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1 Uncovering the Uncovering the Message of the Message of the Nonverbal Older Adult Nonverbal Older Adult R. A. Weise, M.D. R. A. Weise, M.D. Medical Director Medical Director Alexian Older Adult Alexian Older Adult Health Care Health Care
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Uncovering the Message from the Non-Verbal Older Adult

Oct 30, 2014

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Page 1: Uncovering the Message from the Non-Verbal Older Adult

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Uncovering the Uncovering the Message of the Message of the

Nonverbal Older Nonverbal Older AdultAdult

R. A. Weise, M.D.R. A. Weise, M.D.

Medical DirectorMedical Director

Alexian Older Adult Health Alexian Older Adult Health CareCare

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The Nonverbal The Nonverbal Older AdultOlder Adult

A Man Called PeterA Man Called Peter

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•What is What is nonverbalnonverbal communicationcommunication??Nonverbal communication is the giving or Nonverbal communication is the giving or

sharing of information or knowledge, in the sharing of information or knowledge, in the context of feelings/emotions, without using context of feelings/emotions, without using wordswords

Nonverbal communication usually consists of:Nonverbal communication usually consists of:Facial expressionsFacial expressionsBody language/posturesBody language/posturesInformation conveyed through touch, taste, smell, Information conveyed through touch, taste, smell,

sight, and hearingsight, and hearingEmotional behaviorsEmotional behaviors

Uncovering the Message of Uncovering the Message of the Nonverbal Older Adultthe Nonverbal Older Adult

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The Purpose of The Purpose of Communication in Communication in

Health CareHealth Care• To “communicate”, in To “communicate”, in LatinLatin, means :, means :

to impartto impart to participateto participate

• To “communicate”, in To “communicate”, in EnglishEnglish, , means:means: to convey knowledge or informationto convey knowledge or information to make knownto make known to share to share

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• To “communicate”, in To “communicate”, in HealthHealth CareCare, , means:means: to provide general health related to provide general health related

informationinformation to give to give counselcounsel for specific personal illness for specific personal illness to apply to apply technologytechnology for disease management for disease management to promote an to promote an understandingunderstanding of health care of health care

costscosts to extend to extend compassioncompassion to to carecare about the patient/client/resident about the patient/client/resident

The Purpose of The Purpose of Communication in Communication in

Health CareHealth Care

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The Purpose of The Purpose of Communication in Communication in

Health CareHealth CareIs, ultimately, to promote Is, ultimately, to promote

healinghealing

notnot just just fixingfixing

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What is What is Healing?Healing?

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What Healing is Not!What Healing is Not!•HealingHealing is is notnot fixingfixing

““Fixing”, in Latin, means to “make Fixing”, in Latin, means to “make firm or to fasten”, i.e. to tighten firm or to fasten”, i.e. to tighten something that is loosesomething that is loose

In English, “to fix” means “to In English, “to fix” means “to repair repair ” ”

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What Healing is Not!What Healing is Not!

•FixingFixing emphasizes: emphasizes:

ResultsResults over over relationshipsrelationshipsPartsParts over the over the wholewholeProductsProducts over over personspersons RepairRepair over over renewalrenewal

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Healing is Not Fixing!Healing is Not Fixing!• Today’s healthcare is, all to often, Today’s healthcare is, all to often,

basedbased upon “upon “fixingfixing””1. We have improved our “1. We have improved our “outcomesoutcomes” (results) ” (results)

in reducing the impact of cardiovascular in reducing the impact of cardiovascular disease; cancer, infection, etc..disease; cancer, infection, etc..

While, at the same time, While, at the same time, reducingreducing patientpatient / professional / professional caregivercaregiver relationshipsrelationships, i.e. acute care nurse to , i.e. acute care nurse to patient ratios (in reality) are rising (1:4 in patient ratios (in reality) are rising (1:4 in 1991, and now 1:6 ?). 1991, and now 1:6 ?).

