Workshop/presentation by Regi Robnett, Ph.D., OTR/L, FAOTA, professor in the UNE Department of Occupational Therapy and Kathy Clarrage, COMS, Certified Orientation and Mobility Specialist for the State of Maine. Given at the North East Chapter of the Association for Education and Rehabilitation for the Blind and Visually Impaired (NEAER) conference, this presentation encouraged health care providers to work as a team to care for older, visually impaired adults. The professional audience included orientation and mobility specialists, vision rehabilitation therapists, low vision specialists, administrators in the field of blindness, social workers in the field of blindness and vocational rehabilitation counselors.https://dune.une.edu/ot_facpres/1000/thumbnail.jp

Clarrage, Kathy

Robnett, Regula H.

English

University of New England

University of New EnglandDUNE: DigitalUNEOccupational Therapy Faculty Presentations Occupational Therapy Faculty Works11-16-2016When the Challenges of Aging and VisualImpairment Collide: Working Together to Build aToolbox of Rehab Ideas of Best Care for OlderAdultsRegula H. RobnettUniversity of New England, rrobnett@une.eduKathy ClarrageState of MaineFollow this and additional works at: http://dune.une.edu/ot_facpresPart of the Geriatrics Commons, Occupational Therapy Commons, Ophthalmology Commons,and the Optometry CommonsThis Book is brought to you for free and open access by the Occupational Therapy Faculty Works at DUNE: DigitalUNE. It has been accepted forinclusion in Occupational Therapy Faculty Presentations by an authorized administrator of DUNE: DigitalUNE. For more information, please contactbkenyon@une.edu.Preferred CitationRobnett, Regula H. and Clarrage, Kathy, "When the Challenges of Aging and Visual Impairment Collide: Working Together to Build aToolbox of Rehab Ideas of Best Care for Older Adults" (2016). Occupational Therapy Faculty Presentations. 1.http://dune.une.edu/ot_facpres/1Working Together to Build a Toolbox of Rehab Ideas of Best Care for Older Adults   Kathy Clarrage, COMS & Regi Robnett, PhD, OTR/L, FAOTA University of New England   Vision—let’s review Already starts to decline in the 3rd decade Visual problems increase with age (Schieber, 2006) The common conditions...... Decreased vision as a backdrop for other impairments We often use vision to compensate….  Decreased Hearing—presbycusis   Risk factors: male, urban living, chronic noise  Men especially have difficulty hearing high pitched sounds; vowels more easily understood than consonants (Lewis, 2007)  How does ability to hear                              help those who have     difficulty seeing?     (and vice versa) https://www.google.com/search?q=i+can+hear+you+better+  Taste   Fewer taste buds, salty sense decreases, & sweet is maintained (Stalworth & Sloane, 2007)  Relate taste to sight….   Smell—hyposmia  Intricately related to taste  Insidious decline—unnoticed; majority have impaired olfaction (Murphy et al., 2002)  How are smell/taste related to visual skills?   Do not decline significantly with age alone but small declines do occur  Decrease associated with Acquired Brain Injury or Diabetes    Vision key for compensation  Last sense to go      before death? Decreased ROM and strength  Decreased balance Decreased endurance Other changes (e.g. reaction time, coordination, impact of arthritis…)  KEEP THESE IN MIND AS WE MOVE FORWARD….  General changes (not as great as you might assume)   Dementia is in your future?  Mild Cognitive Impairment is in your future?  A decline in memory is expected?  General changes (not as great as you might assume) (Robnett & Bolduc, 2015) Decreased processing speed Decreased memory (especially short term) Decreased attention (increased distractibility) Not only visual skills  (scanning and responding)  Gradual decline; typical aging still functional Life practice does help maintain skills (Salthouse, 2000)  Mild neurocognitive disorders  Amnestic disorder   Delirium  Dementia (Major Neurocognitive Disorders) (American Psychiatric Association, 2013)  Let’s explore how these impact lives      …..  