Demand on your CARE: Communication Challenges: Vision, Hearing and Speech
With advancing age, communication challenges are very common among older adults. Taking this course will help you understand the vision, hearing and speech impairment among older adults. The related strategies in facilitating their daily lives and the communication tips will be discussed.
Introduction
Introduction
Content
What is communication?
Communication challenges at old age
Why is it so important to address the communication issues in older adults?
Did you encounter one of these situations?
As you talk with an older adult about his care plan, you get the feeling that he doesn't really understand you, despite he tells you that he does when you ask him.
When you talk with an older lady who you think may have hearing problem. You talk louder, but she still seems to have some problems hearing and understanding you.
When you explain why and how to take the medication to an older patient, he seems to be listening, smiles, and nods his head. But finally, you find that he is not be able to take the medication.
What is communication?
Interaction between Sender and receiver
Two interacting → a Dyad
Verbal (hearing / listening and speaking / speech)
Non-verbal (visual, touching, gesture)
Sending messages and receiving feedback within physical and psychological contexts
What is communication?
Communication is a complex process of exchanging information and ideas. It involves both expression and understanding (comprehension).
Human communication serves many functions and is essential in our daily life.
Effective communication requires:
Communication Challenges at old age
Biological changes of ageing
Age-related sensorineural changes
Diminish of visual acuity accompany ageing
Cognitive-communicative disorders
Long term conditions with speech and language disorders are commonly found in nursing home residents who have dementia or stroke
Examples of Communication Barriers within nursing homes
Culture that creates an improvised communication environment
Lack of active management of communication problems
Physical environment: background noise, poor acoustics, inadequate lighting, lack of communication aids, seating arrangements that impede conversation between residents
Nonuse / failure to maintain hearing aids
Nonuse of glasses or dirty glasses
Lack of skilled communication partners (staff, visitors, residents)
Lack of community engagement
Lack of meaningful activity
(Morley, et. al., 2013, p.212)
Impact of Communication Impairments
Vision, hearing, speech impairments
Increase communication barriers
Unable to detect environmental dangers
Affect independence of daily livings
Restrict social life
Decrease quality of life
Increase prevalence of dementia and depression
Importance to address the communication issues
Identify communication issues and manage the underlying causes
Enable practitioners to provide quality care
Improve relationship conflicts between family members and older adults
Enable formal and informal caregivers to provide positive support to older adults
Support independent living and improve quality of life
Overview of this Module
1. Speech and Language Disorders in Older Adults
2. Visual Impairment and Communication in Older Adults
3. Hearing, Listening and Communication in Older Adults
4. Effective communication skills
5. Videos for scenario case study
Morley, J., Tolson, D., Ouslander, J. G., Vellas, B. (2013). Nursing home care. McGraw Hill Professional.
Palmer, Andrew D, Carder, Paula C, White, Diana L, Saunders, Gabrielle, Woo, Hyeyoung, Graville, Donna J, & Newsom, Jason T. (2019). The Impact of Communication Impairments on the Social Relationships of Older Adults: Pathways to Psychological Well-Being. Journal of Speech, Language, and Hearing Research, 62(1), 1-21.
Chapter 1
Chapter 1: Speech and Language Disorders in Older Adults
Overview
Define speech and language
Define speech disorder and language disorder
Discuss common speech and language issues in old age
Improving communication – an overview
Use of augmentative and alternative communication tools
Practical tips
Speech vs Language
Speech: how a word is spoken
Language: how words are made and used to express meaning
Speech and Language Disorders
• Speech disorder
Problem in creating / forming speech sounds to communicate with others (A.D.A.M. Medical Encyclopedia)
• Language disorder
Problem with processing of linguistic information
Can be related to morphology (how a word is formed), syntax (word arrangement of a sentence), or semantics (meaning)
Can affect comprehension (receptive), production (expressive) or both
Common Speech and Language issues in old age
Understanding speech and language disorders in older adults
Common speech issues with normal ageing
• Issue on articulation
Denture related: Loss of teeth / gingival recession etc.
Muscle change in tongue and oro-facial muscles
→ Difficulty in pronouncing words
• Voice related (Presbyphonia)
Change of laryngeal structure (Gois, Pernambuco & Lima 2018)
→ Change of voice: hoarseness, aphonia, reduction in voice projection power
Speech / language problem
can lead to social withdrawal and poor Quality of Life
Common language issues with normal ageing
• Expression: Word finding difficulty (Burke & Shafto, 2004)
• Intact non-linguistic cognitive skills but have expressive and/or receptive deficit
• Expressive aspect (not exhaustive):
Word-finding difficulty. E.g. difficult to name objects
Slow and halting speech
Difficult to construct a sentence and mainly express in short & fragmented phrases
Semantic paraphasia. (e.g. mis-naming knife as spoon)
Making grammatical errors and putting words in wrong order
Speak jargons (e.g. making up nonsense words)
Circumlocution may happen (i.e. replacement of specific words with generalizations)
Common manifestations of dysphasia / aphasia
• Receptive aspect (not exhaustive)
Difficult to understand spoken/written words.
Provide unreliable answers.
Difficult to follow fast speech.
Fail to comprehend complex grammars e.g. passive sentences, embedded sentences.
Misinterpret meanings of words/pictures/gestures.
Not aware of own speech errors.
Dysarthria
• Speech disorder characterized by
abnormalities in the strength, speed, range, steadiness, tone, or accuracy of movements required for breathing, phonatory, resonatory, articulatory, or prosodic aspects of speech production that have a neurogenic origin (Duffy, 2013)
• Common Types
Flaccid dysarthria
Spastic dysarthria
Hypokinetic dysarthria
Hyperkinetic dysarthria
Ataxic dysarthria
Mixed dysarthria
Common manifestations of dysarthria (not exhaustive)
Imprecise articulation
Change of voice quality, e.g. hoarseness, decreased loudness
Change of pitch level (too high vs too low or monopitch)
Tremor voice
Change of speech rate (too fast/slow, accelerating)
Short rushes of speech
Hypernasality/hyponasality
(ASHA; Duffy, 2013)
Verbal Apraxia
• Speech disorder that reflects an impaired capacity to plan or program sensorimotor commands necessary for directing movements that result in phonetically and prosodically normal speech (Duffy, 2013, p.4)
Articulators (tongue, lips, palate etc.) are intact and without weakness.
Language ability (comprehension & expression) is intact.
Common manifestation of verbal apraxia
• Features of verbal apraxia (not exhaustive)
Phoneme distortions (speech sounds will be distorted)
Reduced speech rate
Adjacent syllables are with equal stress
Inconsistent articulation errors
Groping for correct speech sounds
Difficulty initiating speech sequence
(Allison et al., 2020; Ballard et al., 2014)
Cognitive communication disorder (CCD)
• Any aspect of communication difficulty that is affected by disruption of cognition. e.g. attention, problem solving/reasoning.