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Healing is Not Fixing!Healing is Not Fixing!2. 2. HealthcareHealthcare has become more and more has become more and more

fragmentedfragmented, placing the responsibility , placing the responsibility for patient care in the hands of the for patient care in the hands of the consultantconsultant rather than in the hands of rather than in the hands of the the primaryprimary carecare physicianphysician..This diffusion of care This diffusion of care dilutesdilutes responsiblyresponsibly for for

the whole (total) patient. the whole (total) patient. The technological repair of the “part” The technological repair of the “part”

becomes more important than the renewal of becomes more important than the renewal of the “whole”(person). the “whole”(person).

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Medical SpecialtiesMedical SpecialtiesEngeman, 1964Engeman, 1964

• PediatricsPediatrics• OpthomologyOpthomology• NeurologyNeurology• OrthopedicsOrthopedics• DermatologyDermatology• PathologyPathology• Public HealthPublic Health• PsychiatryPsychiatry• Surgery Surgery

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Medical SpecialtiesMedical SpecialtiesABIM, Maintenance of

Certification, 2007• Allergy/ImmunologyAllergy/Immunology• AnesthesiologyAnesthesiology• Colon/Rectal SurgeryColon/Rectal Surgery• DermatologyDermatology• Emergency MedicineEmergency Medicine• Family PracticeFamily Practice• GeneticsGenetics• NeurosurgeryNeurosurgery• NeurologyNeurology• PsychiatryPsychiatry• Nuclear MedicineNuclear Medicine• Internal MedicineInternal Medicine• UrologyUrology

• Nuclear MedicineNuclear Medicine• RadiologyRadiology• OB/GYNOB/GYN• OpthomologyOpthomology• OrthopedicsOrthopedics• ENTENT• PathologyPathology• PediatricsPediatrics• Physical Medicine/RehabPhysical Medicine/Rehab• Plastic SurgeryPlastic Surgery• Preventative MedicinePreventative Medicine• General SurgeryGeneral Surgery• Thoracic SurgeryThoracic Surgery

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Healing vs. Healing vs. FixingFixing

IfIf healinghealing is is notnot fixingfixing, , thenthen whatwhat

isis healing healing ??

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What is What is HealingHealing??•HealingHealing is the is the dynamic,dynamic, creativecreative

processprocess of helping an individual of helping an individual changechange illnessillness intointo wellnesswellness byby the the transformationtransformation of: of:

DependencyDependency into into Inter-Inter-dependencydependency

DisconnectionDisconnection into into IntimacyIntimacyDiscouragementDiscouragement into into HopeHope

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What is What is Healing?Healing?

•HealingHealing Emphasizes: Emphasizes:ConnectionConnection over outcome over outcomeThe The wholewhole personperson over the over the

individual organ systemindividual organ systemRevitalizationRevitalization over preservation over preservation Becoming a “Becoming a “servantservant partnerpartner ” ”

rather than, merely, a “rather than, merely, a “serviceservice providerprovider ””

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• Health care communication must, Health care communication must, not only, supply competent fixing not only, supply competent fixing but, also, secure but, also, secure healing healing in our in our patients, clients, and residentspatients, clients, and residents

• CompassionateCompassionate communicationcommunication that promotes that promotes healinghealing is especially is especially difficultdifficult in in the the nonverbalnonverbal older adult older adult

The Purpose of The Purpose of Communication in Communication in

Health CareHealth Care

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Uncovering the Uncovering the Message of the Message of the

Nonverbal Older Nonverbal Older AdultAdult

Barriers to Effective Barriers to Effective Communication Communication in thein the

Nonverbal Older Adult Nonverbal Older Adult

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Barriers to Barriers to EffectiveEffective CommunicationCommunication inin thethe

Nonverbal Older AdultNonverbal Older Adult

• Occur in, predominantly, Occur in, predominantly, three areas:three areas:1.1.Normal AgingNormal Aging

2.2.DiseaseDisease

3.3.TheThe EnvironmentEnvironment

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Barriers to Effective Barriers to Effective CommunicationCommunication inin thethe Nonverbal Older AdultNonverbal Older Adult

