Picture This…..Communicate

1. Picture This…..Communicate Health Literacy for Aging Adults With Communication Difficulties April/May 2006 By: Kathy K. Wright

2. Working with Older People With Communication Difficulties • Many employees of Health and Social Service agencies work with older adults • Health care and service settings include: • Hospitals/doctors offices • Nursing homes/residential care homes • Domiciliary and day care services * Significant numbers of older adults have some kind of communication problem.

3. Effective Communication • Effective communication is an important factor in quality of life • Several authors have suggested that communication interventions are needed to arrest the decline of communication in residential care setting

4. Care givers • Need to receive training to develop their own communication skills • This will in turn help them to communicate effectively with older people who may have a range of complex difficulties with communication

5. Definitions • Literacy • National Literacy Act: Ability to read, write and speak English, compute and solve problems at level of proficiency necessary to function on job and society

6. Health Literacy • Ability to read and comprehend prescription bottles, appointment slips and other essential health-related materials to successfully function as a patient • The degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions

7. Importance of Health Literacy • To assess patients’ ability to understand information • To identify literacy/knowledge deficits • To establish effective communication and teaching strategies that are specific to client’s needs

8. Health Literacy in the United States • National Adult Literacy Study • Functionally illiterate reading level • 45-54 year olds: 16% • 55-64 year olds: 26% • > 65 year olds: 44% Kirsch I. Jungeblut A., Jenkins, L. et al. Adult Literacy in American: A first look at the results of the National Adult Literacy Survey. Washington DC: National Center for Education, US Department of Education. 1993

9. Deafness – either pre-lingual (native speakers) or post lingual Non-English speaking Cognitive Impairment/Dementia Brain damage Stroke victims Mental health/depression Developmental Delay Low IQ Illiteracy Autism Declined physical health Non-English speaking caregivers Chronic diseases Older Adults with Communication Problems

10. Functional Health Literacy & Medication Use • Health literacy affects a client’s ability to understand and adhere to medication directions/and to understand medical terminology • A social worker’s assessment of a client’s health literacy can be beneficial in: • Clarification of understanding of instructions • Tailoring medication counseling • Develop innovative communication using charts, calendars, pictures, and pictographs

11. Examples of adaptation for better health literacy… language modification pill box modification

12. Answers to Medication Challenges • Prepackaged in 30 day supply: like birth control pills • Pillboxes decorated with small pictures or emblems: sun (AM) moon (PM) • Calendars: for reminder emblems or to mark off as daily pills are taken

13. Answers to Communication Challenges • Flashcards: pictures of simple words for communication of tasks (i.e. bathroom, brush teeth, food, etc.) • Books: simple sentences on each page or pictures, • Gestures: simple basic signs that are universal in meaning, ex: bringing right hand with palm toward chest for come here

14. Vision Printed information may be enlarged to a higher font for low vision persons. Black print against yellow or orange paper is easier to read. The blind may handle many tasks independently with proper instruction. Hearing Impairment/Deafness Do not talk louder than normal range – it will further distort if they hear at all. Do stand/sit where they may see your face as they may pick up visual cues or be able to lip read to an extent. Use universal “sign language” gestures. Vision and/or Hearing Impairment

15. Slowing of Speech • Speeding speech in addition to increasing the rate of flow of information also tends to degrade and/or distort the speech signal. • This is possibly the reason why older adults are more affected by speeding speech. Their auditory systems are unable to handle it.

16. Patience • Most older adults or anyone with communication issues will be more than willing to work with someone who is making an effort to communicate with him or her. • Pay attention to non-verbal communication as well as what is being said. • The main ingredient is PATIENCE which along with EFFORT will ultimately lead to SUCCESS.

17. RESOURCES Bialystok, E., Craik, F. I., Klein, R., & Viswanthan, M. (2004). Bilingualism, Aging, and Cognitive Control: Evidence from the Simon Task. Psychology and Aging,19(2), 290-303. Bryan, K., Axelrod, L., Maxim, J., Bell, L., & Jordan, L. (2002) Working with older people with communication difficulties: an evaluation of care worker training. Aging & Mental Health,6 (3), 248-254. Desselle, D. D. (2000). Advocating for the Elderly Hard-of- Hearing Population: The Deaf People We Ignore. SocialWork, 45(3). 277-281.

18. Resources cont. Gutheil, I. A., & Heyman, J. C., (2005). Communication between older people and their health care agents: Results of an intervention. Health & Social Work, 30 (2). 107-116. Kirsch, I., Jungeblut, A., Jenkins, L. et al. (1993). Adult Literacy in America: A first look at the results of the National Adult Literary Survey. Washington DC: National Center for Education. US Department of Education, 1993. Miller, C. (2003). Visible Minorities: Deaf, blind, and special needs adult native literacy access. Canadian Journal of Native Education, 27 (1), 74-78.

19. Resources cont. Sadler, et al. (2001). Brining health care information to the deaf community. Journal of Cancer Education,16 (2) 104-108. Senghas, R. J., & Monaghan, L. (2002). Signs of their times: Deaf communities and the culture of language. Annual. Rev. Anthropology. 31, 69-97. Schneider, B. A., Daneman, M., & Murphy, D. R. (2005). Speech Comprehension Difficulties in Older Adults: Cognitive slowing or age-related changes in hearing? Psychology & Aging, 20 (2), 261-271.