tooth wisdom: get smart about your mouth...suggestion iii - hearing aids hearing aids are improving...
TRANSCRIPT
M I C AH GI N
D E N T I S T R Y
Tooth Wisdom:
Get Smart About Your Mouth
Sensory, cognitive and mental health changes in older adults:
Effects on communication when making group presentations
Marita R. Inglehart, Dr. phil. habil.
University of Michigan –
School of Dentistry
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Outline
▪ The changing world of aging adults and how it affects communication▪ Introduction
▪ Sensory changes:
▪ Vision & hearing
▪ Changes in cognitive abilities:
▪ Processing information and memory
▪ Changes in mental health:
▪ Affective disorders: Depression and oral health
▪ Dementia
▪ Age related changes and beliefs about health
▪ In general
▪ In oral health
▪ Prevention and health promotion
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Part 1. Sensory changes1:
Vision / hearing / smell / taste
▪ When do changes start?
▪ Hearing — the mid 40’s
▪ Vision — the mid 50’s
▪ Touch — the mid 50’s
▪ Taste — the late 50’s
▪ Smell — the mid 70’s
1 Crews & Campbell, 2004
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Changes in vision
▪ Vision changes are found in all your
group participants >65 years!
▪ In 55-64 year old: 55 of 1,000 vision
impaired
▪ In > 85 year old: 225 of 1,000 vision
impaired
▪ But the rest has issues you need to
consider
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Changes in Vision
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Vision change I
▪ Hardening of lens is uneven:
▪ Glare sensitivity
▪ Lesson learned: Older patients don’t
face window or light
▪ Be aware of vision health issues such
as macular degeneration which
makes glare sensitivity even worse
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Vision change II
▪ Cornea thickens with old age
▪ Maximum opening of pupil = reduced to
2/3
▪ Practical consequence: difficulty to
function in low light
▪ Older adults need 3 x more light than
younger adults
▪ Lesson learned: Make sure you have
enough light in the room when you
present!
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Vision change III
▪ Lens becomes less elastic = less
accommodation
▪ Difficulty in near vision
▪ Difficulty when change from far to near
vision
▪ Lesson learnd: Use strong contrasts
(example: black writing on white) for
all written information / ppt
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Becoming hard of hearing / deaf
▪ By 65 years of age:
▪ 13% advanced hearing loss
▪ 40 to 50% mild to moderate
▪ Why?
▪ Structural changes in auditory system
▪ + CNS changes
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D E N T I S T R Y
Suggestion I
▪ Ask group members if they hear you and
find ways to help them hear you
▪ Use microphone if available and make sure
it works well
▪ Repeat questions from the audience to
make sure everybody hears questions
▪ Face your audience when you talk instead
of looking at ppt
▪ Stand close and move towards persons that
might show signs of not hearing you well
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Suggestion II
▪ Speak clearly and loud
▪ But: Not too loud because raising your voice
might result in higher pitched speech –
which might be more difficult to understand
▪ Ask participant questions to see if audience
understands or only pretends to understand
▪ Use ppt and handouts to help with
understanding information
▪ Offer written instructions to take home
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Suggestion III - Hearing aids
▪ Hearing aids are improving hearing: ▪ Based on a new Bluetooth technology designed by
Apple, there are advanced hearing aids that provide
outstanding sound quality, offer many helpful new
features, and are easy to set up and use.
▪ But:
▪ Not everybody can afford these
▪ Background noise is problem
▪ Make sure: Close door to keep
background noise to minimum
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Vision and hearing changes
▪ affect HOW you present
▪ But other sensory changes in older
adults might affect WHAT you talk
about
▪ Examples:
▪ Taste and smell
▪ Pain perceptions
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Taste and Smell2
▪ Age related changes in taste and smell:
▪ As we get older, our olfactory function declines. We
lose our sense of smell & ability to discriminate
between smells.
▪ >75% of people over age of 80 years have major
olfactory impairment
▪ which might affect taste and what they eat such over
sugary foods
2 Boyce et al., 2006
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Pain sensation3
▪ Research showed that older adults might
underreport pain because they might
think it is part of aging.
▪ They have similar pain thresholds, but
seem to tolerate more.
▪ Practical consequence: Make sure you talk
with them about seeking help when they
have pain and asking for pain medication
when procedures are done3 Herr & Garland, 2001
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Part 2. Changes in
cognitive abilities4
▪ Cognitive abilities: Information processing and memory
▪ Two competing forces: ▪ Bodily changes that lead to decline vs.
