A cautious plan for safety measures is wise, since elderly folks often have a longer recovery time after an injury than younger people do. However, there needs to be a balance between safety and independence issues.

Changing Sphere of the Senses

Vision

Vision loss among the elderly is a major health care problem. In the U. S. Department of Health and Human Services' (HHS) Older Americans 2008, Key Indicators of Well-Being, 17% of respondents reported vision problems in response to the question, "Do you have any trouble seeing, even when wearing glasses or contact lenses?" (Federal Interagency Forum 2008, 28)

The most common causes of vision loss among the elderly are (Quillen 1999):

·        Age-related macular degeneration (loss of central vision)

·        Glaucoma (leads to blindness by damaging the optic nerve)

·        Cataracts (clouding of the eye's lens)

·        Diabetic retinopathy (damage to the retina caused by complications of diabetes mellitus)

Signals of vision loss in the elderly include blurred vision, image distortion, difficulty reading, decreased night vision and visual field loss. Slower adaptation when moving from sunlight to indoors or change of focus between closer objects and those more distant are also vision problems. Sensitivity to glare and decline in peripheral vision greatly affect the ability to drive (Life Alarm 2009).

Vision loss can affect many previously enjoyed activities, such as reading, watching television, and attending the theater or sporting events.  Depending on the severity of the vision trouble, it can also impede facial recognition, transportation issues (reading street signs or various public transportation signs), as well as communication---especially non-verbal cues.

Regular visual check-ups are needed to catch the problems early on when there is the best chance of correcting them.

Hearing

As we age hearing often declines.  Difficulty with hearing can be especially frustrating to both the elderly and to those around them.  The ability to hear impacts speaking as well as equilibrium, so a person who has trouble hearing may also have difficulty speaking, or feel off balance or dizzy.  In a national survey of people 65+, 48% of men and 35% of women reported having trouble hearing (Federal Interagency Forum 2008, 28).

This can result in difficult social situations.  Some say, "As you lose hearing you lose people."  In social gatherings it is difficult to stay engaged in conversations when not all the comments are heard.  Frustration over not being able to hear comments can produce anger displaced on those who are speaking.  Communication becomes more laborious and, after time, avoidance of communication can occur. 

A famous audiologist, Mark Ross, once said, "When someone in the family has a hearing loss, the entire family has a hearing problem” (Kricos, n.d.). That is very accurate, because it affects every member of the family, not just the person who’s hard of hearing.

Basic learned hand gestures used between the hearing impaired and loved ones can help increase communication. This may vary from levels of deaf sign language to just basic "homemade" gestures that are shared and understood for communication. Since a great majority of communication is non-verbal, there is still much that can be communicated, especially with those familiar with the hearing impaired.   

"Communication in general is a process of sending and receiving messages that enables humans to share knowledge, attitudes, and skills. Although we usually identify communication with speech, communication is composed of two dimensions---verbal and nonverbal.

"Nonverbal communication has been defined as communication without words. It includes apparent behaviors such as facial expressions, eyes, touching, and tone of voice, as well as less obvious messages such as dress, posture and spatial distance between two or more people" (Fort Hayes, n.d.).

Some who have lost hearing find comfort in the ability to communicate and interact with people through e-mailing and Internet message boards. This provides opportunity to exchange ideas and communicate without the usual frustrations. Because of the more recent access to computers, many of the elderly have avoided its use.  The healthcare professional can help elderly clients overcome their fear or indifference by showing them basic steps of communication over a computer.  Of course, this does not supplant emotionally important personal interactions, but it can provide a feeling of competence and satisfaction lost in face-to-face interactions.

The advanced technology of hearing aids has also helped the elderly suffering from hearing loss to maintain good social interaction. Early hearing aids only amplified all sounds without distinguishing volume or wave levels between things such as the human voice or cars on the road. They also did not allow the hearer to distinguish the direction from which the sound was coming.  Newer hearing aids are able to do these things and have greatly improved the quality of social interactions and of life for those having difficulty hearing.

Edentulousness: Loss of Teeth

The same survey that inquired regarding older persons' sight and hearing also surveyed to find how many are affected by the loss of teeth.  The respondents were asked if they had lost all of their upper and lower teeth.  Twenty-seven percent of men and twenty-five percent of women reported having no natural teeth (Federal Interagency Forum 2008, 101).

