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Tooth Wisdom:

Get Smart About Your Mouth

Sensory, cognitive and mental health changes in older adults:

Effects on communication when making group presentations

Marita R. Inglehart, Dr. phil. habil.

University of Michigan –

School of Dentistry

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Outline

▪ The changing world of aging adults and how it affects communication▪ Introduction

▪ Sensory changes:

▪ Vision & hearing

▪ Changes in cognitive abilities:

▪ Processing information and memory

▪ Changes in mental health:

▪ Affective disorders: Depression and oral health

▪ Dementia

▪ Age related changes and beliefs about health

▪ In general

▪ In oral health

▪ Prevention and health promotion

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Part 1. Sensory changes1:

Vision / hearing / smell / taste

▪ When do changes start?

▪ Hearing — the mid 40’s

▪ Vision — the mid 50’s

▪ Touch — the mid 50’s

▪ Taste — the late 50’s

▪ Smell — the mid 70’s

1 Crews & Campbell, 2004

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Changes in vision

▪ Vision changes are found in all your

group participants >65 years!

▪ In 55-64 year old: 55 of 1,000 vision

impaired

▪ In > 85 year old: 225 of 1,000 vision

impaired

▪ But the rest has issues you need to

consider

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Changes in Vision

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Vision change I

▪ Hardening of lens is uneven:

▪ Glare sensitivity

▪ Lesson learned: Older patients don’t

face window or light

▪ Be aware of vision health issues such

as macular degeneration which

makes glare sensitivity even worse

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Vision change II

▪ Cornea thickens with old age

▪ Maximum opening of pupil = reduced to

2/3

▪ Practical consequence: difficulty to

function in low light

▪ Older adults need 3 x more light than

younger adults

▪ Lesson learned: Make sure you have

enough light in the room when you

present!

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Vision change III

▪ Lens becomes less elastic = less

accommodation

▪ Difficulty in near vision

▪ Difficulty when change from far to near

vision

▪ Lesson learnd: Use strong contrasts

(example: black writing on white) for

all written information / ppt

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Becoming hard of hearing / deaf

▪ By 65 years of age:

▪ 13% advanced hearing loss

▪ 40 to 50% mild to moderate

▪ Why?

▪ Structural changes in auditory system

▪ + CNS changes

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Suggestion I

▪ Ask group members if they hear you and

find ways to help them hear you

▪ Use microphone if available and make sure

it works well

▪ Repeat questions from the audience to

make sure everybody hears questions

▪ Face your audience when you talk instead

of looking at ppt

▪ Stand close and move towards persons that

might show signs of not hearing you well

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Suggestion II

▪ Speak clearly and loud

▪ But: Not too loud because raising your voice

might result in higher pitched speech –

which might be more difficult to understand

▪ Ask participant questions to see if audience

understands or only pretends to understand

▪ Use ppt and handouts to help with

understanding information

▪ Offer written instructions to take home

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Suggestion III - Hearing aids

▪ Hearing aids are improving hearing: ▪ Based on a new Bluetooth technology designed by

Apple, there are advanced hearing aids that provide

outstanding sound quality, offer many helpful new

features, and are easy to set up and use.

▪ But:

▪ Not everybody can afford these

▪ Background noise is problem

▪ Make sure: Close door to keep

background noise to minimum

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Vision and hearing changes

▪ affect HOW you present

▪ But other sensory changes in older

adults might affect WHAT you talk

about

▪ Examples:

▪ Taste and smell

▪ Pain perceptions

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Taste and Smell2

▪ Age related changes in taste and smell:

▪ As we get older, our olfactory function declines. We

lose our sense of smell & ability to discriminate

between smells.

▪ >75% of people over age of 80 years have major

olfactory impairment

▪ which might affect taste and what they eat such over

sugary foods

2 Boyce et al., 2006

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Pain sensation3

▪ Research showed that older adults might

underreport pain because they might

think it is part of aging.

▪ They have similar pain thresholds, but

seem to tolerate more.

▪ Practical consequence: Make sure you talk

with them about seeking help when they

have pain and asking for pain medication

when procedures are done3 Herr & Garland, 2001

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Part 2. Changes in

cognitive abilities4

▪ Cognitive abilities: Information processing and memory

▪ Two competing forces: ▪ Bodily changes that lead to decline vs.

▪ Accumulation of life experiences that leads to higher competence.

