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Communication in aging
Communication is one of the most important capacities of human beings
Basic communication strategies are all applicable in communicating with older adults
Meaningful communication with active involvement in society is key to “aging well”
Enhancing communication with older adults is a foundational skill in gerontological nursing that has rewards for both the nurse and the older person
Common communication challenges
Sensory impairment, including normal age changes
Language impairment (Ex: aphasia)
Cognitive impairment (Ex: dementia)
Also attitudes of nurses/public towards older adults (ageism)
Sensory impairment
Both visual and hearing impairments
Common and can interfere with communication
Major causes of visual impairment among older adults
Cataracts, macular degeneration, and glaucoma
Common causes of hearing loss among older adults include
Sensorineural and conduction issues
Hearing loss statistics
Almost half of older adults above 65 have some kind of hearing loss.
Yet it is underdiagnosed and undertreated in older people
Hearing loss may lead to…
Social isolation
Communication differences related to hearing loss could be frustrating for both the speaker and the listener
Hearing loss 2 major forms
Conductive hearing loss
Sensorineural hearing
Conductive hearing loss
Results from abnormalities that reduce the transmission of sound to the middle ear. Infection, perforated eardrum, fluid in the middle ear or cerumen accumulation can all be caused.
Sensorineural hearing loss
Loss results from damage to the inner ear or neural pathways to the brain. It is usually treated with hearing aids or cochlear implants
Prelingual deafness
Deafness that occurs before the acquisition of spoken language
Strategies for communication: hearing loss
Do not shout when speaking (high pitch makes it more difficult)
Never assume loss is due to old age as it could be treatable such as infections or cerumen buildup
Make sure hearing aids are functioning
Pay attention to articulation, speed of speech, tone, and clarity, face the person and stand at the same level
Reduce background noise
Visual impairment
Vision normally declines with age
Colors become dimmer and images become less clear
Diagnosis of blindness does not equate to complete loss of vision
Major causes of visual impairment and blindness
Cataracts
Macular degeneration
Glaucoma
Diabetic retinopathy
Visual impairment may have consequences on…
Functional ability
Safety
Quality of life
Cataracts
Caused by damage to the lens and by fatty deposits in the lens
Cataracts Causes:
Hereditary, age
Cataracts Risk factors:
Excessive sunlight
Poor dietary habits
Diabetes
Hypertension
Kidney disease
Trauma to the eyes
History of alcohol and tobacco use.
Cataracts Assessment:
Clouding of the ocular lens, appearance of halos around objects, blurring, sensitivity.
Cataracts Management:
Surgery
Cataracts Post surgery:
Avoid heavy lifting, straining, and bending.
Use eye drops
Macular degeneration
Age related, affects the macula, the central part of the eye. Causes progressive loss of central vision, leaving only peripheral vision intact.
Macular degeneration Risks:
Age
Family history
Smoking, obesity
Excessive exposure to sunlight
Macular degeneration treatment:
No cure
Treatment options limited to slowing progression
Glaucoma
A progressive process in which the fluids of the eye are blocked causing gradual buildup of intraocular pressure (IOP) and damage to the optic nerve.
Glaucoma Risk factors:
Age
Steroid use
Injuries
Family history
Diabetes
Glaucoma Management:
Managed by medications that decrease IOP such as beta-blockers, laser surgery
Diabetic retinopathy
Due to diabetes, the retina is affected, blood and lipid leak and lead to macular edema and exudates.
Diagnosed by fundoscopy
Diabetic retinopathy Intervention:
Strict blood sugar intake and control, cholesterol and blood pressure control, laser treatments
Drusen
Yellow deposits under the retina, often found in people over the age of 60
Funduscopy
Ophthalmoscopic examination of the fundus of the eye
Keratoconjunctivitis sicca
Diminished tear production with age
Lipofuscin
An age-related, fatty brown pigment found in the liver, retina, kidneys, adrenals, nerve cells and heart tissue
Tonometry
Procedure used by eye care professionals to determine the intraocular pressure of the eye
Strategies for communication: Visual impairment
Make sure to have the person's attention before talking
Speak promptly, and clearly, get to the the persons level
Use analogy of a clock to help locate objects (meal at 3 o’clock)
Ensure adequate lighting, use large printing with proper contrast
Strategies for communication: Visual impairment (Blind)
Offer arms while walking, safety precautions, don't interfere with guide dogs.
