M I C A H G I 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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Tooth Wisdom: Get Smart About Your Mouth...Suggestion III - Hearing aids Hearing aids are improving hearing: Based on a new Bluetooth technology designed by Apple, there are advanced
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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
M I C AH GI N
D E N T I S T R Y
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
M I C AH GI N
D E N T I S T R Y
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
M I C AH GI N
D E N T I S T R Y
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
M I C AH GI N
D E N T I S T R Y
Changes in Vision
M I C AH GI N
D E N T I S T R Y
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
M I C AH GI N
D E N T I S T R Y
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!
M I C AH GI N
D E N T I S T R Y
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
M I C AH GI N
D E N T I S T R Y
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
M I C AH GI N
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
M I C AH GI N
D E N T I S T R Y
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
M I C AH GI N
D E N T I S T R Y
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
M I C AH GI N
D E N T I S T R Y
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
M I C AH GI N
D E N T I S T R Y
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
M I C AH GI N
D E N T I S T R Y
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
M I C AH GI N
D E N T I S T R Y
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
M I C AH GI N
D E N T I S T R Y
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
M I C AH GI N
D E N T I S T R Y
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
M I C AH GI N
D E N T I S T R Y
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
M I C AH GI N
D E N T I S T R Y
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