Gradual onset—a change in cognitive functioning  Impacts higher level cognitive skills  “Does not interfere with capacity for independence in everyday activities” (APA, p. 605)  Not explained by another mental disorder   More likely to convert to AD   Malek-Ahmadi et al. (2012)   Determined that 4 questions on the Alzheimer’s Questionnaire were most predictive of MCI  Does the patient have trouble remembering the date, year, and time? (most predictive—OR, 17.97; p = .003)  Does the patient repeat questions/statements in the same day? (OR, 13.12;  p = .001)  Does the patient have difficulty managing finances? (OR, 11.60; p = .005)  Does the patient have a decreased sense of direction? (OR, 5.84; p = .04)   Impairments in 3 areas   Decline in memory and learning and at least 1 other cognitive domain   Prevalence increases with age (tops out at 40-50% over 85)  Approximately 2/3rd of dementias are AD   Mean survival is 10 years (3 to 20 range); younger onset means quicker progression  AD tends to progress through stages—reverse developmental    Functional Assessment Staging (FAST) Scale  Stage 1 = typical aging------Stage 7 =Very severe decline (Late Stage) 7. Very severe decline (Late Stage) http://www.ec-online/net/Knowledge/articles/alzstages.html   Higher level cognitive skills lost first   Consider developmental level of cognitive skills    DLB—Neurocognitive Disorder with Lewy Bodies  Up to 30% of the dementias (APA, p. 619)  Problems with executive functioning and complex attention (not necessarily memory)  Involves visual hallucinations and sleep disorders  Frontotemporal Neurocognitive Disorder   Behavior variant OR  Language variant (PPA)  Sparing of learning/memory/visual perception  Parkinson’s Disease  Motor component precedes cognitive component  FEATURES TREATMENT  Sudden onset   Change in baseline  Cognitive disturbance—especially attention and awareness   Often due to medical condition, medical procedure, medications  Prevention is key  Orientation  Cognitive engagement  Use of glasses, hearing aids  Active movement  Promoting productive sleep routine   HELP program (Inouye et al., 1999)  Keeping in mind the typical changes of aging  Sensory losses  Memory decline   Speed of processing  Enhancing learning skills   Adult learning principles  Motivation to learn  Engagement with the material  Multimodal learning activities   Their Needs  Patience   Success  Reminders  Occupations  Connections   Routines  Choice   Respect   The Best Friends Model (Bell & Troxel, 2002)  Treat the person as if he/she is your best friend  Looking out for the best interests of the person  AD Bill of Rights  Imagine what it is like….  Improvisation (Healing Moments)   Not meeting the person where you are, but where he/she is  Yes, and…  Affirmation—Acceptance—Validation (Lagraffe, 2016)   Helps everyone, because the goal is to understand (health) information the first time they hear it or see it   Strategies to improve understanding  Use key elements (below)  Frame what you are going to say   Use teach back methods  Ask for questions  Have client bring a friend/family member   Key elements  Important points first  Use headings   Use chunking  Use plain language—everyday words  Active voice  Short sentences   Photos and pictures  Keep it precise/concise   Size matters (Stableford, 2015)  Who is on the team?    What can we do for each other?    How can we BEST serve the client with visual impairments?  Presentation Slide Notes  Slide 2:  Schieber p 150  Slide 4: Can listen instead of reading; can lip read if one cannot hear Lewis see #89 ch 3 R and C S and S #90 Murphy p 169   Slide 11: #40 p 142  Slide 17: Behavior variant p 614 apathy inertia, disinhibition, loss of empathy, perseveration hyperorality (compulsive eating and drinking)  Slide 18:  Reference for help—A multicomponent intervention to prevent delirium in hospitalized older patients. 