the opinion that there are not enough opportunities for older and
younger people to meet and work together in associations and local community initiatives
can be seen in Figure 1.

Figure 1. The proportion of the population aged 15+ expressing the opinion that there
are not enough opportunities for older and younger people to meet and work together in
associations and local community initiatives (March 2009) (Source: European
Commission, Flash Eurobarometer No. 269- Intergenerational solidarity)
Intergenerational learning can take place in a variety of contexts, programs, and projects,
more or less formally (Angelis, 1996). Such activities prevent age-related stereotypes and
violence against the elderly. Negative stereotypes, lack of intergenerational contacts can
lead to the disappearance of solidarity in society (Clyde & Ker, 2020). Older people may
feel unnecessary and ignored by adult children. Similarly, young people may encounter
indifference and a lack of acceptance by their parents (Janiszewska-Rain, 2005). This can
bring these two generations closer together: grandparents and grandchildren. The
similarity between the situation of young and old people may seem strange, but research
conducted in the EU confirms it. The Proportion of the population participating actively
or working for one of the specified activities can be seen in Figure 2.

Figure 2. The Proportion of the population participating actively or working for one of
the specified activities, EU-27, September-October 2011. (Source: European
Commission, Special Eurobarometer No. 378- Active ageing)
There are many more organizations and activities addressed only to the elderly, and much
less to both generations: young and old (Szarota, 2013). What is worth mentioning both
groups would benefit from joint activities and activities would benefit both groups.
Proposals for educational work involving intergenerational integration can be found on
the Internet. Fun for pre-schoolers and the elderly can be beneficial for both groups.
Children learn and the elderly exercise their memory. Joint activities also shape bonds
between representatives of different generations. Such games include body puzzles,
Plexiglas portraits, space bingo, bubble fun, family pictures hare, balloon bounce, who
took the cookie from the cookie jar? Active storybook time, hike and seek beans,
intergenerational name tags, treasure hunt, noisemakers, stained glass transparencies,
butterfly making, Gack !, float or sink, painting the seasons, decoupage flower pots,
animal puppets, kite making, clay sculpting, leaf rubbing, gourd/pumpkin painting,
swamp activity, springtime walk, collecting and pressing flowers, collage, beanbag

games, animal charades, board games, mail time, letter stamping, letter and word sponge
painting, letter tracing, giant body letter, the word think, boggle jr., pipe cleaner letters,
wild things, musical chairs, ribbon movement, goldfish, and banana snack, making
lemonade (Tried and True). Such games are also exercises aimed at: reminisce/reflect,
exercise motor skills, sensory stimulation, enhance self-esteem, learning new terms/skills,
maintain verbalization.
An example of embedding intergenerational activities in the educational work can be the

French program The Lire et Faire Lire (European Commission, Learning for Active
Aging and Intergenerational Learning: Final Report DG Education and Culture. 2012).
The program made it possible for older people to read to young children. As a result,
children were more motivated to learn to read and write. The program has existed since
1999. Older volunteers had the opportunity to be active.
The benefits of intergenerational relationships between old and young people can (The
10 Benefits of Connecting Youth and Seniors):
• Provide an opportunity for both to learn new skills
• Give the child and the older adult a sense of purpose
• Help to alleviate fears children may have of the elderly
• Help children to understand and later accept their ageing
• Invigorate and energize older adults
• Help reduce the likelihood of depression in the elderly
• Reduce the isolation of older adults
• Fill a void for children who do not have grandparents available to them
• Help keep family stories and history alive
• Aid in cognitive stimulation as well as broaden social circles should introduce

technology into the life of the elderly.
6.2.Involving in the Process of Developing Intergenerational Learning Programs
Intergenerational learning has always happened. It took place in families. It is a natural

process. However, this is no longer enough these days. Intergenerational learning and

lifelong learning can increase social capital (Kaplan, et al. 2017). Older people generate
an experience that they can pass on to younger generations. Observational learning and
dialogue are important to moral growth and personal development.
The Dublin City University (DCU) has been implementing the Intergenerational Learning
Project (DCU ILP) since 2008 (Corrigan, et al. 2013). The focus was initially on the
benefits of the elderly who had the opportunity to meet and learn from the elderly. They
conducted IT classes for the elderly. It was decided on this because poor IT skills among
older people and rapid developments in technology mean that they are cut off from what
is happening in the world. This basic goal was enriched with modules in many areas
including the media, creative writing, genealogy, health and well-being, and science. As
a result, students from various fields were involved. About five hundred students have
taken part in it in for four years. The conclusion from the implementation of the program
is that all universities should treat classes for major students not only as an additional
activity or service but also as an educational experience important in educating students.
Kaplan (2001; 2002; Kaplan, Sanchez, Hoffman, 2017), who has been dealing with the
problems of older people for many years, recommends that intergenerational classes
should not only take place in a one-on-one (student-senior) system but that they should
also be of a group nature. He cites examples where cooperation of schools (primary and
secondary) with the elderly had a positive effect on preventing early school leaving and
strengthening young people's self-esteem and motivation to learn.
World Alzheimer's Day is celebrated each year on September 21. It is always an

opportunity to talk about the situation of older people and present work programs with
this group of patients and promote activities. Many organizations develop programs to
work with people with dementia (Hope for Dementia). It has been found that greater
physical activity, education, and a proper diet prevent cognitive decline. Isolation of
patients exacerbates the disease, so group activities, including intergenerational activities,
play an important role in the programs. Increasingly, modern technologies are
incorporated into these programs. They are used to diagnose the symptoms of the disease
for preventive measures and for activities aimed at slowing down the disease.

