Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
84 Cards in this Set
- Front
- Back
|
What brings challenges to older adults and those caring for them?
|
sensory changes
|
|
|
Elements to good communication
|
2 way sensory activity (expressive and receptive components)
common ground, comfort level, active listening, all senses used, seeing anothers point of view, time |
|
|
Common ground techniques
|
be sensitive to the older adults self perception, suspent stereotypes, develop empathy and flexibility, be warm and sociable, learn the language and customs, dress in a socially and culturally respectful way
|
|
|
Comfort Level
|
know uncomfortable topics (ex: money, sex, change, diet)
Make eye contact Know if touching is appropriate in that person/culture |
|
|
What do sensory losses do?
|
create barriers to communication
reduce ability and desire to communicate lead to social isolation and withdrawal lead to frustration and aggression |
|
|
Physiologic changes with aging that have to do with hearing?
|
thicker,longer hair in auditory canal
difficulty hearing high tones drier skin in canal thickened TM decrease in auditory opening |
|
|
Assessment of auditory
|
combine physical and auditory assessment tooks
Check anatomy, *CERUMEN, canal narrowing, etc Gross hearing assessment (whisper test while rustling fingers in other ear, chart review for hearing loss risk and audiometry) |
|
|
Common reason people cant hear
|
wax/cerumen in the ear
|
|
|
Hearing loss
|
majority of adults over 65 have some hearing loss
|
|
|
most common hearing loss
|
presbycusis
|
|
|
Some causes of hearing loss
|
nerve deterioration
disease environmental medications cerumen impaction |
|
|
Hearing loss usually loses what tone?
|
high tones like z,s, sh, ch (hard time distinguishing between these)
decreased speech discrimination (telephone) |
|
|
Does medicare cover hearing aids?
|
no
|
|
|
Feelings associated with hearing loss
|
isolation and frustration
|
|
|
Some safety issues with hearing loss
|
unable to hear traffic, instructions, phone, doorbell
|
|
|
High tone loss in hearing decreases?
|
speech discrimination
|
|
|
What may happen due to inability to control noisy situations
|
selective hearing or daydreaming
speech may deteriorate |
|
|
Barrier breakers for hearing impaired
|
*Sit in front; light on your face
*ask if person is hard of hearing and check for hearing aid *ask if they can read lips or use sign language *Cut background noise *rephrase rather than repeat *use gestures, diagrams, printed/writing implements *alert when changing the subject *sign language interpreter *use lower pitched tone *speak DONT shout *keep mouth in clear view |
|
|
Vision loss
|
most older adults have some
|
|
|
Causes of vision loss
|
decreased pupil size and accommodation (normal), macular degeneration (impedes central vision), glaucoma (impedes peripheral vision), cataracts (cloud vision)
|
|
|
Impedes central vision
|
macular degeneration
|
|
|
impedes peripheral vision
|
glaucoma
|
|
|
clouds vision
|
cataracts
|
|
|
What is needed for good communication in some cultures
|
eye contact
|
|
|
When do changes in vision occur
|
early 40s
|
|
|
what occurs frequently in women after menopause
|
xeropthalmia (dry eyes)
|
|
|
What are some eye changes with age
|
*light and dark adaptation often a problem
*diminished perception of color *decreased accommodation *diminished recovery from glare 95% wear glasses |
|
|
Decrease vision puts elderly at risk for
|
falls
|
|
|
Some visual reasons for fall risk
|
decreased visual acuity, contrast sensitivity, and depth perception
|
|
|
Is most visual loss in older people correctable
|
yes
|
|
|
Interventions to correct elderly vision loss
|
change glasses or cataract extraction
|
|
|
Environment for vision impaired
|
signs in clear, large bold print
audiotapes contrasting colors task lamps magnifier |
|
|
Barrier Breaks for vision impaired
|
*clearly identify self
*narrate activities *use clear language when giving directions *setting well lit *ask if glasses are needed *use larger (24) point type when giving instructions *be aware if turning away from you or head at one angle trying to see you |
|
|
Nursing interventions for vision impaired
|
*use black felt tip pen on white paper
*review written directions with patient *provide bright light, avoid glare *use bright colors or high contrast to help locate rooms (colored labels with big black print) *dot top of prescription bottles to correlate with dose frequency *avoid clutter |
|
|
Vision important tips
|
*instruct to notify of any acute changes
*add contrast to fixtures in room *annual dilated eye exam***** |
|
|
Cataracts are the
|
5th most common chronic condition in adults over 75
|
|
|
legally blind
|
20/200
best corrected |
|
|
totally blind
|
no light reception
|
|
|
Presbyopia
|
decreased ability to focus on near objects or fine print
|
|
|
Cataracts
|
clouding, painless, progressive, loss of vision, can be uni or bilateral
|
|
|
most common cause of legal blindness
|
AMD
(macular degeneration) |
|
|
What occurs in AMD
|
breakdown of cells in macula (light sensing cells) causing yellow deposits (drussen) in the retina
|
|
|
Wet form AMD
|
abnormal blood vessels around the drussen spots leak causes subretinal hemorrhage/scarring
|
|
|
What is worse: wet or dry AMD?
|
WET
|
|
|
Leading cause of central vision loss
|
AMD
|
|
|
AMD is more common in...