Common manifestations of CCD
(not exhaustive)
Having difficulty concentrating on conversations.
Fleeting attention which may miss important information told by the communication partners.
Having difficulty recalling information, e.g. failed to remember names in social gatherings which may cause embarrassment.
Having difficulty in understanding jokes and just take the literal meaning of speech.
Slow information processing: cannot keep up with a flowing conversation.
Impaired social communication skills. E.g. failure to 'read' non-verbal cues, like facial expressions and body language.
Restorative/restitution: restoring impaired function
Compensatory: improving functions by substitution strategies to compensate for non-amendable deficits.
Adaption: changing communication environment/behaviour to adjust for the disorder
Improving communication – an overview
• Aim
To help the patient to use remaining language abilities, restore language ability as much as possible and learn other ways of communication
(National Institute of Health)
• Two approaches
Impairment-based approach
Functionally oriented/communication approach
Improving communication – an overview
• Impairment based
Focus on improving language functions
Consist of procedures that directly stimulates specific listening, speaking, reading and writing skills
(National Aphasia Association)
More often for initial active rehabilitative stage
• Functionally oriented
Focus on enhancing communication by any means and encourage support from carers
Often include more natural interactions involving real life communication challenges
More often for long term chronic condition
Improving communication in Dysphasia / Aphasia: Examples of impairment-based therapy (not exhaustive)
• Treatment of word-finding difficulty
To provide cueing strategies to help the patients to retrieve, for example, object names.
• Constrained-induced language treatment (CILT)
'Forcing' the patient to use spoken language and discouraging the use of compensatory communication strategies, e.g. writing, gesturing (Pulvermuller, et al. 2001)
• Melodic Intonation Therapy (MIT): the use of musical elements of speech (e.g. stress, melody) to improve speech expression (Norton et al, 2009)
• (Under research)
Non-invasive brain stimulation: transcortical magnetic stimulation (TMS) or transcortical direct current stimulation (tDCS) to stimulate specific areas of the brain in order to enhance aphasia treatment. (Wortmann-Jutt & Edwards, 2017)
Improving communication in Dysphasia / Aphasia: Examples of functionally oriented approach (not exhaustive)
• Supported conversation (Simmons-Mackie,1998)
Patient and care-giver are engaged in conversation.
Patient takes the lead in the conversation and the care-giver follows the patient's lead.
Care-giver provides language facilitation in the conversation context in order to enhance the patient's confidence and skills during conversation with others.
• Life participation Approach to Aphasia (LPAA) [Chapey et al., 2000]
A treatment approach which focuses on enhancing the ability to perform communication activities of daily living.
The primary purpose of therapy is advocation of joint actions aiming at community re-integration.
For example, in the initial stage of CVA, the goal can be to establish effective communication with nursing staff and clinicians in the rehabilitation centre. (https://leader.pubs.asha.org/doi/10.1044/leader.FTR.05032000.4)
Improving communication in dysarthria
• Examples of restorative/restitution based treatment
Treatment focusing on speech motor systems:
• Inspiratory/expiratory muscles strength training to enable better breath support in speech production
• Tongue and lips muscle strength training to enable clearer articulation.
• Examples of compensatory and adaption- based treatment
Altering the communication environment. E.g. reducing background noise
Encouraging the use of more gestures to clarify unclear/slurring speech.
Use of augmentative and alternative communication (AAC) tools. E.g. communication book
Adjust speech rate. E.g. speak more slowly
Improving communication in verbal apraxia (not exhaustive)
• Articulatory kinematic approach
Improving the spatial and timing of speech sounds
Focus on how to move tongue and lips to produce the word correctly
Patient was asked to imitate different speech sounds
Care-giver gives cues to help the patient the produce the target sounds correctly.
(Ruckman, and Travers, 2017)
• Rate/rhythm approach
Manipulation of rate/rhythm to improve speech production or reduce symptoms
For example, the patient will be instructed to speak with speech rate at one syllable per beat of a metronome in order to obtain clearer speech production.
(Shannon, Mauszycki & Wambaugh, 2011)
Improving communication in CCD
• Treatment principle is to identify underlying nature / deficit leading to CCD and treat accordingly (Tompkins, 2012)
CCD can be related to deficit of various underlying cognitive functions, for example, memory, reasoning, attention organization and awareness. Treatment should be targeted at the underlying deficit.
Patients have the same presentation could be due to different underlying deficits.
For example, a patient could not follow a complex command (take a bun from the bag, cut it into 2 and put them in the fridge) could be due to deficits in sustained attention, or it could be due to impaired memory
Intervention will be focused on overcoming the deficit area by adopting impairment-based and /or functionally oriented approach
Restorative/restitution: restoring impaired function
Compensatory: improving functions by substitution strategies to compensate for non-amendable deficits. → Augmentative and Alternative Communication (AAC) tools can be used
Adaption: changing communication environment/behaviour to adjust for the disorder
Use of Augmentative and Alternative Communication (AAC) tools
• Augmentative and Alternative Communication (AAC) refers to all forms of communication that can supplement or compensate for the impairment and disability of people with communication disorders (ASHA)
• 2 modes of AAC communication:
Aided
Unaided
Use of AAC tools
Aided:
• Need some tools/devices to transmit/receive massages
• The devices can be low-tech or high-tech ones.
• Low-tech: do not require battery/electricity.
E.g. Communication boards that the patient can select letters/words/pictures/symbols to express messages (Millar & Scott, 1998).
https://images.app.goo.gl/4z5ZTPahGeyWypYD8
Use of AAC tools
Aided:
• High-tech: speech generating devices.
Device can produce speech according to the symbols/words that the patient selects.
https://images.app.goo.gl/4z5ZTPahGeyWypYD8
Use of AAC tools
Aided:
• High-tech: Apps
There are apps that can be downloaded to mobile phones or iPad or android Pad that can make the mobile phones/iPad/android Pads act like a speech generating device.
e.g.: Text to Speech! app
Use of AAC tools
Unaided:
• No external tools is needed:
Patient expressed by facial expressions, gestures (e.g. pointing) etc.
Use of AAC tools
How to select choices (e.g. pictures/symbols/alphabets) in the communication board/device? (ASHA)
2 types:
Direct selection
Indirect selection/Scanning
Use of AAC tools
How to select choices in the communication board/device? (ASHA; Communication Matters)
Direct selection:
The person using AAC selects directly on the symbols or words or pictures that are shown in the communication books/devices.
For example, he may select specific symbols/alphabets in a communication book by finger-pointing, or use light-pointers or infrared pointing devices to select symbols/alphabets in a computer device.
Typing on a smartphone or tablet is also an AAC using direct selection method.
Use of AAC tools
How to select choices in the communication board/device? (ASHA; Communication Matters)
Indirect selection/Scanning:
The person using AAC selects a target from a set of choices that appears one by one. (for example, alphabets A to Z appears one by one on the computer screen. If the AAC user would like to select letter 'B', then he has to push a switch when the letter 'B' appears in order to select it)
Use of AAC tools
How to choose AAC tools (Mineo, 1990)
Depends on patient's motor abilities: For example, a patient with less precise hand control may need to have a device with larger buttons
Patients who have more severe physical limitations may need to use indirect rather than direct selection method.