Language impairment
Affects a person's ability to communicate in one or more ways:
Speaking
understanding
reading
writing
gesturing
Speech-language pathologists (SLP) should be consulted to come up with rehabilitative plans
Language impairment Types:
Wernicks aphasia (Receptive)
Broca's aphasia (expressive)
Verbal apraxia and dysarthria
Anomic/Nominal aphasia
Global aphasia
Aphasia
Most common language disorders follow CVA or stroke. There may be little or no speech, broken speech, or fluent but empty content
Wernicks aphasia
Person speaks easily but the content does not make sense. They may also have difficulty understanding spoken language
Broca's aphasia
Usually understand others but speak very slowly and use a minimal number of words. They experience difficulties in communicating orally and writing
Apraxia
An impairment in the ability to manipulate objects or perform purposeful acts, including ability to speak.
Verbal apraxia
There is a disruption in the brain's transmission of signals to the muscles controlling speech. When the person thinks about what to say they struggle speaking, but when they do not think about what to say, the person may be able to say many words/sentences correctly
Anomic/Nominal aphasia
Patients understand and speak readily but have difficulty finding the words. Difficulty finding the right words, inability to name objects
Global aphasia
Affects most of the language areas of the brain, person cannot understand words or speak coherently
Dysarthria
A speech disorder caused by weakness or incoordination of the muscles used for speech
Strategies for communication: Aphasia
Explain situations, and treatments and treat the person as an adult, using non-patronizing language
Be patient and allow plenty of time to communicate in a quiet environment. Speak slowly
Ask questions that can be answered with a nod or a blink. Instruct to use nonverbal responses or yes/no questions
Use visual cues, and gestures, and have paper and pencil available
Encourage all speech, do not be too quick guessing words/sentences
Cognitive impairment
Dementia affects thinking, memory and language
Communication challenges can vary depending on the type of dementia
Alzheimer's disease is the most common
Early stages affect thinking and memory
Mild to moderate stages begin to affect language
By the late stage, communication can be very challenging; both expression and understanding can be impaired
Basic communication strategies: summary
Include the person in social gatherings and conversations.
Ensure the hearing aids are in and glasses are on
Explain situations, treatments and anything else that is pertinent to the person.
Treat the person as an adult and avoid patronizing and childish phrases.
Talk as if the person understands.
Be patient and allow plenty of time to communicate in a quiet environment
Speak naturally.
Speak slowly, ask one question at a time, and wait for a response.
Do not shout.
Repeat and rephrase as needed
Enhanced communication strategies
Compensatory strategies
Connecting strategies
Enhanced communication strategies: Compensatory strategies
“Compensate for impairment” by reducing the information processing demands on the person with dementia
One idea sentences
Limit demands on recent memory
Speak at a normal rate (don't slow down)
Eliminate distractions
Redirect when necessary
Avoid ambiguous references and topic shifts
Repeat when necessary
Yes/no questions
Enhanced communication strategies: Connecting strategies
“Connect with the person on a relational level” by affirming their retained abilities and supporting their expression of self
Clarifying
Exploring
Moderating
Connecting
Validating
Assisting
It is not only what you say
Repeated use of yes/no questions can be perceived by the person with dementia as over-accommodating
Viewing the person as incapable of generating his/her own response could lead to a loss of self-esteem
Purposeful communication
Reality orientation
Validation therapy
Purposeful communication: Reality orientation
Provide orienting information (about person, place, and time) to “confused” older adults
Purpose is the give people better understanding of their surroundings, improves sense of control; and self esteem
Purposeful communication: Validation therapy
Empathizing and accepting a person's reality
Purpose is to promote security, meaningful communication and social interactions
Ageism
Involves ways of thinking about older adults based on negative attitudes and stereotypes
A tendency to structure society based on the assumption that everyone is young, thereby failing to respond to the real needs of the older persons
Ageist attitudes often interfere with nurses ability to communicate effectively (When the nurse believes all older people have memory problems). This will subsequently cause respect, dignity and communication problems
It is important for nurses to engage in self-reflection and analyze own attitudes and prejudices
Elderspeak
A form of ageism in which a person alters their speech on the assumption that the older person has difficulty comprehending.
Elderspeak is unfortunately very common in practice settings such as LTC where staff use patronizing language, pet names and other styles of defective communication
Nurses may not be aware that they are using elderspeak, therefore it is very important to be aware and self-reflect in every aspect of our practice and communication
Characteristics of elderspeak
Speaking slowly or loudly
Using a singsong voice
Using patronizing language:
“We, us, our,” in place of “you”
Using pet names, honey or sweetheart
Answering questions for the older person (Ex: “You would like your dinner now wouldn't you?”)