Theories of Aging
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Transcript Theories of Aging
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 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
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 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
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
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
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 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
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
adults
Physical
Social
Psychological
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
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 barriers
Reduced
vision
Reduced hearing
Impaired cognitive function
Depression
Stress
Chronic 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 beginning
Provide 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 slides
Video or CDs
Handouts
Brochures or pamphlets
Posters
Demonstration/equipment
Quizzes
Implications for Educators
Remember to accommodate any unique
physical needs of older adults:
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 lipreading).
Limit programs to about 20 – 40 minutes.
Do
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 takehome 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 Tech
Pencil
grips
Splints
Paper
stabilizers
High Tech
Computers
Environmental
Braille
readers
controls
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 Controls
Switches
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 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
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
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)
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
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
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
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
Other Technology Services
Learning activities
Word
and board games
E-mail
Making cards, letters, etc.
Music and art activities
Health information/Health Care Services
Inform
Educate
Technologies on the Horizon
Robotic Assistance
Sensor-based Monitoring
Intel’s Assistance Program