Communication skills: For example, if patient had difficulty recognizing printed words, we may use pictures/symbols in his communication books.
Communication needs. The communication board should contain contents that the patient usually uses. For example, if he likes eating, we may add more food items in his AAC device for him to select.
Goal to be achieved:
Patient can use the AAC tool efficiently in different context with different communication partners for different purposes.
Use of Augmentative and Alternative Communication (AAC) tools
You may get some insight on how to use AAC the from the websites below or other similar websites from internet:
Gois, A., Pernambuco, L. A., & Lima, K. C. (2018). Factors associated with voice disorders among the elderly: a systematic review. Brazilian journal of otorhinolaryngology, 84(4), 506–513. https://doi.org/10.1016/j.bjorl.2017.11.002
Mauszycki, S. C., & Wambaugh, J. (2011). Acquired Apraxia of Speech: A Treatment Overview. The ASHA Leader, 16(5), 16–19.
A.D.A.M. Medical Encyclopedia. (2020). Speech disorders - children. Retrieved from https://medlineplus.gov/ency/article/001430.htm
Allison, K. M., Cordella, C., Iuzzini-Seigel, J., & Green, J. R. (2020). Differential diagnosis of apraxia of speech in children and adults: A scoping review. Journal of Speech, Language, and Hearing Research, 63(9), 2952–2994. https://doi.org/10.1044/2020_JSLHR-20-00061
American Speech-Language-Hearing Association. (n.d). Apraxia of speech in adults, Augmentative and alternative communication (AAC), Cognitive-communication referral guidelines for adults. Retrieved from https://www.asha.org
Ballard, K. J., Wambaugh, J. L., Duffy, J. R., Layfield, C., Maas, E., Mauszycki, S., & McNeil, M. R. (2015). Treatment for acquired apraxia of speech: A systematic review of intervention research between 2004 and 2012. American Journal of Speech-Language Pathology, 24(2), 316–337. https://doi.org/10.1044/2015_AJSLP-14-0118
Chapey, R., Duchan, J. F., Elman, R. J., Garcia, L. J., Kagan, A., Lyon, J., & Simmons-Mackie, N. (2000). Life participation approach to aphasia: A statement of values for the future. The ASHA Leader, 5, 4–6.
Duffy, J. R. (2013). Motor speech disorders: Substrates, differential diagnosis, and management. St. Louis, MO: Elsevier.
Schröter-Morasch, H., & Ziegler, W. (2005). Rehabilitation of impaired speech function (dysarthria, dysglossia). GMS current topics in otorhinolaryngology, head and neck surgery, 4, Doc15.
Mauszycki, S. C., & Wambaugh, J. (2011). Acquired Apraxia of Speech: A Treatment Overview. The ASHA Leader, 16(5), 16–19.
Mineo, B. (1990). Augmentative and Alternative Communication. Tech Use Guide: Using Computer Technology. Council for Exceptional Children, Reston, VA.
Norton, A., Zipse, L., Marchina, S., & Schlaug, G. (2009). Melodic Intonation Therapy: Shared Insights on How it is Done and Why it Might Help. Annals of the New York Academy of Sciences, 1169(1), 431–436.
Prosser, C. & Morris, R. (2017). Coping with communication problems after brain injury. Nottingham, UK: Headway.
Pulvermüller, F., Neininger, B., Elbert, T., Mohr, B., Rockstroh, B., Koebbel, P., & Taub, E. (2001). Constraint-induced therapy of chronic aphasia after stroke. Stroke, 32(7), 1621–1626. https://doi.org/10.1161/01.str.32.7.1621
Simmons-mackie, N. (1998). In support of supported conversation for adults with aphasia. Aphasiology, 12(9), 831–838.
Tompkins C. A. (2012). Rehabilitation for cognitive-communication disorders in right hemisphere brain damage. Archives of physical medicine and rehabilitation, 93(1 Suppl), S61–S69. https://doi.org/10.1016/j.apmr.2011.10.015
Williams, L. J., Dunlop, J. P., & Abdi, H. (2012). Effect of age on variability in the production of text-based global inferences. PloS one, 7(5), e36161. https://doi.org/10.1371/journal.pone.0036161
Wortman-Jutt, S., & Edwards, D. J. (2017). Transcranial Direct Current Stimulation in Poststroke Aphasia Recovery. Stroke, 48(3), 820–826. https://doi.org/10.1161/STROKEAHA.116.015626
Chapter 2
Chapter 2: Visual Impairment and Communication in the Older Adults
Overview
In this chapter, we will discuss:
- Age-related changes in vision
- Warning signs of eye problems
- Eye problems, eye diseases and management in older adults
- Tips for eye protection in older adults
- Daily life advices for vision impairment
Eye Anatomy
How do the eyes see?
Myopia
Hyperopia
Age-related Changes in Vision
Vision changes in older adults:
Diminishing of vision
Reduced visual field
Slow adaptation to light and dark contrast
→ Increase the risk of falls in the elderly
Dual vision and hearing impairments are common
among older adults.
Vision impairment with ageing
Age-related Changes in Vision
Presbyopia
Ectropion
Entropion
Dry eye syndrome
Excessive tearing
Presbyopia
Definition:
A refractive error that increases with age
Symptoms:
Vision started to decline after 40 years old.
Inability to focus and see close object (e.g. reading)
Causes:
The degree of presbyopia depends on how much adjustment ability is left in the eyes.
From age 40, the lens in the eye slowly loses its elasticity → which affects the adjustment ability of the eyes, and decreases the zoom capacity.
At age 60 or older, insufficiency adjustment of the lens (accommodation) → necessary to rely on the reading glasses to look at close object.
Presbyopia
Ectropion
Photo source: Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong
Definition:
The edge of the eyelid turns outward, more common with the lower eyelid. This leaves the inner eyelid surface exposed and prone to irritation.
Causes:
Due to old age, the eyelid and its ligament tissue are loose.
Eyelid scar, eyelid trauma or facial nerve palsy can also cause ectropion.
Ectropion
Symptoms:
Eyelid turns outward which leaves the conjunctiva exposed and even make the eyes unable to close completely
Eyes overflowing with tears, excessive secretion from the eyes, and eyelid scar, which affect vision.
Treatments:
The optometrist will examine whether the cornea will be dry and damaged due to ectropion
Use eye lubricant to keep the surface of the cornea moist
Use adhesive tape to keep your eyelids closed at night
If the symptoms are severe or the appearance is affected → Undergo surgical correction
Entropion
Photo source: Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong
Definition:
The eyelid edge turns inward, causing the eyelashes to constantly rub against the cornea and conjunctiva, making the eyes uncomfortable and even damaging the cornea and conjunctiva.