6.3.Developing a Series of Courses
Subject and problems of intergeneration activities become more popular year by year.
The results are to create action, websites, organization of it. An example can be
Generations Working Together (GWT). It is the nationally recognised centre of
excellence supporting the development and integration of intergenerational work across
Scotland, which was created in 2007 (Raszeja- Ossowska, 2016).
Projects involving several generations are presented in the report "Impact of

intergenerational activities on older people". The subjects of the classes were varied
(gardening, healthy lifestyle, playing together, music). The programs featured in the
report are Aging Well Torbay, Apples and Honey Nightingale, Brighter Bervie, Anam
Cara.
The Aging Well Torbay Project is interesting, as it organizes not only yoga, chess,
recreational, crafts, and music classes, but also a festival every year, to which the local
community is invited.
An interesting form of the courses was presented in the Grundtvig project - "Seniors in
Action" (European Commission, Learning for Active Aging and Intergenerational
Learning: Final Report DG Education and Culture. 2012). The project included courses
for older people with special skills or professions (honey producers, organic farmers,
horseshoe casters, mathematicians, poets, chess players, and painters). These courses
aimed to prepare older people to be trainers in non-formal school pupils.
The current pandemic situation has significantly limited face-to-face activities. A large
part of human activity has moved to the virtual world. A large proportion of older people
have a problem with IT technology. Their number is increasing, but it is still not too many.
The percentage of internet use and activities carried out by individuals, by age group, in
European countries can be seen in Table 1.

Table 1. Internet Use and Activities Carried Out by Individuals, by Age Group, EU-27
(% of individuals)
American researchers pointed out (Anderson, et al. 2017) that the use of modern
technologies by older people is increasing year by year, but it is still difficult to consider
this level as satisfactory. Within two decades, the use of the Internet in the 65+ age group
increased by 55 percentage points and in 2016 it amounted to 67%. Researchers also
identified the main barriers to IT use reported by the elderly. Among them is a lack of
faith in one's abilities. You need help from others to teach you how to use the device or
application. Despite this, most of them believe that modern technology has a positive
impact on life and society (55%). Only 4% considered this influence mostly negative.
Even those who can use IT often want to improve their skills, but do not know how and
where. Young people through school activities and voluntary activities in NGOs can help
them in this. Both groups will benefit from this. Elderly will gain new IT skills useful in
everyday life, and young trainers will learn to work as a trainer and interpersonal
communication. Intergenerational action will strengthen the self-esteem of both groups
(Barton, 1999; Grzybek, 2012; Klimczuk, 2016).
The COVID-19 pandemic has made us all realize how helpful is digital technology. For

younger people, it is possible to learn and work remotely. For elderly people it can help
buy medicines and food, keep in touch with loved ones and caregivers. It can provide
entertainment in terms of watching movies, plays and listening to concerts. That is why
it is important to organize classes for the elderly that will help them use modern
technologies. Classes should include:
• secure online shopping
• checking the credibility of information on the Internet
• installation and operation of applications
• creating images, videos, texts, or downloading them from the Internet.
There are many definitions of old age, but there is no full agreement on when it begins.
The fact is that societies are ageing. Scientists distinguish five types of ageing (Kotlarska-
Michalska, 2000):
• Constructive attitude - a person is at peace with the passage of time and the
approaching end of life is cheerful, tolerant, and able to enjoy life.
• Dependent attitude - a person is passive, becomes dependent on a spouse or

children
• Defensive attitude - a person is afraid of death, has strong fears, which he hides
under increased activity, may be characterized by jealousy towards younger people.
• An attitude of hostility towards the environment - a person shifts the grievances

onto others - people, institutions. He accuses others of his failings, envies the younger
ones.
• Self-hostile attitude - is characterized by people with low self-esteem, they are

reluctant to recall memories, and they are inactive and not very resourceful. They
have self-regret and self-grudge and treat death as a liberation from a failed life.
When organizing various activities for the elderly, it should be taken into account that
they may have different attitudes, and depending on the one they represent, the methods
and forms of work should be appropriately developed (Świętochowska, 2012; Tried &
True; Corbin, Kagan, Metal-Corbin,1987).
Sociologists wonder what role older people play and will play in societies, what will be

the relations between them and younger families. As the population of old people grows,
more and more elements that are aggressive should be introduced into educational
programs at all stages. Examples of such courses can be found at the Centre for Healthy
Aging of Pennsylvania State University (Intergenerational Learning):
• Digital Media and Social Practice - students learn how to prevent age
discrimination through a variety of media.
• Perspectives on Aging/Lighter as We Go - students in contact with old people

