LTC Objectives:

1. LTC Objectives: • The student will be able to: • Identify hierarchy of the basic human needs. • Explain the dis’abilities the geriatric patient may experience with their vision, hearing, speech, & mental abilities.

2. Objectives: • Explain how to provide general care for the LTC resident: • Safety in preventing injury • Prioritizing care needs • Promoting good mental health by allowing resident for feel independent thus positive self esteem

3. Objectives: • Explains ways to adapt communication techniques to accommodate resident with visual or hearing impairments.

4. DIS”ABILITIES”

5. VISION CHALLENGES • Cataracts • Vision is fuzzy. • Caused by chemical changes in the lens that form deposits and blur the field of vision. • http://www.righthealth.com/topic/Pictures_For_Cataracts?p=l&as=yhoo&ac=534

6. VISION CHALLENGES • Detached retina • Retina separates away from back of portion of eye resulting in loss of vision. http://health.allrefer.com/health/retinal-detachment-repair-detached-retina.html

7. VISION CHALLENGES • Glaucoma • build up of pressure in middle part of eye damaging optic nerve • Loss of peripheral vision

8. VISION CHALLENGES • Hemianopsia • Half vision. • Visual interpretation in brain is affected as with a stroke. http://www.tsbvi.edu/Education/anomalies/Hemianopsia.htm

9. VISION CHALLENGES • Macular Degeneration • Photo cells die in macula (retina). • Results in inability to see directly in front of them. • Peripheral vision OK. Vessels under the retinal layer hemorrhage and cause the retinal cells to die creating blind spots or distorted vision in the central vision. https://health.google.com/health/ref/Macular+degeneration

10. VISION CHALLENGES • Presbyopia • “Old eyes” • Lens hardens and is less flexible. • Inability to see clearly or read things held close to face. https://health.google.com/health/ref/Presbyopia

11. VISION CHALLENGES • Retinopathy • Damage to photo cells. • Tunnel vision.

12. VISION CHALLENGES~coping strategies • Always introduce yourself. • Be more descriptive. • Be cautious about using colors to code or illustrate things. • Speak directly to the person. • Speak in normal conversational tones. • Ask about adequacy of lighting.

13. VISION CHALLENGES~coping strategies • If the person needs assistance to get somewhere, have him/her take YOUR elbow. • Let the sense of touch substitute for vision as often as possible. • If it is necessary to do something to or for a person who does not see well, detail what is happening. • Highlight stair edges with reflective materials.

14. HEARING CHALLENGES • Conductive hearing problems • Difficulty with flow of sound waves through outer or middle ear structures. http://www.contmediausa.com/shop/app/products/Human3D/human3dhumanear.html

15. HEARING CHALLENGES • Presbycusis • Loss of ability to hear high-pitched sounds as we age.

16. HEARING CHALLENGES • Sensorineural hearing loss (central hearing loss) • Impairment in nerve pathway going from inner ear to brain. http://hyperphysics.phy-astr.gsu.edu/hbase/Sound/anerv.html

17. HEARING CHALLENGES • Tinnitus • Constant static or ringing in ear(s).

18. HEARING CHALLENGES~ How to make sure you are heard • DO NOT shout to be heard. • Speak at a slightly slower than normal cadence. • Reduce as much background noise as possible. • Always face the person when speaking. • Sit or stand 3 – 5 feet from the person.

19. HEARING CHALLENGES~ How to make sure you are heard • If talking by telephone, always speak directly into the speaker portion of handset. • Never carry on a conversation while chewing food or gum or while smoking. • Use body language and/or written messages to enhance communication. • Allow a longer time for the person to process the message and respond.

20. HEARING CHALLENGES~ How to make sure you are heard • Do not assume that because the person has a hearing aid their problem has been corrected. • Always treat that person with respect.

21. SPEECH CHALLENGES~ APHASIA~ WebMD • Definition: • Literally – without speech. • The inability to speak or understand speech (verbal and written) or both. • Cause: • Brain injury to speech area due to stroke, infection, dementia, etc.

22. SPEECH CHALLENGES~ APHASIA • Types: • Expressive aphasia. Person knows what he or she wants to say but has difficulty communicating it to others. • Receptive aphasia. Person can hear a voice or read the print, but may not understand the meaning of the message.

23. SPEECH CHALLENGES~ APHASIA • Types: • Anomic aphasia. Person has word-finding difficulties. An inability to find the right words for speaking and writing. • Global aphasia. Most severe type of aphasia. It is often seen right after someone has a stroke. Person has difficulty speaking and understanding words and is unable to read or write.

24. SPEECH CHALLENGES~ APHASIA • Types: • Primary progressive aphasia. A progressive disorder. People lose their ability to talk, read, write, and comprehend what they hear in conversation over a period of time. With a stroke, aphasia may improve with proper therapy. • People with primary progressive aphasia are able to communicate in ways other than speech, like gestures.

25. SPEECH CHALLENGES~ APHASIAHow to help….. • Include the person in your conversation. No one likes to be ignored. • Don’t talk about the patient in his/her presence, even if he/she appears unable to respond. Always assume the patient is hearing and understanding. • It is easier for the patient to understand if only one person is talking with him/her at a time. Extra noises only create confusion for the patient.

26. SPEECH CHALLENGES~ APHASIAHow to help….. • Talk to the patient in a normal tone of voice. There is no need to shout. • Be sure to give him/her enough time to respond. • It is better to ask if help is wanted before giving assistance. • Attempt to phrase the conversation so that the patient can respond, ie. asking yes - no questions. The patient should never be forced to respond.

27. SPEECH CHALLENGES~ APHASIAHow to help….. • Stand where the patient can see you. Face the patient. Avoid standing in front of a bright light. • Use sentences that are short and to the point. For example, instead of saying, “Your wife called and she will be her tomorrow to pick you up and take you home,” you could say, “Your wife called.” (Pause) “She’ll be here tomorrow.” “You can go home then.”

28. SPEECH CHALLENGES~ APHASIAHow to help….. • Remember the patient may tire easily and will not respond as well when he/she is tired. • Never promise the aphasic patient complete recovery, nor tell him/her that he/she will never improve. Rather, focus on any small improvements he/she has made up to that point. • Since communication is the most important goal, it is not essential that words and grammar be perfect. Initially, there is no need to correct his/her attempts outside of speech therapy.

29. SPEECH CHALLENGES~ APHASIAHow to help….. • Don’t pretend to understand. If you’re having difficulty understanding, be honest and say so: “I’m sorry, I don’t understand. Let’s try again.” • If a patient says a word or phrase once, don’t necessarily expect him to say it again. • Above all, remember that even though he/she has a communication problem, he/she should be treated as an adult.

30. PHYSICAL CHALLENGES • Paraplegia – • Loss of sensation and movement in the lower body. • Quadriplegia or Tetraplegia – • Loss of sensation and movement from neck down.

31. PHYSICAL CHALLENGES • Hemiplegia – • Paralysis of one side of body. • Cause: injury to motor area of brain on opposite side. http://medical-dictionary.thefreedictionary.com/hemiplegia Screen clipping taken: 11/16/2009, 9:53 AM

32. MENTAL CHALLENGES • Find out what the person can do and help them to do their best! • Mental retardation • MENTAL ILLNESS • dementia

33. CAREERS RELATED TO DIS”ABILITIES” • Speech Pathologist • Audiologist • Physical Therapist • Occupational Therapist • Recreational Therapist • Early childhood specialist • Special education teacher • Orthotist • Prosthetist • & many more!