Chapter 4: Aging Changes That Affect Communication Bonnie M. Wivell, MS, RN, CNS
Dec 26, 2015
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