get to know all stages of life from youth through adult to old age.
• Art & Science of Healthy Aging - students learn how to build intergenerational
relationships by using science and art.
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7. Important Points in Elderly Care
In this part, physiological changes, problems, and care practices in elderly people will be
discussed first. Next, there will be information about the geriatric assessment. Finally,
the information about the general care of the elderly will be presented.
7.1.Physiological Changes, Problems, and Care Practices in Elderly People
With ageing, physical, psychological, and mental changes occur in the body. In this
chapter, physiological changes, common problems, and care practices in the elderly will
be explained.
7.1.1. Changes in the Cardiovascular System
Changes in the cardiovascular system of the elderly cause circulatory slowness, oxygen
deficiency, fatigue, difficulty adapting to changing situations, and a tendency to edema.
Common diseases related to ageing cardiovascular system are orthostatic hypotension,
coronary artery disease, and increased blood pressure (Fleg & Strait, 2012; Houghton, et
al. 2016).
Recommended interventions to minimizing age-related cardiovascular changes of

elderly;
• Appropriate exercise planning

• Dietary regulation QR Code 1:
• Regular health checks European
Guidelines on
• Regulation of lifestyle Cardiovascular
Disease
• Diet low in sodium, fat, and cholesterol, rich in fiber Prevention
• Adequate fluid intake Practice.
• Avoiding sitting for a long time

• Avoiding standing for a long time
• Avoiding using electric blankets
• Avoiding taking a hot bath
• Keeping a healthy weight
• Limiting portion size

• Stress management (European guidelines on cardiovascular disease prevention in
clinical practice-version 2012) (Further Reading Suggestion: Scan QR Code 1).
7.1.2. Changes in the Respiratory System
Ageing cause to decrease in rib cage elasticity, respiratory capacity, coughs reflex, and
peripheral perfusion. With ageing, alveolar membrane thickness increases, cilia
movements slow down and acid-base regulation can be impaired (Lee et al. 2016; Lalley,
2013).
Common diseases related to ageing respiratory system pulmonary tuberculosis, chronic

obstructive pulmonary disease, and respiratory system infections such as pneumonia and
pulmonary thromboembolism (Fulop, et al. 2010; Vogelmeier, et al. 2017).
Recommended interventions to minimizing age-related respiratory changes of elderly;
• Prevention of infections by vaccine such as pneumonia and influenza vaccine

• Preventing bladder, bowel, and stomach distension
• Allowing enough time for care
• Appropriate exercise planning
• Dietary regulation
• Regular health checks
• Cough and deep breathing exercises
• Training and counseling
• Avoiding air pollution and other pollutants
• Avoiding smoking cigarette
• Keeping a healthy weight (Fulop, et al. 2010; Vogelmeier, et al. 2017)
7.1.3. Changes in Digestive System
Ageing cause to decrease in all secretions and enzymes, absorption, muscle tone,
function, and blood flow to the liver. With ageing pancreatic response and sensitivity of
taste and smell, receptors decrease. The elderly are tending to tooth losses (Dumic, et al.
2019).
Changes in the digestive system of the elderly cause broken teeth and prosthetic lesions,
loss of appetite, indigestion, changes in eating habits, absorption difficulties,

incontinence, and aspiration risk. Common diseases related to ageing digestive system
are malnutrition, atrophic gastritis, diarrhea, and constipation (Rémond, et al. 2015;
Cichero, 2018; Dumic, e.t al 2019).
Recommended interventions to minimizing age-related digestive system changes of

elderly;
• Solving oral-dental problems

• Preventing dehydration
• Keeping a healthy weight
• Keeping constipation under control
• Training and counselling
• Maintaining a healthy diet
• Reducing salt consumption.
• Avoiding white foods such as bread, rice, and potatoes.
• Drink water or other non-caffeinated, non-alcoholic beverages throughout the day
• Avoiding foods that trigger heartburn or reflux (Rémond, et al. 2015; Cichero,
2018; Dumic, e.t al 2019).
7.1.4. Changes in Nervous System
Ageing causes loss of central nervous system cells and sensitivity in nerve endings and
receptors. With ageing, blood circulation and memory become weak. Intellectual
capacity, sympathetic and parasympathetic functions decrease by age (Saxon, et al. 2014).
Changes in the nervous system of the elderly cause reflex weakness, increased risk of
accidents, frostbite, burns, wounds, aspiration risk, sleep problems, learning difficulties,
disorientation. Common diseases related to ageing nervous system are Alzheimer's
disease, depression, dementia, anorexia, delirium, and insomnia (Saxon, et al. 2014;
O'Callaghan & Kenny, 2016).
Recommended interventions to minimizing age-related nervous system changes of

elderly:
• Trying to establish the relationship of the individual with the reality, to ensure his
orientation to the person, place, time frequently

• Reminding the things to do
• Care, education, and counselling
• Preventing accidents
• Physical exercise
• Adequate sleep and rest
• Preventing complications
• Suitable environments
• Providing security and freedom
• Providing social support
• Reading books
• Music (playing musical instruments such as a piano)
• Positive perception
• Meditation
• Cognitive therapy
• Joining the University of the Third Age (Kirk-Sanchez & McGough, 2014;
Bauman, et al. 2016).
7.1.5. Changes in Metabolic-Endocrine System
Ageing cause to decrease in body mass, energy requirement, and hormone levels in the
metabolic-endocrine system. With ageing, the fat ratio increases. Changes in the
metabolic-endocrine system of elderly difficulties to cope with stress, menopause,
andropause, glucose intolerance. Common diseases related to ageing metabolic-endocrine
system are Type II diabetes (Gong & Muzumdar, 2012; De & Ghosh, 2017).
Recommended interventions to minimizing age-related metabolic-endocrine system

