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Uncovering the Message of the Nonverbal Older Adult

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Healing is Not Fixing! Today's healthcare is, ... Healing is Not Fixing! ... Compassionate communication that promotes healing is especially difficult in the ... – PowerPoint PPT presentation

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Title: Uncovering the Message of the Nonverbal Older Adult


1
Uncovering the Message of the Nonverbal Older
Adult
  • R. A. Weise, M.D.
  • Medical Director
  • Alexian Older Adult Health Care

2
The Nonverbal Older Adult
  • A Man Called Peter

3
Uncovering the Message of the Nonverbal Older
Adult
  • What is nonverbal communication?
  • Nonverbal communication is the giving or sharing
    of information or knowledge, in the context of
    feelings/emotions, without using words
  • Nonverbal communication usually consists of
  • Facial expressions
  • Body language/postures
  • Information conveyed through touch, taste, smell,
    sight, and hearing
  • Emotional behaviors

4
The Purpose of Communication in Health Care
  • To communicate, in Latin, means
  • to impart
  • to participate
  • To communicate, in English, means
  • to convey knowledge or information
  • to make known
  • to share

5
The Purpose of Communication in Health Care
  • To communicate, in Health Care, means
  • to provide general health related information
  • to give counsel for specific personal illness
  • to apply technology for disease management
  • to promote an understanding of health care costs
  • to extend compassion
  • to care about the patient/client/resident

6
The Purpose of Communication in Health Care
  • Is, ultimately, to promote healing
  • not just fixing

7
What is Healing?

8
What Healing is Not!
  • Healing is not fixing
  • Fixing, in Latin, means to make firm or to
    fasten, i.e. to tighten something that is loose
  • In English, to fix means to repair

9
What Healing is Not!
  • Fixing emphasizes
  • Results over relationships
  • Parts over the whole
  • Products over persons
  • Repair over renewal

10
Healing is Not Fixing!
  • Todays healthcare is, all to often, based upon
    fixing
  • 1. We have improved our outcomes (results) in
    reducing the impact of cardiovascular disease
    cancer, infection, etc..
  • While, at the same time, reducing patient /
    professional caregiver relationships, i.e. acute
    care nurse to patient ratios (in reality) are
    rising (14 in 1991, and now 16 ?).

11
Healing is Not Fixing!
  • 2. Healthcare has become more and more
    fragmented, placing the responsibility for
    patient care in the hands of the consultant
    rather than in the hands of the primary care
    physician.
  • This diffusion of care dilutes responsibly for
    the whole (total) patient.
  • The technological repair of the part becomes
    more important than the renewal of the
    whole(person).

12
Medical Specialties Engeman, 1964
  • Pediatrics
  • Opthomology
  • Neurology
  • Orthopedics
  • Dermatology
  • Pathology
  • Public Health
  • Psychiatry
  • Surgery

13
Medical Specialties ABIM, Maintenance of
Certification, 2007
  • Allergy/Immunology
  • Anesthesiology
  • Colon/Rectal Surgery
  • Dermatology
  • Emergency Medicine
  • Family Practice
  • Genetics
  • Neurosurgery
  • Neurology
  • Psychiatry
  • Nuclear Medicine
  • Internal Medicine
  • Urology
  • Nuclear Medicine
  • Radiology
  • OB/GYN
  • Opthomology
  • Orthopedics
  • ENT
  • Pathology
  • Pediatrics
  • Physical Medicine/Rehab
  • Plastic Surgery
  • Preventative Medicine
  • General Surgery
  • Thoracic Surgery

14
Healing vs. Fixing
  • If healing is not fixing, then what is healing ?

15
What is Healing?
  • Healing is the dynamic, creative process of
    helping an individual change illness into
    wellness by the transformation of
  • Dependency into Inter-dependency
  • Disconnection into Intimacy
  • Discouragement into Hope

16
What is Healing?
  • Healing Emphasizes
  • Connection over outcome
  • The whole person over the individual organ system
  • Revitalization over preservation
  • Becoming a servant partner rather than,
    merely, a service provider

17
The Purpose of Communication in Health Care
  • Health care communication must, not only, supply
    competent fixing but, also, secure healing in
    our patients, clients, and residents
  • Compassionate communication that promotes healing
    is especially difficult in the nonverbal older
    adult

18
Uncovering the Message of the Nonverbal Older
Adult
  • Barriers to Effective Communication in the
  • Nonverbal Older Adult

19
Barriers to Effective Communication in the
Nonverbal Older Adult
  • Occur in, predominantly, three areas
  • Normal Aging
  • Disease
  • The Environment

