Transcript Sensory Changes and Communication with Older Adults

Sensory Changes and
Communication with
Older Adults
1
Objectives
• Identify the fundamental elements of
good communication with older
adults.
• Identify the sensory losses in older
adults that create barriers to good
communication. List some techniques
to break these physical barriers.
2
Objectives
• Identify the cognitive barriers to good
communication in older adults. List barrier
breakers.
• Identify psychological barriers to good
communication and list barrier breakers.
• Identify sociocultural barriers to good
communication and how to use language
translators effectively in the nursing practice
setting
3
Fundamentals of communication
• Two-way sensory activity
• Shared reality and expectations
(common ground)
• High comfort level
• Active listening
4
Common Ground techniques
Different perspectives
• Be sensitive to the older
adults’ self-perception
• Suspend stereotypes
• Develop empathy
• Develop flexibility
• Be warm and sociable
• Learn the language and
customs
TAKE HOME MESSAGE:
• Dress in a socially and
culturally respectful way
We don’t always see things the same way as others do.
5
Sensory losses lead to
• Reduced ability and desire to
communicate
• Isolation
• Frustration leads to aggression or
withdrawal
6
Hearing Loss
Definition. Decreased ability to hear highfrequency tones
Causes.
• Nerve deterioration
• Disease
• Environmental situations
• Medications
• Cerumen (earwax)
7
Hearing Loss
Communication Consequences.
• Decreased speech discrimination –
miscomprehension of speech
• Difficult telephone use and face-to-face
interaction; “inappropriate” or “awkward”
• “selective hearing” and “ daydreaming”
• Social isolation
• Deterioration of speech and voice quality
8
Hearing Aids
1. In -The -Ear (ITE)
2. Behind-The-Ear
3. Canal Aid
4. Body Aids
9
Barrier Breakers: hearing loss
•
•
•
•
•
•
•
Sit in front; light on your face
Ask if the person is hard of hearing
Check hearing aid
Ask if the can read lips; sign language
Cut background noise
Rephrase rather than repeat
Use gestures, diagrams, printed/writing
implements
• Alert when you are changing the subject
• Sign-language interpreter
10
Vision Loss
Causes.
• Decreased pupil size and
accommodation
• Macular degeneration – central
vision loss
• Glaucoma – peripheral vision loss
• Cataracts – cloud vision
11
Vision Loss
Communication Consequences.
• Inability to identify doors, stair edges,
light switches
• Avoidance of light sources which
cause glare. Patient will stay in a
dimly lit room – social isolation.
• Stares at television; inability to talk
about what one is viewing (scenery;
pictures)
• Appears “inattentive”
12
Welcoming environments
• Signs in clear, large bold print at eye level;
use audiotapes; Braille
• Contrasting colors
• Good, even lighting levels
• Use task lamps
• Soft furnishings – curtains, carpet – to reduce
sound resonance
• Use of accessibility feature (magnifier) when
using a computer
13
Barrier Breakers: vision loss
•
Always identify yourself clearly and narrate
your activities
•
Use clear language when you give
directions (“right” and “left”, not “over
there”; use “yes” or “correct” , not “right”).
•
Obtain and encourage the use of lowvision aids (magnifying glasses) and make
sure that the setting is well lit.
14
Barrier Breakers: vision loss
•
If an older adult is not wearing glasses, ask
whether glasses are usually worn and for
what purposes.
•
BE AWARE: pulls away or turns head to
one side and seems to be looking away, it
may only be to adjust the visual distance
and angle to see you.
15
Barrier Breakers: vision loss
•
When using printed material, make sure
that it is a size that the older adult person
can read (at least 14-point type).
•
Research and use resources within your
community that may offer assistance.
16
Speech Loss
Causes.
• Stroke
• Dental difficulties – lack of teeth; ill-fitting
dentures
• Xerostomia (dry mouth)
Communication Consequences.
• Isolation and frustration
• Loss of self-esteem
• Embarrassment
17
Barrier Breakers: speech loss
• Find out before interacting, whether the
older adult has a speech impairment
• Show that you do not expect them to
speak well – do their best
• Provide alternate forms of
communication
• Use gestures and body language
18
Touch/Tactile Loss
Causes.
• Neurons die and are not replaced
• Stroke
• Fear
• Discomfort
• Stereotypes
• Sense of one’s own vulnerability
• Isolation
19
Movement Loss
Causes.
• Osteoporosis
• Arthritis
• Lack of exercise
• Stroke
• Weight gain
20
Movement and tactile loss
Communication Consequences.
• Feeling of fatigue
• Body language may appear
inappropriate and misinterpreted
• Limited stamina may lead to loss of
initiative and cooperation with
caregivers
• Feels loss of independent living
21
Barrier Breakers: tactile and
movement loss
• Be aware of movement limitations
• Be aware of pain and its impact
• Gestures are effective
• Touch to reassure
• Verbal encouragement – exercise
• Ensure a safe environment
22
Taste and Smell Loss
Causes.
1. Normal aging
2. Certain disease states
3. Medication
4. Surgical interventions
5. Environmental exposure
23
Taste and Smell Loss
Communication
Consequences.
• Reluctance to discuss
food
• Reduced pleasure and
comfort
• Decreased socialization
Breaking Barriers:
• encourage yearly
dental visits
• use of dentures
• frequent cleaning of
mouth
• Nutritional /immune
deficiencies
24
Cognitive Barriers
Causes.
• Multidrug interactions
• Dementia
• Alcoholism
• Inadequate sleep
25
Cognitive Loss
Communication Consequences.
• Difficulty in achieving shared reality
• “acting out” behavior
Barrier Breakers.
• Keep expectations realistic
• GO SLOW! Use one-step commands
• Validate behavior
• Discover meaning behind behavior
• Ask “yes-no” questions
26
Psychological Barriers
Causes.
• Depression
• Anger
• Personal “baggage”
• Personality types
• Losses
.
Communication
Consequences.
• Violent acting out
• Abusive behaviors
• Irritability
• Great concern with
health problems
• Isolation and
loneliness
27
Circumventing Psychological
Barriers
• Be aware of personality types
• Become an active listener
• Leave “personal baggage” at home, and
try to see what the older person is bringing
with them
• Empathize but do not legitimize fatigue
and apathy
28
Sociocultural and Language
Barriers
• Sociocultural beliefs: respect, nutrition, pain,
and death
• Language reflects or creates reality
• Translation vs. interpretation
• Differing agendas: client, caregivers,
translators
• Translator competencies
29
Sociocultural and Language
Barrier Breakers
•
Learn key words
•
Differentiate translation from
interpretation.
•
Ask family interpreters to “translate” rather
than “interpret”
•
Learn the beliefs and values
•
Learn key ethnic customs and rituals
•
Suspend your stereotypes and prejudice
30
Summary
• Fundamental elements of good
communication
• Sensory losses: hearing, vision, speech,
touch, movement, taste and smell,
cognitive, psychological and social, and
language barriers
• Techniques for breaking barriers in
communication
31
QUESTIONS?
32