Normal AgingNormal Aging

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DefinitionsDefinitions

• Aging: post maturational / intrinsic Aging: post maturational / intrinsic deteriorationdeterioration decline in reproductive decline in reproductive

capacitycapacity increasing vulnerabilityincreasing vulnerability increasing likelihood of deathincreasing likelihood of death 70% environmental / 30% 70% environmental / 30%

genetic genetic

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DefinitionsDefinitions

• AgingAging: : ChangeChange over Time over Time

• NormalNormal AgingAging: : BalancedBalanced changechange over timeover time

positivespositives >> negativesnegatives

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NormalNormal AgingAging•We age in We age in fourfour domains domains::

PhysicallyPhysically EmotionallyEmotionally SociallySocially SpirituallySpiritually

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GeneralGeneral Principles of Principles of Normal AgingNormal Aging

1.1. Aging is Aging is gradualgradual large physiological reservelarge physiological reserve loose 1% reserve/ yearloose 1% reserve/ year

2.2. The The moremore complexcomplex the function, the function, the the greatergreater the the declinedecline

balance vs. single nervebalance vs. single nerve

3.3. With advancing age comes With advancing age comes increasedincreased variabilityvariability

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GeneralGeneral Principles of Principles of NormalNormal AgingAging

4.4. With old age comes a With old age comes a diminisheddiminished speedspeed of of adaptationadaptation

adaptation occurs adaptation occurs butbut the the greater stress the greater stress the slowerslower the the adjustmentadjustment

especially true in especially true in frailfrail older older adults adults

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SpecificSpecific Changes Changes

Associated with Associated with NormalNormal AgingAging

• What can we What can we expectexpect in terms of in terms of organ system “specific” change, organ system “specific” change, with advancing age, that may with advancing age, that may negatively impact communication negatively impact communication with the nonverbal older adult with the nonverbal older adult

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Normal Aging andNormal Aging and CNS CNS FunctionFunction

• MemoryMemory slowsslows downdown with age (age associated memory with age (age associated memory change)change) delayed recall becomes sluggishdelayed recall becomes sluggish attention span diminishesattention span diminishes

• Executive function is less efficientExecutive function is less efficient sequential reasoning slowssequential reasoning slows new learning slowsnew learning slows specialized knowledge maintainedspecialized knowledge maintained judgment intactjudgment intact

• Language & Communication skills mostly Language & Communication skills mostly improveimprove with age with age

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CNSCNS FunctionFunction

• Visual-Spatial Visual-Spatial coordinationcoordination declinesdeclines with age with age

perceptual speed diminishesperceptual speed diminishes

• Personality becomes Personality becomes moremore personalpersonal as we be come an older adultas we be come an older adult

• EmotionalEmotional identification and identification and experience remains experience remains intactintact

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Normal AgingNormal Aging of the of the SensorySensory SystemSystem

• HearingHearing High-pitched hearing loss High-pitched hearing loss

(Presbycusis)(Presbycusis) looseloose consonantsconsonants in the English in the English

language ( s; th; k; f ;etc.) language ( s; th; k; f ;etc.) The most common type ofThe most common type of hearing hearing

loss in the elderly loss in the elderly

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SensorySensory SystemSystem

ello i Aleian Broer ello i Aleian Broer Medical enterMedical enter

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SensorySensory SystemSystem

• VisionVision lens becomes thicker and more dense; lens becomes thicker and more dense; more light is needed (watts in more light is needed (watts in

bulb=age !)bulb=age !) slower accommodationslower accommodation slower light/ dark adaptationslower light/ dark adaptation need more contrast need more contrast reduced peripheral vision reduced peripheral vision less tears (but watery eyes)less tears (but watery eyes)

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SensorySensory SystemSystem

•TasteTaste decreases in acuity with old agedecreases in acuity with old age saliva production reduced saliva production reduced no decrease in # taste budsno decrease in # taste buds

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NormalNormal AgingAging andand MovementMovement

•MusclesMusclesdecrease in size and strength with decrease in size and strength with

age (50 %)age (50 %)less elasticless elasticbut but trainable trainable at at everyevery ageage

(regular, consistent (regular, consistent aerobicaerobic andand resistanceresistance exercise a exercise a must for optimal aging !) for optimal aging !)

