Download Sensory Changes and Communication with Older Adults

Sensory Changes and
Communication with
Older Adults
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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.
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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
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Fundamentals of communication
• Two-way sensory activity
• Shared reality and expectations
(common ground)
• High comfort level
• Active listening
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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.
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Sensory losses lead to
• Reduced ability and desire to
communicate
• Isolation
• Frustration leads to aggression or
withdrawal
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Hearing Loss
Definition. Decreased ability to hear highfrequency tones
Causes.
• Nerve deterioration
• Disease
• Environmental situations
• Medications
• Cerumen (earwax)
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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
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Hearing Aids
1. In -The -Ear (ITE)
2. Behind-The-Ear
3. Canal Aid
4. Body Aids
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Barrier Breakers: hearing loss
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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
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Vision Loss
Causes.
• Decreased pupil size and
accommodation
• Macular degeneration – central
vision loss
• Glaucoma – peripheral vision loss
• Cataracts – cloud vision
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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”
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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
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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.
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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.
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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.
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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
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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
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Touch/Tactile Loss
Causes.
• Neurons die and are not replaced
• Stroke
• Fear
• Discomfort
• Stereotypes
• Sense of one’s own vulnerability
• Isolation
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Movement Loss
Causes.
• Osteoporosis
• Arthritis
• Lack of exercise
• Stroke
• Weight gain
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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
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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
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Taste and Smell Loss
Causes.
1. Normal aging
2. Certain disease states
3. Medication
4. Surgical interventions
5. Environmental exposure
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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
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Cognitive Barriers
Causes.
• Multidrug interactions
• Dementia
• Alcoholism
• Inadequate sleep
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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
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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
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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
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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
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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
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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
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QUESTIONS?
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