WORKING WITH OLDER ADULTS

OUR CHANGING SENSES

Introduction

At D.ESCAL8™ we tend not to use the term 'Challenging Behaviour', but prefer to focus on assisting individuals with their distress. Why not read our post to find out why? d8.is/b2.

Working with individuals who are in distress can be stressful for family members, carers and supporters. Within an older population it is important for carers to gain an understanding of some of the effects ageing can have. D.ESCAL8™ hope this overview will give an introduction to the myriad of changes a person goes through later in life.

The ageing senses

With age our senses change and decrease. This affects our vision, hearing, touch, smell and taste. This can affect the way that we perceive the information coming from our senses and can be frightening. Conflicts can occur with what we see and hear and what we perceive.

Vision can be affected by the perception of colour and it is harder to see the contrast between colours. People have reduced peripheral vision, smaller visual fields, less ability to tolerate glare, their sharpness of the vision deteriorates (visual acuity) and a decreased pupil size means that they are able to take in less light. This reduction in our vision can be very confusing. You may notice that individuals wear more brightly coloured clothing, that they are not be able to get to the bathroom in time, or that they lose their way around the building due to sight issues.

Hearing is affected with the loss of high frequency hearing, and they may have tinnitus. Hearing also affects balance so individuals are more likely to fall. Individuals may not be able to hear the higher notes in a tune, or female carers’ voices as they tend to be softer and higher in pitch. Hearing noises that are not present in the environment can be distracting and will interfere with normal hearing.

Taste declines including less sensitivity to sweet and salty tastes. The sense of smell diminishes after the age of 70. Taste and smell can also be affected by medications. Individuals may feel their food tastes bland which can lead to malnutrition. Individuals may not notice that they need a wash or that their clothes need washing or that food has ‘gone off’. You may notice that individuals are having more sugar in their tea or putting more salt on their dinner. Food could be enhanced with herbs and spices to enhance the flavour and colour. We can also use brighter coloured dishes to enable individuals to see the food. You may find that people will eat more if they can see it and if it tastes good to them.

Touch may be reduced or changed with aging; people are less able to detect vibration and pressure which increases the risk of injuries. We may have a reduced sensitivity to pain or an increased sensitivity to light touch. We may experience problems with walking due to the reduced ability to perceive where their/our body is in relation to the floor. Watching for signs of pain by flinching or facial expression is important if we have dementia, stroke or Parkinson’s disease as people may not be able to tell you they are in pain or may not be able to find the words.

WHAT IS DEMENTIA?

The term 'dementia' describes a set of symptoms which include loss of memory, mood changes and problems with communication and reasoning. It affects over 850,000 people in the UK, with numbers set to rise to over 1 million by 2025. This will soar to 2 million by 2051.

Dementia is progressive, which means the symptoms will gradually get worse. How fast dementia progresses will depend on the individual person and what type of dementia they have. Each person is unique and will experience dementia in their own way. It is often the case that the person's family and friends are more concerned about the symptoms than the person may be themselves.

Symptoms of dementia may include the following:

• Loss of memory - this particularly affects short-term memory, for example forgetting what happened earlier in the day, not being able to recall conversations, being repetitive or forgetting the way home from the shops. Long-term memory is usually still quite good.
• Mood changes - people with dementia may be withdrawn, sad, frightened or angry about what is happening to them.
• Communication problems - including problems finding the right words for things, for example describing the function of an item instead of naming it. In the later stages of dementia, the person affected will have problems carrying out everyday tasks and will become increasingly dependent on other people.

More information about dementia is available on the Alzheimer’s Society website.

Dementia affects more than a person’s memory, it can also affect the following:

• What people see, or how they interpret what they see
• What people hear, or how they interpret what they hear
• The language and words people use (we may think they are using the right word for something when we are not)
• How people react to things and their emotions
• How people relate to others
• Individual’s co-ordination skills in tasks/ actions e.g. walking, eating, swallowing, dressing, etc.
• Physical ability / habits – knowing when they are hungry, knowing when they need the toilet, knowing when to sleep etc.

DEMENTIA CARE AND DISTRESS

As carers working with older people with dementia, you will be involved in looking for the reason for, or the triggers of behaviours. Many of the individuals you work with may not be able to verbally express how they are feeling, what they want or need. You will need to know about the individual's history and be observant to help them when they become distressed. Know how to distract an individual because some may think that they need to pick up children from school, cook tea, go shopping, go to work; activities or routines that in their adult life they would have done. Reassuring them is very important so that they won’t worry.

As the disease progresses and an individual becomes more dependent, it is still important that we encourage the them to maintain their independence and give them a sense of purpose. Encouraging people to complete tasks that they are able to do is essential e.g. folding napkins or cooking. Finding out the music and films that they like and playing it for them, reminiscing using their family photos or objects can be especially important as their mobility decreases. Place objects of interest where they can seen and reached, and encourage any conversation where possible. This could be as simple as sorting through a handbag or showing a DVD about a place that is significant to them; use any triggers to stimulate a memory.