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MovementMovement

•BalanceBalance- - complexcomplex mechanismmechanism involving involving

brain, brain, vessels, skin, senses, vessels, skin, senses, joints, muscles, etc.joints, muscles, etc.

- - slowerslower toto respondrespond to sudden to sudden change with agechange with age

- can be - can be improvedimproved in advanced age in advanced age

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SexualitySexuality andand NormalNormal AgingAging

• Desire Desire persistspersists into advanced age into advanced age inin womenwomen (meno(menopausepause not meno not menostopstop)) ; ; butbut desiredesire decreasesdecreases in in menmen

• Vagina shortens/ gets dryerVagina shortens/ gets dryer• Arousal takes longerArousal takes longer• Orgasms are fewer and further apart Orgasms are fewer and further apart

(especially for men) (especially for men)

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SexualitySexuality and and Normal Normal AgingAging

• The frequency of sexual The frequency of sexual intercourse among 85 y/o (who intercourse among 85 y/o (who have opportunity), is about the have opportunity), is about the same frequency as a a Fortune same frequency as a a Fortune 500 C.E.O.(2x month)500 C.E.O.(2x month)

• SexualitySexuality infusesinfuses vibrant vibrant colorcolor intointo the, often, black and white the, often, black and white relationshipsrelationships of aging of aging

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EmotionalEmotional AgingAging

• LossLoss is the hallmark of emotional is the hallmark of emotional agingaging

• With age, we not only loose parts of our With age, we not only loose parts of our bodies but also our:bodies but also our:

work (retirement)work (retirement) spouse (death)spouse (death) Children (busyness)Children (busyness) friendsfriends (immobility or death) (immobility or death)

• Loss, in old age, can promote , in old age, can promote Self-centeredness

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SocialSocial AgingAging

• Can promote Can promote isolationisolation

• With advancing age:With advancing age:Our Our once high position, becomes once high position, becomes lowlow

positionpositionBeing needed becomes being a Being needed becomes being a burdenburden

Once we controlled ourselves, now we Once we controlled ourselves, now we are are controlledcontrolled byby othersothers

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• Physical Aging can lead to Aging can lead to DependencyDependency

• EmotionalEmotional Aging can lead to to Aging can lead to to Self-CenterednessSelf-Centeredness

• SocialSocial Aging can lead to Aging can lead to IsolationIsolation

• Progressing to to SpiritualSpiritual ApathyApathy in old age

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TheThe AgingAging SpiritSpirit

• The The MostMost ImportantImportant Domain of Domain of AgingAgingOperates on Operates on FaithFaith > > FactsFactsFavors Favors RelationshipsRelationships > > ResultsResultsProvides Provides BalanceBalanceProvides Provides EnergyEnergyProvides Provides MaturityMaturity, , Imagination, Imagination,

and and WisdomWisdom

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•PhysicalPhysical AgingAging can lead to can lead to DependencyDependency

• EmotionalEmotional Aging can lead to Aging can lead to SelfishnessSelfishness

•SocialSocial AgingAging can lead to can lead to IsolationIsolation

BUTBUT ……

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TheThe AgingAging SpiritSpirit

•Provides the Provides the powerpower to to transformtransform::

- DependencyDependency intointo ChosenChosen RelianceReliance- SelfishnessSelfishness intointo ServiceService- IsolationIsolation intointo CommunityCommunity- - ApathyApathy intointo HopeHope

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Barriers to Barriers to EffectiveEffective CommunicationCommunication inin thethe

Nonverbal Older AdultNonverbal Older Adult

• Occur in, predominantly, Occur in, predominantly, three areas:three areas:1.1.Normal AgingNormal Aging

