Helping Relationships With Older Adults. Adelle M. Williams

light on in darkened rooms (such as the hallway or bathroom) makes it easier to see than a regular night light (white/yellow in color) (Salvi, Currie, &Akhtar, 2005). Another common visual change in older adults is the increase of floaters or tiny black specks moving across their field of vision. These specks are bits of normal fluid in the eye that have solidified. Floaters do not significantly interfere with vision and are not a cause for concern unless they suddenly increase in number. Additionally, the eyes tend to become dry. This change occurs due to a decrease in the number of cells that produce fluids to lubricate and a decrease in tear production (Porter, 2009). Vision loss has profound effects on the quality of life of older adults, as does the loss of hearing.

      Hearing

      Conductive and sensory hearing losses occur with age. Individuals with hearing loss may be unable to hear higher tones, making consonants in speech difficult to differentiate. Other consequences of hearing loss include difficulty in localizing sound and understanding speech, usually accompanied by hypersensitivity to loudness. Common conditions in old age (ruptured eardrum, wax buildup, infection) are superimposed upon these changes, often resulting in worsening hearing impairment (Besdine & Wu, 2008).

      Hearing loss can create a psychological solitary confinement, yet many older adults with hearing loss deny the disability or the impact it exerts on their quality of life. A practitioner working with older adults experiencing hearing loss may need to ascertain the individual’s stage of acceptance. Family members who attribute hearing loss as mild or moderate inadvertently bolster the individual’s denial (Dewane, 2010).

      Older adults who are hard of hearing often report that when their hearing loss causes communication problems, it can result in difficulty thinking or concentrating. This results in inattentiveness, distraction, and boredom. The most serious consequence is withdrawal or abandoning participation in conversations. Older adults with hearing loss face many of the same fears that anyone with a disability encounters: They worry about loss of significant relationships or jobs or about being perceived as incompetent. Communication breakdown problems may show up in physical symptoms such as tension, exhaustion, and psychological symptoms (Dewane, 2010).

      Sometimes hearing loss exerts a direct impact on mental health. Depression and adjustment disorder can occur as a natural response to hearing loss and its subsequent impact on the quality of life. On the other hand, some people have premorbid mental health issues and hearing loss simply compounds the problem. Inability to hear and discern messages and their meaning can result in feelings of shame, humiliation, and inadequacy. It can be highly embarrassing to be unable to behave according to applicable social rules. The feeling of shame linked to hearing loss stems from older adults inadvertently reacting in inappropriate and socially unacceptable ways, such as responding to a misunderstood question in an inaccurate fashion (Dewane, 2010).

      Most changes in hearing are likely due as much to noise exposure as to aging. Exposure to loud noise over time damages the ear’s ability to hear. Nonetheless, some changes in hearing occur as people age, regardless of their exposure to loud noise. As people age, hearing high-pitched sounds becomes more difficult. This change is considered age-associated hearing loss (presbycusis). For example, violin music may sound less bright. The most frustrating consequence of presbycusis is that words become harder to understand. As a result, older people may think that other people are mumbling. Individuals need to articulate consonants more clearly, rather than speak louder. Many older people have more trouble hearing in loud places or in groups because of the background noise. Also, earwax, which interferes with hearing, tends to accumulate more (Porter, 2009; Talbot & Hogstel, 2001). Changes in the ability to hear impacts older adults in many ways, and the change in taste also interferes with personal well-being.

      Taste

      Taste helps all of us recognize when food is good or bad. When an elderly person loses taste, it can cause a loss of appetite, weight loss, poor nutrition, weakened immunity, and even death (Sollitto, 2015). When older persons lose the ability to taste certain foods, they may also lose interest in eating them, which could affect the amount of nutrients they consume, and they could accidentally consume food that has gone bad or contains harmful ingredients (Orenstein & Marcellin, 2015). Mental health professionals can refer older adults to a nutritionist. They can also provide ways to make meals more enjoyable by eating with others, teaching the use of herbs and spices, experimenting with new foods. Mental health professionals are able to develop programs with older persons to educate and monitor progress toward healthier dietary habits.

      Older adults will experience a reduction in their taste sensation. Taste buds diminish; perception of salty and sweet tastes decrease first, followed by bitter and sour tastes. The volume and quality of saliva diminish. Such changes combine to make eating less interesting. These aging changes are compounded by common diseases (periodontal) and medications (Besdine & Wu, 2008).

      This decreased taste sensation leads to a change in the type of foods that older people prefer. They generally like highly seasoned foods or simply more sugar or salt in food so it can be tasted. The ability to taste and smell starts to diminish when individuals are in their 50s. Both senses are needed to enjoy the full range of flavors in food. The tongue can identify only five basic tastes: sweet, sour, bitter, salty, and umami (commonly described as meaty or savory). Also, the mouth tends to feel dry more often, partly because less saliva is produced, and dry mouth further reduces the ability to taste food.

      Guided Practice Exercise 1.1 provides an opportunity to obtain the perception of taste sensation and its effect on adequate nutrition from an older adult. Adequate nutrition is critical to maintaining one’s health at all points in life.

      Guided Practice Exercise 1.1

      Visit an assisted living facility and interview an older adult regarding the changes in his or her sense of taste over time. Inquire as to what effect it has had on his or her nutritional intake and satisfaction with meals.

      Smell

      As individuals age, the olfactory (smell) function declines. Not only is there a loss of sense of smell, but also a loss of ability to discriminate between smells (Boyce & Shone, 2006). More than 75% of people over the age of 80 years have evidence of major impairment in ability to smell, and smell declines considerably after the seventh decade (Boyce & Shone, 2006). A major consequence of the loss of smell could pose a threat to the health and well-being of the older persons and other individuals within the environment. For example, if an older adult does not know that the pot is burning on the stove, a fire could develop. An older person who is unable to smell a gas leak places himself or herself in danger and potentially others in close proximity. If the elder cannot smell the freshness of food in the refrigerator, which has now spoiled, they will consume harmful foods, which may lead to hospitalization for an illness. Older persons may become depressed at the changes they are experiencing, and a mental health professional can provide counseling and referral services to manage the depression. Mental health practitioners can also provide education and support services to facilitate a continued good quality of life for their clients while facilitating coping and adaptation to their environment.

      Smell activity declines with aging. There is atrophy of olfactory bulb neurons, and central processing is altered. The result is decreased perception and less interest in food. Again, these age-related changes are compounded by disease. For example, Alzheimer’s disease (AD) and Parkinson’s disease (PD) are related to diminution and alteration of smell (Besdine & Wu, 2008). The ability to smell diminishes because the lining of the nose becomes thinner and drier and the nerve endings in the nose deteriorate. However, the change is slight, usually affecting only subtle and complex smells. Because of these changes, many foods tend to taste bitter, and foods with subtle smells may taste bland.

      The olfactory nerves are also thought to have fewer cells functioning in older adults. Because the odor of foods stimulates salivation and hunger, a diminished sense of smell often contributes to a decreased appetite. A decreased sense of smell also leads to the inability to smell danger in the environment, such as leaking gas stove burners that are not completely turned off, and spoiled food. Older adults who live alone should develop the habits of