Educating the “Sensory Challenged”
Presented by:
Christina Williamson, OTR
Geriatric Occupational Therapist
A. Touch/Tactile Sensory System:
Conditions that may affect the elderly:
1. Diabetes- Can lead to damage to the nerves that extend out to the
extremities causing sensory loss in hands/feet. Referred to as Diabetic Neuropathy.
2. CVA/Stroke- Can cause one-sided sensory loss of varying degrees.
Can be accompanied by loss of “proprioception” or awareness of position in space.
3. Peripheral Nerve Injuries- Trauma or injury to the nerves the supply
sensory and motor feedback to the extremities. The three main nerves that supply the arm/hand are the Radial nerve, the Median nerve, and the Ulnar nerve. Injuries often work related or due to
cumulative trauma, however; dialysis/renal patients that have shunts placed in their arms often develop peripheral nerve related trauma.
Some Facts About Tacile Sensory Loss:
• Certain medications and/or vitamin deficiencies can lead to loss of sensation.
• Care must be taken to avoid burns from stove, hot water etc.
• Skin on feet should be monitored for sores, breakdown.
B. Sight/Visual Sensory System:
Conditions that may affect the elderly:
1. Macular Degeneration- Deposits collect in Macular region of eye
causing possible object distortion, decreased visual acuity, increased
glare sensitivity, decreased color vision and decreased contrast
sensitivity.
2. Glaucoma- Disease characterized by increased intra-ocular
pressure which can lead to damage of the retinal nerve fibers and
possible blindness.
3. Cataracts- Opacity of the lens, its capsule or both which causes
“cloud like” vision.
4. Diabetic Retinopathy- Diabetes related visual loss. Can be
detected and treated more successfully with early intervention.
5. Diplopia- “Double vision” occurs when both eyes are used but not in
focus. (The more distant appearing object usually true image).
6. Visual Field Deficits- Usually associated with neurological conditions
such as stroke. Often a portion of the visual field or area within sight is absent or decreased such as with “homonymous hemianopsia”.
Some Facts Related to Visual System Sensory Loss:
• Visual impairment becomes more prevalent with age.
• Routine screening promotes early detection and treatment for most diseases.
• Among nursing home residents age 65 or older, nearly one-half are reported to have some problems with vision including 35% with mild to moderate visual limitations and 13% with severe loss in visual function.
• Among persons who are legally blind, 51.7% are age 65 or older.
• For efficient visual function, a person age 65 or older requires three times the amount of light required by a 20 year-old.
C. Hearing/Auditory Sensory System:
Conditions that may affect the elderly:
1. Aucuostic Neuroma- Damage to the aucoustic nerve causing partial
or total hearing loss of the involved ear.
Some Facts About Auditory Sensory Loss:
• Nearly all Americans over age 65 have substantial amounts of hearing
loss in the high-frequency range.
• In countries and cultures in which people aren’t exposed to loud noises,
and eat low fat diets, there is minimal hearing loss.
• Damage from loud noise is cumulative, so the best way to prevent or
slow damage is to wear hearing protection.
• The semi-circular canals located in the inner ear are responsible for equilibrium and assist with balance control. Impairments to this system can lead to many other problems including Vertigo.
D. Smell/Olfactory Sensory System:
The sense of smell diminishes with age. Heredity, injury or nutritional deficiencies often are behind the loss of smell. Zinc is especially important to preserve it. Odors can be pleasing and have a calming effect on a person, or can be noxious and have an arousing effect. Smell is closely related to taste.
E. Taste/Gustatory Sensory System:
The sensory “taste” receptors on the tongue distinguish between the tastes of sweet, sour, bitter, and salty. Several factors contribute to loss of taste, such as nutritional deficiencies, poor oral hygiene, smoking, dentures, and yeast infections in the mouth. Taste buds can be damaged by burning the tongue with hot foods and are also known to shrivel with age. These factors can lead to changes in appetite. Zinc, Vitamin A, Niacin have been determined to keep taste buds functioning well. Increasing use of condiments may improve loss of appetite for elderly persons.
What Can We Do to Improve Education to the Sensory Challenged?
A. Environmental Factors:
1. Be sure that there is adequate lighting in the room.
2. Eliminate/reduce background noise and disturbances.
3. Control room temperature for maximum comfort or provide blankets
or sweaters for temperature regulation.