The lower eyelid is more prone to turn inward than the upper eyelid.
Causes:
Ageing → The tissue supporting the lower eyelid is loose, causing the edge of the eyelid to turn inward
Long-term eyelid inflammation, injury to the inner surface of the eyelid, or scar shrinkage due to chronic infection.
Entropion
Symptoms:
Inverted eyelids and lashes can rub the cornea and eyeball
Red eyes, tingling pain, foreign body sensation, watery eyes, etc.
Severe cases can cause corneal damage, causing keratitis and affecting vision
Treatment:
If the condition is not severe, artificial tears can relieve the symptoms.
In severe cases of entropion, corrective surgery can be performed to improve the problem and restore the normal position of eyelid edges and eye lash.
If entropion is caused by chronic inflammation (such as trachoma) or scab, mucosal transplantation can be performed to treat eyelid scars.
Dry Eye Syndrome
Reasons why the older adults are more prone to having dry eye syndrome:
Decreased lacrimal secretion
Old age
Immune diseases such as systemic lupus erythematosus and rheumatoid arthritis
Drug side effects such as the use of antihistamines, antidepressants, and hormone supplements due to menopausal symptoms
Other diseases such as diabetes and hyperthyroidism
Unstable tear quality (mainly divided into three categories: evaporative, aqueous-deficient and mixed)
Meibomian gland dysfunction (MGD)
Dry Eye Syndrome
Human tears have the following three layers, as long as one of them has problem, it can cause dry eye syndrome.
1. Lipid layer: Insufficient oil content makes tears easy to volatilize
2. Aqueous layer: Insufficient secretion of pure tears
3. Mucin layer: Poor ocular mucins, less tears
Symptoms: (Symptoms are the same as common dry eye)
Dry eye
Foreign body sensation
Red eye
Blurred vision
Dry Eye Syndrome
Role of tears:
There are strips of meibomian glands in the upper and lower eyelids that secrete oil and form a lipid layer in the tear film
Oil in the tear → Slow down the volatilization of tears, keep ocular surface moist, reduce the chance of corneal damage or virus entering the eye
Treatment recommendations:
Evaporative → Wear goggles to keep out the wind and avoid being blown directly by the wind
Meibomian gland dysfunction → Close your eyes and apply warm compress for 10-20 minutes every morning and evening with a hot pack or hot towel, to warm and liquefy the oil blocked in the eyelid gland, which is easier to discharge when blinking, and slow down the evaporation time of tears.
Wearing a mask can cause dry eyes
Excessive tearing
Photo source: Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong
Excessive tearing may cause annoyance and inconvenience.
Symptoms:
Long-term watery eyes
Red, sore and swollen eyes
Pus & thick discharge from the eye if suffering from dacryocystitis
Causes of persistent watery eyes in the older adult:
Eyelids are loose as we age. Tears cannot flow into the small holes that collect tears, then down into the throat.
Obstruction in the tear ducts
Inversed eyelash, eyelid inflammation and ectropion will stimulate the eyes to secrete tears
People suffering from allergic rhinitis or allergic conjunctivitis
Excessive tearing can also be one of the symptoms of dry eye
Warning Signs of Eye Problems
Blurred vision not corrected by appropriate corrective glasses
Persistent eye pain or acute sharp pain
Over-sensitivity to light. Halo or rainbow is seen around lights
Partial loss of visual field
Red eyes or burning sensation experienced
Sudden appearance of large amounts of floaters or black spots in the visual field
Abnormal growth in the eye or on the eyelid
The transparent part of the eye looks cloudy
Eyes become watery, with persistent discharge or crust
In addition to age-related changes in vision, older adults should also pay attention to the above warning signs.
Seek medical advice immediately to avoid affecting vision if having any of the above sign.
Vision problems - Common eye diseases in older adults
Cataract - Common eye diseases in older adults
Glaucoma - Common eye diseases in older adults
Macular degeneration - Common eye diseases in older adults
Eye problems, eye diseases and management in older adults
Cataract
Glaucoma (chronic vs acute)
Macular degeneration
Diabetic retinopathy, also known as diabetic eye disease (DED), Hypertensive retinopathy
Cataract
Definition:
As the lens becomes cloudy and opaque, the light cannot be concentrated, resulting in decreased vision
Lens ages with aging; diabetes, trauma, steroids, and congenital factors can all cause cataract
Cataracts are not regarded as presence or absence, but depend on the mature level (just like steamed eggs). Early cataracts will not have much impact on vision, and only need regular eye examinations.
Causes:
Old age
Iritis
Eye trauma
Long-term use of steroid drugs
Diabetes
Cataract
Common symptoms of cataract:
Blurred vision
Sensitivity to light
Change of color tone
Decreased contrast sensitivity
Even double image
But the eyes will not be red, swollen, sore
Cataract
Simulate the vision of eyes without cataract
Simulate the vision of eyes having mild cataract that is able to cope with daily life
Simulate the vision that cataract began to affect daily life, such as looking at the bus number.
Simulate the vision of severe cataract
Cataract
Treatment:
At present, there is no clinical drug that can restore cataract
Cataract surgery to implant an artificial lens to restore vision is the contemporary treatment.
Since the cataract will get worse over time, surgery may be required when it starts to affect daily life. With current technology, it is best not to wait until the cataract is fully mature, as it is a minimally invasive surgery
Hospital Authority Public-Private Partnership Programme-
Cataract Surgeries Programme (CSP)
Patients on Hospital Authority clusters' routine cataract surgery waiting lists can join the programme, and receive cataract surgery performed by private ophthalmologists.
https://www4.ha.org.hk/ppp/en/ppp-programmes/csp/programme-intro
Glaucoma (chronic vs acute)
Photo source: Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong
Definition:
progressive optic neuropathy and peripheral visual field loss
Glaucoma is generally divided into acute and chronic
Eye Anatomy
Simulate glaucoma vision
Glaucoma (chronic vs acute)
People who are more likely to develop glaucoma:
Family history
Over 45 years old
Need to take steroids
Deep myopia (above 600 degrees)
Ocular hypertension
Since glaucoma can occur without warning signs, it is important to regularly check for the health of intraocular nerve and intraocular pressure.
Glaucoma (chronic vs acute)
Treatment:
There is no radical cure for glaucoma temporarily.
The general treatment is to reduce the intraocular pressure as much as possible to avoid further degeneration of the optic nerve.
According to research conducted by the HKU and PolyU, it was found that wolfberry can protect the retinal ganglion cell on the retina from glaucoma.
Hospital Authority Glaucoma Public-Private Partnership Programme
Patients with glaucoma receiving treatment in the Hospital Authority will be invited for voluntary participation and receive private specialist medical services in the community.
https://www4.ha.org.hk/ppp/ppp-programmes/glaucomappp/programme-intro
Macular Degeneration
Definition:
Common eye diseases in the older adults, the number one killer of blindness among people over 60 years old.
