3. Objectives
✘ Describe normal sensory and cognitive functions.
✘ Describe how sensory perception and cognition change
with aging.
✘ Examine the effects of disease processes on perception
and cognition.
✘ Describe methods of assessing changes in perception
and cognition.
3
4. Objectives
✘ Identify current nursing diagnoses related to cognitive
and perceptual problems.
✘ Select nursing interventions that are appropriate for
older individuals experiencing problems related to
perception or cognition.
✘ Discuss pain assessment and management as they
relate to older individuals.
✘ Identify older adults who are most at risk for
experiencing perceptual or cognitive problems.
4
5. COGNITIVE-PERCEPTUAL HEALTH
PATTERN
- deals with the ways people gain
information from the environment and
the way they interpret and use this
information.
- Cognition and perception are
intimately connected to the
functioning of the central nervous
system and the special senses of
vision, hearing, touch, smell, and
taste.
5
6. ✘ Perception includes the collection,
interpretation, and recognition of
stimuli, including pain.
✘ Cognition includes intelligence,
memory, language, and decision
making.
6
COGNITIVE-PERCEPTUAL HEALTH
PATTERN
8. ✘ Older adults are increasingly
susceptible to misperception and
therefore misinterpretation when
one or more of these changes are
present.
8
9. COMMON CHANGES
USUAL VISUAL CHANGES
✘ Presbyopia
✘ Farsightedness
✘ Decreased ability to respond to changes in
light, resulting in night blindness
✘ Cataracts, which cloud the lens and result
in blurred vision and sensitivity to glare
9
12. COMMON CHANGES
COMMON AUDITORY CHANGES
• Loss of hearing acuity, particularly of
higher-pitched sounds (presbycusis)
• Loss of hearing resulting from decreased sound
transmission (otosclerosis)
• Ringing in the ears (tinnitus), which can be
caused by Ménière disease, age-related changes,
or medications
12
17. ✘ Cognitive development starts at the
time of birth and perhaps even earlier.
When the human brain is repeatedly
exposed to stimuli, connections
develop between nerve fibers of the
cerebral cortex.
17
18. ✘ Each time stimuli are introduced to the brain, they
are associated (at an unconscious level) with the
pool of facts, memories, and experiences that are
stored there. Once these connections are firmly
established, information is said to be learned. Once
learning has taken place, information or skills can
be retrieved as needed.
18
19. ✘ Memory enables people to retain
and recall previously experienced
sensations, ideas, concepts,
impressions, and all information
that has been previously learned.
19
20. ✘ The human mind is extraordinary in its
ability to learn and process extensive
amounts of information.
✘ It is able to retrieve information on
demand, correlate random pieces of
information, make judgments, solve
problems, and create ideas.
20
21. COGNITIVE AND INTELLIGENCE
✘ FLUID INTELLIGENCE
✗ The ability to perform tasks or make
judgments based on unfamiliar stimuli.
This is sometimes referred to as the
ability to “think on your feet.”
21
22. ✘ Crystallized intelligence (often called wisdom) is
the ability to perform tasks and make judgments
based on the knowledge and experience acquired
throughout a lifetime.
22
24. ✘ Intelligence is often measured by means of tests.
✘ Intelligence tests are normally timed. Because all
individuals do not process information at the same
speed, two individuals with a similar pool of knowledge
and skills may be judged very differently, simply
because they respond at different speeds.
24
25. ✘ Those with a rapid rate of information
processing are typically judged as more
intelligent than those who take longer to process
information, even if the end result is the same.
This is probably reflective of our culture, which
values speed.
25
26. ✘ Most written tests measure verbal and mathematic
ability. Thus, a person who has had little formal
education can have a high level of cognition and yet
score poorly on standardized intelligence tests.
✘ Cognition is not the same as education.
✘ Cognition is the ability to think and reason. Many
people have good cognitive skills but limited
education
26
27. ✘ Cognition is the mental process of acquiring
knowledge and understanding through thought,
experience, and the senses, while intelligence is
the ability to easily learn or understand things
and to deal with new or difficult situations.
27
28. COGNITION AND LANGUAGE
✘ Language is a product of cognitive function.
✘ In both spoken and written forms, language
allows humans to communicate ideas and
thoughts.
