NURSING CARE OF THE

OLDER ADULTS IN
CHRONIC ILLNES
DISTURBANCE
IN SENSORY
PERCEPTION
Presentor:
Calzado, Kyla Nicole C.
Contents:
● Definition
● Introduction
● Different Sensory System
Different Sensory System
 QUESTION
 In your own observation/experience, what
sensory changes are most likely to affect
older adults?
 VISION
 People's eyes change as they get older: lenses lose stiffness or form cataracts, pupils grow slower
to adjust, it takes longer to react to changes in illumination, and glare becomes more annoying.
 The majority of cases of vision loss and blindness are caused by ocular abnormalities. A German
researcher reports in a review article published in the Journal of Ophthalmology in 2013 titled
"The Psychological Challenge of Late-Life Vision Impairment: Concepts, Findings, and Practical
Implications" that age-related macular degeneration (AMD) is the leading cause of poor vision in
seniors, affecting 20% of the population. In all but a few cases, the disease damages retinal light-
sensing cells in the macula, leading in the loss of central vision. A history of hypertension,
smoking, or cardiovascular illness, as well as a family history of AMD, are all risk factors for
AMD.
 VISION
 Cataracts are created by the lenses of the eye becoming increasingly opaque, clouding vision and
giving the world a brownish tinge. Cataracts are more common in elderly persons who have
smoked or used alcohol, had diabetes or other disorders, and are exposed to too much sunshine.
Fortunately, most lenses can be replaced.
 Glaucoma is a condition in which fluids in the eye do not drain properly, putting pressure on the
optic nerve and causing loss of peripheral vision. A family history of glaucoma is the most
significant risk factor. Medications and surgeries can stop further progression, but won’t restore
lost vision.
 For many people, losing their vision comes as a shock and can be distressing. As seniors lose
touch with their social and civic networks, simple activities become more difficult. Seniors who
have always been fiercely independent may find themselves suddenly reliant on others.
Furthermore, many seniors discover that their vision issues have a severe impact on their entire
health.
 HEARING
 Hearing loss affects one-third of persons aged 65 to 74 and half of those aged 75 and up,
according to the National Institute on Deafness and Other Communication Disorders. Men are
more likely to develop it, owing to their exposure to excessive work noise. Hearing loss is a
complicated issue that is influenced by a number of factors:
- A person’s age
- How much loud noise a person has been exposed to
- The level of conversational speech affected
- The degree and frequencies of hearing lost
- If one or both ears are affected (hearing loss typically affects one ear more than the other)
- Which part of the ear is affected
- Brain involvement and other medical conditions
 HEARING
 Hearing loss can make it difficult to understand doctors and other professionals, interact with
family, and participate in many social activities. A senior may be embarrassed by this problem,
or may feel misunderstood by others who dismiss them as stubborn, dumb, or suffering from
some unidentified mental or medical condition. These reactions frequently result in depression
and social isolation.
 Sensorineural hearing loss occurs when the auditory nerves, particularly in the inner ear, are
destroyed. This sort of hearing loss is typically irreversible.
 Adults above the age of 50 are prone to two issues:
- Presbycusis - hearing loss that develops over time
- Tinnitus - ringing sounds in the ears
 Because of its gradual onset, presbycusis can go unnoticed for years. Tinnitus is more noticeable
than presbycusis, yet both conditions should be taken seriously. Hearing loss that occurs suddenly
is a medical emergency.
 TASTE AND SMELL
 The senses of taste and smell are two separate sensory systems. While smell disorders are more
common, the majority of taste-related difficulties are not disorders. Both are typically short-term,
decrease with age, are caused by many of the same factors, pose similar risks, and have similar
solutions. A medical evaluation is required since either condition could indicate a major health
problem.
 The following are the most common types of smell and taste loss:
- Hyposmia which is a loss of smell and Hypogeusia which is loss of taste
- Dysosmia and Dysgeusia wherein smells and/or tastes, respectively are distorted.
- Anosmia and Ageusia, which occur with the absence of smell or taste respectively.
- Phantosmia which is the perception of smells that don’t exist, and phantom taste perception, which
is the false perception of taste.
 TOUCH
 A connection between the brain and tactile nerves is required for speech, movement, hand use,
and pain perception. Peripheral neuropathy is one of the most common problems affecting the
sense of touch. According to the Hartford Institute of Geriatric Nursing, approximately 60% of
women have neuropathy by the age of 65.
 Up to one-third of neuropathies have no known cause, whereas the other one-third is due to
diabetes. The rest are caused by diseases of the spine, infections, autoimmune disorders, and
genetics, among other things. Each has a negative impact on the capacity to utilize the hands for
finer sensorimotor tasks such as opening pill bottles or writing. However, the greatest concern of
neuropathy is the increased risk of falling. Falls are the top cause of injury among the elderly,
according to the CDC.
The more a person becomes older, the
more probable he/she is to suffer from
sensory deprivation. Healthcare providers
and caregivers have access to technology
and resources that can assist people with
multiple sensory losses in leading normal
lives. It's critical that seniors and those
who care for them learn about the different
types of sensory deprivation, understand
the dangers they pose to a senior's health,
and take steps to prevent or help their
loved ones cope.
 CHRONIC
CONFUSION
Presentor:
Calzado, Kyla Nicole C.
Contents:
● Definition
● Introduction
● Subtypes
● Symptoms of Delirium (Hyperactive and
Hypoactive)
Definition of Chronic Confusion
 Delirium (acute confusional state) is characterized by a change in cognition and a disturbance of
consciousness that develops over a brief period of time. Throughout the day, the disorder has a
propensity to fluctuate.
 Delirium is common, has multiple causes and causes distress to numerous patients and their
relatives.
 All four criteria in the DSM IV definition must be met for the diagnosis to be made. Delirium is
frequently misdiagnosed, necessitating a high level of suspicion. Delirium is diagnosed based on
the following criteria: Typical features, an acute onset, and a variable course characterize the
condition. After then, the aetiology is searched. The characteristics of delirium in the individual
patient, as well as the patient's past medical history and any pre-existing cognitive abnormalities
(if known), might help guide additional diagnostic tests.
Definition of Chronic Confusion
 Delirium screening techniques are useful because delirium is frequently misdiagnosed clinically.
These are some of them:
1. The Confusion Assessment Method (CAM) is the most extensively used instrument, although it
requires specific training and requires an understanding of inattention.
2. In oncology patients, the single question in delirium (SQiD): “Do you think (name) has been
more confused lately?” has demonstrated promise.
3. Tests alertness, attention, AMT4, and acute history with the 4AT test. It is short and
uncomplicated, with a sensitivity of 89.7% and a specificity of 84.7 percent. There is no need to
comprehend inattention.
Introduction
 Confusion is a typical concern among those over the age of 65. Normal
cognitive capacity decrease can be either abrupt or chronic and
progressive. Confusion is frequently a symptom of delirium or dementia
in older people, but it can also be an indication of serious depression or
psychosis.
 Because of various reasons that are common among the elderly,
managing confusion is difficult. Living alone, a lack of specific history
on presentation, cognitive impairment, complex comorbidities, a number
of limits on thorough diagnosis and assessment, and the need for
teamwork for complete assessment and management are only a few of
them. Biological ageing is marked by a loss of adaptability over time, as
well as a reduction in functional reserves and the ability to recover from
a physiological harm. At the same time, aging can lead to a variety of
diseases and polypharmacy, as well as changes in the physical and
personal surroundings of the patient.
 SUBTYPES