Everyone has macula lutea. The macula lutea is located in the center of the retina and is responsible for central vision. It is the most accurate position of vision.
Therefore, macula lutea is an important structure of the eye, and macular degeneration can greatly affect vision and daily life.
Macular Degeneration
Macular degeneration can be divided into dry and wet:
Dry macular degeneration, accounting for about 90% of cases
It does not affect the eyesight of the patient in the early stage, and the development is slow. There is no effective treatment for dry macular degeneration, only focusing on prevention and slowing down the deterioration.
Once it deteriorates and turn into wet macular degeneration, the impact on vision will be greater.
Macular Degeneration
Symptoms:
Generally, "dry" age-related macular degeneration has no symptoms
Symptoms of "wet" age-related macular degeneration include:
➤ Deformation and bending appear when looking at a straight line
➤ Deformation of the scene
➤ Blurred central vision, difficulty in reading and recognition
➤ In severe cases, a blind spot gradually forms in the center of vision
Macular Degeneration
People who are more likely to develop macular degeneration:
The older one gets, the greater the risk.
People aged 50-60: about 2%
> 75 years old: about 30%
People who spend a lot of time in the sun (ultraviolet light)
Risk factors such as smoking, alcohol abuse, high cholesterol, and genetics
It is a 10cm x 10cm grid drawn with thick white lines on a black background, with a white dot in the center.
The grid helps to detect the early signs of macular degeneration, including wet age-related macular degeneration and macular bleeding or fluid accumulation caused by deep myopia (600 degrees).
However, this cannot replace regular detailed eye examinations by an ophthalmologist.
How to use the Amsler grid for self-assessment:
Place the grid table at a distance of 30 cm from the eye level, with sufficient and even light.
If the user wear glasses daily, they need to wear the original glasses for assessment. The older adult should also wear presbyopic glasses for examination.
Cover your left eye with your hand, and stare at the white spot in the center of the grid with your right eye.
When staring at the central white spot, if one founds that the white line in the center of the square table or other areas is curved, broken or distorted, or the position of the square part is blurred or vacant, which may be the problem of the macular area in the fundus, and it is necessary to seek an ophthalmologist for detailed examination as soon as possible.
Repeat the above steps for the left eye.
Eye problems caused by chronic diseases-Diabetes/hypertensive retinopathy
Definition:
Both hypertension and diabetes affect the blood vessels in the eyes
Continuous high blood pressure → blood vessels in the eyes have sclerosis, bleeding, and papillary edema, which are collectively referred to as "hypertensive retinopathy".
The disease is similar to the condition of diabetic eyes, it can also affect vision and cause permanent damage in severe cases.
If one has diabetes, it will significantly increases the risk of retinopathy.
Therefore, one cannot ignore the impact of blood pressure on the body and eye health. In addition to controlling blood sugar, attention must be paid to the problem of high blood pressure.
Eye problems caused by chronic diseases-Diabetes/hypertensive retinopathy
Dietary recommendations for the prevention of diabetes/hypertension:
Balanced diet
Less salt
Less sugar
Low fat
Avoid foods with high cholesterol
Diabetic patients should avoid adding too much sugar in drinks, and try to replace with sweetener substitute
→ Keep blood pressure and blood sugar at a stable level to reduce the burden on blood vessels in the eyes.
Eye protection tips for older adults
Tips for Eye Protection in Older Adults
Indoors
- 20-20-20 rule
-Balance the light around
Outdoors
Lifestyle and diet habits
Eyelid cleaning care
Regular eye test
Indoors
20-20-20 rule
Rest your eyes regularly
Take a break every 20 minutes and look at an object 20 feet (six meters) away for at least 20 seconds
If you can't take a break too frequently, you must take a break at least once an hour. You can go to the toilet, drink a glass of water, or have a snack
Indoors
‧ Balance the light around
Suggestions for computer screen position:
➤ The screen should be placed in front of about an arm's length, 18-28 inches (45-70 cm) away
➤ The top of the screen is at the eye level, and the best angle is 10-20 degrees when looking down
Indoors
‧ Enough, balanced and stable light
➤ The muscles that control the size of pupil and light response will lose some strength with age, causing the pupils gradually become smaller and less light enters the eyes, which affects visual performance.
➤ Rod cells dominate our vision in the dark environment. As rod cells begin to have a slower recovery of night vision, middle-aged and older adults are less able to adapt in the dark, leading to slower responses that may increase the risk of falls and traffic accidents at night.
Outdoors
UV light can cause cataracts and macular degeneration
Use protective lenses against UV light when working outdoors for a long period of time
Choose lenses that can filter light with a wavelength of 400nm or below
Older adults can also choose color-changing lenses, to avoid the trouble of changing sunglasses when going in or out of the room
Color-changing lenses can effectively block "strong light" (visible light) and "UV light" from entering the eyes
The stronger the UV light exposed to the color-changing lens, the darker the color becomes
The picture shows the same pair of glasses with color-changing lenses. When the intensity of the surrounding ultraviolet rays increases, the color of the lenses will change from transparent (left) to darker (right).
(Provided by Dr. Bruce CHAN, a registered optometrist of Jockey Club Cadenza Hub)
Lifestyle and diet habit
Food suggestions for eye care:
Foods containing anthocyanin, such as red, purple, purple, blue and black vegetables and fruits, among which berries are particularly high in content. (e.g., eggplant, purple sweet potato, blueberry)
Foods containing lutein, including dark green vegetables and yellow fruits.(e.g., spinach, corn, yellow/red/green pepper, carrot, kale, orange, mango)
Foods containing omega-3, such as fresh fish
Consume moderate amount of berries and nuts. Nuts have mineral zinc in the surface, which can delay the development of dry macular degeneration
Life style suggestions:
Avoid smoking and drinking
Aerobic exercise can delay vision deterioration
How to clean your eyelid
Eyelid cleansing care
If excessive oil secretion in eyelid, coupled with improper eye care, it may cause eye dermatitis.
A simple and comfortable eye cleansing method can reduce the chance of developing eyelid dermatitis.
What you need: warm boiled water, cotton swabs, a small amount of neutral shampoo (or baby shampoo without astringent formula), mirror, cup
Cleaning steps:
Wash your hands first to avoid bringing more bacteria into your eyes during cleaning.
First remove secretions, scales, loose eyelashes, etc.
Pour warm water into the cup. If excessive oil secretion in eyelid, you can add a drop of shampoo.
Facing the mirror, first pull down one eyelid and use a wet cotton swab to clean the eyelid from the inside of the canthus to the outside. Remember to also clean the roots of the eyelashes.
Each side of the cotton swab can only be used once. Use a new small cotton ball every time you clean your eyes, and wipe 3-5 times on one eye in total.
When you wipe upper eyelid , look downward slightly; When you wipe the lower eyelid, look upward slightly.
Repeat the above steps on the other eye.