4. Placement of participants within the room is of extreme importance.
Circles allow for the best access.
5. Attempt to have assistance if more than 7 or 8 participants in group.
6. Check to see that participants have glasses, hearing aides or other
other sensory compensation items.
*Enlist the help of Activity Director, Social Service, or Nursing
to assist with these areas. It may greatly enhance the success
of your session.
B. Communication Factors:
1. Speak slowly and distinctly.
2. Gain the attention of person(s) before speaking.
3. Speak facing person(s), at the same level if able.
4. Speak no more than 3-6 feet away from a person.
5. Rephrase unfamiliar statements rather than repeating over and
over in a louder voice.
6. Speak in normal fashion without shouting.
7. Wearing lipstick may add to the ability of person to “read your lips”.
8. Do not eat, chew or cover your mouth when speaking to the elderly.
9. Provide multiple opportunities to hear, read, and write information
to assist in the learning process. Many persons are too proud to
admit that they have not heard or understood what you said.
10. Pause for questions especially if person(s) look puzzled.
11. Any reading material should be large type and bold print. This
font, called “Arial”, is very easy to read. Highlight key points.
12. The elderly may have problems locating and reading moving signs
or objects, as well as adapting to dim light or sudden glare. A
video program may, therefore, not be an appropriate teaching tool
for some.
13. Present information using a variety of formats such as posters,
tape cassette players.
14. Do not present material too quickly. Attention span may be
limited to approximately 30-45 minutes.
15. Be aware that information is often processed efficiently but more
slowly by the elderly. It may take longer for them to absorb
pertinent facts. BE PATIENT!
C. Appropriate Choice of Activity/Content of Information:
1. Be aware of “age appropriateness” of material, music etc.
2. Seek activities/material that are “intrinsically motivating” to the
particular group. Elderly often enjoy items/material pertaining to
their youth such as:
a. Photos/discussions of their youth
b. Photos/discussions of previous employment, family duties
c. Reminiscence activities
d. Trivia/Information from their past (Elder Trivia)
3. Provide experiences that are stimulating to multiple sensory
systems. Some items meeting this criteria but not limited to:
a. Flowers/brightly colored plants (non-allergic in nature)
b. Animals that are easily managed/held
c. Food/food related activities
d. Music-especially live performances
4. Activities/Games that encourage “friendly competition” are often
enjoyed by the elderly. Some ideas include:
a. Bingo
b. Balloon Volleyball
c. Word Search games
d. Cards
e. Trivia Games
5. Exercise. Can greatly benefit the elderly. Most people can
participate on some level. Attempt to make fun and enjoyable.
D. Ability to Adapt/Alter Methods and/or Material To Meet Needs:
1. Cultivate the ability to alter your teaching style, material, activity
to meet the needs of the group participants. May include such things as:
a. Reorganizing placement/seating of people in room.
b. Sensing frustration in participant and altering activity to encourage and maximize their success and enjoyment.
c. Eliminating or restructuring your presentation based on
response/feedback from group.
d. Spending more time in preparation of materials.
e. Altering time of groups/presentations to better meet the needs
of elderly population or the facility.
Be aware that even though a person may not outwardly appear to be enjoying or participating in your session, they may be benefiting greatly from the interaction, stimulation and company. Even non-verbal or confused patients can usually find a way to communicate if they truly want to leave.
Be enthusiastic and encouraging. It’s contagious!
References and Resources:
California State Library
Braille and Talking Book Library
P.O. Box 942837
Sacramento, CA 94237-0001
(916) 654-0640 Toll Free 1-800-952-5666
Lighthouse for the Blind and Visually Impaired
214 Van Ness Ave.
San Francisco, CA 94102
(415) 431-1481
Fax (415) 863-7568
The Hearing Society
1428 Bush Street
San Francisco, CA 94109
(415) 775-5700
ElderGames (Elder Trivia and other products designed by
11710 Hunters Lane professionals in gerentology).
Rockville, MD 20852
(301) 881-8433
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Contributor's Note
When I present this inservice, I often have audience put on rubber gloves and attempt tasks such as buttoning, cover their eyes with celophane,and put cotton in their ears. By the end of the inservice they have a direct experience of what it might be like to have loss in multiple sensory systems and have often gained empathy and patience for the elderly!
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