1 Sensory Changes and Communication with Older Adults.

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Sensory Changes and Sensory Changes and Communication with Communication with Older AdultsOlder Adults

Sensory Changes and Sensory Changes and Communication with Communication with Older AdultsOlder Adults

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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.

• 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.

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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

• 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

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Fundamentals of communication

• Two-way sensory activity

• Shared reality and expectations (common ground)

• High comfort level

• Active listening

• Two-way sensory activity

• Shared reality and expectations (common ground)

• High comfort level

• Active listening

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Common Ground techniques• 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

• 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

Different perspectives

TAKE HOME MESSAGE:

We don’t always see things the same way as others do.

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Sensory losses lead to

• Reduced ability and desire to communicate

• Isolation

• Frustration leads to aggression or withdrawal

• Reduced ability and desire to communicate

• Isolation

• Frustration leads to aggression or withdrawal

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Hearing Loss

Definition. Decreased ability to hear high-frequency tones

Causes.

• Nerve deterioration

• Disease

• Environmental situations

• Medications

• Cerumen (earwax)

Definition. Decreased ability to hear high-frequency tones

Causes.

• Nerve deterioration

• Disease

• Environmental situations

• Medications

• Cerumen (earwax)

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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


• 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

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Hearing Aids

1. In -The -Ear (ITE)

2.Behind-The-Ear

3.Canal Aid

4.Body Aids

1. In -The -Ear (ITE)

2.Behind-The-Ear

3.Canal Aid

4.Body Aids

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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

• 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

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Vision Loss

Causes.

• Decreased pupil size and

accommodation

• Macular degeneration – central

vision loss

• Glaucoma – peripheral vision loss

• Cataracts – cloud vision

Causes.

• Decreased pupil size and

accommodation

• Macular degeneration – central

vision loss

• Glaucoma – peripheral vision loss

• Cataracts – cloud vision

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Vision Loss


• 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”


• 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”

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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

• 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

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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.

• 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.

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• 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.

• 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.

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• 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.

• 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.

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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

Causes.• Stroke• Dental difficulties – lack of teeth; ill-

fitting dentures• Xerostomia (dry mouth)

Communication Consequences.• Isolation and frustration• Loss of self-esteem• Embarrassment

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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

• 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

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Touch/Tactile Loss

Causes.

• Neurons die and are not replaced

• Stroke

• Fear

• Discomfort

• Stereotypes

• Sense of one’s own vulnerability

• Isolation

Causes.

• Neurons die and are not replaced

• Stroke

• Fear

• Discomfort

• Stereotypes

• Sense of one’s own vulnerability

• Isolation

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Movement Loss

Causes.

• Osteoporosis

• Arthritis

• Lack of exercise

• Stroke

• Weight gain

Causes.

• Osteoporosis

• Arthritis

• Lack of exercise

• Stroke

• Weight gain

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Movement and tactile loss


• 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


• 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

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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

• 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

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Taste and Smell Loss

Causes.

1. Normal aging

2. Certain disease states

3. Medication

4. Surgical interventions

5. Environmental exposure

Causes.

1. Normal aging

2. Certain disease states

3. Medication

4. Surgical interventions

5. Environmental exposure

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Taste and Smell Loss


• Reluctance to discuss food

• Reduced pleasure and comfort

• Decreased socialization

• Nutritional /immune deficiencies


• Reluctance to discuss food

• Reduced pleasure and comfort

• Decreased socialization

• Nutritional /immune deficiencies

Breaking Barriers:

• encourage yearly dental visits

• use of dentures

• frequent cleaning of mouth

Breaking Barriers:

• encourage yearly dental visits

• use of dentures

• frequent cleaning of mouth

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Cognitive Barriers

Causes.• Multidrug interactions• Dementia• Alcoholism• Inadequate sleep

Causes.• Multidrug interactions• Dementia• Alcoholism• Inadequate sleep

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Cognitive LossCommunication 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


• 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

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Psychological Barriers

Causes.

• Depression

• Anger

• Personal “baggage”

• Personality types

• Losses

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Causes.

• Depression

• Anger

• Personal “baggage”

• Personality types

• Losses

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• Violent acting out• Abusive behaviors• Irritability• Great concern with

health problems• Isolation and

loneliness


• Violent acting out• Abusive behaviors• Irritability• Great concern with

health problems• Isolation and

loneliness

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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

• 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

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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

• Sociocultural beliefs: respect, nutrition,

pain, and death

• Language reflects or creates reality

• Translation vs. interpretation

• Differing agendas: client, caregivers,

translators

• Translator competencies

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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

• 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

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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

• 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

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QUESTIONS?QUESTIONS?

1 Sensory Changes and Communication with Older Adults.

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