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Chapter 4: Aging Changes That Affect Communication


Chapter 4: Aging Changes That Affect Communication Bonnie M. Wivell, MS, RN, CNS * See glossary for definitions * * * * * * * * * * * * * * * Lifelong Learning Needs ... – PowerPoint PPT presentation

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Title: Chapter 4: Aging Changes That Affect Communication

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
  • 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
  • Thalamus relay station
  • Forebrain interprets information

Review of Normal Age Related Changes That Affect
  • 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 Contd
  • Speech and language can become shaky or breathy
  • Touch at risk for hypothermia and pressure
  • 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

  • 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

  • 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
  • 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
  • Early diagnosis over 50 should have eye exam
    every 2 years

Pathological Processes Associated with Hearing
  • Presbycusis difficulty with high pitched tones
    and speech discrimination
  • Tinnitus persistent ringing, buzzing, or
  • Ototoxicity hearing loss due to medications or

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 Parkinsons Disease tremor,
    rigidity, stiffness, slowness of movement,
    postural instability, and/or impaired balance and

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

  • 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
  • Parkinsons disease memory problems,
    hallucinations, depression
  • Delirium
  • Dementia
  • Depression
  • ADL/IADL impairment

  • Normal aging changes may result in a decreased
    ability of the older adult to communicate
  • 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

  • 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 Im 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 patients
    health literacy level
  • Follow- through forms trust

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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
  • They should be shown a reason for learning a
    particular task.
  • Theory of self-efficacy actions influence
  • 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.

Technology for Lifelong Learning in the Older
  • 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,
  • 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,
  • Education needs to be tailored to the needs of
    the individual or group.

Barriers to Lifelong Learning
  • Disabilities
  • Cognitive, Affective, Sensory, and Psychomotor
  • Reduced vision
  • Reduced hearing
  • Impaired cognitive function
  • Depression
  • Stress
  • Chronic illnesses

Cultural Diversity and Health Disparities
  • How does education differ in culturally diverse
  • 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
  • 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
  • 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
  • Do not stand in front of a window avoid glare.
  • Speak loudly and slowly. Use a microphone if
    needed. Turn off fans and other distracting
  • Face the audience (remember that elders often
    fill in what they cannot hear by lip-reading).
  • Limit programs to about 20 40 minutes.

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
  • 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
  • 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 take-home
  • Be sure that handouts are appropriate to the
    literacy level and cultural background of the

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 controls
  • Braille readers

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 (contd)
  • 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 (contd)
  • 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
  • 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
  • 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

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
  • Intels Assistance Program