Precautions:
Recommended to clean 3 times a day when the eyes are inflammated or itchy; when the condition improves, clean once every morning and evening before freshening up.
If you have an allergic reaction to baby shampoo, including rash and swelling on the eyelids, stop using it immediately and seek medical advice.
Regular Comprehensive Eye Examination
Regular comprehensive eye examination can identify problems early and receive appropriate treatment
Regular monitoring and treatment are required when suffering from chronic degenerative diseases, such as macular degeneration and glaucoma
An ophthalmologist or optometrist can provide advice to patients with low vision and use assistive devices to help with daily activities
Daily Life Advices for Vision Impairment
Home Environment
Assistive Devices
Home Environment
Have enough, balanced, stable and soft lighting or natural light.
The color contrast between the door frame and the wall should be obvious.
Home Environment
Avoid color contrast of objects is too close, because it is difficult for older adults to judge the distance of the object (it is prone to having accidents for the bench on the right ).
Normal visionVision of visual impaired person
Home Environment
Use non-reflective floors to reduce glare interference.
Tape down the carpet and remove the wires from the aisle to reduce the risk of falls and injuries.
Assistive Devices
Fitted with proper visual aids; magnifying glass, binoculars or computer software with magnifying function can also be used.
Assistive Devices
Pay attention to home environment to facilitate their daily life.
Add tactile marks on home appliance buttons.
Assistive Devices
Household items
For example: Simple TV remote controller, large key phone, magnifying nail clippers
- End of Chapter 2-
Reference
Chu, P.H.W., Li, H.Y., Chin, M.P., So, K.F., & Chan, H.H.L. (2013). Effect of Lycium Barbarum (Wolfberry) Polysaccharideson Preserving Retinal Function after Partial Optic Nerve Transection. PLoS One, 8 (12), e81339. https://doi.org/10.1371/journal.pone.0081339.
The University of Hong Kong. (2017). Prevention of Ageing-associated Neurodegeneration in Alzheimer's Disease and Glaucoma with a Wolfberry Extract. Retrieved from https://www.ke.hku.hk/story/all/wolfberry-extract
Chapter 3: Hearing, Listening and Communication in Older Adults
Overview
In this chapter, we will discuss:
- What is hearing, listening and communication
- Processes involved in listening and communication
- The WHO International Classification of Functioning, Disability and Health (ICF) Model
- Causes of hearing impairment in older adults
- Assessment of hearing impairment
- Interventions in coping with hearing impairment
Hearing versus Listening
Hearing versus Listening
Hearing
You may know each alphabet without knowing the word
You may know the word without knowing the phrase
Listening
You need the number (alphabet), the line (word) to form the outline and the combinations to form a cow (sentence)
Listening to a song / a conversation
Conversation for communication is
more than hearing tones only
Processes involved
Factors affecting Listening and Communication
Bodily function and structure
- Sound perception
- Neural conduction time
- Memory and cognition
Participation / personal factors
- Apathy and lack of interests
Environmental
- Competing noise (reduce discrimination of words / auditory cues)
- Distractions
Factors affecting Listening and Communication
Adoption of bio-psycho-social-spiritual model of health
Centre point is on activities.
Different domains serve as contributing factor to activities maintenance
The different levels of WHO ICF Model: An illustration
Restoration if possible.
If not possible, re-enablement for re-integration / social participation.
Improve hearing if possible.
If not, improve listening for effective communication.
Epidemiology
Hearing impairment among age >65
- World-wide : About one-third (WHO)
- Hong Kong : 117 600 (HK CSD, 2013)
Age 65-69 : 5%
Age >70 : 14.2%
Community screening program
- Among ~1000 community living elders (age > 60) (CUHK, 2003)
Normal : 20%
Mild hearing loss : 43%
Moderate : 23.5%
Moderately severe : 9.4%
Severe to profound : 4.2%
Common manifestations
Unable to hear under less favorable environment (e.g. background noise)
Always asking others to repeat
Speaking louder and louder subconsciously
Unable to hear unless seeing face of the person
Common manifestations
"He hears you when he wants to"
- Possible reasons / functional impairment (remember the process of conversation at overview)
Impaired sensitivity → hearing deficit
Derange loudness perception / decline in discrimination → difficult in hearing speech
Impaired sound localization → not able to focus on source of sound especially in noisy environment
Hearing impairment with ageing
What is hearing loss?
Consequence of uncorrected hearing loss
Reduced listening selectivity → alarms not alerted
Poor quality of life
Social isolation
Paranoid tendency / anxious
Reduced adherence to healthcare advice
Depression
Reduced higher cognitive function
Causes of hearing impairment
Presbyacusis - Age-related sensorineural changes
- Most common in older adults
- Typically
Slow onset
Progressive
Bilateral
Symmetrical
- Four sub-types patterns
‧High tone involvement most common
Others
- Commonly unilateral
Trauma
Neoplasm
Vascular cause
Infection
- Commonly bilateral (though one may be affected more than the other)
Wax impaction
Metabolic cause (DM, hypothyroid)
Ototoxic drugs
Excessive noise
Age-related changes in Pure Tone Audiometry (PTA -- to detail later)
High tone (>1000 Hz) impairment
Male > female
Source: J. Clin. Med. 2020, 9, 218; doi:10.3390/jcm9010218
Other common functional impairment / manifestations
Abnormal loudness perception
- Hypersensitive to high intensity
- Loudness recruitment phenomenon
→ Intolerable sound that limits use of hearing aids
Hearing Handicap Inventory for the Elderly – Chinese version (HHIE-C) 70% accuracy in assessing > 40 dB hearing deficit
Also useful in assessing handicap &
Monitor improvement with intervention
Exclude Warning features Against Presbyacusis
Sudden onset
Unilateral
Ear discharge
Ear pain
Early onset
Recent trauma
Cognitive impairment
- Can be result of long standing hearing problem, or
- Share common feature of "not hearing"
Early specialist consultation is necessary
Another common cause of hearing impairment – ear wax impaction
Normal secretion with proper functioning
- no special attention unless causing hearing impairment
Exclude warning symptoms (or special precautious if previous ear procedures)
Can try with cerumen-removing /softening drops if NO previous ear surgery or a perforated eardrum
AVOID ear candle / cotton-tipped swabs
Other preliminary workups
Rinne and Weber Test
- Use tuning fork
- For localization and nature of problem (conduction / sensorineural defect)
Otoscope examination
- Direct visualization
Detail Assessment
Commonly measured by Pure Tone Audiometry (PTA) or Speech Audiometry (SA)
- PTA: use pure tone with changing intensity
- SA: use undistorted test words above threshold intensities
Quiet, acoustic protected setting
One ear after the other
Threshold of hearing (dB)
Limitations of PTA in Assessment
At a concert
A melody
- Tone
- Loudness
- Tempo
Relational (different instruments)
Melody (chorus?) → Song
Meaning of the song