▪ Result: Large individual differences

▪ Cultural effects:▪ In China: old person dies – loss of wisdom

▪ In US: old person dies – lived long life / death is ok4 Wilson et al., 2002

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Changes in

information processing

▪ Cross sectional studies (= comparing different age groups) show decline with age.

▪ WHY? Educational differences

▪ In your situation when teaching groups: be aware of health literacy issues

▪ Lesson learned: Use easy to understand terms

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Changes in memory

▪ There are different memory tasks▪ Recall: Tell me what the correct answer is.

▪ Recognition: Here is a list. Please identify which answer is correct.

▪ Older adults differ in different tasks: Recall is worse / recognition not so much!

▪ For some older adults: Recall is just slowed down.

▪ 7 to 10% of US citizens over 60: loss of memory for recent events

▪ Lesson learned: provide take home information

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Changes in information

processing: How can you help?▪ Structure information you give:

▪ Step by step

▪ Link points together

▪ Do not present too much information at once

▪ Give more time, relax, be patient

▪ Use active inquiry – teach back method

▪ Use multiple modes of presentation: talk about it and provide written information

▪ Eliminate distractions

▪ Relate it to something pt. already knows

▪ Write down main points and use external aids to assist recall

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Part 3: Changes in mental

health: Depression5

➢ According to the National Institutes of Health:

of the 35 million Americans age 65 or older:

- about 2 million suffer from full-blown depression

- another 5 million suffer from less severe forms of depression

- 15 to 20% of community living older adults have depressed mood

- 10 to 15% have depression that requires clinical intervention

- Suicide in older white males is highest of all groups

5 McFarland & Inglehart, 2010

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Depression affects oral health

▪ Loss of energy: no brushing / flossing

/ visit to dentist

▪ Dry mouth

▪ Change in types of food eaten

▪ Lower self efficacy:

▪ Self efficacy is belief in capabilities to

manage upcoming tasks

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Depression, Self Efficacy, and

Oral Health – An Exploration

▪ Survey data and chart review data were collected from 399 regularly scheduled dental patients ▪ 173 male / 226 female;

▪ average age: 50 years; range: 19 – 93 years

▪ Depression was measured with the Center of Epidemiological Studies Depression Scale (CESD)

▪ Generalized self efficacy with the General Self Efficacy Scale (GSE),

▪ Ohrqol with the Michigan Oral Health-related Quality of Life Scale – Adult Version (MOHRQoL-A).

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RESULTS

▪ The more depressed the patients were,

▪ the more decayed teeth and

▪ the fewer restored teeth they had,

▪ the poorer their subjective oral health,

▪ the worse their ohrqol was,

▪ the less saliva they had,

▪ the less often they brushed,

▪ the less often they flossed,

▪ THE LESS SELF EFFICACY THEY HAD

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Results

▪ The more positive the patients’ sense of

self efficacy was,

▪ the better their subjective oral health,

▪ the better their ohrqol was,

▪ the more often they brushed and

▪ The more often they flossed.

▪ Lesson learned: Increase sense of self

efficacy

▪ HOW? Active learning & Hands on

learning.

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SUMMARY▪ What does it mean to be 55 / 65 / 75 / 85

years of age or older?

▪ There are sensory and cognitive and

mental health changes that affect

▪ HOW you present to older adults

▪ WHAT you present to older adults

▪ BUT: OLDER ADULTS ARE MORE DIVERSE

THAN ANY AGE GROUP!

▪ Avoid STEREOTYPES – Generalizations

▪ Instead: Listen and learn!

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References

1. Crews JE, Campbell VA. Vision Impairment and Hearing Loss

Among Community-Dwelling Older Americans: Implications for

Health and Functioning. American Journal of Public Health May

2004; 94(5):823-829.

2. Boyce M, Shone GR. Effects of ageing on smell and taste. J.

Postgrad Med J 2006;82:239–241.

3. Herr KA, Garand L. Assessment and measurement of pain in

older adults. Clin Geriatr Med. 2001 August ; 17(3): 457–vi.

4. Wilson, R. S., Beckett, L. A., Barnes, L. L., Schneider, J. A.,

Bach, J., Evans, D. A., & Bennett, D. A. (2002). Individual

differences in rates of change in cognitive abilities of older

persons. Psychology and Aging, 17(2), 179-193.

5. McFarland M, Inglehart MR: Depression, Self Efficacy, and Oral

Health – An Exploration. Oral Health and Dental Management

2010; 9(4):214-222.

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QUESTIONS?

mri@umich.edu