changes of elderly:
• Coping with stress

• Counselling for menopause and andropause.
• Regular health checks (Stute et al. 2016).
7.1.6. Changes in Hematopoietic System
Ageing cause to decrease in bone marrow and lymphoid tissue function in the
hematopoietic system. Changes in the hematopoietic system of the elderly cause fatigue

and decreased resistance. Common diseases related to ageing hematopoietic system are
anemia and infections (Snoeck, 2013; Kovtonyuk et al. 2016).
Recommended interventions to minimizing age-related hematopoietic system changes of

elderly:
• Activity planning
• Balanced diet
• Preventive measures (Snoeck, 2013; Oliveira et al. 2018).
7.1.7. Changes in Immune System
Ageing cause to decrease in antibody response and an increase in autoantibody. Changes

in the immune system of the elderly cause delayed wound healing and infections (Castelo-
Branco & Soveral 2014; Ciabattini et al 2018).
Recommended interventions to minimizing age-related immune system changes of

elderly;
• Protecting programmes such as vaccination

• Getting active
• Reducing stress
• Spending time outdoors (Castelo-Branco & Soveral 2014; Ciabattini et al 2018).
7.1.8. Changes in Senses
Ageing cause to decrease in the flexibility of the lens and corneal reflex. Visual acuity,
peripheral vision, tears decreases in the elderly. Pupils’ adaptation is delayed and
symmetrical hearing is decreased by age. Changes in the senses of the elderly cause
accident risk, eye infection, darkness and excessive light adaptation problem,
dependence, communication problem, disorientation, and blindness (Rosenthal &
Fischer, 2014; Humes & Young, 2016; Saftari & Kwon, 2018).
Recommended interventions to minimizing age-related sense changes of elderly:
• Taking measures against accidents

• Ensuring communication
• Supporting independence

• Training and consultancy
• Protective measures (Rosenthal & Fischer, 2014; Humes & Young, 2016; Saftari
& Kwon, 2018).
7.1.9. Changes in Skin
Ageing cause to decrease in subcutaneous adipose tissue, the function of sweat glands,
pigmentation, and the elasticity of the skin. Changes in the skin of the elderly cause
increased pigmentation, dryness, wrinkles, heat regulation problem, and pressure ulcers
risk. Common diseases related to ageing of the skin are herpes zoster, skin cancer, fungal
infections, calluses, and nail thickening (Al-Nuaimi, et al. 2014; Blume-Peytavi, et al.
2016; Humbert et al. 2016).
Recommended interventions to minimizing age-related skin changes of the elderly:
• Taking measures to protect skin integrity

• Ensuring adequate hygiene
• Taking necessary precautions and applying if there is incontinence
• Taking preventive measures against cross infections
• Keeping the skin dry and clean
• Preventing or keeping dehydration and edema under control
• Foot care (Al-Nuaimi, et al. 2014; Blume-Peytavi, et al. 2016; Humbert et al.
2016).
7.1.10. Changes in Musculoskeletal System
Ageing cause to decrease in elasticity, mass, and strength of muscles. With ageing, hip,
knee joint synovial membrane changes, and bone mineral loss increases, especially in
women. Joint mobility decreases and body fat mass increases by age (Reuter, 2012;
Gheno et al. 2012; Saxon et al. 2014).
Changes in the musculoskeletal system of the elderly cause fatigue, hip fracture, balance,
and walking problems. Common diseases related to ageing of the musculoskeletal system
are atrophy and arthrosis problems, osteoarthritis, osteoporosis, scoliosis, and
degenerative arthritis (Reuter, 2012; Gheno et al. 2012; Saxon et al. 2014).

Recommended interventions to minimizing age-related musculoskeletal system changes
of elderly:
• Ensuring adequate intake of calcium, protein, and vitamin D in the diet

• To take precautions against accidents
• Exercise practices
• Training and consultancy (Cadore, et al. 2013; Apóstolo, et al. 2018).
7.1.11. Changes in Genito-Urinary System
Ageing cause to decrease in oestrogen level, secretions, and perineal muscle tonus. By
age, the uterus becomes smaller, and vaginal epithelium atrophies in women. Ageing
cause to decrease of testosterone level and sperm count. By age, testicular atrophies in
men (Mannella, et al. 2013; Gunes et al 2016).
Age-related changes in the genito-urinary system of women cause decreasing in

intercourse frequency and incontinence. Age-related changes in the genitourinary system
of men cause increasing in urination frequency due to prostate enlargement and
decreasing in intercourse frequency. Recommended intervention to minimizing age-
related genitourinary system changes of elderly is training consultancy as required (Mac
Bride et al 2010; Eilber & Lee, 2020).
7.2.Geriatric Assessment
Geriatric assessment allows an effectively assessing and actively managing their health
care (Elsawy & Higgins, 2011).
Aims of geriatric assessment are;
• To determine the basic characteristics of the patient, his history, and the results of
his treatment,
• To make the correct diagnosis,
• To reveal hidden diseases,
• To improve medical treatment,
• To improve functional status,
• To increase the quality of life,
• To make long-term care plans,