20
Barriers to Effective Communication in the
Nonverbal Older Adult
  • Normal Aging

21
Definitions
  • Aging post maturational / intrinsic
    deterioration
  • decline in reproductive capacity
  • increasing vulnerability
  • increasing likelihood of death
  • 70 environmental / 30 genetic

22
Definitions
  • Aging Change over Time
  • Normal Aging Balanced change over time
  • positives gt negatives

23
Normal Aging
  • We age in four domains
  • Physically
  • Emotionally
  • Socially
  • Spiritually

24
General Principles of Normal Aging
  • Aging is gradual
  • large physiological reserve
  • loose 1 reserve/ year
  • The more complex the function, the greater the
    decline
  • balance vs. single nerve
  • With advancing age comes increased variability

25
General Principles of Normal Aging
  • With old age comes a diminished speed of
    adaptation
  • adaptation occurs but the greater stress the
    slower the adjustment
  • especially true in frail older adults

26
Specific Changes Associated with Normal Aging
  • What can we expect in terms of organ system
    specific change, with advancing age, that may
    negatively impact communication with the
    nonverbal older adult

27
Normal Aging and CNS Function
  • Memory slows down with age (age associated memory
    change)
  • delayed recall becomes sluggish
  • attention span diminishes
  • Executive function is less efficient
  • sequential reasoning slows
  • new learning slows
  • specialized knowledge maintained
  • judgment intact
  • Language Communication skills mostly improve
    with age

28
CNS Function
  • Visual-Spatial coordination declines with age
  • perceptual speed diminishes
  • Personality becomes more personal as we be come
    an older adult
  • Emotional identification and experience remains
    intact

29
Normal Aging of the Sensory System
  • Hearing
  • High-pitched hearing loss (Presbycusis)
  • loose consonants in the English
    language ( s th k f etc.)
  • The most common type of hearing loss in the
    elderly

30
Sensory System
  • ello i Aleian Broer Medical enter

31
Sensory System
  • Vision
  • lens becomes thicker and more dense
  • more light is needed (watts in bulbage !)
  • slower accommodation
  • slower light/ dark adaptation
  • need more contrast
  • reduced peripheral vision
  • less tears (but watery eyes)

32
Sensory System
  • Taste
  • decreases in acuity with old age
  • saliva production reduced
  • no decrease in taste buds

33
Normal Aging and Movement
  • Muscles
  • decrease in size and strength with age (50 )
  • less elastic
  • but trainable at every age (regular,
    consistent aerobic and resistance exercise a must
    for optimal aging !)

34
Movement
  • Balance
  • - complex mechanism involving brain, vessels,
    skin, senses, joints, muscles, etc.
  • - slower to respond to sudden change with age
  • - can be improved in advanced age

35
Sexuality and Normal Aging
  • Desire persists into advanced age in women
    (menopause not menostop) but desire decreases
    in men
  • Vagina shortens/ gets dryer
  • Arousal takes longer
  • Orgasms are fewer and further apart
    (especially for men)

36
Sexuality and Normal Aging
  • The frequency of sexual intercourse among 85 y/o
    (who have opportunity), is about the same
    frequency as a a Fortune 500 C.E.O.(2x month)
  • Sexuality infuses vibrant color into the, often,
    black and white relationships of aging

37
Emotional Aging
  • Loss is the hallmark of emotional aging
  • With age, we not only loose parts of our bodies
    but also our
  • work (retirement)
  • spouse (death)
  • Children (busyness)
  • friends (immobility or death)
  • Loss, in old age, can promote Self-centeredness

38
Social Aging
  • Can promote isolation
  • With advancing age
  • Our once high position, becomes low position
  • Being needed becomes being a burden
  • Once we controlled ourselves, now we are
    controlled by others

39
  • Physical Aging can lead to Dependency
  • Emotional Aging can lead to to Self-Centeredness
  • Social Aging can lead to Isolation
  • Progressing to Spiritual Apathy in old age

40
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41
The Aging Spirit
  • The Most Important Domain of Aging
  • Operates on Faith gt Facts
  • Favors Relationships gt Results
  • Provides Balance
  • Provides Energy
  • Provides Maturity, Imagination, and Wisdom

42
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43
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44
  • Physical Aging can lead to Dependency
  • Emotional Aging can lead to Selfishness
  • Social Aging can lead to Isolation
  • BUT …

45
The Aging Spirit
  • Provides the power to transform
  • Dependency into Chosen Reliance
  • Selfishness into Service
  • Isolation into Community
  • - Apathy into Hope

46
Barriers to Effective Communication in the
Nonverbal Older Adult
  • Occur in, predominantly, three areas
  • Normal Aging
  • Disease
  • The Environment

