Uncovering the Message of the Nonverbal Older Adult

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Uncovering the Message of the Nonverbal Older
Adult

• R. A. Weise, M.D.
• Medical Director
• Alexian Older Adult Health Care

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The Nonverbal Older Adult

• A Man Called Peter

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Uncovering the Message of the Nonverbal Older
Adult

• What is nonverbal communication?
• Nonverbal communication is the giving or sharing
  of information or knowledge, in the context of
  feelings/emotions, without using words
• Nonverbal communication usually consists of
• Facial expressions
• Body language/postures
• Information conveyed through touch, taste, smell,
  sight, and hearing
• Emotional behaviors

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The Purpose of Communication in Health Care

• To communicate, in Latin, means
• to impart
• to participate
• To communicate, in English, means
• to convey knowledge or information
• to make known
• to share

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The Purpose of Communication in Health Care

• To communicate, in Health Care, means
• to provide general health related information
• to give counsel for specific personal illness
• to apply technology for disease management
• to promote an understanding of health care costs
• to extend compassion
• to care about the patient/client/resident

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The Purpose of Communication in Health Care

• Is, ultimately, to promote healing
• not just fixing

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What is Healing?

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What Healing is Not!

• Healing is not fixing
• Fixing, in Latin, means to make firm or to
  fasten, i.e. to tighten something that is loose
• In English, to fix means to repair

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What Healing is Not!

• Fixing emphasizes
• Results over relationships
• Parts over the whole
• Products over persons
• Repair over renewal

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Healing is Not Fixing!

• Todays healthcare is, all to often, based upon
  fixing
• 1. We have improved our outcomes (results) in
  reducing the impact of cardiovascular disease
  cancer, infection, etc..
• While, at the same time, reducing patient /
  professional caregiver relationships, i.e. acute
  care nurse to patient ratios (in reality) are
  rising (14 in 1991, and now 16 ?).

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Healing is Not Fixing!

• 2. Healthcare has become more and more
  fragmented, placing the responsibility for
  patient care in the hands of the consultant
  rather than in the hands of the primary care
  physician.
• This diffusion of care dilutes responsibly for
  the whole (total) patient.
• The technological repair of the part becomes
  more important than the renewal of the
  whole(person).

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Medical SpecialtiesEngeman, 1964

• Pediatrics
• Opthomology
• Neurology
• Orthopedics
• Dermatology
• Pathology
• Public Health
• Psychiatry
• Surgery

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Medical SpecialtiesABIM, Maintenance of
Certification, 2007

• Allergy/Immunology
• Anesthesiology
• Colon/Rectal Surgery
• Dermatology
• Emergency Medicine
• Family Practice
• Genetics
• Neurosurgery
• Neurology
• Psychiatry
• Nuclear Medicine
• Internal Medicine
• Urology

• Nuclear Medicine
• Radiology
• OB/GYN
• Opthomology
• Orthopedics
• ENT
• Pathology
• Pediatrics
• Physical Medicine/Rehab
• Plastic Surgery
• Preventative Medicine
• General Surgery
• Thoracic Surgery

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Healing vs. Fixing

• If healing is not fixing, then what is healing ?

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What is Healing?

• Healing is the dynamic, creative process of
  helping an individual change illness into
  wellness by the transformation of
• Dependency into Inter-dependency
• Disconnection into Intimacy
• Discouragement into Hope

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What is Healing?

• Healing Emphasizes
• Connection over outcome
• The whole person over the individual organ system
• Revitalization over preservation
• Becoming a servant partner rather than,
  merely, a service provider

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The Purpose of Communication in Health Care

• Health care communication must, not only, supply
  competent fixing but, also, secure healing in
  our patients, clients, and residents
• Compassionate communication that promotes healing
  is especially difficult in the nonverbal older
  adult

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Uncovering the Message of the Nonverbal Older
Adult

• Barriers to Effective Communication in the
• Nonverbal Older Adult

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Barriers to Effective Communication in the
Nonverbal Older Adult

• Occur in, predominantly, three areas
• Normal Aging
• Disease
• The Environment

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Barriers to Effective Communication in the
Nonverbal Older Adult