• To save on care costs by avoiding unnecessary expenses (Ellis et al. 2011; Michel
et al. 2018).
The core domains of geriatric assessment are;
• Functional status,
• Mobility,
• Daily living activities,
• Gait speed,
• Cognition,
• Mood and emotional status,
• Nutritional status,
• Comorbidities and polypharmacy,
• Geriatric syndromes (fall risk, delirium, urinary incontinence, dentition, visual, or
hearing impairments),
• Disease-specific rating scales (ie, parkinsonism, dementia),
• Goals of care,
• Advanced care planning (Ward & Reuben, 2016; Pilotto et al 2017).
For more information, you can read “Integrated care for older people: Guidelines on
community-level interventions to manage declines in intrinsic capacity” published by
World Health Organization in 2017.
7.3.General Care of The Elderly
General care such as hygienic care, eye care, nutrition, elimination of drug use, and sleep
is important processes in the elderly (Nies & McEwen, 2014). To achieve this goal; it is
of great importance to control diseases in the early period, to protect and maintain the
current health status, to benefit from existing opportunities for the elderly, to improve
existing opportunities, and to develop new areas of needs (World Health Organization,
2017).
7.3.1. Hygienic Care
Skincare and general hygienic care are important due to changes in the skin of elderly
people. The elderly should have dry skin and normal temperature (Ackley et al., 2017).
Since the skin dries, a bath twice a week using mild soap is sufficient (Brennan-Cook and

Turner, 2019). Alcohol-free soaps and shampoos should be used for hair and should be
combed with a soft brush. After bathing, it is important to thoroughly dry the under
breasts, armpits, and between the feet.
Foot care is important in the elderly community. After a bath, elderly people should use
cream and alcohol should not be used while massaging. Also, between the toes, nail edges
and soles should be checked regularly. Nails should be cut straight and should not be cut
deeply. Elderly people also do not walk barefoot and they should prefer cotton and thick
socks(American Diabetes Association, 2013; Miikkola et al., 2019). Regular eye
checkups and artificial tears for tear reduction are recommended (Nies and McEwen,
2014).
7.3.2. Oral and Dental Care
The elderly should brush their teeth at least twice a day to help prevent gum disease and
tooth decay. Toothbrush handle used by elderly people should be thick and easy to shape.
Mechanical cleaning expresses the removal of plaque using a brush or ultrasonic cleaning.
Chemical cleaning products are depending on sodium hypochlorite, peroxides, neutral
peroxides with enzymes, enzymes, or acids (Duyck et al, 2016). Also, brush cleaning
tablets or solutions for dentures and artificial saliva for dry mouth are recommended.
Teeth or dentures should be cleaned after eating. Prostheses used by elderly people should
be kept in prosthetic water and avoided from hot food and drinks (Baumgartner et al.,
2015; Delwel et al., 2018; Razak et al., 2014).
7.3.3. Nutrition
Elderly people face many problems such as slowness in eating, difficulty in chewing and
swallowing generally caused imbalanced nutrition (Ackley et al., 2017). Therefore, the
diet of the elderly person should be planned to include carbohydrates, fat, protein,
vitamins, and minerals. Soft foods and soups should be preferred, and salt consumption
should be reduced. Besides, elderly people should avoid white food such as bread, rice,
and potatoes (World Health Organization, 2017). It is advised to elderly people to take a
fluid intake of 1.5 to 2 L of fluid each day (ideally, 6 to 8 glasses of water) (Ackley et al.,
2017). Three main meals or 3 small meals and 2-3 larger snacks and nutritious drinks are
recommended. Main meals should be available every 4 to 5 hours during the day. The

maximum period between the last main meal at night and the following breakfast should
not excess 12 hours (LlyWodraeth Cymru Welsh Government, 2019).
7.3.4. Elimination
Elderly people should prefer aqueous and cellulose foods and meet the toilet requirement
every day at certain times. Also, regular walking for the elderly is recommended. Besides,
strengthening effective muscles in the perineum and micturition is important for
elimination in the elderly population (Nies & McEwen, 2014; Sharma and Bhutta, 2020).
It is recommended to go to the toilet at certain times (a regular toilet routine) and drink
warm water in the morning to prevent constipation in elderly individuals (Schuster et.,
2015).
7.3.5. Sleep and Movement
Elderly need to sleep about 7 to 9 hours each night. For healthy sleep, they should avoid
short naps during the day and from mental stimulation activities and exercise before
bedtime. Advice against the sleep-deprived client’s chronic use of caffeinated drinks to
overcome daytime fatigue and or drowsiness; focus on elimination of factors that lead to
chronic sleep loss(Ackley et al., 2017). Environmental regulations such as night light
increase the sleep quality of elderly people. At the same time, safe sleeping pills can be
preferred for quality sleep. However, ensuring that the distance between the bedroom and
the toilet is close and safe is important for quality sleep (Charlesworth et al., 2015; Cooke
and Ancoli-Israel, 2011; Scheuermaier and Loughlin, 2016; Mander et al., 2017; Molano
and Vaughn, 2014). Summarily, ensuring a dark and quiet nighttime environment,
supplying a suitable sleeping temperature, inducing physical activity, maintaining a
consistent schedule of meals and activities, maintaining a bright daytime environment,
and facilitating outdoor activity are all methods of improving sleep (Ackley et al., 2017).
Establishing suitable home, garden, and landscaping for elderly people, encouraging them
to do daily work, regular body exercises, walking, breathing exercises, and good posture
and position exercises increase the movement of elderly individuals (Ackley et al., 2017;
Nies and McEwen, 2014).
In summary, the exercise training to be taught to the elderly with VR can be as follows.
• Exercise should be appropriate to the capacity of the individual.