 Hyperactive Delirium - Increased motor activity, restlessness, agitation, hostility,

roaming, hyper alertness, hallucinations and delusions, and inappropriate behavior are
all symptoms of this condition.
 Hypoactive Delirium - Reduced motor activity, lethargy, withdrawal, drowsiness, and
looking into space are all symptoms of this condition.
 Mixed Type - where people have features of hyperactive and hypoactive delirium.
 QUESTION
 Is delirium a disease?
Is Delirium and Dementia the same?

Delirium and dementia (which encompasses

illnesses like Alzheimer's disease) are comparable
but not the same.
 Delirium mostly impacts a person's ability to
pay attention. Memory loss is a symptom of
dementia.
 Delirium is a transient state that appears out of
nowhere. Dementia is a type of long-term
disorientation that normally starts slowly and
gets worse over time.
 Symptoms
The symptoms of delirium vary depending on the type. Symptoms usually appear out of nowhere and
worsen over the course of a few hours or days. A person suffering from delirium may appear inebriated.
The inability to focus attention is the most common symptom. Sun downing refers to the tendency for
symptoms to worsen in the evening.

Hyperactive Delirium Hypoactive Delirium

• Acting disoriented. • Apathy.
• Anxiety. • Decreased responsiveness.
• Hallucinations. • Flat affect.
• Rambling. • Laziness.
• Rapid changes in emotion. • Withdrawal
• Restlessness.
• Trouble concentrating.
 IMPAIRED
VERBAL
COMMUNICATIO
N
Presentor:
Calzado, Kyla Nicole C.
Contents:
● Definition
● Introduction
● Types of Communication
● Ways of Communication
● Factors Affecting Communication
● Barriers of Communication
● How to Communicate with Elderly Person
● How to Communicate with Elderly Person
with Sensory Deficit
● Communication with Alzheimer Patient
 DEFINITION INTRODUCTION
• Is the process of conveying important • The communication process is tough in
information. A sender, a message, and general, and it can be made even more
an intended recipient are required for challenging by aging. One of the most
communication, although the receiver difficult aspects of dealing with elderly
does not need to be present or aware of patients is that they are more diverse
the sender's desire to communicate at than younger people. The typical aging
the time of communication. Once the process can also obstruct
recipient has comprehended the communication, which can include
sender's message, the communication sensory loss, memory loss, slower
process is complete. information processing, a loss of
authority and influence over their own
life, retirement from job, and separation
from family and friends.
 Elements of Communication Process
Sender
● Is the communicator who is in charge of conveying actions, words, and feelings. The same
message is conveyed by facial expression and body language.
Message
● The information that the sender has conveyed. The receiver translates the communication into
feelings and mental images; the message should be clear and in language that the receiver is
familiar with, and it should be understood.
Receiver
● Is the person who listens to the massage and interprets it. The ability of the receiver to
comprehend is determined by mental function and interpretation ability.
Feedback
● Allows the sender to check whether the message was appropriately received by the receiver. The
sender asks a question that allows the receiver to clarify the message, which is a sort of feedback.
 Ways of Communication
• Two-way communication: is a dynamic process in which people
exchange ideas and thoughts on a continual basis. It requires the
receiver to be actively involved and provide feedback.
• One-way communication: allows the sender to maintain control
while the receiver stays in a passive state. Isn't the most efficient way
to communicate.
 Factors Influencing Communication
PERSONAL FACTOR
• Perception: In communication, a person's perception is crucial. People can view the same object
and see something completely different.
• Values: People's values, such as their perception, influence the communication process.
• Culture: Each culture teaches its members about the structure of the world and how to utilize
language and space to express specific massage and techniques that vary by culture.
• Attitude: The attitude of a nurse toward the elderly is important because the old need to be
respected and cherished, so the nurse should communicate trust and empathy through verbal and
nonverbal communication.
• Trust: A therapeutic nurse-patient connection is built on mutual trust. The conversation is shallow
without a sense of trust; trust in a relationship entails confidence, dependability, and credibility.
ENVIRONMENTAL FACTOR
• Seating arrangement, room comfort, chair mobility, objects that facilitate or distract, noise, and lack
of privacy are all factors to consider.
 TYPES OF COMMUNICATION
VERBAL COMMUNICATION
- It is the use of words to describe one's feelings, thoughts, and attitudes. When interacting with
older folks, it is critical to elicit their opinions and seek for additional explanations.
Informing: Make straightforward statements about facts; a good information statement is clear, brief,
and communicates itself in language that the elderly can comprehend.
Direct questioning: When the nurse needs specific information, direct questioning is useful. It is also
good when information needs to be collected fast.
Open ended technique: Allows the person to speak more about their feelings and perceptions, as well
as allowing the nurse to double-check that the information exchanged is correct.
Active listening: The nurse uses eye contact and facial expressions to pay attention to both verbal and
nonverbal communication.
NON VERBAL COMMUNICATION

