Academic Exchange Quarterly Winter
2003: Volume 7, Issue 4
Guidelines for
Communicating with our Most Elderly
By
James L.
Giordano and E.L. Deckinger
James
L. Giordano, M.S, is Instructor, Accounting and
Managerial Studies Department,
E. L. Deckinger, D. C. S, retired after 18 years as marketing
professor,
Abstract
It
is crucial that we pay increasing attention to the specific needs of the
expanding aging population. Based on an increasing number of elderly clients
requiring assisted-living residences, the expanding costs of care, and the
inability of many seniors to anticipate and express their needs, our research
centered on the question, How could facilities and care-providers most
effectively communicate information with their elderly residents in order to
deliver quality care? One effective answer would be to design a system
congruent with the learning styles of residents.
Learning Style101
Learning style is the way in which each
person concentrates on, processes, and retains new and difficult information.
Rita and Kenneth Dunn (Dunn, 1993) identified 21 elements as influencing how
people learn (see Figure 1). Our findings indicate that learning style
significantly influences the elderly and enables us to improve care with
cost-effective strategies.
[Insert Figure 1 Here.]
During
the past 35 years, Professors Rita and Kenneth Dunn have developed several age
appropriate assessments that identify individuals' reaction to each of their 21
learning-style elements. After administration of the appropriate assessment, a
profile indicates those elements that are Strong Preferences, Preferences,
Non Preferences, Opposite Preferences, and Strong Opposite Preferences--each
person's learning style.
To capitalize on their learning style, people
need to be made aware of their:
We
examined several major learning style models to compare ways in which they were
similar, and different from the Dunn and Dunn Model’s characteristics listed
above. The Model is multidimensional in
that it covers 5 stimuli groups and 21 elements (see Figure 1). The following
instruments: Productivity Environmental Preference Survey (PEPS), Learning
Style Inventory (LSI), and Business Excellence (BE) are employed,
based on age, in order to identify the learner’s style. This allows
complementary teaching techniques to be applied. Research over three decades has established a
logical principle. The closer one
teaches to the particular learning style of the individual, the greater the
learning and retention (see www.learningstyles.net).
Model
Comparisons
The
National Association of Secondary School Principals (NASSP) model pioneered by Dr. James Keefe includes the five
stimuli plus study skills cognitive dimensions as a major component. The NASSP instrument is the Learning Style Profile (DeBello).
One
of the earliest learning styles theorists was Joseph Hill, who developed the Cognitive
Style Profile in which cultural influences are among 15 elements. He framed learning style as the way in which
individuals search for meaning (DeBello).
The
Cognitive Style Delineators developed by Charles Letteri
views learning as information processing, in which high achievers are
analytical and low achievers are global. Letteri’s
model focuses on seven different cognitive dimensions, identified by the Cognitive
Style Delineator (DeBello).
Manuel
Ramirez developed the Child Rating Form; he defines learning in terms of
cognitive style and is similar to Letteri in
recognizing field dependence and independence.
Ramirez views independence as positive, global rather than analytical (DeBello).
In
addition there are learning style guides, rather than full models, such as the Visual,
aural, read-write, and kinesthetic (Vark). The Vark
Learning Style Inventory utilizes a13 question assessment in order to
determine learner’s preference. The focus is on the taking-in, and out-takes
of information in a learning context (http://www.Vark-learn.com/
English/index.asp).
Over
the past 30 years hundreds of studies have documented that learning-style
responsive environments statistically increase students’ achievement-test
scores (Dunn & Griggs, 2003).
Considering all the research there remained a black hole in our
knowledge base. That black hole
concerned the eldest elderly—those aged 85+.
No previous studies of learning styles focused exclusively on this
group. As the aging process runs its course, special needs become
paramount. For most senior citizens it
often seems like everything hurts. What
doesn’t hurt, doesn’t work. For the growing population of eldest in retirement
residential care, we need to know how to best communicate, while our knowledge
has been the least. That is, until
now.
Identifying the Needs of
Our Target Population (85+):
Penetrating the
Previously Unpenetrated
The black hole in our knowledge base of
learning styles has been illuminated; care providers can now apply new methods
to help enhance the residential care experience for this age group. We now know the sound, lighting, temperature,
and time of day preferences for this population segment never identified before
because of just recently completed research by a team pooling resources from
Population, Instrument, and Procedures
Thirty-seven randomly selected residents
of Flushing House’s 275 total population, were interviewed one to three
times. We used a comprehensive
instrument that stood the test of time in hundreds of studies worldwide—Productivity
Environmental Preference Survey (PEPS), (Dunn, Dunn, & Price, 2000).
