As we age, our sensory systems gradually lose their sharpness. Because our brain requires a minimal amount of input to remain alert and functioning, sensory loss for older adults puts them at risk for sensory deprivation. Severe sensory impairments, such as in vision or hearing, may result in behavior similar to dementia and psychosis, such as increased disorientation and confusion. Added restrictions, such as confinement to bed or a Geri-chair, increases this risk. With nothing to show the passage of time, or changes in the environment, the sensory deprived person may resort to repetitive problem behaviors (calling out, chanting, rhythmic pounding/rocking) as an attempt to reduce the sense of deprivation and to create internal stimulation/sensations.
This article is the third in a series of three articles that discuss the prominent sensory changes that accompany aging, and considers the necessary behavioral adjustments or accommodations that should be made by professional, paraprofessional, and family caregivers who interact with older adults. Though the medical conditions are not reviewed in depth, the purpose of this article is to introduce many of the behavioral health insights, principles, and approaches that should influence our care giving roles. This article addresses age-related changes in taste, smell, and touch, and a related subject, facial expressiveness.
I. TASTE AND SMELL
A. Changes in taste and smell with aging:
1. Less involved in interpersonal communication, leading to decreased quality of life, and contributing to depression and apathy;
2. The decline in taste sensitivity with aging is worsened by smoking, chewing tobacco, and poor oral care. This results in more complaints about food tasting unpleasant or unappetizing, and sometimes causing the person to stop eating altogether;
3. With aging, there is a decline in the sense of smell, resulting in a decreased ability to identify odors. Also the person with a declining sense of smell is more tolerant of unpleasant odors, and this can be further exacerbated by smoking, some medications, and certain illnesses.
B. Effects of taste and smell changes on demented elderly:
1. Individuals with Alzheimers Disease lose their sense of smell more than non-dementia individuals, due to change in their recognition thresholds. This is because there is a concentration of tangles and plaques characteristic of Alzheimers Disease found in olfactory areas of the brains of patients with this disease, compounding the declining sense of smell that accompanies old age;
2. The impairment in the ability to distinguish flavors in foods for those with dementia results in diminished eating pleasure, and a loss of appetite. Recommendation: more attention to and greater awareness of the importance of eating, and reminders of having eaten, which can minimize the risk of malnutrition and dehydration;
3. The impaired sense of taste and smell can result in a serious inability to sense danger, such as gas leaks, smoke or other odors, which would obviously interfere with taking necessary steps for safety. Also, problems with taste may cause the person to overcook or use spoiled foods, raising the risk of food poisoning. Recommendation: use smoke detectors, clean out refrigerators regularly, and check drawers for food hoarding.
A. Changes in sense of touch with aging:
1. The sense of touch includes perception of pressure, vibration, temperature, pain, position of body in space, and localization of a touch. Some of this sense of touch diminishes with aging, but affects no more than 50% of older adults;
2. The most pronounced changes occur in the feet, and changes become less apparent as we move up the body. A decline in the sense of perception in the feet contributes to increased danger of falling or tripping over objects. Changes in hand sensitivity will often lead to dropping of objects;
3. Because the sense of touch is the most intact of all senses in older adults, and least impacted by advancing years, it can be the more important means of communicating, whether to gain his or her attention, to reassure him or her, to let the person know that you are there to help, and to guide the person in an activity;
4. Touch is therapeutic since older adults may be touch deprived. In medical and institutional settings, such as nursing homes, there may be even fewer opportunities for touch and physical contact. Recommendation: take extraordinary steps to make appropriate physical contact with the older adult for reassurance, to gain attention, to confirm communication, and to provide a greater sense of safety and security.
III. FACIAL EXPRESSIVENESS
1. Some neurological disorders, like Alzheimers
disease, Parkinsons, and other types of dementia result in decreased facial expressiveness. This makes it difficult to discern emotional reactions or expressions that would otherwise be apparent in those without such disorders;
2. Because we depend so much on non-verbal communications and facial expressiveness, it is difficult to know if the other person is hearing and understanding what we are communicating. This makes it less enjoyable and less rewarding to communicate with someone who does not show the expected emotional reaction, such as a smile, a laugh, a grimace, or even a shrug.
Recommendation: even in the absence of facial expressiveness, do not avoid communicating with this person, but do not be upset or disappointed when the emotional reaction does not appear. Caregiver disappointment and rejection only contributes further to apathy and withdrawal.
PRINCIPLES FOR CAREGIVERS
The following principles apply to caregiving approaches with older adults who have diminished sensory function. Increased sensitivity and insight to the needs of these individuals improves their quality of life and improves our effectiveness:
1. Observe his or her behavior, and look for cues and signs of pain or discomfort;
2. Help the person work through the emotional impact of the sensory changes, allowing expression, acceptance, and support of the grief and sadness accompanying these losses;
3. Do not try to fix the unpleasantness; acceptance and support goes a longer way toward healing than a quick fix or a patronizing attitude;
4. Reduce excess disability by maximizing whatever functioning is still left, such as proper eyeglass prescriptions, or functioning hearing aids;
5. Consider assistive devices (phone amplifiers, large text books, headphones, and the Braille Institute for a variety of useful visual aids).
6. Remember that the need for touch increases during periods of stress, illness, loneliness, and depression;
7. Touch is especially important when communicating with blind, deaf, and cognitively impaired individuals;
8. Use touch often, but only to the extent that the person is comfortable with it;
9. Do not give the person a pat on the head, or a tap on the cheek, as this can be perceived as condescending.
Normal aging brings with it a general decline in sensory functioning. To minimize the emotional, behavioral and attitudinal impact these losses have on older adults, caregivers should develop insights and approaches that take the special needs into account, and try to turn unpleasant, frustrating situations into more caring, helpful, and sensitive interactions. As caregivers can integrate behavioral principles in the delivery of the health care with older adults, we can have a positive impact on the management of these losses.
Copyright 2008 Concept Healthcare, LLC
Joseph M. Casciani, PhD, is a geropsychologist who has devoted his professional career to working with older adults and their caregivers. His company, Concept Healthcare, http://www.cohealth.org, offers online resources to integrate behavioral health approaches in the health care of older adults.