Communicating with Older Adults: Sensory Perception

Learning Objectives: Upon completion of this module, learners will be able to: 1 2 3 4 Describe the Describe how ageism Describe strategies Identify visual and importance of negatively impacts that foster...

Learning Objectives: Upon completion of this module, learners will be able to: 1 2 3 4 Describe the Describe how ageism Describe strategies Identify visual and importance of negatively impacts that foster auditory changes that communication communication with communication with may occur and their older adults. older adults that have impact on older sensory and other adults. impairments. Communication in Aging Communication is one of the Meaningful communication with most important capacities of active involvement in society is human beings. key to “aging well”. Enhancing communication with Basic communication strategies older adults is a foundational are all applicable in skill in gerontological nursing communicating with older that has rewards for both the adults. nurse and the older person.  What are common challenges to communicating with older adults effectively? Sensory impairment, including normal age changes. Language impairment (e.g. aphasia). Cognitive impairment (e.g. dementia). Also… Attitudes of nurses/public towards older adults (e.g. ageism). Common causes of hearing loss among older adults includes sensorineural and conduction issues. Major causes of visual impairment among older adults includes cataracts, macular degeneration, and glaucoma. Both visual and hearing impairments are common and can interfere with communication. 1. Hearing Loss Almost half of older adults above 65 years of age have some kind of hearing loss. Yet it is underdiagnosed and undertreated in older people. Hearing loss may lead to social isolation, and communication difficulties related to hearing loss could be frustrating for both the speaker and the listener. 2 major forms: Conductive and Sensorineural  Conductive hearing loss results from abnormalities that reduce the transmission of sound to the middle ear. Infection, perforated eardrum, fluid in the middle ear or cerumen accumulation can all be causes. Sensorineural hearing loss results from damage to the inner ear or the neural pathways to the brain. It is usually treated with hearing aids or cochlear implants.  Can you think of strategies you can use to communicate with an older adult who has hearing loss? Think about what or not you should do? 01 02 03 04 05 06 Do not shout Never assume Make sure Pay attention to Reduce See more when speaking loss is due to old hearing aids articulation, background strategies in (high pitch age as it could be are functioning speed of speech, treatable such as tone, clarity, face noise your makes it more in infections or the person and textbooks difficult) cerumen buildup stand at same level. 2. Vision Impairment Vision normally declines with age: colors become dimmer and images less clear. Major causes of visual impairment and blindness: cataracts, macular degeneration, glaucoma, and diabetic retinopathy. Diagnosis of blindness does not equate to complete loss of vision. Visual impairment may have consequences on functional ability, safety and quality of life.  Glaucoma: a progressive process in which the fluids of the eye are blocked causing gradual buildup of intraocular pressure IOP and damage to optic nerve. Risk factors: age, steroid use, injuries, family history, diabetes. Managed by medications that decrease IOP such as Beta-blockers, laser surgery.  Cataracts: caused by damage to the lens and by fatty deposits in the lens. Causes: hereditary, age. Risk factors: excessive sunlight, poor dietary habits, diabetes, hypertension, kidney disease, trauma to the eye, and history of alcohol and tobacco use. Assessment: clouding of the ocular lens, appearance of halos around objects, blurring, sensitivity. Management: surgery. Post-surgery: avoid heavy lifting, straining, and bending. Use eye drops.  Macular Degeneration: age related, affects the macula, the central part of the eye. Causes progressive loss of central vision, leaving only peripheral vision intact. Risks: age, family history, smoking, obesity, excessive exposure to sunlight. No cure, treatment options limited to slowing progression.  Diabetic Retinopathy: due to diabetes, retina affected, blood and lipid leak and lead to macular edema and exudates. Diagnosed by fundoscopy. Intervention: strict blood sugar intake and control, cholesterol and blood pressure control, laser treatments.  What are some strategies you could think of to communicate with older adults who are visually impaired? 01 02 03 04 05 06 Make sure to Speak Use analogy of Ensure Do not change If blind: offer arm have person’s promptly, a clock to help adequate room furniture, while walking, attention clearly, get to locate objects lighting, use belongings safety precautions, before talking person’s level (e.g. meal at 3 large printing without don’t interfere o’clock) with proper explanation with guide dog. contrast Affects a person’s ability to communicate in one or more ways: –Speaking, understanding, reading, writing, and gesturing -Speech Language Pathologists (SLP) should be consulted to come up with rehabilitative plans. Types: –Wernicke’s aphasia (receptive) –Broca’s aphasia (expressive) –Global aphasia –Verbal apraxia and dysarthria –Anomic aphasia  Aphasia: most common language disorder, follows CVA or stroke. There maybe little or no speech, broken speech, or fluent but empty in content. Wernick’s aphasia: person speaks easily but the content does not make sense. They may also have difficulty understanding spoken language. Watch Byron: Fluent Aphasia (Wernicke's Aphasia) - YouTube  Broca’s aphasia: usually understand others but speak very slowly and use a minimal number of words. They experience difficulties in communicating orally and in writing. Watch Mike Caputo: Broca's Aphasia (Non-Fluent Aphasia) - YouTube Verbal apraxia: there is a disruption in the brain’s transmission of signals to the muscles controlling speech. When the person thinks about what to say they struggle speaking, but when they do not think about what to say, the person maybe able to say many words/sentences correctly. Watch Gina Helms: Adult apraxia of speech - YouTube  