The PEPS consists of 100 short, dichotomous statements, running the gamut of
influences describing how each individual best learns new and difficult
information (Dunn & Griggs, 2003). For each statement, respondents
indicated the degree of agreement or disagreement on a five-point Likert-type scale. All interviewing was conducted in 2001.
The purpose of our research was to extend
our knowledge of how our most senior population learns, and how best to
communicate important-perhaps life-saving, information under ideal
conditions. We compared our PEPS results
with the average results from a national database developed from hundreds of
earlier studies to use as our baseline (Research with the Dunn and Dunn Model,
2001, available on www.learningstyles.net). Quantitative comparisons of average mean
scores provided the basis for our analysis.
Our research yielded statistically
significant differences between our eldest elderly with the general population
for 10 of the 21 learning-style elements (Figure 1) and reported in
To maximize the benefits of this
analysis, we probed well beyond the formal PEPS questions. That made it
possible to better understand past and current patterns of our sample, and of
the PEPS-generated findings when postulating the 10 Guidelines.
10 Guidelines Derived
From Our Research Findings
What Kind of Environment
Do the Eldest Elderly Prefer?
Sound off! We found that our sample residential care 85+
population prefers to handle new and important information in a quiet
environment. The eldest elderly do not
enjoy extraneous sounds—particularly loud unexpected noises. Despite this finding, they tend not to be as
bothered by noises as much as younger people, as they tend to be hearing
impaired.
The eldest are not saying that they want
to eat their meals in silence, normal dinnertime chitchat is appropriate, as is
interaction with servers. They enjoy the
music they knew decades ago—golden oldies relax often-frayed nerves, and
brings back fond memories.
Lighten-up! The eldest elderly
strongly prefer bright light. Creature comfort and communication can be
enhanced if all incandescent lights are replaced with fluorescent lighting.
This group has long been told reading in
low light is a No No! A major cause of their need is development of
cataracts- a film over the eye occurring during the aging process. Cataracts make their world darker, making
reading and writing more difficult.
Moreover, the brighter their
surroundings, the less likely uncertain walkers are to fall. Falling is a universally dreaded fear of the
elderly. They are well aware of the high
incidence of injury. High luminous levels can play a major role in instilling
confidence and reducing disorientation among residents as they navigate their
new living facility. Bright light ensures safety and comfort.
Cool it! The elderly prefer to
work in a cool setting. Initially this may come as a shock to most observers
because the elderly seem to need warmth.
Our in-depth study indicated preferences for cool temperatures, they
perceive working in warm areas as unproductive. This does not mean that
the eldest elderly are as concerned with cool temperature as much as they are
interested in maintaining comfort, which may account for the ubiquitous
sweater.
What Do We Know About the Emotionality of the
Eldest Elderly?
The spirit is willing;
the body’s thinking it over! Motivation, the desire to engage in activities,
is ever present among the elderly, but there are many considerations affecting
decisions. The following concerns will need to be satisfied. How will they
feel? Will weather permit it? Who else is going? How long will it take? Will
they remember? Who will assist them?
For any new activity our population had
to deal with serious preplanning that younger people often take for
granted. Each day so much depends on whether
it’s a good or bad day in terms of the pains and problems they encounter. Can
they navigate easily or will they be limited and frustrated. For what lengths of time should they plan,
and how much will it cost, that motivation becomes secondary. At any age, when
physically able, most elderly will be motivated to join in. To ease the burden, plan for ample
assistance, remind them of what they need to bring by telling, singing,
acting-out, and demonstrating important information, arrange for comfortable
seating and transportation, and keep timing sensible. Most need frequent,
intermittent relaxation periods.
Whose life is it anyway?
When
examining responsibility distinguishing whether our population was always
inclined toward being responsible or whether they changed with age. Our seniors consistently exhibited
statistical tendency toward doing what they believed was the right thing to
do, which is responsibility.
This strong sense of responsibility can
generate involvement and nurture pride
in their new residence. Inviting able
and interested individuals to join committees and focus groups with management
and staff can be a real win-win situation.
Your benefits can be ideas for improvements in the design and delivery
of important resident services.
What’s wrong with a
little nap? We’ll do it later!
Persistence is a quality highly valued by employers and educators,
elderly value health and strength more than task completion. If tired, they nap; if a task isn’t finished,
it’ll still be there when they wake up.
For people who jest about not buying
green bananas (in case they do not survive to eat them when they are ripe),
these senior citizens are self-assured about smelling the flowers and relaxing
when the need arises. Persistence is
not necessarily their cup of tea. They are far more concerned with feeling
good!
Straighten Up and Fly
Right!