47
Barriers to Effective Communication in the
Nonverbal Older Adult
  • Disease creates significant barriers to optimum
    communication with nonverbal older adults
  • Dementias ( A.D. Lewy Body Dementia etc.)
  • Stroke
  • Immobility
  • Cataracts
  • Hearing loss
  • Depression/Anxiety
  • Pain (Chronic and Acute)
  • Loose dentures/ poor dentition
  • Arthritis

48
Barriers to Effective Communication in the
Nonverbal Older Adult
  • Occur in, predominantly, three areas
  • Normal Aging
  • Disease
  • The Environment

49
Barriers to Effective Communication in the
Nonverbal Older Adult
  • Environmental pressures can significantly reduce
    communication with the nonverbal older adult
  • Always in a bed or chair
  • Isolation
  • Crowding
  • Poor lighting
  • Too much or too little sensory stimulation
  • Hurried
  • Lack of privacy
  • Ageism

50
Uncovering the Message of the Nonverbal Older
Adult
  • How to Improve Communication with the Nonverbal
    Older Adult

51
How to Improve Communication with the Nonverbal
Older Adult
  • General principles of nonverbal communication in
    older adults
  • It may involve noise without recognizable
    language
  • It is emotionally based
  • It has purpose and meaning
  • It is accurate

52
How to Improve Communication with the Nonverbal
Older Adult
  • Specific strategies to enhance communication with
    the nonverbal older adult
  • Demonstrate respect and guarantee safety with
    each interaction
  • Decide to develop a caring relationship with the
    patient/resident/client
  • Determine to be a Servant Partner, not simply,
    a Service Provider.

53
How to Improve Communication with the Nonverbal
Older Adult
  • Practical actions that will promote and enrich
    communication with the nonverbal elderly
  • Promote excellence in health and health care
    delivery
  • Prevent illness
  • Focus on Function
  • Concentrate on Feelings (Emotions)
  • Direct communicative efforts at the specific
    barriers that impair understanding
  • Normal Aging
  • Disease
  • The Environment

54
How to Improve Communication with the Nonverbal
Older Adult
  • Over coming the barriers of Normal Aging
  • Slow down all interactions
  • Taylor the communication to the quality of the
    relationship, in the moment!
  • Speak slowly, firmly, and rephrase rather than
    repeat
  • Maintain compassionate eye contact, in adequate
    light, at or below their eye level (kneel or sit)
  • Honor their sexuality
  • Respect their privacy and time (schedule)
  • Make them physically safe
  • Know them

55
How to Improve Communication with the Nonverbal
Older Adult
  • Over coming the barriers of Emotional Aging
  • Identify the feelings/emotions they are
    expressing
  • Listen for understanding of the feelings/emotions
  • Validate their feelings
  • Smile
  • Use affirmative body language (head nodding)
  • Redirect them towards service to others

56
How to Improve Communication with the Nonverbal
Older Adult
  • Over coming the barriers of Social Aging
  • Determine to connect to them and to limit their
    isolation
  • Use affirmative touch, when appropriate
  • Help them connect to those around them, as well
    as, family and friends
  • Give the something that they can control
  • Give them choice and then honor their choices

57
How to Improve Communication with the Nonverbal
Older Adult
  • Over coming the barrier of an Apathetic Spirit
  • The most difficult of tasks in communication
  • Help them cultivate a healthy spirit based upon
    truth, in the context of, their faith
  • Help them make good choices, serve others, and
    connect with those around them
  • Encouragement and hope improve communication

58
How to Improve Communication with the Nonverbal
Older Adult
  • Over coming the barriers caused by Disease
  • Comprehensive Geriatric Assessment
  • Focus on improving or maintaining function
    (ADLs)
  • Treat depression
  • Get hearing aids
  • Remove cataracts/ get glasses/ treat Macular
    Degeneration
  • Limit medication
  • Exercise
  • Relieve pain
  • See Dentist
  • Get physical/occupational/speech therapy

59
How to Improve Communication with the Nonverbal
Older Adult
  • Over coming barriers caused by the Environment
  • Mobilize the patient/client/resident
  • Supply adequate light, space, and privacy
  • Provide appropriate sensory stimulation
  • Compassionately balance safety with personal
    freedom

60
Uncovering the Message of the the Nonverbal Older
Adult
  • Understanding and being understood by the
    nonverbal older adult is essential to providing
    them with adequate health care
  • Committing ourselves to establish and maintain
    their personal safety and respect, will provide
    the soil for our understanding of one another to
    grow and flourish
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