Chapter 4: Aging Changes That Affect Communication

1. Chapter 4: Aging Changes That Affect Communication Bonnie M. Wivell, MS, RN, CNS

2. Senses and Communication • Vision – 70% of all sensory info comes through the eyes • Hearing – provides source of info as well as interpretation of meaning • Pitch – high/low • Timber – quality • Touch – may be substitute for sight • Smell & Taste – convey meaning and trigger feelings • Movement – allows receipt of info from environment, nonverbal communication • Note that disability can affect ability to convey or receive info

3. The Role of the Brain in Communication • Cortex – responsible for higher thought and function; contains all sensory and motor information • Thalamus – relay station • Forebrain – interprets information

4. Review of Normal Age Related Changes That Affect Communication • Vision • Visual acuity and accommodation decline • Presbyopia starts age 45-55 • 80% have adequate vision past age 90 • Hearing • Start to lose pitch age 50-55 • 20-30% over age 65 • 40-50% over age 75 • 89% over the age of 80

5. Age Related Changes Cont’d • Speech and language – can become shaky or breathy • Touch – at risk for hypothermia and pressure ulcers • Movement – reduced speed and accuracy • Cognitive changes • Fluid Intelligence: new info, declines over time • Crystallized: accumulated info, remains stable • Psychological changes – onset of mental illness

6. Pathological Processes that Affect Communication Common Visual Diseases

7. Cataracts Painless progressive vision loss – 70% of Americans develop after age 75 Increasing lens opacity causes spraying of light and blurriness around edges of objects Cause: hereditary, advancing age Corrective surgery – most common surgery in US

8. Glaucoma Increase of intraocular pressure which causes damage to optic nerve which can lead to blindness Asymptomatic until late in disease Early detection important Screening identifies 90% of patients with increased pressure Treat with eye drops to prevent vision loss

9. Diabetic Retinopathy Visual complication of elevated blood sugar, which causes microaneurysms in retinal capillaries Accounts for 7% of blindness in US Early detection and treatment of diabetics to prevent substantial vision loss Annual eye exams

10. Macular Degeneration • Most common cause of legal blindness in people over 50 • Women • Blue eyes • Caucasion • Progressive degeneration of macula and loss of central vision • Starts in one eye and moves to other eye in 5 years • Early diagnosis – over 50 should have eye exam every 2 years

11. Pathological Processes Associated with Hearing Loss • Presbycusis – difficulty with high pitched tones and speech discrimination • Tinnitus – persistent ringing, buzzing, or roaring • Ototoxicity – hearing loss due to medications or poisons

12. Pathological Changes in Speech and Language • Dysarthria – lose ability to articulate, brain lesions main cause • Aphasia • Expressive: unable to produce language • Receptive: unable to comprehend • Verbal apraxia – impaired initiation, coordination and sequencing of muscle movements which execute speech, caused by damage to parietal lobe

13. Movement Disorders in Older Adults Activities of Daily Living – basic tasks such as eating, bathing, toileting, grooming Instrumental Activities of Daily Living – more complex tasks such as handling finances, managing meds, preparing meals As seen in Parkinson’s Disease – tremor, rigidity, stiffness, slowness of movement, postural instability, and/or impaired balance and coordination

14. Common Pathological Cognitive and Psychological Changes in Older Adults Delirium: sudden onset, lasting days to months, reversible, recent and remote memory impaired Dementia: insidious onset, lasting from months to years, irreversible but can be slowed with use of meds, progressive loss of memory with recent affected prior to remote

15. Depression • Very serious; Characterized by at least 5 of the following symptoms: • Sadness • Lack of interest or pleasure in activities they once enjoyed • Significant weight loss or gain • Marked decrease or increase in sleep • Psychomotor agitation or retardation • Fatigue • Feelings of worthlessness or inappropriate guilt • Impaired ability to think or concentrate • Recurrent thoughts of death, including suicide ideation or attempts

16. The Potential Impact on Communication • Consider how all of the following can impact an older adults ability to communicate effectively: • Visual deficits • Speech and language deficits • Somatosensory deficits • Parkinson’s disease – memory problems, hallucinations, depression • Delirium • Dementia • Depression • ADL/IADL impairment

17. Summary Normal aging changes may result in a decreased ability of the older adult to communicate effectively. These changes may affect both the ability to receive and transmit information. Nurses should be mindful of and sensitive to these changes when planning care and teaching.

18. Chapter 5: Therapeutic Communication Bonnie M. Wivell, MS, RN, CNS

19. Communication • A core skill for nurses • Gather and share information • Form relationships • An exchange of information • Verbal and nonverbal • Augmentive and alternative communication system (AAC) = all forms of communication that enhance or supplement speech and writing; can enhance or replace conventional forms of expression • Hearing aids • Picture boards • Synthesized (computer-generated) and digitalized (recorded) speech

20. Communication in Healthcare • Instrumental communication: behavior necessary for assessing and solving problems • Affective communication: focuses on how the HCP is caring about the person and his or her feelings and emotions

21. Communicating with the Older Adult Basic principles for communication (Satir, 1976): • Invite: “I’m interested”, open-ended questions • Arrange environment: make it conducive to communication, eye to eye contact • Maximize understanding: be a good listener • Maximize communication: consider the patient’s health literacy level • Follow- through: forms trust