1999 Inouye SK, Bogardus ST, Charpentier PA, Leo-Summers L, Acampora D, Holford TR, Cooney LM. The New England journal of medicine, 340:9 (669-76)   Slide 21:  Bell, V., & Troxel, D. (2002). A Dignified Life. Deerfield Beach, FL: Health Communications, Inc. p. 137-159. References American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed.). Arlington, VA: Authors.  Baddeley, A. D. (2004). The psychology of memory. The essential handbook of memory disorders for clinicians, 1-13. Bell, V. & Troxel, D. (2002). A Dignified life: The best friends approach to Alzheimer’s care. Deerfield Beach, FL: Health Communications, Inc.  Gregory, C.J. & Sandmire, D. A. (2015). The physiology and pathology of aging. In R.H. Robnett & W.C. Chop (Eds.), Gerontology for the health care professional. (3rd ed.)(pp.  51-101). Burlington, MA: Jones & Bartlett Learning. Inouye, S..K, Bogardus, S.T., Charpentier, P.A., Leo-Summers, L., Acampora. D., Holford, T.R., …Cooney, L.M. (1999) A multicomponent intervention to prevent delirium in hospitalized older patients. The New England Journal of Medicine, 340(9), 669-676. Lagraffe, D. (2016). Improvisation with people who have Alzheimer’s Disease. Healing moments. Retrieved from: http://healingmomentswebsite.webs.com/ourteam.htm  Lewis, T.J. (2007). Hearing impairment. In R.J. Ham, P.D. Sloane, G.A. Warshaw, M.A. Bernard & E. Flaherty (Eds.) Primary care geriatrics: A case based approach. (5th Ed.) (p. 334). Philadelphia: Mosby. Malek-Ahmadi, M., Davis, K. Belden, C.M., Jacobson, S., & Sabbagh, M.N. (2012). Informant reported cognitive symptoms that predict amnestic mild cognitive impairment, BMC Geriatrics, 12(3) doi:10.1186/1471-2318-12-3.  Murphy, C., Schubert, C.R., Cruickshanks, K.J., Klein, B.E., Klein, R., & Nondahl, D.M. (2002). Prevalence of olfactory impairment in older adults. Journal of the American Medical Association, 288(18), 2307-2312. Reisberg, B. (2016). Functional Assessment Staging (FAST) Scale. Retrieved from: http://www.ec-online/net/Knowledge/articles/alzstages.html Robnett, R.H. & Bolduc, J.J. (2015). The cognitive and psychosocial changes associated with aging. In R.H. Robnett & W.C. Chop (Eds.), Gerontology for the health care professional. (3rd ed.) (pp.  103 – 145). Burlington, MA: Jones & Bartlett Learning. Robnett, R.H., Bolduc, J.J., & Murray, J. (2015). Functional performance in later life: Basic sensory, perceptual, and physical changes associated with aging.  In R.H. Robnett & W.C. Chop (Eds.), Gerontology for the health care professional. (3rd ed.) (pp.  147 – 170). Burlington, MA: Jones & Bartlett Learning. Salthouse, T. (2000). A theory of cognitive aging. Advances in Psychology 28, North Holland: Elsevier.  Schieber, V. (2006). Vision and aging. In J.E. Birren & K.W. Schaie (Eds.) Handbook of the psychology of aging. (pp. 129-161). Burlington, MA: Elsevier Inc. Stableford, S. (2015). Health literacy and clear health communication. In R.H. Robnett & W.C. Chop (Eds.), Gerontology for the health care professional. (3rd ed.) (pp. 323-336). Burlington, MA: Jones & Bartlett Learning. Stalworth, M., & Sloane, P.D. (2007). Clinical implications of normal aging. In R.J. Ham, P.D. Sloane, G.A. Warshaw, M.A. Bernard, & E. Flaherty (Eds.) Primary care geriatrics: A case based approach. (5th ed.) (p. 23). Philadelphia: Mosby.  

When the Challenges of Aging and Visual Impairment Collide: Working Together to Build a Toolbox of Rehab Ideas of Best Care for Older Adults

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When the Challenges of Aging and Visual Impairment Collide: Working Together to Build a Toolbox of Rehab Ideas of Best Care for Older Adults

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