At conversation
A word / phrase
- Vowel / Consonant → word
- Frequency / Loudness / Duration
Relational (environment)
Spatial / interval → sentence
High level interpretation
PTA only assess frequency and loudness
Not others that are also important for conversation
Limitations of SA
"Let's eat Grandpa" or
"Let's eat, Grandpa"
"I like cooking my family and my dog" or
"I like cooking, my family, and my dog"
己所不欲 勿施於人 or
己所不欲勿 施於人
Does not address on time factor that
influence understanding of speech
Degree of Hearing Loss
Assessing Hearing Impairment
Disabling hearing loss refers to hearing loss greater than 40dB in the better hearing ear
Hong Kong Society of Audiology
Assessing Activities Limitation
From Impairment to Handicap
- Aim to improve communication
- Improve listening is an intermediate process only
Hearing Handicap Inventory for the Elderly – Chinese version (HHIE-C):
- Useful to monitor response to hearing aids / management
Ways for improving hearing in older adults
Reducing Disability (Re-enablement) : Hearing Aids (HAs) and Assistive Listening Devices (HALD)
Mobility Aids
Hearing Aids
Basic Components of HAs
A microphone
- Sound to signal
A Processor / Amplifier
Receiver
- Signal to sound
Earmold / tubing to deliver sound to ear
Key Variations
Amplifier / Processor
- Digital type
Programmed (at site) to allow adjustment on pitch (frequency) selectivity and intensity, direction of sound
Allow tinnitus masking
- Analog
Programmable to different environment
Other variations
Size, cosmetics, color
In general
Body worn HAs
- Less feedback
- Greater amplification
- More effective for bone conduction problem
- More suitable for severe to profound deafness
- Less cosmetic
From BTE to ITE/ITC type
- more demanding in application and maintenance
- BTE: more to severe deafness
- ITE/ITC: mild to moderate deafness
Hearing Aids – bilateral or unilateral
Binaural recommended (for bilateral hearing impairment)
- Balanced hearing
- Localization of sound
- Understands speech better in noisy environment
- Increase overall loudness and allow reduce volume of individual HA (problem of feedback)
Behind-the-ear type
- Soap ear mold with mild soap and water. Do NOT use alcohol
- Replace tubing every 3-6 months
Issues of HAs in older adults
Intrinsic problems of HAs
- Partially adjusted with digital type
Selectivity on pitch / intensity
Much costly
- Universal amplification at different setting
Construction site, railway, concert, home
- Cannot differential voice with noise
- Speech discrimination scores might not improve
Temporal, amplitude not adjusted
Issues of HAs in older adults
Intrinsic problems
- Problem of auditory process >> hearing problem (reference to Overview section)
- Not perceived on the need
Elevated voice / louder sound system as compensation
- Abnormal loudness perception (reference to earlier slides)
Hypersensitive to high intensity
Loudness recruitment phenomenon
- Cognitive factor
Learning / memory on appropriate use and maintenance of HAs (see previous slide)
- Psychological factors
Self esteem, stigma
Issues of HAs in older adults
Problems with HAs and elderly interface
- Hand Dexterity, Tactile sensation in manipulating the HA
The smaller the size (cosmetic reason), the higher the requirement on hand dexterity
On – off switch, switch between modality, volume control
Wear on-wear off
Change of battery
- Cumulating Ear wax → whistling
- Dry / wrinkled skin → irritation when using ear mold / difficulty fitting
- Changing body structure → new earmold required
- Allergy to the mold → otorrhoea
Alternatives to HAs: Simple Amplifier / Assistive Listening Device (ALD)
Assistive Listening Devices
Instead of direct HAs, and obvious external amplifier system /communicator is used
- Direct hardwire
- Wireless: FM / Infrared system
Advantage
- Easy on – easy off: use only as required
- Easier to adjust / handle
- Can be one to many
- Suitable to use at institution
Assistive Listening Devices
Others
- Telephone amplifier / built-in volume control
- Loop Induction System
Requires special setting and pairing with external Has / devices
Available at many public services (barrier free facilities under LCSD)
Choose a hearing aid / assistive hearing device
Hearing aids should be chosen according to the individual listening needs, subjective preferences, age, dexterity, cosmetic concern, severity and nature of the hearing loss.
Wearing a hearing aid at first time:
Give older adult 3-6 months to adapt. They should get used to using a hearing aid in a generally quieter environment before gradually using hearing aids in other difficult listening environments (such as small groups or noisy environments).
If the older adult still has hearing difficulties after wearing the hearing aid for a period of time, it is advised to consult audiologist for a hearing test to adjust the hearing aid.
Hong Kong Society of Audiology
Others (surgical procedures)
Bone anchored hearing aids
Implantable hearing aids
Totally integrated cochlear amplifier
Cochlear implants
CONSULT ENT specialist
Re-enablement beyond HA/ ALD (Environment)
Enablement factors for communication
(cross reference: communication process in previous section) - Environment
quiet room (less distractive)
Lighting to facilitate visual clues for lip speaking
(Institutions): LED information / Visual Alarms
Enablement factors for communication (Communicator)
Attention
- Draw attention first
- Speak in front of subject
Speechreading
- Proper lip and facial expression
Rate
- Avoid talking fast to allow central processing
Speech clues
- "Newspaper" instead of "paper"
- "Headlines" to start with
Modulated voice
- Avoid shouting
- Avoid dropping loudness of voice at end of a sentence
- Avoid exaggerating words (distorted speech)
Comprehension
- "Headlines"
- Short phrase / sentences
- Rephrase
Summary
- End of Chapter 3-
Extended Reading
‧ Armstrong, C. Diagnosis and management of cerumen impaction. Am Fam Physician. 2009 Nov 1;80(9):1011-1013
‧ Ciorba A. The impact of hearing loss on the QOL of elderly adults. Clin Inter Ageing 2012; 7: 159-163
‧ Kang JS. The Impact of Communication on the overall QOL in Elderly Korean. Int J Adv Cult Tech 2019; 7(3): 58-64
‧ Lee JC. Hearing loss amongst the elderly in a SE Asian Population. Ann Acad Med Sing 2017; 46: 145-54
‧ McCormack A. Why do people fitted with hearing aids not wear them? Int Jour Audio 2013; 52(5)360-368
‧ Schwartz, S. R et al. Clinical Practice Guideline (Update): Earwax (Cerumen Impaction) Executive Summary. Otolaryngology – Head and Neck Surgery. 2017; 156(1): 14-29
‧ Wong PWY. Reasons for non-adoption of a hearing aid among elderly Chinese. Asian J Gerontol Geriatr 2010; 5: 62-68
Chapter 4
Chapter 4: Effective Communication Skills
Overview
In this chapter, we will discuss:
Tips for caregivers :
8 ways to promote communication with older adults
Communication skills for older adults with special needs
- People with dementia
- Frail older adults in residential care home
Tips for older adults :
6 Communication strategies for older adults with hearing impairment
Effective communication skills between caregivers and the older adults
When caregivers get along with the older adults, a good two-way communication can reduce misunderstandings and conflicts, maintain a good relationship with each other, and help reduce life pressure and keep the mood happy.