✘ Sensory and cognitive problems can result in
poor language development or loss of language
skills.
28
29. aphasia
✘ What is the condition that refers to the
damage to the language centers of the
brain, a condition in which people are
unable to understand or express
themselves through language?
29
30. ✘ Aging people commonly experience sensory
changes that interfere with the collection of
information. Visual and hearing changes,
changes in taste and smell, and changes in touch
and sensation all interfere with the ability to
collect accurate information from the
environment.
30
31. ✘ Many older people who are considered confused
actually perceive their environment inaccurately.
An older person who does not hear well or see well
may walk into traffic or make mistakes about
directions; these mistakes are not made because of
confusion, but rather because the person does not
have enough sensory information to make an
appropriate decision.
31
32. ✘ Multiple competing stimuli can also
cause problems if older adults are
unable to focus on the important stimuli
and disregard nonessential stimuli.
32
33. ✘ Intelligence does not automatically decrease with
aging, nor does the ability to learn.
✘ The speed of information processing and recall by
the brain changes with age.
✘ It is common for older adults to take longer to
recall a specific piece of information.
✘ Short-term memory is more likely to be affected
than is long-term memory.
33
34. ✘ Some degree of forgetfulness or memory loss is
common with aging. This problem can be
disturbing to the alert older adult.
✘ There is no known reason why memory loss
happens, but nearly 13% of those over age 60
surveyed reported memory loss (Centers for
Disease Control and Prevention [CDC], 2013).
34
35. ✘ The more memories a person has developed
throughout life, the more he or she will retain, so
well-educated older adults tend to retain a higher
level of function than do less well- educated older
adults.
✘ Even without formal education, many older people
are able to compensate for memory gaps by relying
more on the large pool of experience gathered over
a lifetime
35
38. DISTURBANCE IN SENSORY
PERCEPTION
1. Ensure that all caregivers are aware of the
person’s sensory problems
2. Make appropriate sensory contact before
beginning care.
3. Determine the best methods for
communicating with older adults.
4. Modify the environment to reduce risks.
5. Verify that prostheses such as eyeglasses and
hearing aids are functional.
38
39. DISTURBANCE IN SENSORY
PERCEPTION
The following interventions should take place in the
home:
1. Modify the home environment to compensate
for sensory changes.
2. Assist sensorially impaired people in
developing techniques or acquiring devices
that will help compensate for losses.
1. Hearing-Impaired People.
2. Visually Impaired Persons.
39
41. ✘ Cognitive function can be affected by sensory
changes, physiologic factors, or emotional
disorders.
✘ Cognitive problems can range from mild and
reversible forms of disorientation to severe and
irreversible forms of dementia. Depression,
hypothyroidism, and vitamin deficiencies are
common treatable causes of pseudodementia.
41
42. ✘ Sensory changes can result in behaviors that
mimic cognitive problems but actually are not.
The two should not be confused. Sensory
misperception should be ruled out before further
cognitive assessment is performed.
42
43. ✘ The term confusion is used to
describe a wide range of behaviors.
Both lay people and professionals
use this term far too frequently,
often incorrectly and
inappropriately.
43
44. ✘ Confusion is defined as a mental state
characterized by disorientation regarding time,
place, or person that leads to bewilderment,
perplexity, lack of orderly thought, and the
inability to choose or act decisively and to
perform activities of daily living
44
45. ✘ Acute confusion, often called delirium, is
characterized by disturbances in cognition,
attention, memory, and perception. This type of
confusion is usually caused by a physiologic
process that affects the autonomic nervous
system.
45
46. ✘ Conditions that can cause delirium include
uncontrolled pain, infection, metabolic
disturbances, vitamin deficiencies, uremia,
hypoxia, hypercalcemia, endocrine imbalance,
myocardial infarction, constipation, drug
toxicity, and drug withdrawal.
46
49. ✘ It is characterized by rapid mood swings,
disorganized sleep cycles, changes in
psychomotor activity (hypoactivity,
hyperactivity, or both), tremors or spasmodic
activity, rapid speech patterns, loss of attention,
and a wide range of cognitive changes.
49
50. ✘ Confusion can sometimes be idiopathic, or from
an unknown cause.
