Sensory Loss in Older Adults – Taste, Smell & Touch – Behavioral Approaches for Caregivers

As we age, our sensory systems gradually lose their sharpness. Because our brain requires a minimal amount of input to remain alert and functioning, sensory loss for older adults puts them at risk for sensory deprivation. Severe sensory impairments, such as in vision or hearing, may result in behavior similar to dementia and psychosis, such as increased disorientation and confusion. Added restrictions, such as confinement to bed or a Geri-chair, increases this risk. With nothing to show the passage of time, or changes in the environment, the sensory deprived person may resort to repetitive problem behaviors (calling out, chanting, rhythmic pounding/rocking) as an attempt to reduce the sense of deprivation and to create internal stimulation/sensations.

This article is the third in a series of three articles that discuss the prominent sensory changes that accompany aging, and considers the necessary behavioral adjustments or accommodations that should be made by professional, paraprofessional, and family caregivers who interact with older adults. Though the medical conditions are not reviewed in depth, the purpose of this article is to introduce many of the behavioral health insights, principles, and approaches that should influence our care giving roles. This article addresses age-related changes in taste, smell, and touch, and a related subject, facial expressiveness.

I. TASTE AND SMELL

A. Changes in taste and smell with aging:

1. Less involved in interpersonal communication, leading to decreased quality of life, and contributing to depression and apathy;

2. The decline in taste sensitivity with aging is worsened by smoking, chewing tobacco, and poor oral care. This results in more complaints about food tasting unpleasant or unappetizing, and sometimes causing the person to stop eating altogether;

3. With aging, there is a decline in the sense of smell, resulting in a decreased ability to identify odors. Also the person with a declining sense of smell is more tolerant of unpleasant odors, and this can be further exacerbated by smoking, some medications, and certain illnesses.

B. Effects of taste and smell changes on demented elderly:

1. Individuals with Alzheimers Disease lose their sense of smell more than non-dementia individuals, due to change in their recognition thresholds. This is because there is a concentration of tangles and plaques characteristic of Alzheimers Disease found in olfactory areas of the brains of patients with this disease, compounding the declining sense of smell that accompanies old age;

2. The impairment in the ability to distinguish flavors in foods for those with dementia results in diminished eating pleasure, and a loss of appetite. Recommendation: more attention to and greater awareness of the importance of eating, and reminders of having eaten, which can minimize the risk of malnutrition and dehydration;

3. The impaired sense of taste and smell can result in a serious inability to sense danger, such as gas leaks, smoke or other odors, which would obviously interfere with taking necessary steps for safety. Also, problems with taste may cause the person to overcook or use spoiled foods, raising the risk of food poisoning. Recommendation: use smoke detectors, clean out refrigerators regularly, and check drawers for food hoarding.

II. TOUCH

A. Changes in sense of touch with aging:

1. The sense of touch includes perception of pressure, vibration, temperature, pain, position of body in space, and localization of a touch. Some of this sense of touch diminishes with aging, but affects no more than 50% of older adults;

2. The most pronounced changes occur in the feet, and changes become less apparent as we move up the body. A decline in the sense of perception in the feet contributes to increased danger of falling or tripping over objects. Changes in hand sensitivity will often lead to dropping of objects;

3. Because the sense of touch is the most intact of all senses in older adults, and least impacted by advancing years, it can be the more important means of communicating, whether to gain his or her attention, to reassure him or her, to let the person know that you are there to help, and to guide the person in an activity;

4. Touch is therapeutic since older adults may be touch deprived. In medical and institutional settings, such as nursing homes, there may be even fewer opportunities for touch and physical contact. Recommendation: take extraordinary steps to make appropriate physical contact with the older adult for reassurance, to gain attention, to confirm communication, and to provide a greater sense of safety and security.