• Normal Aging

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Definitions

• Aging post maturational / intrinsic
  deterioration
• decline in reproductive capacity
• increasing vulnerability
• increasing likelihood of death
• 70 environmental / 30 genetic

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Definitions

• Aging Change over Time
• Normal Aging Balanced change over time
• positives gt negatives

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Normal Aging

• We age in four domains
• Physically
• Emotionally
• Socially
• Spiritually

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General Principles of Normal Aging

• Aging is gradual
• large physiological reserve
• loose 1 reserve/ year
• The more complex the function, the greater the
  decline
• balance vs. single nerve
• With advancing age comes increased variability

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General Principles of Normal Aging

• With old age comes a diminished speed of
  adaptation
• adaptation occurs but the greater stress the
  slower the adjustment
• especially true in frail older adults

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Specific Changes Associated with Normal Aging

• What can we expect in terms of organ system
  specific change, with advancing age, that may
  negatively impact communication with the
  nonverbal older adult

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Normal Aging and CNS Function

• Memory slows down with age (age associated memory
  change)
• delayed recall becomes sluggish
• attention span diminishes
• Executive function is less efficient
• sequential reasoning slows
• new learning slows
• specialized knowledge maintained
• judgment intact
• Language Communication skills mostly improve
  with age

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CNS Function

• Visual-Spatial coordination declines with age
• perceptual speed diminishes
• Personality becomes more personal as we be come
  an older adult
• Emotional identification and experience remains
  intact

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Normal Aging of the Sensory System

• Hearing
• High-pitched hearing loss (Presbycusis)
• loose consonants in the English
  language ( s th k f etc.)
• The most common type of hearing loss in the
  elderly

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Sensory System

• ello i Aleian Broer Medical enter

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Sensory System

• Vision
• lens becomes thicker and more dense
• more light is needed (watts in bulbage !)
• slower accommodation
• slower light/ dark adaptation
• need more contrast
• reduced peripheral vision
• less tears (but watery eyes)

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Sensory System

• Taste
• decreases in acuity with old age
• saliva production reduced
• no decrease in taste buds

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Normal Aging and Movement

• Muscles
• decrease in size and strength with age (50 )
• less elastic
• but trainable at every age (regular,
  consistent aerobic and resistance exercise a must
  for optimal aging !)

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Movement

• Balance
• - complex mechanism involving brain, vessels,
  skin, senses, joints, muscles, etc.
• - slower to respond to sudden change with age
• - can be improved in advanced age

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Sexuality and Normal Aging

• Desire persists into advanced age in women
  (menopause not menostop) but desire decreases
  in men
• Vagina shortens/ gets dryer
• Arousal takes longer
• Orgasms are fewer and further apart
  (especially for men)

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Sexuality and Normal Aging

• The frequency of sexual intercourse among 85 y/o
  (who have opportunity), is about the same
  frequency as a a Fortune 500 C.E.O.(2x month)
• Sexuality infuses vibrant color into the, often,
  black and white relationships of aging

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Emotional Aging

• Loss is the hallmark of emotional aging
• With age, we not only loose parts of our bodies
  but also our
• work (retirement)
• spouse (death)
• Children (busyness)
• friends (immobility or death)
• Loss, in old age, can promote Self-centeredness

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Social Aging

• Can promote isolation
• With advancing age
• Our once high position, becomes low position
• Being needed becomes being a burden
• Once we controlled ourselves, now we are
  controlled by others

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• Physical Aging can lead to Dependency
• Emotional Aging can lead to to Self-Centeredness
• Social Aging can lead to Isolation
• Progressing to Spiritual Apathy in old age

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The Aging Spirit

• The Most Important Domain of Aging
• Operates on Faith gt Facts
• Favors Relationships gt Results
• Provides Balance
• Provides Energy
• Provides Maturity, Imagination, and Wisdom

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• Physical Aging can lead to Dependency
• Emotional Aging can lead to Selfishness
• Social Aging can lead to Isolation
• BUT

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The Aging Spirit

• Provides the power to transform
• Dependency into Chosen Reliance
• Selfishness into Service
• Isolation into Community
• - Apathy into Hope

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Barriers to Effective Communication in the
Nonverbal Older Adult

• Occur in, predominantly, three areas
• Normal Aging
• Disease
• The Environment

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Barriers to Effective Communication in the
Nonverbal Older Adult