▪ Accumulation of life experiences that leads to higher competence.
▪ Result: Large individual differences
▪ Cultural effects:▪ In China: old person dies – loss of wisdom
▪ In US: old person dies – lived long life / death is ok4 Wilson et al., 2002
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Changes in
information processing
▪ Cross sectional studies (= comparing different age groups) show decline with age.
▪ WHY? Educational differences
▪ In your situation when teaching groups: be aware of health literacy issues
▪ Lesson learned: Use easy to understand terms
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Changes in memory
▪ There are different memory tasks▪ Recall: Tell me what the correct answer is.
▪ Recognition: Here is a list. Please identify which answer is correct.
▪ Older adults differ in different tasks: Recall is worse / recognition not so much!
▪ For some older adults: Recall is just slowed down.
▪ 7 to 10% of US citizens over 60: loss of memory for recent events
▪ Lesson learned: provide take home information
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Changes in information
processing: How can you help?▪ Structure information you give:
▪ Step by step
▪ Link points together
▪ Do not present too much information at once
▪ Give more time, relax, be patient
▪ Use active inquiry – teach back method
▪ Use multiple modes of presentation: talk about it and provide written information
▪ Eliminate distractions
▪ Relate it to something pt. already knows
▪ Write down main points and use external aids to assist recall
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Part 3: Changes in mental
health: Depression5
➢ According to the National Institutes of Health:
of the 35 million Americans age 65 or older:
- about 2 million suffer from full-blown depression
- another 5 million suffer from less severe forms of depression
- 15 to 20% of community living older adults have depressed mood
- 10 to 15% have depression that requires clinical intervention
- Suicide in older white males is highest of all groups
5 McFarland & Inglehart, 2010
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Depression affects oral health
▪ Loss of energy: no brushing / flossing
/ visit to dentist
▪ Dry mouth
▪ Change in types of food eaten
▪ Lower self efficacy:
▪ Self efficacy is belief in capabilities to
manage upcoming tasks
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Depression, Self Efficacy, and
Oral Health – An Exploration
▪ Survey data and chart review data were collected from 399 regularly scheduled dental patients ▪ 173 male / 226 female;
▪ average age: 50 years; range: 19 – 93 years
▪ Depression was measured with the Center of Epidemiological Studies Depression Scale (CESD)
▪ Generalized self efficacy with the General Self Efficacy Scale (GSE),
▪ Ohrqol with the Michigan Oral Health-related Quality of Life Scale – Adult Version (MOHRQoL-A).
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RESULTS
▪ The more depressed the patients were,
▪ the more decayed teeth and
▪ the fewer restored teeth they had,
▪ the poorer their subjective oral health,
▪ the worse their ohrqol was,
▪ the less saliva they had,
▪ the less often they brushed,
▪ the less often they flossed,
▪ THE LESS SELF EFFICACY THEY HAD
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Results
▪ The more positive the patients’ sense of
self efficacy was,
▪ the better their subjective oral health,
▪ the better their ohrqol was,
▪ the more often they brushed and
▪ The more often they flossed.
▪ Lesson learned: Increase sense of self
efficacy
▪ HOW? Active learning & Hands on
learning.
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SUMMARY▪ What does it mean to be 55 / 65 / 75 / 85
years of age or older?
▪ There are sensory and cognitive and
mental health changes that affect
▪ HOW you present to older adults
▪ WHAT you present to older adults
▪ BUT: OLDER ADULTS ARE MORE DIVERSE
THAN ANY AGE GROUP!
▪ Avoid STEREOTYPES – Generalizations
▪ Instead: Listen and learn!
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References
1. Crews JE, Campbell VA. Vision Impairment and Hearing Loss
Among Community-Dwelling Older Americans: Implications for
Health and Functioning. American Journal of Public Health May
2004; 94(5):823-829.
2. Boyce M, Shone GR. Effects of ageing on smell and taste. J.
Postgrad Med J 2006;82:239–241.
3. Herr KA, Garand L. Assessment and measurement of pain in
older adults. Clin Geriatr Med. 2001 August ; 17(3): 457–vi.
4. Wilson, R. S., Beckett, L. A., Barnes, L. L., Schneider, J. A.,
Bach, J., Evans, D. A., & Bennett, D. A. (2002). Individual
differences in rates of change in cognitive abilities of older
persons. Psychology and Aging, 17(2), 179-193.
5. McFarland M, Inglehart MR: Depression, Self Efficacy, and Oral
Health – An Exploration. Oral Health and Dental Management
2010; 9(4):214-222.