Chapter 13 Connecting With Others

1. Chapter 13Connecting With Others

2. Rewards of Social Interaction • Sharing joys and burdens. • Deriving feelings of normalcy. • Validating perceptions. • Maintaining a link with reality.

3. Presbycusis • Definition • Age-related sensorineural hearing loss. • May cause speech to be inaudible or distorted. • Effect on Communication • May cause problems due to self-consciousness and difficulty using the telephone. • Corrective measures for hearing problems should be explored.

4. Use of Hearing Aids • Hearing aids can benefit persons with some hearing disorders, but they may not solve all hearing problems. • An audiometric evaluation can determine if the specific hearing problem can be improved by the use of a hearing aid. • A hearing aid should never be purchased without being specifically prescribed.

5. Problems Associated with Hearing Aid Use • Inability to adjust to the presence of the aid. • Distortion of sound: • Caused by the amplification of environmental noise along with speech sounds.

6. Suggestions for Hearing Aid Use • Wear the aid for progressively longer periods until comfort is gained. • Avoid its use in noisy environments. • Check the aid regularly to ensure earpiece is not blocked with cerumen and the battery is working.

7. Interventions for Patients with Hearing Deficits (Without Hearing Aids) • Speak clearly and distinctly, in a low frequency but at an audible level, while facing the individual. • Avoid shouting as it raises the high-frequency sounds that older persons already have difficulty hearing. • Cup the hands over the less deficient ear and talk directly into the ear. • Use gestures and pictures and point to items while talking about them.

8. Advocating for Hearing Safety • Provide health education about the effects of environmental noise on hearing and general health. • Take an active role in advocating legislation to control noise pollution and the enforcement of that legislation.

9. Measures for Assisting with Visual Deficits • Schedule a thorough eye examination, including tonometry, performed by an ophthalmologist. • Detects vision changes and needs for alterations in corrective lenses. • Discovers problems such as cataracts, glaucoma, and other disease processes. • Assess the financial ability of the individual to afford an eye examination and glasses.

10. Compensating for Visual Limitations • Face the individual. • Exaggerate gestures and facial expressions when speaking. • Approach the individual from the front. • Ensure that seating allows for full sight of persons or objects in the conversation. • Supply ample lighting using several soft indirect lights. • Use large-print materials.

11. Nursing Interventions Promoting Social Interaction • Review and readjust the person’s schedule to conserve energy and maximize opportunities for socialization. • Plan medication administration to accommodate social activity. • Plan fluid intake and bathroom visits prior to activities. • Promote social activity among the elderly. • Help persons of all ages see the attributes of the unique human being housed within the aged body.

12. Prejudice Toward the Sexuality of Elders • Respect for the elderly as vital, sexual beings is minimized by: • The lack of privacy afforded them. • The lack of credence given to their sexuality. • The lack of acceptance, respect, and dignity granted to their continued sexual expression.

13. Role of the Nurse in Promoting Sexuality • The myths, ignorance, and vulgar status previously associated with sex have been conferred on the sexuality of the aged. • Nurses can play a significant role in educating and counseling about sexuality and the aged. • Nurses can encourage attitude changes by their own examples.

14. Factors Contributing to Lack of Research on Sex and the Elderly • The acceptance and expansion of sexology has been relatively recent. • Impropriety was formerly associated with open discussions of sex. • There is a misconception that the aged are neither interested in, nor capable of, sex. • Practitioners lack experience in discussing sex with any age group.

15. Sex and the Older Person • There tends to be a decrease in sexual responsiveness and a reduction in the frequency of orgasm. • Older men are slower to erect, mount, and ejaculate. • Older women may experience dyspareunia (painful intercourse). • Many older women gain a new interest in sex.

16. Factors That May Interfere with Sexual Expression in Later Life • The unavailability of a partner • Ageism • Changes in body image • Boredom • Misconceptions • Physical conditions/cognitive impairments • Medications

17. Misconceptions about Sex in Later Life • Erections are not possible after prostatectomy. • Penile penetration can be harmful to a woman after a hysterectomy. • Menopause eliminates sexual desire. • Sex is bad for a heart condition. • After a hip fracture, intercourse can refracture the bone. • Sexual ability and interest are lost with age.

18. Anticholinergics Benztropine Clonidine Cytoxic agents Digoxin Diphenhydramine Guanethidine Haloperidol Phenothiazines Reserpine Sedatives Thiazide diuretics Tranquilizers Trihexyphenidyl Tricyclic antidepressant Examples of Drugs Affecting Sexual Functioning

19. Strategies to Facilitate Connections • Assist patients in evaluating current relationships. • Guide patients in becoming aware of their behaviors and responses that impact relationships. • Teach strategies that promote effective expression of inner feelings. • Provide information on sources of social activities. • Refer patients for hearing and/or vision examinations as needed.

20. Strategies to Facilitate Connections (cont.) • Respect patients’ interest and efforts to be sexually active. • Assist patients in improving sexual function. • Provide positive feedback for successful connections with others.

21. Source • Eliopoulos, C. (2005).  Gerontological Nursing, (6th ed.).  Philadelphia: Lippincott, Williams & Wilkins (ISBN 0-7817-4428-8).