Sensory Changes and Communication with Older Adults

1. Sensory Changes and Communication with Older Adults

2. Objectives • Identify the fundamental elements of good communication with older adults. • Identify the sensory losses in older adults that create barriers to good communication. List some techniques to break these physical barriers.

3. Objectives • Identify the cognitive barriers to good communication in older adults. List barrier breakers. • Identify psychological barriers to good communication and list barrier breakers. • Identify sociocultural barriers to good communication and how to use language translators effectively in the nursing practice setting

4. Fundamentals of communication • Two-way sensory activity • Shared reality and expectations (common ground) • High comfort level • Active listening

5. Common Ground techniques Different perspectives • Be sensitive to the older adults’ self-perception • Suspend stereotypes • Develop empathy • Develop flexibility • Be warm and sociable • Learn the language and customs • Dress in a socially and culturally respectful way TAKE HOME MESSAGE: We don’t always see things the same way as others do.

6. Sensory losses lead to • Reduced ability and desire to communicate • Isolation • Frustration leads to aggression or withdrawal

7. Hearing Loss Definition. Decreased ability to hear high- frequency tones Causes. • Nerve deterioration • Disease • Environmental situations • Medications • Cerumen (earwax)

8. Hearing Loss Communication Consequences. • Decreased speech discrimination – miscomprehension of speech • Difficult telephone use and face-to-face interaction; “inappropriate” or “awkward” • “selective hearing” and “ daydreaming” • Social isolation • Deterioration of speech and voice quality

9. Hearing Aids • In -The -Ear (ITE) • Behind-The-Ear • Canal Aid • Body Aids

10. Barrier Breakers: hearing loss • Sit in front; light on your face • Ask if the person is hard of hearing • Check hearing aid • Ask if the can read lips; sign language • Cut background noise • Rephrase rather than repeat • Use gestures, diagrams, printed/writing implements • Alert when you are changing the subject • Sign-language interpreter

11. Vision Loss Causes. • Decreased pupil size and accommodation • Macular degeneration – central vision loss • Glaucoma – peripheral vision loss • Cataracts – cloud vision

12. Vision Loss Communication Consequences. • Inability to identify doors, stair edges, light switches • Avoidance of light sources which cause glare. Patient will stay in a dimly lit room – social isolation. • Stares at television; inability to talk about what one is viewing (scenery; pictures) • Appears “inattentive”

13. Welcoming environments • Signs in clear, large bold print at eye level; use audiotapes; Braille • Contrasting colors • Good, even lighting levels • Use task lamps • Soft furnishings – curtains, carpet – to reduce sound resonance • Use of accessibility feature (magnifier) when using a computer

14. Barrier Breakers: vision loss • Always identify yourself clearly and narrate your activities • Use clear language when you give directions (“right” and “left”, not “over there”; use “yes” or “correct” , not “right”). • Obtain and encourage the use of low-vision aids (magnifying glasses) and make sure that the setting is well lit.

15. Barrier Breakers: vision loss • If an older adult is not wearing glasses, ask whether glasses are usually worn and for what purposes. • BE AWARE: pulls away or turns head to one side and seems to be looking away, it may only be to adjust the visual distance and angle to see you.

16. Barrier Breakers: vision loss • When using printed material, make sure that it is a size that the older adult person can read (at least 14-point type). • Research and use resources within your community that may offer assistance.

17. Speech Loss Causes. • Stroke • Dental difficulties – lack of teeth; ill-fitting dentures • Xerostomia (dry mouth) Communication Consequences. • Isolation and frustration • Loss of self-esteem • Embarrassment

18. Barrier Breakers: speech loss • Find out before interacting, whether the older adult has a speech impairment • Show that you do not expect them to speak well – do their best • Provide alternate forms of communication • Use gestures and body language

19. Touch/Tactile Loss Causes. • Neurons die and are not replaced • Stroke • Fear • Discomfort • Stereotypes • Sense of one’s own vulnerability • Isolation

20. Movement Loss Causes. • Osteoporosis • Arthritis • Lack of exercise • Stroke • Weight gain

21. Movement and tactile loss Communication Consequences. • Feeling of fatigue • Body language may appear inappropriate and misinterpreted • Limited stamina may lead to loss of initiative and cooperation with caregivers • Feels loss of independent living

22. Barrier Breakers: tactile and movement loss • Be aware of movement limitations • Be aware of pain and its impact • Gestures are effective • Touch to reassure • Verbal encouragement – exercise • Ensure a safe environment

23. Taste and Smell Loss Causes. • Normal aging • Certain disease states • Medication • Surgical interventions • Environmental exposure

24. Taste and Smell Loss Breaking Barriers: • encourage yearly dental visits • use of dentures • frequent cleaning of mouth Communication Consequences. • Reluctance to discuss food • Reduced pleasure and comfort • Decreased socialization • Nutritional /immune deficiencies

25. Cognitive Barriers Causes. • Multidrug interactions • Dementia • Alcoholism • Inadequate sleep

26. Cognitive Loss Communication Consequences. • Difficulty in achieving shared reality • “acting out” behavior Barrier Breakers. • Keep expectations realistic • GO SLOW! Use one-step commands • Validate behavior • Discover meaning behind behavior • Ask “yes-no” questions

27. Psychological Barriers Communication Consequences. • Violent acting out • Abusive behaviors • Irritability • Great concern with health problems • Isolation and loneliness Causes. • Depression • Anger • Personal “baggage” • Personality types • Losses .

28. Circumventing Psychological Barriers • Be aware of personality types • Become an active listener • Leave “personal baggage” at home, and try to see what the older person is bringing with them • Empathize but do not legitimize fatigue and apathy

29. Sociocultural and Language Barriers • Sociocultural beliefs: respect, nutrition, pain, and death • Language reflects or creates reality • Translation vs. interpretation • Differing agendas: client, caregivers, translators • Translator competencies

30. Sociocultural and Language Barrier Breakers • Learn key words • Differentiate translation from interpretation. • Ask family interpreters to “translate” rather than “interpret” • Learn the beliefs and values • Learn key ethnic customs and rituals • Suspend your stereotypes and prejudice

31. Summary • Fundamental elements of good communication • Sensory losses: hearing, vision, speech, touch, movement, taste and smell, cognitive, psychological and social, and language barriers • Techniques for breaking barriers in communication

32. QUESTIONS?