Chapter 4: Aging Changes That Affect Communication

Bonnie M. Wivell, MS, RN, CNS

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

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

Review of Normal Age Related Changes That Affect Communication Vision

Visual acuity and accommodation declinePresbyopia starts age 45-5580% have adequate vision past age 90

HearingStart to lose pitch age 50-5520-30% over age 6540-50% over age 7589% over the age of 80

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

Pathological Processes that Affect Communication

Common Visual Diseases

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

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

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

Macular Degeneration Most common cause of legal blindness in

people over 50WomenBlue eyesCaucasion

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

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

Pathological Changes in Speech and Language

Dysarthria – lose ability to articulate, brain lesions main cause

AphasiaExpressive: unable to produce languageReceptive: unable to comprehend

Verbal apraxia – impaired initiation, coordination and sequencing of muscle movements which execute speech, caused by damage to parietal lobe

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

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

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

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

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.

Chapter 5: Therapeutic Communication

Bonnie M. Wivell, MS, RN, CNS

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

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

Communicating with the Older Adult

Basic principles for communication

(Satir, 1976): Invite: “I’m interested”, open-ended questionsArrange environment: make it conducive to

communication, eye to eye contactMaximize understanding: be a good listenerMaximize communication: consider the patient’s

health literacy levelFollow- through: forms trust

Aphasia

Visual Impairments

Hearing Impairments

Individuals Who are Deaf

Individuals with Dysarthria

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

Chapter 9: Teaching Older Adults

Bonnie M. Wivell, MS, RN, CNS

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

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)

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 adultsPhysicalSocialPsychological

Lifelong Learning Needs of Older Adults Educational topics on desired skills

needed for education (AARP, 2000):Diet and nutritionExercise and fitnessWeight controlStress ManagementComplementary and Alternative PracticesCareer Advancement

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

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.

Barriers to Lifelong Learning Disabilities Cognitive, Affective, Sensory, and

Psychomotor barriersReduced visionReduced hearing Impaired cognitive functionDepressionStressChronic illnesses

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?

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 beginningProvide reasons for them to learn by pointing

out the significance of the topic using statistics and research.

Implications for Educators

Use multiple teaching modalities to keep the material interesting and maintain attention, such as:Power Point slidesVideo or CDsHandoutsBrochures or pamphletsPostersDemonstration/equipmentQuizzes

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.

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.

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.

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.

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!

Chapter 16: Using Assistive Technology to Promote Quality of Life for Older Adults

Bonnie M. Wivell, MS, RN, CNS

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

Types of Assistive Devices

Low TechPencil gripsSplintsPaper stabilizers

High TechComputersEnvironmental controlsBraille readers

Patient/Family Education

Maintain independence Live at home Increase quality of life Promote function and adaptation Reduce health-related costs

Common Applications of Assistive Technology Position and Mobility

Walkers, wheelchairs, chair inserts, straps Environmental Access

Modifications to buildings, increased accessibility, Braille

Environmental ControlsSwitches that control the surroundings such as

touching a switch for lights, TV, phone, opening doors via mouthstick or key pad

Common Applications (cont’d)

Self CareEmergency response systems (ERS)

Sensory ImpairmentAugmentative 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

Common Applications (cont’d)

Social Interaction and RecreationDrawing 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

The Internet and the World Wide Web

Nursing InformaticsNursing informatics encompasses the use of

information technologies in relation to any functions that are within the sphere of nursing and that are carried out by nurses in the performance of their practice (Mauk, page 568)

Using the Web

Web use by older adults:Enhances self-esteem Increases a sense of productivity and

accomplishment Increases social interactionMeets need for personal controlStimulates brain functionProvides fun

Web Site Design

Sites sometimes fail to recognize older adults as a potential user group Increasing font size to at least 18 points or using

computer magnification screens (visual deficit)Tab key or a touch screen attached to a monitor

(fine motor skill deficit)External speakers or headphones to increase

amplification (hearing deficit) See page 571 of text

Teaching Access to Web Sites

The older adult must: be orientedhave an attention span and short-term

memorynot be agitated, combative, or destructivebe able to respond to one-step commands

and make choices

Teaching Access to Web Sites

Factors affecting outcomesRate of presentation individualizedBe organizedAllow plenty of time for personal practiceMake it meaningful and relativeHave a comfortable environment for learningStep-by-step graphic instructions or video demoGive supportive verbal feedback

Other Technology Services Learning activities

Word and board gamesE-mailMaking cards, letters, etc.Music and art activities

Health information/Health Care Services InformEducate

Technologies on the Horizon

Robotic Assistance

Sensor-based Monitoring

Intel’s Assistance Program