Aging Flashcards
How to make food safe and palatable for the very elderly:
- Increase moisture content with sauces, custards etc - easier to form bolus.
- Soft foods (Avoid dry or crunchy food, ie flaky pastry, corn, meat).
- Hot/cold drinks/food
- finger foods (easier than cutlery)
- No mixed textures - need to have enough control to hold soupy bit in the mouth while chewing the meat and harder bits, which requires good control, so make everything one texture.
- Strong flavours, as taste is reduced in elderly.
Communication Predicament of Aging model:
- Encounter with older person
- recognition of old age cues
- stereotyped expectations
- modified speech behaviour (‘elderspeak’)
- a) reinforcement of age stereotyped behaviours b) constrained opportunities for communication (ie hostility, communication shut down)
- a) Lessened psychological activity and social interaction b) Loss of personal control and self esteem
- Negative changes in old age cues
back to 1. encounter …(giving off even more old age cues -> downward spiral)
Communication enhancement model:
- Encounter with older person
- Recognition of cues on an individual basis
- modified communication to accommodate individual needs (or not, if no special needs)
- Individual assessment for multi-focused interventions
- empowerment of client and provider
- a) increased effectiveness and satistfaction of provider
b) optimised health well-being and competence of elder - maximized communication skills and opportunities.
and back to 1. encounter with older person (who feels good about themselves and competent…)
How does language change as people become elderly?
- declines in both comprehension and production.
- 6 cognitive aging models of language processing
- 3 categories of language
1. phonology and orthography
2. Semantics
3. Syntax
What happens with phonology and orthography in aging?
PERCEPTION: 1. Decline in sensory processes: - visual and auditory acuity 2. Decline in cognition/processing: -speech in noise -speech rates PRODUCTION: 1. Decline in word retrieval 2. Decline in spelling
What happens with semantics in aging?
PERCEPTION: **Area of STRENGTH until very old age** -Slower processing of speech -better vocab (education) PRODUCTION: -Decreased density of ideas in discourse - More off-topic speech -maybe communication goals are different -> rich story telling
What happens with syntax in aging?
PERCEPTION:
- declines for text with greater sytactic complexity
- ?working memory declines
PRODUCTION:
-Decline in syntactic complexity in spoken and written language (fewer left-branching sentences)
Some challenges with diagnosing communication/swallowing difficulties in elders:
- Increased age = increased complexity *multiple medical conditions more likely.
- medication can affect communication and swallowing.
- Can be difficult to tell if swallowing changes are normal ages, or whether there is an underlying pathalogical process.
Factors which impact on speech and swallowing changes in old age:
- Tooth loss
- Tissue and muscular changes in jaw, tongue, salivary glands and throat.
- Decreased salivery glands -> reduced taste sensation -> a) decreased appitite b) more difficulty masticating c) more time taken to eat d) change in food choices -> nutritional impact.
- Decreased saliva can make articulation more difficult (speech)
What imact to respiration changes in aging have on speech, swallowing and voice?
- chest wall complience and elasticity, decrease elastic recoil of lungs
- reduced lung and airway function due to environmental exposures
- -> reduced ease of respiration affects both speech, voice and swallowing.
Cognitive Model of aging 1 - Resource theory:
Premise: Human capactiy for processing information is limited
- > Difficulty percieving a word affects subsequent mental operations such as how well it is remembered
- > Difficult perceptual operations use more resources and this drains resources from subsequent cognitive operations, including language and memory processes.
Cognitive Model of aging 2 - General Slowing theory
- > age-related declines in cognitive performance are caused by slowing of component processes (phonology, morphology, syntax, semantics, pragmatics)
- > some cognitive operations may be executed too slowly for their successful competion in the available time or their completion may spill over depeting the time available for succeesive operations.
- > cause increase in speech comprehension errors
- > slowing impairs functionsrequiring simultaneous availablity of information because information from early processes may have decayed by the time intormation from later processes is produced.
Cognitive Model of aging 3 - Inhibition deficit theory
- > aging weakens inhibitory processes that regulate attention and the contents of working memory
- > older adults’ conversations are more likely to go off topic
Cognitive Model of aging 4 - Working memory theories
- Storage and processing functions
- Older adults suffer reductions in working memory capacity and this contains ability to comprehend and produce complex semantic content and complex syntax
- Working memory is limited by capacity rather than overall processing efficiency of the language system
Cognitive Model of aging 5 - Transmission deficit theory
- Connections are strengthened by recent and frequent use, but are weakened by ageing
- Causes general processing deficits
- Linked to the atrophy of white matter (brain)
Cognitive Model of aging 6 - Degraded signal theory
- Age-related declines in sensory and perceptual processes create incomplete erroneous input
- Older adults select incorrect words or none at all
Some age-related swallowing differences:
- Increased swallow durations and some (mild) delays in initiation (that do not necessarily impact on function overall)
- Interactions between respiration and swallow
- Changes in appetite
- These issues may become more problematic when the person is unwell - decompensation
Changes in swallowing during aging -> anticipatory (before pre-oral)
¯ sense of smell
¯ sense of taste
¯ perception of thirst (men)
¯ regulation of fluid intake (men)
Changes in swallowing during aging -> pre-oral and oral phases:
¬ number of chewing strokes ¬ time to complete oral phase ¬ retention post swallow ¯ tongue driving force (necessary to propel the bolus into the oropharynx) ¯ suction pressure during straw drinking
Changes in swallowing during aging -> Pharyngeal stage:
-Delay in triggering the swallowing reflex
¬ pharyngeal transit time (women); possibly higher pharyngeal contraction amplitudes
¬ pharyngeal residue post-swallow
¬ penetration no increase in aspiration
more than one swallow needed to clear the bolus
¯ laryngeal excursion reserve (men)
¯ laryngeal and pharyngeal sensation
Changes in swallowing during aging -> Oesophageal phase:
¯ oesophageal transit speed
¯ oesophgeal clearance efficiency
¯ amplitude of the oesophageal pressure wave, but no change to duration (time) and velocity (speed) of the pressure wave.
Evidence based practice (EBP) involves integrating and utilising the best available evidence from empirical research, clinical expertise, client values and preferences, as well as knowledge of context-specific factors to make decisions about the care and management of individual clients.
STRENGTHS?
- Uses multiple sources to draw best practice from
- Provides reasoning behind therapy choices (basis for clinical judgement)
- Finds better therapy approaches
- Removing therapy approaches that don’t work
- Learning from mistakes
- Legal protection
- Best clinical practice
- Best utilisation of resources
- Includes client values (demonstrates CRP)
Evidence based practice (EBP) involves integrating and utilising the best available evidence from empirical research, clinical expertise, client values and preferences, as well as knowledge of context-specific factors to make decisions about the care and management of individual clients.
WEAKNESSES?
- What constitutes as evidence?
- Limitations to samples in research
- Need to make clinical judgement still
- Requires clinician to be proficient in literature research
- Time consuming process that may be restricted by environmental factors
- Client perspective/clinical expertise is often overlooked in favour of scientific evidence
- Some evidence on what works could work because of the clinician themselves, not the therapy approach
Family centred practice involves “Helping families to identify concerns, priorities, and resources for their child [or family member] and including them as integral members of the intervention team”
STRENGTHS?
- Families know their family best and want the best for them
- Families are different and unique
- Optimal family functioning occurs within a supportive family framework and community context
- Parents hold expert knowledge of their children