Obviously, periodontal disease and tooth decay, with the complication of loss of teeth, are major health concerns for the elderly population.  However, the majority of the cases of edentulousness have no apparent reason, no underlying cause or origin, other than a symptom of the aging process (Cadena 2008).

In a six-year study, it was shown that edentulous elderly in nursing homes who had no dentures had a significant deterioration of their systemic health compared to those who had twenty or more teeth. Their mortality rate was also decidedly higher. At least a major reason from this is that the loss of teeth is known to influence the mastication of foods, endangering nutritional status (Shimazaki et al 2001).

Tooth loss has also been identified as a significant risk factor for head and neck, esophageal, and lung cancers. Efforts to preserve the teeth may decrease the risk of these cancers (Hiraki et al 2008).

Another study, using self-assessed chewing ability rather than number of teeth, found that the 80-year-old subjects able to chew four foods or less ranged from 2-7 times more dissatisfied with their social interactions, physical condition, meals, and daily living (Takata et al 2006).

Apparently the functional and psychological problems can be offset to some extent if the way the elderly person looks can be satisfactorily improved. A group of elderly who were studied were interested in surgical, restorative, and rehabilitation procedures, to the detriment of preventive actions and promotion of health. This suggests that there needs to be plans to educate the elderly client in the essentiality of oral health (Unfer et al 2006).

Technological advances in dentistry have benefitted the elderly. The elderly have even better results with oral implants than younger individuals (Bryant 2005). However, some seniors may need to be reminded that having dentures or oral implants still requires care for oral cleanliness.

Speech

Slow speech and thought processes usually represent an aging change, although some diseases such as depression and Parkinson's can also cause these (Kane et al 2004).

Changes in Motor Processes

As a person ages, there are numerous anatomic and physiologic changes in their body. Several of these can affect a person's speech (Cherney 2002, 49):

·        Respiration (breath under lung pressure)

·        Phonation (opening and closing of the glottis; with Respiration, sound is produced)

·        Resonance (the sizes of interrelated cavities in the head, chest, and throat that influence volume and quality of speech sounds)

·        Articulation (the changes in shape and movements of speech organs, particularly the tongue and throat, that cause a particular verbal sound to be made)

Respiration

Expired air is the foundation for all speech. Of course, the health of the lungs is the primary aspect of respiration. However, changes in the rigidity of the spinal cord, vertebral column and disks, and rib cartilage can restrict the ability of the lungs to inhale and express air.

This can affect voice volume, the ability to adequately make some sounds, changing the voice quality to a breathless characterization; it can disturb the natural rhythm or flow of speech because the individual may need to catch his or her breath more often when speaking.

Phonation

Physical changes that can affect phonation include changes in the structure and physiology of the pharynx such as calcification of the cartilage and fatty degeneration of tissue. Either or both of the two pairs of folds called vocal cords can bow, atrophy, or swell with water retention; the laryngeal mucous glands may also atrophy. Reduced blood flow to the laryngeal muscles can affect speech, as can stiffening of laryngeal ligaments.

These sorts of physical changes cause an elderly person's voice to sound hoarse, tremulous, rough, or breathy. Men's voices may take on a higher pitch, while women's tend to sound lower.

Resonance

Nasality and denasality are determined by the size and shape of the pharynx and the nasal and oral cavities. Although such changes in these structures are not common through normal aging, other causes have been noted to affect resonance: loss of teeth (some or all), lower jaw structural changes, and decreased function of the pharynx.

Articulation

There are a number of oral-facial changes that take place as a person ages---loss of teeth, bone alterations, changes in muscles used for chewing, weakening of the facial muscles (primarily affecting the firmness of the skin), and acquiring "extra chins" through fat accumulation. These usually do not significantly alter the articulation of sounds. Sometimes if an elderly person just doesn't feel well, or if they have a disease such as Parkinson's, they may just not care to work at speaking well. If clients are becoming more unintelligible, a speech-language pathologist may be able to assist them. On the other hand, if it is severe, dysarthria must be considered (see below, Changes in Neurological Processes).