Therefore, both carergivers and older adults need to learn effective communication skills.
Communication tips for caregivers
Tips for caregivers— 8 ways to promote communication with older adults
1.Active listening
Listening patiently and giving enough time for older adults to express can reduce their loneliness
Urge the older adults to respond, leaving them with insufficient time to express.
2.The speed and intonation should match the needs of the older adults
The speed and intonation should match the needs of the older adults - Speak slowly to the older adult
- When you meet an older adult with poor hearing, you can speak on the side with better hearing
- Pay attention to your intonation when speaking loudly, and don't make the older adult misunderstand that you are scolding him/her
- If the older adult wears a hearing aid, ask him/her to wear it before talking
Speak too fast
Perceive the older adult cannot hear clearly, and deliberately speak louder
3.Guide the older adults to answer with yes-no question
Give simple choices
- Such as:
Caregiver asked, "Do you want to eat apple or orange?"
Older adult replied, "Apple."
Caregiver asked, "I will cut an apple for you, ok?"
Older adult said, "Okay!"
- Too many open-ended questions
Such as, "What do you want to eat?"
4.Use simple and specific words
Keep sentences short
Each sentence contains only one message
Emphasize and repeat key points if necessary
- Such as:
Caregiver asked, "Shall we visit aunt today?"
Older adult said, "Yes!"
Caregiver asked, "Remember to bring your Octopus, Octopus." (Emphasize and repeat key points )
Long sentences and contain too much information
- Such as:
Caregiver said, "Last time you said that you wanted to see aunt. The weather is fine today and there is no traffic jam on Tuen Mun Highway. Uncle said that aunt is free today, why don't we take the bus to visit her today?"
5.Use adult tone
When communicating with the older adults, please use "adult tone", although simple sentences are encouraged
Avoid using the tone that speaks to small children.
Use the tone that speaks to small children.
- Such as, "Buy nice things", "Wear nice clothes", "Be good"
6.Avoid using too many pronouns
Avoid using pronouns, such as "he", "them", "here", "that"
- For example, "Your phone is on the dining table."
Use too many pronouns
- For example, "Your stuff is just there!"
7.Non-verbal communication skills
Attitude: friendly, kind, sincere, respectful
Eye contact: Face to face with an older adult, maintain eye contact and be sure to get their attention
Posture and behavior: Such as nodding, proper gestures, proper seating arrangement
Touch: When chatting, hold the hand of older adult more often to make him/her feel safe; nodding and tapping on the shoulder are all positive encouragement and contact
An impatient, careless, or dismissive attitude
No eye contact with the older adult, talking to them while walking around/doing your own things
8.Environment and tools to promote communication
Keeping the environment quiet and reducing noise can help concentrate
- If the older adult is watching TV and it is very loud, the caregiver can turn down the volume before talking to him/her
If the older adult has vision/hearing impairment, remind him/her to wear glasses and hearing aids first
Talk to the older adult in a noisy environment
- For example:
TV and radio sounds, noisy restaurants
Communication skills for older adults with special needs:
1.People with dementia
2.Frail older adults in residential care home
Skills for communicating with older adults with dementia
Skills for communicating with older adults having dementia
When caring older adults with dementia,
be aware of the following 10 communication tips:
Start the conversation by addressing the older adult and introducing yourself by saying your name. Call him/her the title he/she likes.
Make enough eye contact to let them know that you are talking to him/her
Smile more and give proper physical contact, such as light touch of arm, hand or shoulder.
Always speak concisely, straightforwardly and in an understandable way, use simple and direct sentences.
Ask only one question at a time and allow enough time to response.
Start the conversation by addressing the older adult and introducing yourself by saying your name. Call him/her the title he/she likes.
Make enough eye contact to let them know that you are talking to him/her
Smile more and give proper physical contact, such as light touch of arm, hand or shoulder.
Always speak concisely, straightforwardly and in an understandable way, use simple and direct sentences.
Ask only one question at a time and allow enough time to response.
Skills for communicating with frail older adults in residential care homes
Communication skills with frail older adults in residential care home
Frail older adults in residential care homes may be prone to feeling unhappy due to their physical disability.
If family visits are less frequent, the older adults may feel more lonely.
Common emotional manifestations:
Silence
Upset
May be unkind
Easy to lose temper due to trivial matters
It is understandable for residents to have these emotional manifestations. What can the caregivers do?
Communication skills with frail older adults in residential care
The caregivers need to:
Be patient and keep calm
Smile more and give proper physical touch, e.g. light touch of arm, hand or shoulder.
Try to show understanding, toleration and consideration
Respect
Give support
Seek support from senior colleagues in case of emergency
Communication strategies for older adults with hearing impairment
Tips for older adults- 6 Communication strategies for older adults with hearing impairment
Older adults with hearing impairment can facilitate communication by using the following strategies:
Show your needs
For example, the older adult can say, "I don't hear well. If I can't hear you clearly, please repeat."
Chat in a quiet environment
If you meet a friend in a noisy environment and want to chat with him/her, you can take the initiative to propose a quieter place
Offer your advice
If the other person speaks in a way that makes you hard to hear, such as speaking too fast, you can advise him/her speak slowly
Don't be afraid to clarify
Don't be afraid to clarify when you're not sure what the other person is saying. Let others help you make sure you heard correctly
For example:
Granddaughter said, "I will take you to mum's later, wait for me at home."
Older adult, "Are we going to your grandma's?" (Try repeating to confirm that it is correct)
Granddaughter, "No, go to my mum's."
Older adults said, "Oh, go to your mum's, I wait for you at home." (Try repeating to confirm that it is correct)
Granddaughter said, "Yeah, that's right!"
Ask questions if you are not clear
When in doubt, don't be afraid of trouble. Use some questions to clarify.
For example: "Where?", "When?", "Why?"
Sum up the main points
If the other person makes a long speech, and the older adult is worried that he/ she can't hear clearly, he/ she can try to sum up the main points, to make sure it is correct.
- End of Chapter 4-
Extended Reading
Harwood, J., Leibowitz, K., Lin. M.C., Morrow, D.G., Rucker, N.L., & Savundranayagam, M.Y. (2012). (2012). Communicating With Older Adults An Evidence-Based Review of What Really Works. The Gerontological Society of America.
https://www.geron.org/publications/communicating-with-older-adults
The videos in this course provide information for educational purposes only. The videos do not provide medical recommendations or diagnoses and are not substitutes for medical advice. It is crucial that you talk with your healthcare providers to discuss any questions you may have and seek them for medical advice, before you make any medical decisions. As the videos are only for educational purposes, we will not be responsible for any decisions you will make or consequences you will have based on the information they provide.
Warning Signs of Eye Problems
Vision of visual impaired person