|
fair haired, blue eyes
smoking, excessive sun exposure, Cardiovascular disease, HTN |
|
|
Where should you sit in a patient with AMD
|
to the side
|
|
|
Prevention of AMD
|
beta carotene 25,000 units (NOT if smoker)
Vit E 400 IU Vit C 500 mg Zinc 80 mg |
|
|
What is contraindicated in smokers
|
beta carotene supplements (can increase risk of lung cancer)
|
|
|
Foods high in beta carotene
|
palm oil and supplements
|
|
|
foods high in vitamin E
|
vegetable oils, nuts, green leafy veggies, fortified cereals
|
|
|
Foods high in Vitamin C
|
citrus fruits, sweet peppers
|
|
|
Foods high in zinc
|
red meat, poultry, beans, nuts, seafood, whole grains, fortified cereals, dairy products
|
|
|
Treatment of AMD
|
VEGF (Avastin)- inhibits angioneogensis (inhibits vascular endothelial growth factor)
Avastin however is not approved (approved are Macugen and Lucentis) Laser treatment Photo therapy |
|
|
What is photo therapy for AMD
|
low energy light and photosensitizing agent to cause vascular occlusion
this stabilizes vision and prevents further loss |
|
|
Open angle glaucoma
|
most common
increased IOP causing cupping and atrophy of optic nerve head, causing visual field defects that can lead to: blindness, loss of peripheral vision, intolerance to glare, or decreased ability to adapt to dark |
|
|
Diabetic retinopathy
|
end or damage from Diabetes Mellitus, causing retinal blood vessels to leak and grow abnormally from scar tissue
causes spotty vision Starts out as non proliferative and progresses to proliferative |
|
|
Reduce risk of diabetic retinopathy
|
tight blood sugar control
|
|
|
Treatment diabetic retinopathy
|
laser photocoagulation
|
|
|
Every diabetic should have...
|
annual dilated eye exam
|
|
|
Main causes of speech impairment
|
stroke/ neuro
dental difficulties isolation/frustration xerostomia (dry mouth due to lack of saliva) dysarthria (motor speech impairment from neuro injury) aphasia (loss of ability to make sound or interpret due to neuro injury) |
|
|
Barrier breakers to speech impaired
|
identify speech problems before interaction
encourage to do best they can alternate forms of communication gestures, body language |
|
|
Touch/tactile loss
|
in later stages of life, individuals are often derived of tender and nuturing physical contact that enhances communication
|
|
|
Factors of touch/tactile loss
|
loss, discomfort, fear, stereotypes, sense of vulnerability, isolation
|
|
|
Effects of touch in older people
|
nurturing gesture
increases motivation decreases feelings of abandonment calming and reassuring |
|
|
You must be careful when touching....
|
a person with a spinal cord injury
prolonged pressure in one area can cause autonomic reflex reaction |
|
|
Movement loss causes
|
osteoporosis, arthritis, lack of exercise, stroke, weight gain, chronic illness or disability
|
|
|
Physical impairments relating to movement loss
|
fatigue, inappropriate or misinterpreted, limited stamina (loss of initiative), decrease in vision and mobility, threat of independence
|
|
|
Barrier breaks to movement loss
|
be aware of limitations and pain
gestures are effective in communication Touch is reassuring and should be used if acceptible encourage participation in regular exercise and meaningful socialization |
|
|
Loss of taste and small causes
|
decreased saliva, normal aging, meds, surgical procedures
|
|
|
Most adults lose...
|
taste, especially for sweets
sense of smell |
|
|
Effects of taste/smell loss
|
reduces socialization
affects willingness to talk about food |
|
|
Encourage what with taste and small loss
|
yearly dental visits
|
|
|
Cognitive barriers to good communication
|
all cognitive losses impact communication!!!
multi-drug interactions or side effects (cognitive fog) dementia can cause difficulties alcoholism (can cause cognitive problems) inadequate sleep |
|
|
Barrier breakers to cognitive loss
|
*keep expectations realistic
*keep interaction simple and go slow *reassure and reward *use one step commands *validate behavior *discover meaning behind behavior *use simple sentences *dont argue or ask questions that rely on good memory |
|
|
Psychological and social barriers to communication
|
all psych problems impact trust and comfort
try to see what elderly is bringing with them |
|
|
Causes of psycho or social barriers
|
depression
anger personal baggage personality type |
|
|
barrier breakers to psychological or social barriers in communication
|
empathize but do not legitimize the fatigue of apathy and depression
be active listener |
|
|
Additional techniques for communication
|
think how you are presenting self
be at eye level (creates balance of power) break concepts down into parts and allow time for each part to be considered don't talk about people when they are present but can no longer communicate spend time to allow for communication needs |
|
|
Terminology tips
|
put the person first (person with disability rather than disabled person) (Ex: person with alzheimers)
avoid outdated terms like handicapped or crippled...use physically challenged don't define person by disability say wheel chair use rather than wheel chair bound |
|
|
More tips for communication with disabled
|
avoid disempowering words, such as victim or sufferer
Don't touch or push wheel chair without asking Don't ask to use to hold coats or items Keep ramps unlocked and unblocked |
|
|
Tips for working with persons who are blind
|
If using a guide dog, walk on opposite side of dog
Don't take their arm, offer YOUR arm when crossing street |
|
|
Tips for working with persons who are speech or hearing impaired
|
give full attention
ask if you have trouble understanding, don't just nod if after trying, you still cant understand, ask to write it down quiet environment helps |
|
|
common groupd and shared reality tips
|
be sensitive to self perception
look through patient's view suspend stereotypes develop empathy and flexibility be warm and sociable learn about customs and languages of older adults translator vs. interpreter |