Changes in Neurological Processes

Aphasia

The term aphasia has replaced the earlier term "dysphasia" to prevent confusion with the swallowing disorder dysphagia. According to the National Aphasia Association (NAA), "aphasia is an acquired communication disorder that impairs a person's ability to process language, but does not affect intelligence. Aphasia impairs the ability to speak and understand others, and most people with aphasia experience difficulty reading and writing" (NAA 2009). Aphasia is caused by brain damage, usually from a stroke or head trauma.

The NAA recommends several things people can do to aid communication with someone suffering from aphasia:

·        Wait: Give them time to speak. Resist the urge to finish sentences or offer words unless there is a clear signal that a suggestion is welcome.

·        Be sensitive to noise. Turn off competing sounds (like radios, TVs, appliances). Keep your own voice at a normal level---shouting does not help.

·        Be open to different ways of getting and sending messages like drawings, gestures, writing, and facial expressions. Shared understanding is more important than perfect grammar.

·        Confirm that you are communicating successfully. Verify that your partner uses "yes" and "no" consistently, then use yes/no questions to check key points.

Dysarthria

Dysarthria is the name for slurred, slow, distorted speech. It is cause by lack of ability to control or coordinate the muscles used in speaking. Mayo Clinic lists the following common causes (Swanson 2008):

·      Stroke

·      Traumatic brain injury

·      Brain tumor

·      Degenerative disorders such as Parkinson's disease, amyotrophic lateral sclerosis (ALS) and multiple sclerosis

·      Conditions that cause facial paralysis or weakness, such as Bell's palsy

·      Excessive use of alcohol

·      Certain medications, such as sedatives or narcotics

The severity of the dysarthria is the guide for what treatments to use. If the individual has a mild or moderate form of the disorder, he or she can learn methods to make their speech more intelligible. Training and work towards improving physiological support for articulation, resonance, and respiration should be tried before compensatory methods are used. Compensatory techniques are those that help the individual make good use of whatever physiological abilities they still have to speak understandably.

A speech-language pathologist should be the one to guide the treatment. Possible goals of treatment are suggested by the American Speech-Language-Hearing Association (ASHA 2009):

·        Slowing the rate of speech

·        Improving the breath support so the person can speak more loudly

·        Strengthening muscles

·        Increasing mouth, tongue, and lip movement

·        Improving articulation so that speech is more clear

·        Teaching communication strategies to caregivers and family members

·        In severe cases, learning to use alternative means of communication (e.g., simple gestures, alphabet boards, or electronic or computer-based equipment)

Taste and Smell

Taste and smell are often spoken of as if they were one unit. To a great extent that is true. Approximately 80-90% of what we perceive as "taste" actually is due to the sense of smell (Kalamuck n.d.). Because our tongues only discern five true "taste sensations" (sweet, sour, bitter, salty, and umami (the taste elicited by glutamate, which is found in chicken broth, meat extracts, and some cheeses) (NIDCD n.d.), smell is the means by which we savor the complex, wide range of flavors that make our mouths water or cause us to turn up our noses.

It is rare to have a true loss of taste. When one perceives a taste loss, it is usually instead caused by a smell loss (NIDCD n.d.).

In the first massive study of loss of smell, Doty and others (1984) found that the average ability to identify odors usually peaks between twenty and forty years of age. From that point on, it begins to decline in a constant monotonic manner. They also discovered that more than 80% of those tested over age eight showed major olfactory damage. In fact nearly half of them had essentially total loss of smell. More than 60% of those individuals in the test groups between ages 65 and 80 also showed major olfactory damage, with nearly one-fourth of them being anosmic.

This study also indicated that there is compelling circumstantial evidence that these changes in smell may be due to degenerative processes within the olfactory epithelium, as well as changes in more central neural pathways.

In addition to these possibly untreatable causes, other causes include (Takahashi 2007):

·        Nasal and sinus problems (e.g., allergies, sinusitis and nasal polyps)

·        Certain medications (e.g., some antibiotics, high blood pressure medications and chemotherapy)

·        Mouth sores, tooth decay, or poor dental hygiene

·        Head injury

·        Cigarette smoking

·        Neurodegenerative diseases (e.g., Parkinson's disease and Alzheimer's disease)