• Exercise should be increased gradually.
• Exercise should be a part of the individual's life.
• Exercise should not strain the cardio-pulmonary system.
• Exercise should be easy and enjoyable
7.3.6. Body Temperature and Clothing
Controlling body temperature in the elderly population is important for raising living
standards. Elderly body temperature ranges from 35.1 to 37 (Nies and McEwen, 2014;
Günes and Zaybak, 2008). Inappropriate clothing for environmental temperature is risk
factors for body temperature(Ackley et al., 2017). Wearing comfortable, protective
clothing (uniforms and athletic gear) which do not transmit heat and is suitable for the
season should be preferred. For example, lightweight cotton clothing is more comfortable
In hot weather (Ackley et al., 2017; Schlader et al., 2018; Tan et al., 2020).
7.3.7. Auxiliary/Assistive Devices
With old age, elderly individuals face many problems such as decreased vision loss and
walking difficulties. Necessary assistive such as a walker, canes, crutches devices, or
equipment needed. If needed, promote the use of glasses, assistive hearing devices,
hearing aids, and dentures. For these reasons, auxiliary devices become an important part
of their lives. Therefore, elderly people need to be able to maintain the auxiliary devices
they use. For example, cleaning dentures, cleaning glasses, preventing breakage of
glasses, removing the hearing aid used at night, and the maintenance and cleaning of the
hearing aid increase the living standards of the elderly and ensure that they stay safe (Nies
and McEwen, 2014). Also, education, monitoring, regular check-up, and improvements
should be made when necessary for the adaptation of elderly individuals to assistive
devices.
7.3.8. Use of Medicine
Many medications are used due to the high prevalence of chronic diseases in elderly
people. Therefore, irregular and improper medicine use is common. Polypharmacy is an
area of concern for the elderly because of several reasons such as metabolic changes,
reduced drug clearance, and drug-drug interactions. These risks are furthermore
exacerbated by increasing the number of drugs used (Dagli and Sharma, 2014). Taking

medicines the wrong way or mixing certain drugs can be dangerous for the elderly.
Therefore, the following instructions, are important for the safety of the elderly (Lugo-
Trampe and Trujillo-Murillo, 2010; National Institute on Aging, 2019; Nies and
McEwen, 2014):
using the right amount, QR Code 2:

National Institute
correct and regular use, on Ageing: Safe
turn on the light, Use of Medicines
for Older Adults.
tell the doctor about alcohol, tobacco, and drug use,
checking before stopping,
do not share own drugs with anyone,
monitoring of adverse effects,
cooperation with family and physician,
monitoring of blood pressure, blood sugar,
use of drugs such as analgesic, anticoagulant, diuretic, and oral hypoglycemic
under the supervision of the doctor. (Further Reading Suggestion: Scan QR Code
2)
Daily medicine boxes should be used by the elder population. Medicine reminders such
as mobile application and alerts should be used ( Sevais, 2016).
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health#:~:text=Common conditions in older age,conditions at the same time.

8. How Conditions Elderly Face As They Age Should Be Taken Into Account
When Creating VAR Content for Them
8.1. Ageing of Societies
Among the documents, dealing with the rights of older people there is “The Charter of
Fundamental Rights of the European Union”. In article 25, it is stated that the Union
“recognises and respects the rights of the elderly to lead a life of dignity and independence
and to participate in social and cultural life”. The situation of older people is an important
topic and it will increasingly appear in discussions, publications, and activities of
individual countries and the entire EU. It is related to the aging of societies. The
population of old people in the EU is constantly increasing. Comparing the EU countries,
one can see that the trend is similar. The differences relate to the pace of change.
(Gostomski, 2013; Kubiak, 2013). This is shown in the statistics in Table 1.
Table 1. Elderly Population Age Structure by Major Age Groups, 2009 and 2019 (% of
the total population)
(Source:https://ec.europa.eu/eurostat/statisticsexplained/index.php?title=Population_stru
cture_and_ageing)

There will be more and more elderly people. Their percentage in the total population will
be increasing. This applies to the whole world, but in Europe to almost all countries. It is
predicted that in 2050, there will be over 30% of people aged over 60 in Europe. It can
be seen in Figure 1.
Figure 1. The Estimated Elderly Population Ratio in Europe in 2050 (Source: UN