✘ Idiopathic confusion tends to affect memory and
concentration.
✘ Idiopathic confusion tends to affect memory and
concentration.
50
51. ✘ Affected older adults are often depressed.
Common symptoms of idiopathic confusion
include appetite changes, loss of interest in
activities, changes in sleep patterns, agitation,
feelings of worthlessness or guilt, fatigue, or
other physiologic complaints
51
52. ✘ Individuals experiencing this form of
confusion usually respond well to
reorientation interventions and approaches
that reduce stress levels.
✘ Symptoms may be reversible but may not
disappear completely.
52
53. ✘ Dementia is a slow, insidious process that
results in progressive loss of cognitive function.
✘ Dementia is caused by damage to the cerebral
cortex that is most commonly a result of disease
conditions (e.g., Alzheimer disease; Box 10-4),
multiple infarcts of the cerebrum secondary to
stroke, or other pathologic conditions of the
brain
53
54. ✘ Dementia is characterized by changes in memory,
judgment, language, mathematic calculation, abstract
reasoning, and problem-solving ability; impulsive
behavior; stupor; confusion; and disorientation.
✘ Changes related to dementia are progressive and
irreversible. In the early stages, many cases of
dementia are mistakenly considered a part of normal
aging, which can result in delayed diagnosis and
treatment.
54
57. ✘ Common behaviors seen with advanced
dementia include wandering, excessively
emotional reactions (catastrophic reactions),
combative behaviors, suspiciousness, and
hallucinations or delusions. These agitated
behaviors, which are often worse late in the day,
are referred to as the sundown syndrome or
sundowning.
57
58. ✘ Affected persons often do not recognize even
their closest family members and friends. These
abnormal behaviors are frightening to the family
and anyone who cares about the affected
individual.
58
59. ✘ Dementia affects up to 10% of adults older than
age 65 who live in the community.
Approximately 5 million older Americans suffer
from Alzheimer disease, the most common type
of dementia. The incidence of dementia in those
85 years or older is estimated as high as 50%.
59
61. NURSING
INTERVENTIONS/IMPLEMENTATIO
N
1. Assess behavior on admission and at regular
intervals.
2. Provide assistive sensory devices.
3. Orient the person to person, place, and time, and
provide any other important situational
information, but do not force the issue, because it
can lead to agitation.
4. Provide a structured environment that ensures
safety yet enables the person to keep active as
long as possible
61
62. 5. Provide continuity.
6. Administer psychotherapeutic medications as
ordered.
7. Avoid use of physical and chemical restraints.
8. Structure participation in activities of daily living.
9. structure the environment to minimize disruption;
avoid sudden changes of room or environment.
62
NURSING
INTERVENTIONS/IMPLEMENTATIO
N
63. 10. Develop a plan to deal with “acting out”
behaviors.
11. Use effective communication skills
12. Consult with family and the
multidisciplinary team.
63
NURSING
INTERVENTIONS/IMPLEMENTATIO
N
64. The following interventions should take place in the
home:
1. Help the family accept the diagnosis.
2. Help the family adjust to the demands of
providing care for a cognitively impaired older
person.
3. Provide emotional support and help the family
identify coping strategies.
4. Identify community resources.
64
65. 5. Help families make arrangements for
institutional placement, if necessary.
6. Encourage families to plan for end-of-life
decisions
7. Use any appropriate interventions that are used in
the institutional setting
65
70. 1. Assess the older adult’s communication
problems and abilities.
2. Identify specific approaches that are effective
for each person.
3. Document in the care plan the selected
techniques that facilitate communication.
4. Explain effective communication techniques to
family members and friends.
70
DISTURBANCE IN SENSORY
PERCEPTION
71. 5. Teach verbally impaired older adults methods for
their specific communicating needs.
6. Consult with a speech therapist/pathologist to
determine the most effective communication
strategies.
71
DISTURBANCE IN SENSORY
PERCEPTION
74. NURSING
INTERVENTIONS/IMPLEMENTATION
1. Thoroughly assess the nature and severity of
the pain.
2. Provide comfort measures
3. Avoid actions that increase pain.
4. Anticipate situations likely to cause pain.
5. Teach nonpharmacologic approaches to pain
control.
6. Administer medications as ordered.
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