2.2.DiseaseDisease

3.3.The EnvironmentThe Environment

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• DiseaseDisease creates significant barriers to creates significant barriers to optimum communication with nonverbal optimum communication with nonverbal older adults:older adults: Dementias ( A.D.; Lewy Body Dementia; etc.)Dementias ( A.D.; Lewy Body Dementia; etc.) StrokeStroke ImmobilityImmobility CataractsCataracts Hearing lossHearing loss Depression/AnxietyDepression/Anxiety Pain (Chronic and Acute)Pain (Chronic and Acute) Loose dentures/ poor dentitionLoose dentures/ poor dentition ArthritisArthritis

Barriers to Effective Barriers to Effective CommunicationCommunication inin thethe Nonverbal Older AdultNonverbal Older Adult

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Barriers to Barriers to EffectiveEffective CommunicationCommunication inin thethe

Nonverbal Older AdultNonverbal Older Adult

• Occur in, predominantly, Occur in, predominantly, three areas:three areas:1.1.Normal AgingNormal Aging

2.2.DiseaseDisease

3.3.The EnvironmentThe Environment

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• EnvironmentalEnvironmental pressures can pressures can significantly reduce communication with significantly reduce communication with the nonverbal older adult:the nonverbal older adult: Always in a bed or chairAlways in a bed or chair IsolationIsolation CrowdingCrowding Poor lightingPoor lighting Too much or too little sensory stimulationToo much or too little sensory stimulation HurriedHurried Lack of privacyLack of privacy AgeismAgeism

Barriers to Effective Barriers to Effective CommunicationCommunication inin thethe Nonverbal Older AdultNonverbal Older Adult

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How to How to ImproveImprove CommunicationCommunication with with

thethe Nonverbal Older Nonverbal Older AdultAdult

Uncovering the Uncovering the Message of the Message of the

Nonverbal Older Nonverbal Older AdultAdult

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I.I. GeneralGeneral principlesprinciples of of nonverbal communication in nonverbal communication in older adults:older adults:

A.A. It may involve It may involve noisenoise without without recognizable languagerecognizable language

B.B. It is It is emotionallyemotionally based based

C.C. It has It has purposepurpose and and meaningmeaning

D.D. It is It is accurateaccurate

How to Improve How to Improve Communication with the Communication with the Nonverbal Older AdultNonverbal Older Adult

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II.II. SpecificSpecific strategiesstrategies to enhance to enhance communication with the nonverbal communication with the nonverbal older adultolder adult

A.A. Demonstrate Demonstrate respectrespect and guarantee and guarantee safetysafety with each interaction with each interaction

B.B. DecideDecide to develop a caring to develop a caring relationshiprelationship with the with the patient/resident/clientpatient/resident/client

C.C. Determine to be a “Determine to be a “ServantServant PartnerPartner”, not simply, a “”, not simply, a “ServiceService ProviderProvider.”.”

How to Improve How to Improve Communication with the Communication with the Nonverbal Older AdultNonverbal Older Adult

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How to Improve How to Improve Communication with the Communication with the Nonverbal Older AdultNonverbal Older Adult

III.III.PracticalPractical actionsactions that will promote that will promote and enrich communication with the and enrich communication with the nonverbal elderly nonverbal elderly A.A. Promote excellence in health and health care deliveryPromote excellence in health and health care delivery

B.B. Prevent illness Prevent illness

C.C. Focus on FunctionFocus on Function

D.D. Concentrate on Feelings (Emotions)Concentrate on Feelings (Emotions)

E.E. Direct communicative efforts at the specific barriers Direct communicative efforts at the specific barriers that impair understanding:that impair understanding:

1.1. Normal AgingNormal Aging

2.2. DiseaseDisease

3.3. The EnvironmentThe Environment

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1.1. OverOver comingcoming the barriers of the barriers of NormalNormal AgingAging

a)a) Slow down all interactionsSlow down all interactionsb)b) Taylor the communication to the quality of the Taylor the communication to the quality of the

relationship, in the moment!relationship, in the moment!c)c) Speak slowly, firmly, and rephrase rather than Speak slowly, firmly, and rephrase rather than

repeatrepeatd)d) Maintain compassionate eye contact, in adequate Maintain compassionate eye contact, in adequate

light, at or below their eye level (kneel or sit)light, at or below their eye level (kneel or sit)e)e) Honor their sexuality Honor their sexuality f)f) Respect their privacy and time (schedule)Respect their privacy and time (schedule)g)g) Make them physically safeMake them physically safeh)h) Know themKnow them