23. Aphasia

24. Visual Impairments

25. Hearing Impairments

26. Individuals Who are Deaf

27. Individuals with Dysarthria Dysarthria is difficulty with the muscles used in speech. Unable to articulate

28. Chapter 9: Teaching Older Adults Bonnie M. Wivell, MS, RN, CNS

29. Adult Learning and the Older Adult • Changes in adult learning • Lifelong learning • Post-WWII era & GI Bill of Rights • Malcolm Knowles’ Adult Learning Theory • Adults need a motivation to learn. • They are independent learners who build on past experiences. • They should be shown a reason for learning a particular task. • Theory of self-efficacy: actions influence outcomes • Social cognitive theory: certain behavior produces certain outcomes

30. Health Literacy • “The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions” (Mauk, 2010, pg. 289)

31. Technology for Lifelong Learning in the Older Adult • Technology can be a good educational tool for older adults • Barriers to using the computer with older adults • Physical • Social • Psychological

32. Lifelong Learning Needs of Older Adults • Educational topics on desired skills needed for education (AARP, 2000): • Diet and nutrition • Exercise and fitness • Weight control • Stress Management • Complementary and Alternative Practices • Career Advancement

33. Older Adults Express a Desire to Continue to Develop in: • Basic life skills: Reading, writing, math, driving • Hobbies • Community involvement • Volunteering • Arts and culture or personal enrichment • Enjoyment out of life • Educational travel • Spiritual and personal Growth • Getting along with others

34. Lifelong Learning Needs of Older Adults • Learning in formal and informal settings (community, long term care, health care agencies, colleges/universities) • Education needs to be tailored to the needs of the individual or group.

35. Barriers to Lifelong Learning • Disabilities • Cognitive, Affective, Sensory, and Psychomotor barriers • Reduced vision • Reduced hearing • Impaired cognitive function • Depression • Stress • Chronic illnesses

36. Cultural Diversity and Health Disparities • How does education differ in culturally diverse groups? • What is the impact of education on health outcomes in the minority older adult?

37. Implications for Educators • Use the principles of adult learning theory: • Assess readiness to learn. • Involve the audience at the start with questions or stories to which they can relate. • Draw the participants into the material from the beginning • Provide reasons for them to learn by pointing out the significance of the topic using statistics and research.

38. Implications for Educators • Use multiple teaching modalities to keep the material interesting and maintain attention, such as: • Power Point slides • Video or CDs • Handouts • Brochures or pamphlets • Posters • Demonstration/equipment • Quizzes

39. Implications for Educators • Remember to accommodate any unique physical needs of older adults: • Do not stand in front of a window – avoid glare. • Speak loudly and slowly. Use a microphone if needed. Turn off fans and other distracting noise. • Face the audience (remember that elders often fill in what they cannot hear by lip-reading). • Limit programs to about 20 – 40 minutes.

40. Implications for Educators • Use a room that is large enough to accommodate persons with wheelchairs, walkers, and other adaptive devices. • Handouts should be in large font and black type on white paper for easy readability. • Keep slides uncluttered. Use large font with easy-to-see backgrounds for slides.

41. Implications for Educators • Control the environment • Arrange the room to best suite the particular presentation. Be sure the room is large enough for the expected number of attendees. • Have a helper to assist with seating late-comers without disrupting the program or to help those who must leave during the presentation for some reason. • Be sure the room is a neutral temperature – not too hot nor cold, and free from drafts.

42. Implications for Educators • Make presentations elderly-friendly • Choose topics of interest to older adults such as living wills, vitamins and minerals, and stroke prevention. • Create a catchy title for the presentation that will pique interest and curiosity. • Use lay-terms or explain any confusing medical jargon. Define all terms.

43. Implications for Educators • Invite special speakers who are well known in the area to promote attendance. • Offer prizes, gifts, or some type of take-home item. • Be sure that handouts are appropriate to the literacy level and cultural background of the group!

44. Chapter 16: Using Assistive Technology to Promote Quality of Life for Older Adults Bonnie M. Wivell, MS, RN, CNS

45. Assistive Technology Assistive technology devices are mechanical aids that substitute for or enhance the function of some physical or mental ability that is impaired May enable Independent performance Increase safety Reduce risk of injury Improve balance and mobility Improve communication Limit complications of an illness or disability

46. Types of Assistive Devices • Low Tech • Pencil grips • Splints • Paper stabilizers • High Tech • Computers • Environmental controls • Braille readers

47. Patient/Family Education Maintain independence Live at home Increase quality of life Promote function and adaptation Reduce health-related costs

48. Common Applications of Assistive Technology Position and Mobility Walkers, wheelchairs, chair inserts, straps Environmental Access Modifications to buildings, increased accessibility, Braille Environmental Controls Switches that control the surroundings such as touching a switch for lights, TV, phone, opening doors via mouthstick or key pad

49. Common Applications (cont’d) Self Care Emergency response systems (ERS) Sensory Impairment Augmentative and Alternative Communication (AAC); all forms that supplement or enhance communications (writing, speech etc…) Goal of AAC is to improve communication and thus participation in home and community

50. Common Applications (cont’d) Social Interaction and Recreation Drawing software, computer games, adapted puzzles, computer simulations Computer-based Adaptations to computers that allow those with limitations access – switches, alternative keyboards, mouse, trackball, touch window, speech recognition, head pointers