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Chapter 13 Connecting With Others Rewards of Social Interaction • Sharing joys and burdens. • Deriving feelings of normalcy. • Validating perceptions. • Maintaining a link with reality. Presbycusis • Definition – Age-related sensorineural hearing loss. – May cause speech to be inaudible or distorted. • Effect on Communication – May cause problems due to self-consciousness and difficulty using the telephone. – Corrective measures for hearing problems should be explored. Use of Hearing Aids • Hearing aids can benefit persons with some hearing disorders, but they may not solve all hearing problems. • An audiometric evaluation can determine if the specific hearing problem can be improved by the use of a hearing aid. • A hearing aid should never be purchased without being specifically prescribed. Problems Associated with Hearing Aid Use • Inability to adjust to the presence of the aid. • Distortion of sound: – Caused by the amplification of environmental noise along with speech sounds. Suggestions for Hearing Aid Use • Wear the aid for progressively longer periods until comfort is gained. • Avoid its use in noisy environments. • Check the aid regularly to ensure earpiece is not blocked with cerumen and the battery is working. Interventions for Patients with Hearing Deficits (Without Hearing Aids) • Speak clearly and distinctly, in a low frequency but at an audible level, while facing the individual. • Avoid shouting as it raises the high-frequency sounds that older persons already have difficulty hearing. • Cup the hands over the less deficient ear and talk directly into the ear. • Use gestures and pictures and point to items while talking about them. Advocating for Hearing Safety • Provide health education about the effects of environmental noise on hearing and general health. • Take an active role in advocating legislation to control noise pollution and the enforcement of that legislation. Measures for Assisting with Visual Deficits • Schedule a thorough eye examination, including tonometry, performed by an ophthalmologist. – Detects vision changes and needs for alterations in corrective lenses. – Discovers problems such as cataracts, glaucoma, and other disease processes. • Assess the financial ability of the individual to afford an eye examination and glasses. Compensating for Visual Limitations • Face the individual. • Exaggerate gestures and facial expressions when speaking. • Approach the individual from the front. • Ensure that seating allows for full sight of persons or objects in the conversation. • Supply ample lighting using several soft indirect lights. • Use large-print materials. Nursing Interventions Promoting Social Interaction • Review and readjust the person’s schedule to conserve energy and maximize opportunities for socialization. • Plan medication administration to accommodate social activity. • Plan fluid intake and bathroom visits prior to activities. • Promote social activity among the elderly. • Help persons of all ages see the attributes of the unique human being housed within the aged body. Prejudice Toward the Sexuality of Elders • Respect for the elderly as vital, sexual beings is minimized by: – The lack of privacy afforded them. – The lack of credence given to their sexuality. – The lack of acceptance, respect, and dignity granted to their continued sexual expression. Role of the Nurse in Promoting Sexuality • The myths, ignorance, and vulgar status previously associated with sex have been conferred on the sexuality of the aged. – Nurses can play a significant role in educating and counseling about sexuality and the aged. – Nurses can encourage attitude changes by their own examples. Factors Contributing to Lack of Research on Sex and the Elderly • The acceptance and expansion of sexology has been relatively recent. • Impropriety was formerly associated with open discussions of sex. • There is a misconception that the aged are neither interested in, nor capable of, sex. • Practitioners lack experience in discussing sex with any age group. Sex and the Older Person • There tends to be a decrease in sexual responsiveness and a reduction in the frequency of orgasm. • Older men are slower to erect, mount, and ejaculate. • Older women may experience dyspareunia (painful intercourse). • Many older women gain a new interest in sex. Factors That May Interfere with Sexual Expression in Later Life • The unavailability of a partner • Ageism • Changes in body image • Boredom • Misconceptions • Physical conditions/cognitive impairments • Medications Misconceptions about Sex in Later Life • Erections are not possible after prostatectomy. • Penile penetration can be harmful to a woman after a hysterectomy. • Menopause eliminates sexual desire. • Sex is bad for a heart condition. • After a hip fracture, intercourse can refracture the bone. • Sexual ability and interest are lost with age. Examples of Drugs Affecting Sexual Functioning • Anticholinergics • Phenothiazines • Benztropine • Reserpine • Clonidine • Sedatives • Cytoxic agents • Thiazide diuretics • Digoxin • Tranquilizers • Diphenhydramine • Trihexyphenidyl • Guanethidine • Tricyclic antidepressant • Haloperidol Strategies to Facilitate Connections • Assist patients in evaluating current relationships. • Guide patients in becoming aware of their behaviors and responses that impact relationships. • Teach strategies that promote effective expression of inner feelings. • Provide information on sources of social activities. • Refer patients for hearing and/or vision examinations as needed. Strategies to Facilitate Connections (cont.) • Respect patients’ interest and efforts to be sexually active. • Assist patients in improving sexual function. • Provide positive feedback for successful connections with others. Source • Eliopoulos, C. (2005). Gerontological Nursing, (6th ed.). Philadelphia: Lippincott, Williams & Wilkins (ISBN 0-7817-4428-8).