Download Theories of Aging

Chapter 4: Aging
Changes That Affect
Communication
Bonnie M. Wivell, MS, RN,
CNS
Senses and Communication
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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
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Cortex – responsible for higher thought
and function; contains all sensory and
motor information
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Thalamus – relay station
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Forebrain – interprets information
Review of Normal Age Related
Changes That Affect
Communication
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Vision
 Visual
acuity and accommodation decline
 Presbyopia starts age 45-55
 80% have adequate vision past age 90
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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
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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
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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
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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
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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
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Macular Degeneration
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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
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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
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Pathological Changes in Speech
and Language
Dysarthria – lose ability to articulate, brain
lesions main cause
 Aphasia
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 Expressive:
unable to produce language
 Receptive: unable to comprehend
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Verbal apraxia – impaired initiation,
coordination and sequencing of muscle
movements which execute speech,
caused by damage to parietal lobe
Movement Disorders in Older
Adults
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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
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Depression
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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
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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.
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Chapter 5: Therapeutic
Communication
Bonnie M. Wivell, MS, RN,
CNS
Communication
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A core skill for nurses
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Gather and share information
 Form relationships
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An exchange of information
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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
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Hearing aids
 Picture boards
 Synthesized (computer-generated) and digitalized
(recorded) speech
Communication in Healthcare
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Instrumental communication: behavior
necessary for assessing and solving
problems
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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
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Changes in adult learning
 Lifelong
learning
 Post-WWII era & GI Bill of Rights
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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
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Technology can be a good educational
tool for older adults
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Barriers to using the computer with older
adults
 Physical
 Social
 Psychological
Lifelong Learning Needs of Older
Adults
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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:
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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
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Learning in formal and informal settings
(community, long term care, health care
agencies, colleges/universities)
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Education needs to be tailored to the
needs of the individual or group.
Barriers to Lifelong Learning
Disabilities
 Cognitive, Affective, Sensory, and
Psychomotor barriers
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 Reduced
vision
 Reduced hearing
 Impaired cognitive function
 Depression
 Stress
 Chronic illnesses
Cultural Diversity and Health
Disparities
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How does education differ in culturally
diverse groups?
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What is the impact of education on health
outcomes in the minority older adult?
Implications for Educators
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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
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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
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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.
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Implications for Educators
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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
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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!
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Chapter 16: Using
Assistive Technology
to Promote Quality of
Life for Older Adults
Bonnie M. Wivell, MS, RN,
CNS
Assistive Technology
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Assistive technology devices are mechanical
aids that substitute for or enhance the function of
some physical or mental ability that is impaired
May enable
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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
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Low Tech
 Pencil
grips
 Splints
 Paper
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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
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Common Applications of Assistive
Technology
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Position and Mobility
 Walkers,
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wheelchairs, chair inserts, straps
Environmental Access
 Modifications
to buildings, increased
accessibility, Braille
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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)
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Self Care
 Emergency
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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)
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Social Interaction and Recreation
 Drawing
software, computer games, adapted
puzzles, computer simulations
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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
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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
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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
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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)
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See page 571 of text
Teaching Access to Web Sites
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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
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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
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Learning activities
 Word
and board games
 E-mail
 Making cards, letters, etc.
 Music and art activities
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Health information/Health Care Services
 Inform
 Educate
Technologies on the Horizon
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Robotic Assistance
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Sensor-based Monitoring
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Intel’s Assistance Program