III. FACIAL EXPRESSIVENESS

1. Some neurological disorders, like Alzheimers
disease, Parkinsons, and other types of dementia result in decreased facial expressiveness. This makes it difficult to discern emotional reactions or expressions that would otherwise be apparent in those without such disorders;

2. Because we depend so much on non-verbal communications and facial expressiveness, it is difficult to know if the other person is hearing and understanding what we are communicating. This makes it less enjoyable and less rewarding to communicate with someone who does not show the expected emotional reaction, such as a smile, a laugh, a grimace, or even a shrug.
Recommendation: even in the absence of facial expressiveness, do not avoid communicating with this person, but do not be upset or disappointed when the emotional reaction does not appear. Caregiver disappointment and rejection only contributes further to apathy and withdrawal.

PRINCIPLES FOR CAREGIVERS

The following principles apply to caregiving approaches with older adults who have diminished sensory function. Increased sensitivity and insight to the needs of these individuals improves their quality of life and improves our effectiveness:

1. Observe his or her behavior, and look for cues and signs of pain or discomfort;

2. Help the person work through the emotional impact of the sensory changes, allowing expression, acceptance, and support of the grief and sadness accompanying these losses;

3. Do not try to fix the unpleasantness; acceptance and support goes a longer way toward healing than a quick fix or a patronizing attitude;

4. Reduce excess disability by maximizing whatever functioning is still left, such as proper eyeglass prescriptions, or functioning hearing aids;

5. Consider assistive devices (phone amplifiers, large text books, headphones, and the Braille Institute for a variety of useful visual aids).

6. Remember that the need for touch increases during periods of stress, illness, loneliness, and depression;

7. Touch is especially important when communicating with blind, deaf, and cognitively impaired individuals;

8. Use touch often, but only to the extent that the person is comfortable with it;

9. Do not give the person a pat on the head, or a tap on the cheek, as this can be perceived as condescending.

Normal aging brings with it a general decline in sensory functioning. To minimize the emotional, behavioral and attitudinal impact these losses have on older adults, caregivers should develop insights and approaches that take the special needs into account, and try to turn unpleasant, frustrating situations into more caring, helpful, and sensitive interactions. As caregivers can integrate behavioral principles in the delivery of the health care with older adults, we can have a positive impact on the management of these losses.

Copyright 2008 Concept Healthcare, LLC

Overview of Financial Barriers to Integrated Behavioral Healthcare Reform

There are many complexities associated with the financial and structural barriers to integration in mental and behavioral healthcare. For example, there has been considerable discussion about whether behavioral healthcare should be “carved-in” or “carved-out” when states or other purchasers make purchasing decisions. Some “carve-out” models have been customized to support clinical integration efforts, while some “carve-in” models have had the effect of reducing overall levels of behavioral healthcare spending and services, especially for the population with serious mental illness.

Treating depression in a Primary Care setting is a key factor in the financing issue. Many privately funded, national programs have been created with the goal of increasing the use of effective models for treating depression in primary care settings. Importantly, these programs addressing the impact that financial and structural issues that are being proposed will affect Medicare and Medicaid, as well as other clinical models. Many of the issues these programs raise speak directly to the financial and policy barriers in our existing behavioral healthcare system.

The clinical interventions that have been so successful in controlled research environments have proved difficult to sustain in the rough and tumble of daily practice. Existing financial and organizational arrangements are thought to impede incorporation of evidence-based depression care into routine practice. Common problems include the inability of primary care providers to bill for depression treatment (in the context of behavioral health care carve-out programs) and the absence of payment mechanisms for key elements of the collaborative care model such as care management and psychiatric consultation services. Also, since appropriate care of people with depression typically involves more time than the average case, primary care providers reimbursed on a capitated basis or rewarded for the number of patients seen may opt to refer patients to specialty care that could be treated successfully in primary care. Fragmentation in financing and delivery of care due to managed behavioral health carve-out contracts, multiple health plan contracts, and separate prescription drug budgets contribute to and reinforce tendencies to avoid attending to cases of depression using evidence-based practice.

While these demonstration programs pursued similar clinical innovations consistent with the collaborative care model, they adopted strikingly different approaches to altering the economic and organizational environment surrounding the primary care treatment of depression. Variation in the economic and organizational strategies across sites reflects both contextual differences in local delivery systems, as well as distinct judgments about which organizations should take responsibility for spearheading and financing quality improvement. Developing an economic and organizational strategy also proved to be significantly more difficult to conceptualize and implement compared with changes in clinical practice.