How to Improve How to Improve Communication with the Communication with the Nonverbal Older AdultNonverbal Older Adult

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2.2. OverOver comingcoming the barriers of the barriers of EmotionalEmotional AgingAging

a)a) Identify the feelings/emotions they are Identify the feelings/emotions they are expressingexpressing

b)b) Listen for understanding of the Listen for understanding of the feelings/emotionsfeelings/emotions

c)c) Validate their feelingsValidate their feelings

d)d) SmileSmile

e)e) Use affirmative body language (head nodding)Use affirmative body language (head nodding)

f)f) Redirect them towards service to othersRedirect them towards service to others

How to Improve How to Improve Communication with the Communication with the Nonverbal Older AdultNonverbal Older Adult

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3.3. OverOver comingcoming the barriers of the barriers of SocialSocial AgingAging

a)a) Determine to connect to them and to limit their Determine to connect to them and to limit their isolation isolation

b)b) Use affirmative touch, when appropriateUse affirmative touch, when appropriatec)c) Help them connect to those around them, as well Help them connect to those around them, as well

as, family and friendsas, family and friendsd)d) Give the something that they can controlGive the something that they can controle)e) Give them choice and then honor their choices Give them choice and then honor their choices

How to Improve How to Improve Communication with the Communication with the Nonverbal Older AdultNonverbal Older Adult

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4.4. OverOver comingcoming the barrier of an the barrier of an ApatheticApathetic SpiritSpirit

a)a) The most difficult of tasks in The most difficult of tasks in communicationcommunication

b)b) Help them cultivate a healthy spirit based Help them cultivate a healthy spirit based upon truth, in the context of, their faithupon truth, in the context of, their faith

c)c) Help them make good choices, serve Help them make good choices, serve others, and connect with those around others, and connect with those around themthem

d)d) Encouragement and hope improve Encouragement and hope improve communication communication

How to Improve How to Improve Communication with the Communication with the Nonverbal Older AdultNonverbal Older Adult

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2.2. OverOver comingcoming the barriers caused by the barriers caused by DiseaseDisease

a)a) Comprehensive Geriatric AssessmentComprehensive Geriatric Assessment

b)b) Focus on improving or maintaining function (ADL’s) Focus on improving or maintaining function (ADL’s)

c)c) Treat depressionTreat depression

d)d) Get hearing aids Get hearing aids

e)e) Remove cataracts/ get glasses/ treat Macular Remove cataracts/ get glasses/ treat Macular DegenerationDegeneration

f)f) Limit medicationLimit medication

g)g) ExerciseExercise

h)h) Relieve painRelieve pain

i)i) See DentistSee Dentist

j)j) Get physical/occupational/speech therapyGet physical/occupational/speech therapy

How to Improve How to Improve Communication with the Communication with the Nonverbal Older AdultNonverbal Older Adult

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c)c) Over coming barriers caused by the Over coming barriers caused by the EnvironmentEnvironment

a)a) Mobilize the patient/client/residentMobilize the patient/client/resident

b)b) Supply adequate light, space, and Supply adequate light, space, and privacyprivacy

c)c) Provide appropriate sensory Provide appropriate sensory stimulationstimulation

d)d) Compassionately balance safety with Compassionately balance safety with personal freedompersonal freedom

How to Improve How to Improve Communication with the Communication with the Nonverbal Older AdultNonverbal Older Adult

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Uncovering the Message of Uncovering the Message of the the Nonverbal Older Adultthe the Nonverbal Older Adult

• Understanding and being Understanding and being understood by the nonverbal older understood by the nonverbal older adult is essential to providing them adult is essential to providing them with adequate health carewith adequate health care

• Committing ourselves to establish Committing ourselves to establish and maintain their personal safety and maintain their personal safety and respect, will provide the soil for and respect, will provide the soil for our understanding of one another to our understanding of one another to grow and flourishgrow and flourish