Create sensitivity to the elderly’s sensory changes

Inservice on aging does the trick

Sometimes home health aides and nurses forget how differently their elderly patients experience day-to-day life. The perfect hearing, vision, and mobility that young and healthy people take for granted are eroded over the years. By the time people reach 70 or 80, their perceptions may be markedly different from those of younger people.

Columbine Home Health Service in Fort Collins, CO, employs a nurse practitioner who has conducted seminars and inservices on aging to educate the public and health care professionals about the sensory changes that affect the lives of elderly people.

"Sensory changes substantially alter the lifestyle and independence people once took for granted," says Barb Hope, RN, C-GNP, nurse practitioner for the full-service agency, which serves a college town and several small communities surrounding the city.

"Aging is an individual process in any stage of our development, and not all changes occur to the same degree," she says. "But these changes do affect the quality of life."

By giving an inservice on sensory changes in the elderly, home care educators help their staff understand what these changes are and how they affect the provider as he or she cares for the patient. Hope provides this outline of the important sensory changes:

1. Vision changes.

Ninety percent of people over age 65 experience some changes in their vision, Hope states. They may experience decreased visual acuity, decreased tolerance to glare, difficulty in night driving, and decreased peripheral vision.

Also, colors look different to older people. "The blues, violets, and greens are seen less well, and the reds, yellows, and oranges are better seen," Hope says. "Sometimes this is a problem with seniors driving because they may not see a green light as readily."

Home care staff can help patients adjust window shades to reduce glare. They also should educate patients and families about these vision changes, so if elderly clients choose to drive, at least they will be aware of potential problems.

2. Hearing loss.

Loss of hearing is a common affliction of age, Hope says. "Auditory changes that occur gradually can be devastating since hearing is the major avenue of communication."

First, seniors may lose the ability to hear some high-pitched sounds. Women and children, whose voices are higher-pitched, may be harder to understand for all older people. "To compensate, I usually teach people to speak low and slower," she says. "You can lower your voice."

Aides and other providers should learn to not raise their voices when they believe someone is having difficulty hearing them. When people raise their voices, their pitch goes up. Instead, they should speak lower. Eliminating background noises when speaking to an elderly person helps as well. "Also, directly face the person because often people can lip read, even if you don’t recognize that they’re doing that," she says.

Few people who could benefit from hearing aids actually wear them. Their hesitancy may be fueled by the social stigma. Health care professionals may encourage seniors to wear their aids.

3. Taste sensation.

Usually people experience some decrease in the ability to taste with age. While this decrease may begin after age 40, it usually is not perceptible until a person is over 60. "We have taste receptors for salt, sour, sugar, and bitter, and they tend to disappear as we get older," Hope says. "Our foods contain a mixture of those tastes, and sometimes we find that older people will over-sweeten or over-salt their foods because it takes much more seasoning to get the same taste."

This can be a problem if the person has high blood pressure or is diabetic. "I usually suggest that often we have a belief that older people just need bland diets because they can’t tolerate anything else," she says. "When usually they prefer using a little spice because it makes their food taste better."

If home care professionals find that a patient isn’t eating well, it might be a matter of experimenting with the diet to find better-tasting foods. It’s a good idea simply to ask if patients would like a little spice on their food and then give them a taste of the food with the extra seasoning.

Another change in the mouth involves a decrease in saliva output, which can lead to an inability to moisten food adequately. Home care aides can recommend seniors drink fluids with their meals to improve the moistening effect and prevent choking.

4. Progressive loss of smell.

Typically after age 50 or 60, people begin to lose their sense of smell; this affects men more than women, Hope says. "This might present itself as a person who uses too much perfume or aftershave. Some people may not be aware of their own body odor or incontinence because of the loss of smell."

Home care staff might mistakenly attribute such problems to mental confusion, when they could be caused by a diminished sense of smell. Home care aides and nurses need to be aware that their elderly patients could be keeping food in the refrigerator too long partly because they no longer can determine by smell that a food has spoiled. "So I usually tell aides to look through the refrigerator and see if there’s anything that looks like it’s spoiled," Hope says, adding that they should ask for the patient’s permission first.

5. The need for touch.

Touch remains an important part of each person’s senses throughout life, she says. "It’s so easy to reach out and touch a baby, and you almost cannot help doing that. But an older person perhaps needs that touch even more, and we’re less inclined to do that."

This may not apply to every patient, because some will need more personal space than others. But, in general, home care professionals could try a little touching when visiting with an elderly patient. For example, they could give the patient a hand massage or shoulder rub. Some people are comfortable with hugs, but others are not. Often, a simple touch on the hand will suffice.

Pets often meet this need for touch, which is the reason pet therapy is becoming so popular in hospices and nursing homes. "We’ve instituted it here in a big way in our assisted-living facility, and amazingly enough, I think the staff benefits as much as anyone," Hope says.

6. Muscle changes.

People lose muscle mass as they age, and with that they lose some strength and endurance. For this reason, home care aides and other staff should emphasize exercise and encourage patients to follow their prescribed exercise programs.

Home care educators should encourage staff to participate in the patient’s exercise program rather than take away any tasks of daily living the patient may be able to do alone, she suggests. For example, rather than going to the kitchen to pour a glass of water for a patient, an aide could encourage the patient to walk to the kitchen and pour his or her own drink.

7. Skin changes.

Skin changes as people age because body fat is distributed differently. It tends to leave the periphery — such as the arms and legs — and center more in the middle. "We find skin on hands and arms that takes on a fragile appearance, and it tends to tear very easily," she explains.

An elderly patient’s skin also may bruise more easily. Home care aides need to be aware of these types of differences so they are more sensitive and gentle in touching elderly patients to prevent tearing or bruising the skin.

The loss of some fat beneath the skin also may cause an elderly person to be more sensitive to cold. That’s why the elderly are at greater risk for hypothermia in the winter. Home care staff could encourage elderly patients to not turn their thermostats down too low at night. For example, setting the thermostat at 60 may be too cold.

Also, similar problems may occur in the summer. Because elderly people lack some fatty insulation, they are at greater risk for heat stroke, Hope says. "Their bodies don’t cool and warm up according to an internal mechanism as well as ours do. If aides notice a home is too hot, they should ask if the patient has a fan that they could set up for the patient."

8. Senility.

Health care experts no longer believe senil ity is a normal part of the aging process in the absence of disease. But some elderly patients disagree, she says. "I think our aides can be helpful in encouraging clients to keep their minds active, to watch news programs, to read if they’re able, and to do puzzles or whatever they are able to do to exercise their minds. Then anything aides see as a change in a patient’s mental status could be related to some other problem and should be reported."


Barb Hope, RN, C-GNP, Nurse Practitioner, Columbine Home Care, 947 Worthington Circle, Fort Collins, CO 80526-1841. Phone: (970) 482-5096. Fax: (970) 224-2518.