Many of the observations regarding financing and policy made by privately funded organization continue to be true as we move closer to integrated behavioral healthcare reform. However, only after major financing issues are addressed will we be able to turn these observations and recommendations into a functional system.

Behavioral Health – Personality Development Through Dream Therapy

Your dreams are more important than what you may imagine. The psychiatrist Carl Jung managed to prove to the world that our dreams are produced by a wise unconscious mind that works like a psychiatrist and psychologist. He discovered the meaning of the mysterious dream language after conducting arduous research. Jung also discovered how to use dream therapy in order to help people completely develop their personality.

Our dreams reflect the way we conduct our lives, (our behavior and subsequent health concerns). They can also denounce the existence of a mental illness, which threatens our mental stability and distorts our behavior.

I continued Jung’s research discovering that the unconscious mind which produces our dreams always tries to protect the human side of our conscience because we have inherited an absurd content in our brain.Jung ignored the existence of the anti-conscience, the violent and wild side of our conscience, which remains in a primitive condition. This is why he couldn’t completely understand the unconscious psychotherapy.

The anti-conscience provokes all existent mental illnesses and mental disorders found within the human side of our conscience. It is therefore responsible for the appearance of abnormalities in our behavior, since the anti-conscience’s absurdity influences not only our thoughts; it influences our reactions as well.

My discoveries complete Jung’s pioneer research, giving you all the answers you need. I simplified his complicated method of dream interpretation, transforming it into a simple method of instant translation from images into words. You will understand all dream messages because now you can see the entire content of your brain and psyche.

By following dream therapy you completely develop your personality and all your capacities, while eliminating the negative components you have inherited. Your wild roots are absurd, violent, selfish, and immoral. You must tame your wild side and transform it into positive human content that will help you achieve all your goals. This means that you have to transform the selfish and violent behavior that is part of your animal nature into positive and balanced human behavior.

You may believe that you are balanced because you are used to following the aggressive behavioral patterns associated with violence. These patterns have formed the mindset of our civilization. What you consider as being a balanced and normal behavior could be an indifferent and cruel maladaptive reaction to any given situation. This maladaptive behavior should in fact alarm you.

Your conscious experience is limited and you have no idea about what perfect mental health really is. Therefore, you are incapable of discerning the clear indications of personality disorders and mental illnesses in someone’s behavior.However, you can have a very clear vision about your mental state thanks to the lessons and explanations that the unconscious mind will reveal to you through your dreams.

You only have to study my simplification of the dream language in order to be in contact with a wise unconscious mind that answers all your questions in dreams. You’ll build a fascinating unique personality. You will also pass through a process of spiritual evolution. In addition, you will learn the importance of wisdom, and the true meaning of life.

If you have no time for studies but you see vivid dreams, recurring dreams, or nightmares, send me your dreams for a professional dream translation so that I may immediately help you with my knowledge.

Later, you’ll certainly want to study the dream language independently using my dynamic method. You will no longer need to depend upon me in order to understand the meaning of your dreams. You’ll have the free guidance of the wise unconscious mind always helping you throughout your life.

Mental Health Services – Providing Tools That Help You Tackle Life’s Challenges

If you have been battling anxiety, depression, anger, grief, relationship problems, or substance abuse you can receive mental health services from a trusted and reputable charity organization. The behavior health services you can receive are by professionals who are licensed, trained, and highly qualified. No matter what your problems, there is a solution for you out there. Some of the amazing behavioral health services you may be able to receive can include:

• Premarital preparation
• Domestic violence group counseling
• Substance abuse treatment
• Individual, family, and child counseling

This charity organization may collaborate with other partners and agencies to meet the different needs of communities and clients which may include state and local funding contracts and sources to deliver services.

Many charity organizations provide assistance for families and individuals regardless of their religion or background. These professionals can provide help to those who need in which may include, but not limited to, mental health services. The well – trained staff at this charity organization is committed to empowering individuals and improving their lives by helping them reach their goals.