DESA Report, World Population Prospects: The 2015 Revision).
Therefore, the attention of researchers, politicians, and governments is increasingly
focused on demographic problems. The prognosis for the future of Europe is worrying.
The percentage of young people is falling, and the percentage of people 60+ is growing.
It has to do with increasing life expectancy. Another factor is the decline in birthdays.
Another factor is the number of children in the family. The age of women who become
mothers for the first time also influences this situation. The situation of old people differs
from country to country. It is influenced by legal regulations, the economic situation,
traditions, and customs as well as the attitude towards the elderly people. Many countries
have extended their expenses for the elderly, but it will continue to grow (Bounding,
2013).
The situation of some elderly is such that their pensions and other incomes are sufficient
for living, purchasing medical services, and employing personal assistants. However

there is also a group of people who need the help of children and relatives and a group
that has a low income, who has no close relatives, and are dependent on social care
(Bledowski, Pedich,& Bien, 2006).
Research on the situation of elderly people includes various aspects: social, medical, and
health. The conclusions drawn from the research require appropriate preparation of the
society - people and institutions. There is a need to develop a strategy that takes into
account the social and economic aspects of the changes (Stan obecny i przyszłość opieki
długoterminowej w starzejącej się Polsce, 2015).
The conditions in which the elderly live can be described in relation to individual
European countries or to the places where they live: alone, in multi-generational families,
in social care homes. The European Union is taking various actions to introduce common
standards and regulations (Badania i raporty, 2017; Gostomski, 2013; European
Commission, 2018).
In most countries, local authorities are responsible for the care of the elderly. For example,
in Sweden, the 1992 "Ędel reform" (Ędelreformen) introduced the rule that municipalities
are responsible for the care of the elderly and disabled. The competent municipality must
pay if the patient stays in the hospital longer than necessary (Skubiszewska, 2011).
The general tendency is integration, creating friendly environments for older people.
Active ageing has a positive effect on physical and mental health, and thus reduces state
spending on caring for the elderly (Bounding, 2013). These QR Code 1:
expenses will increase as a percentage, and this is influenced not “Investing in later
life. A toolkit for
only by the ageing of the population but also crises such as the social services
covid-19 pandemic. A decline in the state's income may limit providing care
for older
social spending. This may lead to a reduction in financial people” by
resources to support the elderly. Therefore, intergenerational European Social
Network.
integration and active ageing can help maintain the health,
fitness, and standard of living of older people (European Social
Network, 2017). For more informaton on social services
providing care for older people, scan QR Code 1.

8.2. The Housing Situation of Elderly People
The housing situation of older people varies. In the Polish study done by Błędowski,
Szatur-Jaworska, Szweda-Lewandowska, and Kubicki, (2012), it was found that: people
living alone - 22%; marriages - 32.2%; married couples living with children14 - 8.5%;
families consisting of an elderly person and their children - 8.6%; married couples living
with children and grandchildren - 9.9%; families consisting of an elderly person, her
children, and grandchildren - 10.1%. Moreover, it was found in the same study that the
number of elderly people living alone increases with age.
8.2.1. Elderly Living Alone
Many reasons cause such a situation:
• These are people whose spouse has died (widows and widowers). Sometimes they
decide to live with another family member (child, grandson), but most prefer to
live alone.
• Another group consists of childless people. After the spouse's death, they usually
do not enter into other marriages. They rarely benefit from the care of their
extended family (nephews, nephews).
• Older people who have children also often live alone. Due to the large migration
of people (study and work mobility), parents are left alone in their family homes.
Adult children away from their homeland are unable to take care of their old
parents, and the elderly do not want to change their place of residence (Badania i
raporty., 2017)
Elderly lonely people often need social assistance (paid from various sources: private and
state). Most often it takes the form of assistants who come and perform specific work,
provide help with household chores). They are often looked after by neighbours and
volunteers from non-governmental organizations (Nowak-Kapusta, Franek, Leszczyńska,
& Ćmiel-Giergielewicz, 2017).

8.2.2. Elderly Living In Multigenerational Families
There are fewer and fewer multigenerational families. It largely depends on traditions and
customs, but the tendency to reduce them is visible in all countries. Today,
multigenerational families are usually limited to two generations (Badora et al., 2001).
The reasons for this vary. Researchers point out that the change of the traditional family
pattern (short marriages, divorces, greater popularity of informal relationships) results in
the fact that extended families are less and less frequent (Holzer et al., 2003).
8.3.Types of Care
There are broadly three types of long term care:
• Institutional care may relate to nursing homes and care homes run by public,
private, or not-for-profit providers.
• Home care covers both nursing care and basic living services delivered at home.
• Informal or no specific formal care covers care that is provided by family or
friends or a situation where an older person does not receive any care from formal
providers of care (Degavre & Nyssens, 2012; Bettio & Verashchagina, 2012).
Nursing homes are most often intended for people who need institutional support. One of
the types of these institutions is homes for the elderly. Based on research and observations
(Kubiak et al., 2012), it is concluded that people should stay in their environment as long
as possible. They should go to nursing homes when it is necessary for their health and
safety.
Social Welfare Homes is run by state and private institutions and non-governmental
organizations. Staying in them may be free, partially paid, and fully paid. They can be
divided into two groups:
• Homes where there are able-bodied elderly. They stay in them due to the lack of
their apartment, poverty, and lack of a family;
• Homes with medical care for elderly people who need professional help, but who
do not have to stay in a hospital. (Szatur-Jaworska, Błędowski, & Zubrzycka-

