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

2. 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

3. 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

4. Review of Normal Age Related Changes That Affect Communication
Vision
Visual acuity and accommodation decline
Presbyopia starts age 45-55
80% have adequate vision past age 90
Hearing
Start to lose pitch age 50-55
20-30% over age 65
40-50% over age 75
89% over the age of 80

5. 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

6. Pathological Processes that Affect Communication
Common Visual Diseases

7. 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

8. 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

9. 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

10. Macular Degeneration
Most common cause of legal blindness in people over 50
Women
Blue eyes
Caucasion
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

11. 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

12. Pathological Changes in Speech and Language
Dysarthria – lose ability to articulate, brain lesions main cause
Aphasia
Expressive: unable to produce language
Receptive: unable to comprehend
Verbal apraxia – impaired initiation, coordination and sequencing of muscle movements which execute speech, caused by damage to parietal lobe
See glossary for definitions

13. 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

14. 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

15. 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

16. 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

17. 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.

18. Chapter 5: Therapeutic Communication
Bonnie M. Wivell, MS, RN, CNS

19. Communication A core skill for nurses An exchange of information
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

20. 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

21. Communicating with the Older Adult
Basic principles for communication
(Satir, 1976):
Invite: “I’m interested”, open-ended questions
Arrange environment: make it conducive to communication, eye to eye contact
Maximize understanding: be a good listener
Maximize communication: consider the patient’s health literacy level
Follow- through: forms trust

23. Aphasia

24. Visual Impairments

25. Hearing Impairments

26. Individuals Who are Deaf

27. Individuals with Dysarthria
Dysarthria is difficulty with the muscles used in speech. Unable to articulate

28. Chapter 9: Teaching Older Adults
Bonnie M. Wivell, MS, RN, CNS

29. 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

30. 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)

31. 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 adults
Physical
Social
Psychological

32. Lifelong Learning Needs of Older Adults
Educational topics on desired skills needed for education (AARP, 2000):
Diet and nutrition
Exercise and fitness
Weight control
Stress Management
Complementary and Alternative Practices
Career Advancement

33. 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

34. 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.

35. Barriers to Lifelong Learning
Disabilities
Cognitive, Affective, Sensory, and Psychomotor barriers
Reduced vision
Reduced hearing
Impaired cognitive function
Depression
Stress
Chronic illnesses

36. 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?

37. 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 beginning
Provide reasons for them to learn by pointing out the significance of the topic using statistics and research.

38. Implications for Educators
Use multiple teaching modalities to keep the material interesting and maintain attention, such as:
Power Point slides
Video or CDs
Handouts
Brochures or pamphlets
Posters
Demonstration/equipment
Quizzes

39. 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.

40. 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.

41. 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.

42. 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.

43. 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!

44. Bonnie M. Wivell, MS, RN, CNS
Chapter 16: Using Assistive Technology to Promote Quality of Life for Older Adults
Bonnie M. Wivell, MS, RN, CNS 44

45. 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 45

46. Types of Assistive Devices
Low Tech
Pencil grips
Splints
Paper stabilizers
High Tech
Computers
Environmental controls
Braille readers 46

47. Patient/Family Education
Maintain independence
Live at home
Increase quality of life
Promote function and adaptation
Reduce health-related costs 47

48. Common Applications of Assistive Technology
Position and Mobility
Walkers, wheelchairs, chair inserts, straps
Environmental Access
Modifications to buildings, increased accessibility, Braille
Environmental Controls
Switches that control the surroundings such as touching a switch for lights, TV, phone, opening doors via mouthstick or key pad 48

49. Common Applications (cont’d)
Self Care
Emergency response systems (ERS)
Sensory Impairment
Augmentative 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 49

50. Common Applications (cont’d)
Social Interaction and Recreation
Drawing 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 50

51. The Internet and the World Wide Web
Nursing Informatics
Nursing 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) 51

52. Using the Web Web use by older adults: Enhances self-esteem
Increases a sense of productivity and accomplishment
Increases social interaction
Meets need for personal control
Stimulates brain function
Provides fun 52

53. 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

54. Teaching Access to Web Sites
The older adult must:
be oriented
have an attention span and short-term memory
not be agitated, combative, or destructive
be able to respond to one-step commands and make choices 54

55. Teaching Access to Web Sites
Factors affecting outcomes
Rate of presentation individualized
Be organized
Allow plenty of time for personal practice
Make it meaningful and relative
Have a comfortable environment for learning
Step-by-step graphic instructions or video demo
Give supportive verbal feedback 55

56. Other Technology Services
Learning activities
Word and board games
Making cards, letters, etc.
Music and art activities
Health information/Health Care Services
Inform
Educate 56

57. Technologies on the Horizon
Robotic Assistance
Sensor-based Monitoring
Intel’s Assistance Program 57