• Disease creates significant barriers to optimum
  communication with nonverbal older adults
• Dementias ( A.D. Lewy Body Dementia etc.)
• Stroke
• Immobility
• Cataracts
• Hearing loss
• Depression/Anxiety
• Pain (Chronic and Acute)
• Loose dentures/ poor dentition
• Arthritis

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Barriers to Effective Communication in the
Nonverbal Older Adult

• Occur in, predominantly, three areas
• Normal Aging
• Disease
• The Environment

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Barriers to Effective Communication in the
Nonverbal Older Adult

• Environmental pressures can significantly reduce
  communication with the nonverbal older adult
• Always in a bed or chair
• Isolation
• Crowding
• Poor lighting
• Too much or too little sensory stimulation
• Hurried
• Lack of privacy
• Ageism

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Uncovering the Message of the Nonverbal Older
Adult

• How to Improve Communication with the Nonverbal
  Older Adult

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How to Improve Communication with the Nonverbal
Older Adult

• General principles of nonverbal communication in
  older adults
• It may involve noise without recognizable
  language
• It is emotionally based
• It has purpose and meaning
• It is accurate

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How to Improve Communication with the Nonverbal
Older Adult

• Specific strategies to enhance communication with
  the nonverbal older adult
• Demonstrate respect and guarantee safety with
  each interaction
• Decide to develop a caring relationship with the
  patient/resident/client
• Determine to be a Servant Partner, not simply,
  a Service Provider.

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How to Improve Communication with the Nonverbal
Older Adult

• Practical actions that will promote and enrich
  communication with the nonverbal elderly
• Promote excellence in health and health care
  delivery
• Prevent illness
• Focus on Function
• Concentrate on Feelings (Emotions)
• Direct communicative efforts at the specific
  barriers that impair understanding
• Normal Aging
• Disease
• The Environment

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How to Improve Communication with the Nonverbal
Older Adult

• Over coming the barriers of Normal Aging
• Slow down all interactions
• Taylor the communication to the quality of the
  relationship, in the moment!
• Speak slowly, firmly, and rephrase rather than
  repeat
• Maintain compassionate eye contact, in adequate
  light, at or below their eye level (kneel or sit)
• Honor their sexuality
• Respect their privacy and time (schedule)
• Make them physically safe
• Know them

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How to Improve Communication with the Nonverbal
Older Adult

• Over coming the barriers of Emotional Aging
• Identify the feelings/emotions they are
  expressing
• Listen for understanding of the feelings/emotions
• Validate their feelings
• Smile
• Use affirmative body language (head nodding)
• Redirect them towards service to others

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How to Improve Communication with the Nonverbal
Older Adult

• Over coming the barriers of Social Aging
• Determine to connect to them and to limit their
  isolation
• Use affirmative touch, when appropriate
• Help them connect to those around them, as well
  as, family and friends
• Give the something that they can control
• Give them choice and then honor their choices

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How to Improve Communication with the Nonverbal
Older Adult

• Over coming the barrier of an Apathetic Spirit
• The most difficult of tasks in communication
• Help them cultivate a healthy spirit based upon
  truth, in the context of, their faith
• Help them make good choices, serve others, and
  connect with those around them
• Encouragement and hope improve communication

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How to Improve Communication with the Nonverbal
Older Adult

• Over coming the barriers caused by Disease
• Comprehensive Geriatric Assessment
• Focus on improving or maintaining function
  (ADLs)
• Treat depression
• Get hearing aids
• Remove cataracts/ get glasses/ treat Macular
  Degeneration
• Limit medication
• Exercise
• Relieve pain
• See Dentist
• Get physical/occupational/speech therapy

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How to Improve Communication with the Nonverbal
Older Adult

• Over coming barriers caused by the Environment
• Mobilize the patient/client/resident
• Supply adequate light, space, and privacy
• Provide appropriate sensory stimulation
• Compassionately balance safety with personal
  freedom

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Uncovering the Message of the the Nonverbal Older
Adult

• Understanding and being understood by the
  nonverbal older adult is essential to providing
  them with adequate health care
• Committing ourselves to establish and maintain
  their personal safety and respect, will provide
  the soil for our understanding of one another to
  grow and flourish