Czarnecka, 2016). The rules of staying in such homes depend on the legal
regulations in individual countries.
8.4. Pensions
The age at which a person can retire varies across the EU. In some, it is different for
women (lower) and men (higher). The amount of the old-age pension depends on the
length of service and earnings. All countries strive to extend working hours (Dziubińska-
Michalewicz & Kłos, 2020). The statutory retirement age, early retirement schemes
decided about the numbers of pensioners.
In most countries, the pension system is based on contributions on earnings. Contributions

may vary depending on the profession. In several EU countries, for example, Ireland,
Greece, Malta, the Netherlands, and the United Kingdom, the public pension system
provides a flat-rate pension, which may be supplemented by a professional or private
contribution. Some countries (Poland, Slovakia, and Hungary) have recently decided to
transfer funds from segregated private accounts back to the system (European
Commision, 2018; Global AgeWatch Index, 2015; Bledowski, Pedich & Bien, 2006).
Regardless of the pension system, pensions are lower than earnings. The elderly need
money mainly for medicines and medical care. Living costs vary, but one can see that
prices are rising faster than pensions. The costs of housing, food, and transport can be a
heavy burden for the elderly people. The price comparison taken from Eurostat (2016) is
presented in Figure 2.

Figure 2. Comparative Price Levels (EU-28, 2016)
The year 2020 has brought everyone's attention to the elderly, who are particularly
vulnerable to COVID-19. States have undertaken various forms of protection and support
for this group. It can be seen in Table 2.

Table 2. Government Social Protection Responses to COVID-19 Targeting Older People
(September 2020)
Source: https://socialprotection.org/discover/publications/responding-covid-19-
improved-social-protection-older-people-december-2020
The pandemic reduces interpersonal contacts. It is especially difficult for the elderly if
they cannot meet their children, grandchildren, or peers. Even though the COVID-19
crisis brought many impacts, it highlighted that the generations need each other, not only
for the economic situation but also for life balance. All these factors should be taken into
account when planning activities for the elderly. The differences will relate to the needs,
material conditions, and place of residence of the elderly, family situation.

References
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people in Europe: the national background report for Poland (Vol. 3). LIT
Verlag Münster.
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emerytury w bazowych systemach emerytalnych krajów Unii Europejskiej.
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Projections for the 28 EU Member States (2016-2070). Brussels: European Union.
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providing care for older people. Brighton: European Social Network.
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- Compared with the Polish. Retrieved 29.12.2020 from
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Nowak-Kapusta Z., Franek G., Leszczyńska K., & Ćmiel-Giergielewicz M. (2017). A
characteristic of selected elements of social-health situation among elderly
people staying in residential homes with taking into account depressive
symptoms. Retrieved 11.12.2020 from https://gerontologia.org.pl/wp-
content/uploads/2017/06/Gerontologia-Polska_1_2017-1
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Barcelona, Spain (2021)
© Copyright VARTES partnership 2020-2022 (grant no. 2020-1-ES01-KA204-082270)
Creative Commons (CC) licence: everyone is welcome to share, use and build upon our
work.
"Funded by the Erasmus+ Program of the European Union. However, European

Commission and Spanish National Agency cannot be held responsible for any use which
may be made of the information contained therein”.

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VIRTUAL & AUGMENTED REALITY TOOLKIT TO ENGAGE ELDERLY BRAIN

WITH INTER-GENERATIONAL UNDERSTANDING

Intellectual Output 1-A2:

CARE AWARENESS GUIDE

Version 1 (2020): 27-11-2020

PROJECT NUMBER – 2020-1-ES01-KA204-082270

Project acronym: VARTES

Funding European Commission, Erasmus+ Programme, Key Action 2

Grant agreement: 2020-1-TR01-ES204-082270

Project dates 01-09-2020 - 31-08-2022

Date of publication: 30.04.2021

PROJECT NUMBER – 2020-1-ES01-KA204-082270 2

PROJECT NUMBER – 2020-1-ES01-KA204-082270 3

PROJECT NUMBER – 2020-1-ES01-KA204-082270 4

PROJECT NUMBER – 2020-1-ES01-KA204-082270 5

The potential co-presence triggered by VR and AR are playing an increasingly significant

The Digital Guidelines have three parts:

• VR and AR Empowerment Guide

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Ageing is a lifelong process and it is a natural, ongoing, universal, and heterogeneous

• Chronological ageing is defined as “the number of years a person has lived so

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Healthy ageing is the focus of WHO’s work on ageing

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Ageing and Health. World Health Organization. Available at: https://www.who.int/news-

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Cardiovascular disease remains the most common cause in death

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2.3. Gastrointestinal System

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Age-related changes occur in esophageal function (Akdeniz et al., 2019). Swallowing

Ageing is associated with several changes in gastrointestinal physiology and function,

2.4. Urinary System

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2.5. Endocrine System

2.6. Nervous System

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Figure 1. Cognitive Decline with Ageing (Source: The biology of aging.

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Alterations of cognitive function result in age-associated reduction in speed of processing

Ageing is an important risk factor for the development of neurodegenerative diseases

2.7. Immune System

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2.8. Musculoskeletal System

Age-related muscle atrophy is associated with significant impairment of function, such

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2.9. Sensory Changes

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2.9.3. Taste and smell

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Ağar A. Yaşlılarda Ortaya Çıkan Psikolojik Değişiklikler. Geriatrik Bilimler Dergisi.

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Cognition is the combination of processes such as attention, learning, and reacting to

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3.1. Preserving and Maintaining Physical Health

• Recommended health screening should be done.

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3.3. Healthy Nutrition