This type of organization works to create a safe and nurturing family environment for both adults and children in addition to improving the community by specific outreach programs. The emphasis of this organization is child welfare, community outreach, mental health services, and family preservation. The community outreach programs may consist of pantry and food programs in addition to social ministry goals. The behavioral health programs may consist of programs that will provide child safety such as foster care and adoption. The family preservation programs offered by the charity organization may include programs that will strengthen families.

A nonprofit organization is one that typically relies on the generosity of many volunteers, corporation, families, foundations, and individuals. The mental health services you may be able to receive to include foster parenting, volunteer service, financial contributions, and donations.

If you are in need of family counseling from the charity organization, a highly trained therapists can provide you, your child, or entire family with the therapy support and counseling you need. Everyone goes through periods when they need someone to help them sort out their feeling and thoughts, and organization can do just that.

If you are dealing with issues that may cause you to need mental health services, you can contact a reputable services, charity organization and see if they can provide you with the help you need.

Start a Pet Exercise Plan and Increase Health, Behavior and Longevity

When it comes to exercising, it’s probably not something you get very excited about. However, pet exercise might be one of the most exciting things in a dog or cat’s life. Most of them love to run around and be active, especially if they’re healthy. The key to keeping them healthy and energized is to exercise them, and they cannot always do this by themselves.

Exercise varies between dogs and cats. They cannot do the same exercises due to different body sizes and behavior. For example, a dog can run around a fenced back yard but this is unlikely for an indoor cat.

The first step in beginning a pet exercise plan is to talk to your vet. Take them in for a check-up to make sure there are not any underlying issues that could put their health at risk. Veterinarians can also help you determine which kind of exercise is best for your dog or cat. Some types of exercise they might recommend for dogs are:

• Walking/Jogging/Running

• Swimming

• Playing fetch, tug of war

One really great option in terms of dog toys is Zogoflex. These toys are guaranteed tough toys… so tough that they offer a money back guarantee. They have found that even for those skeptical pet parents of “power chewers” only 1% of customers return their toy and most of them request a replacement as opposed to their money back. Zogoflex has a great toy called the Zogoflex Tux which you can hide a treat in and toss. This is a great way to offer a treat while also getting your dog up and running after a toy in a game of fetch.

Just like humans, when starting a pet exercise plan, you need to start slow. On the first day you might want to keep the activity to 10-15 minutes and build up to 30-60 minutes. Regular exercise is important, so make sure to keep your dog active most days of the week. It is important to keep a close eye on your dog during exercise. If you notice that he/she is having unusual signs of fatigue or trouble breathing, it’s probably a good time to stop. If your pet wants to stop, stop! Dogs that overdo it could suffer several orthopedic problems. Make sure to stay aware of your surroundings and wear reflectors if you bring your pet outside at night to ensure safety. Always keep your dog hydrated. Dehydration can be detected through lack of skin elasticity, dry gums, sunken eyes, dry nose, too much or too little urination and lethargy. They will need more water when exercising in very warm weather conditions.

So, what about cats? It’s hard to take them out for daily walks, but there are plenty of other ways to get them their exercise. Here is a list of ways to keep them active below:

• Keep things that can be hit and chased around the house, such as yarn balls.

• Keep things that can be climbed on/up and scratched around the house, such as empty boxes, paper bags, scratching posts, etc…

• Outdoor cats get exercise by walking

Cat exercise is a bit different than dogs. They’re bodies can handle short, frequent periods of intense activity, rather than long, slower-paced exercise sessions. Make sure that the exercise “accessories” that you give your cat cannot be choked on or cause suffocation. This can happen accidentally but the best way to prevent it is by keeping a close eye on your cat and its environment.

Pet exercise can help to prevent a number of health issues, especially with the heart and lungs. Also, it can help relieve joint and bone problems such as arthritis. If you find that your pet is suffering from joint pain so has trouble with exercising, or if he has been diagnosed with arthritis, you can supplement with something such as Duralactin which will help alleviate joint pain.

Behavior, health and life span can be improved with a pet exercise plan so get out there and start today!