Anomic/Nominal aphasia: patients understand and speak readily but have difficulty finding the words. Difficulty finding the right words, inability to name objects. Watch first 90 seconds of Anomic Aphasia – YouTube Global aphasia: affects most of the language areas of the brain, persons cannot understand words or speak coherently. Watch Gene: Reel-Example: Global Aphasia - YouTube 01 02 03 04 05 06 Explain situations, Be patient and Ask questions that Use visual Encourage all See more treatments and treat allow plenty of can be answered speech, do not the person as an with a nod or a cues, gestures, strategies in time to have paper be too quick adult, using non- communicate in a blink. Instruct to use guessing your patronizing quiet nonverbal and pencil words/sentences. textbooks language. responses or yes/no environment. questions. available. Speak slowly. C. Cognitive Impairment Dementia affects thinking, memory, and language Communication challenges can vary depending on the type of dementia Alzheimer disease is most common –Early stages affects thinking and memory –Mild to moderate stages begins to affect language –By late stage, communication can be very challenging; both expression and understanding can be impaired. We will discuss dementia more later during the term.  Include the person in social gatherings and conversations. Ensure that hearing aids are in and glasses are on. Explain situations, treatments, and anything else that is pertinent to the person. Treat the person as an adult and avoid patronizing and childish phrases. Talk as if the person understands. Be patient and allow plenty of time to communicate in a quiet environment. Speak naturally. Speak slowly, ask one question at a time, and wait for a response. Do not shout. Repeat and rephrase as needed. Enhanced communication strategies Compensatory strategies “compensate for impairment” by reducing the information processing demands on the person with dementia. Connecting strategies “connect with the person on a relational level” by affirming their retained abilities and supporting their expression of self. Compensatory Strategies One idea sentences Limit demands on recent memory Speak at a normal rate (don’t slow down!) Eliminate distractions Redirect when necessary Avoid ambiguous references and topic shifts Repeat when necessary Yes-no questions It is not only WHAT you say For example: Repeated use of yes-no questions can be perceived by the person with dementia as overaccommodating. Viewing the person as incapable of generating his/her own response could lead to loss of self-esteem. Connecting Strategies Clarifying Exploring Moderating Connecting Validating Assisting Purposeful communication Reality Orientation Provide orienting information (about person, place, and time) to “confused” older adults. Purpose is to give people better understanding of their surroundings, improved sense of control and self-esteem. Validation Therapy Empathizing and accepting a person’s reality. Purpose is to promote security, meaningful communication and social interactions. Ageism Involves ways of thinking about older adults based on negative attitudes and stereotypes AND A tendency to structure society based on the assumption that everyone is young, thereby failing to respond to the real needs of the older persons. (Ontario Human Rights Commission, 2011) Ageist attitudes often interfere with nurses’ ability to communicate effectively. E.g., when the nurse believes all older people have memory problems. This will subsequently cause respect, dignity and communication problems. It is important for nurses to engage in self-reflection and analyze own attitudes and prejudices. Elderspeak is a form of ageism in which a person alters their speech on the assumption that the older person has difficulty comprehending.  Elderspeak is unfortunately very common in practice settings such as LTC where staff use patronizing language, pet names and other styles of defective communication. Nurses may not be aware that they are using elderspeak, therefore it is very important to be aware and self-reflect in every aspect of our practice and communication. Speaking slowly or loudly Using a singsong voice Using patronizing language: “we, us, our” in place of “you” Using pet names, honey or sweetheart Answering questions for the older person e.g., you would like your dinner now, wouldn’t you? Case study: Mr. Holton with diabetic retinopathy Mr. Robert Holton, 74 years old and retired, spent his entire working career as a self-employed carpenter. He has a 22- year history of type 2 diabetes; he also has hypertension and emphysema. He is an active smoker (52-pack-year smoking history), although he has attempted to stop smoking on several occasions. He wears a hearing aid in each ear because of hearing loss as a result of working around machinery for many years. Robert presents for a routine 3-month visit with the nurse practitioner accompanied by his wife. Mrs. Holton reports that Robert’s feet smell very bad, but he does not seem to notice the odor. The nurse practitioner removes Robert’s shoes and socks; a large infected foot ulcer is observed on the bottom of the foot. Robert is surprised that he was unaware of the wound. When asked about other changes, Robert does not respond. Mrs. Holton reports that he recently failed his visual acuity test for driver’s license renewal and now must depend on her for transportation. She adds that he has become increasingly withdrawn over the past 6 months and does little to communicate with her or others; he is also not interested in leaving the house. She asks the nurse practitioner if he is depressed. Case Analysis Questions 1. What risk factors are present in this case that relate to the concept? 2. What sensory and perception impairments are exemplified in this case? Learning Objectives Accomplished 1 2 3 4 Described the importance Described how ageism Described strategies that Identified visual, language, of communication with negatively impacts foster communication with cognitive and auditory older adults, talked about communication with older older adults that have changes that may occur challenges to adults. We also talked sensory and other and their impact on older communicating with older about elderspeak. impairments. adults. adults.