The most accurate type of communication is one in

which people use their facial expressions, eye
contact, gestures, and body language instead of
words.
BARRIERS OF COMMUNICATION
● Inappropriate reassurances.
● Making judgments .
● Giving advice, telling the person what should
be avoided .
● Challenging.
● Improper questioning
EFFECTIVE COMMUNICATION
● Be aware of the person's health issues.
● Allow the elderly person to reminisce, and to
grieve.
● Respect the elderly person’s background,
knowledge, and values.
● Be attentive to the environment in which you are
communicating
● Speak clearly and articulately, and make eye
contact.
● Adjust your volume appropriately
● Use clear and precise questions and sentences
● Employ visual aids, if possible.
● Take it slow, be patient, and smile.
COMMUNICATING WITH HEARING IMPAIRED
● Check to see if the hearing aid is in the person’s ear. Also check to see that it is
turned on.
● Wait until you are directly in front of the person, you have that individual’s
attention and you are close enough to the person before you begin speaking.
● Be sure that the individual sees you approach
● Face the hard-of-hearing person directly and be on the same level with him/her
whenever possible.
● Keep your hands away from your face while talking
● Recognize that hard-of-hearing people hear and understand less well when
they are tired or ill.
● Reduce or eliminate background noise as much as possible .
● Speak in a normal fashion without shouting.
● If the person has difficulty understanding something, find a different way of
saying the same thing, rather than repeating the original words.
● Use simple, short sentences to make your conversation easier to understand.
● Write messages if necessary.
● Allow time to converse with a hearing impaired person.
COMMUNICATING WITH DEAF
● Write messages if the person can read.
● Use a pictogram grid or other device with
illustrations to facilitate communication.
● Be concise with your statements and
questions.
● Utilize as many other methods of
communication as possible to convey your
message (i.e. body language).
● Spend time with the person, so you are not
rushed or under pressure.
COMMUNICATING WITH VISUALLY IMPAIRED
● Describe the room layout, other people who are in the room, and what is
happening.
● Tell the person if you are leaving. Let him/her know if others will remain in
the room or if he/she will be alone.
● Allow the person to take your arm for guidance.
● Allow the person to touch you.
● Ask how you may help: increasing the light, reading the menu, describing
where things are, or in some other way.
● Call out the person’s name before touching. Touching lets a person know that
you are listening.
● Use the words "see" and "look" normally.
● Use large movement, wide gestures and contrasting colors.
● Explain what you are doing as you are doing it, for example, looking for
something or putting the wheelchair away.
● Describe walks in routine places. Use sound and smell clues.
● Encourage familiarity and independence whenever possible.
● Leave things where they are unless the person asks you to move something.
COMMUNICATING WITH PERSONS WITH ALZHEIMERS
DISEASE
● Always approach the person from the front, or within his/her line of
vision .
● Speak in a normal tone of voice .
● Face the person as you talk to him/her.
● Avoid a setting with a lot of sensory stimulation, like a big room
where many people may be sitting or talking, a high-traffic area or a
very noisy place.
● Maintain eye contact and smile. Be respectful.
● Use a low-pitched, slow speaking voice which older adults hear
best.
● Ask only one question at a time. More than one question will
increase confusion.
● Repeat key words if the person does not understand the first time
around.
● Nod and smile only if what the person said is understood.
 QUESTION
 Why do you think communication is
important in older adults?
REFERENCES

● https://slideplayer.com/slide/15122104/
● https://
www.gmjournal.co.uk/confusion-in-the-older-patient-a-dia
gnostic-approach
● https://
www2.health.vic.gov.au/hospitals-and-health-services/patie
nt-care/older-people/cognition/delirium/delirium-serious
● https://
my.clevelandclinic.org/health/diseases/15252-delirium
● https://
www.lifeline.philips.com/resources/blog/2014/08/sensory-
deprivation-among-older-adults.html