Our population indicated a strong emotional need for structure. The eldest elderly were most comfortable with
set routines. Irregular schedules
confused them. Regular meal hours provided reference points for daily planning.
When days and hours for activities become
routine, seniors are likely to show up on time for events. Our findings support
the notion that with age we become conditioned to routines and
reveal more analytic tendencies (Dunn
& Griggs, 1995).
What Do We Know About
Social Preferences of the Eldest Elderly?
Are you talking to me? The eldest elderly are
suspicious of people who pepper them with questions, seek to sell them
something, or ask them for money. One catalyst for caution has been repeated
media warnings about fraud and crimes perpetrated by disreputable persons.
However, the words of some people are
more accepted than those of others by the elderly. This is true for persons in authority.
High-ranking people are considered trustworthy when it comes to offering
suggestions and advice. The use of
authority figures adds credence to the message.
Involvement of the president, director, board member, or the
organization’s CEO as a spokesperson is a great place to start.
Doing it my way! Everyone is
different! Some eldest seniors prefer concentrating on issues alone. They are
not antisocial; they think best without intrusion of other opinions.
These older persons were often intelligent, independent leaders when young;
they trusted their own judgment and still do. Allow them to think things
through on their own—with dignity and without imposing suggestions.
My buddy! Because everyone is
different, some of our eldest seniors prefer concentrating on issues with
others—in pairs or small groups. Some have been dependent, or peer-oriented,
accept their choice of talking things through with others. Sometimes
they are just lonely, and use any issue to interact.
How To Communicate With
the Eldest Elderly
No news is bad news! Most eldest elderly
are visually impaired. When sending written communications use oversized, wide
black fonts. Providing equipment for magnifying printed or written material in
each room can open priceless vistas. Greater access to newspapers, magazines,
letters, books, memoranda, or plain old-fashioned notes can be enjoyed. Such access would lead to happy and
productive lives.
I hear what you say! Physical
limitations aside, our study sample grew up prior to the advent of television.
In their youth, radio was the most powerful and universal medium. They kind of
auditioned for audio messages from the get-go. They grew up in an environment
in which communication of major world
news, entertainment, as well as what they learned in schools was primarily
through listening. Communication with
residents utilizing clear, distinct, spoken words and sounds is preferable. For
the hearing impaired, use multi-media, drawings supplemented with words and
acting. Work with people’s strengths and around their disabilities.
Audio and video equipment for playing
tapes, CDs and DVDs in each room would help these elderly residents. Making music and audio books available to all
would be positive! Given a choice, communicate with our most senior people
through their ears, rather than their eyes. Messages have a better chance of
being received and retained. One good investment would be the production of
audio-newsletters and audio-memos, as the printed word becomes increasingly
difficult to discern.
Are you out of touch? It’s not
easy for the eldest elderly to learn tactually. Other than for physical
therapy, their merchandise should not be handled. If handling is mishandling
in the mind of the handled, for all practical purposes, that’s what
it is. Perception becomes reality. We’re
talking about an invasion of privacy here.
On the other hand, some elderly may crave
a tender touch. If you have developed a nice relationship with one of these
elderly people, ask politely, “May I hug you?”
If “Yes,” hug very gently! The aged tend to bruise and bleed easily.
Are you moving along? Children and many male
adolescents learn kinesthetically; while in motion(Cohen, 1986; Lam-Phoon, 1986). Our
eldest elderly have outgrown that tendency; most would just as soon sit
quietly, talk and reminisce about the good old days. Visiting
them earns an A+; activities of short duration are at the top of their
list—like Bingo, Scrabble (for the intellectually elite), cards, and game
shows. Always encourage, but make it a matter of their choice!
What Do We Know About Physiological Preferences
of the Eldest Elderly?
No snacking! Our research strongly
indicated that the eldest elderly do not like to mix serious business with food
intake. When they work, they work; when they snack, they
socialize-quietly. The two clearly are
perceived as separate and mixing is best avoided.
This preference became repeatedly evident
as we collected information during interviews. All offers to join us in sipping
beverages or munching on snacks were declined as our very seniors focused on
completing questionnaires.
Nor do they appreciate being harangued at
mealtimes, messages should be delivered at the beginning or end of meals.
Interruptions during the meal tend to be frowned upon. It also does not mean that subdued, balmy, background
dinner music is inappropriate at meal times, to the contrary.
Rise and shine! Biologically, we found
distinct patterns that affect time-of-day preferences. Collectively, the eldest
elderly tend to be morning people.
Program design and planning should consider the best time to get
through to our population is in the morning, when the majority of seniors
are most alert, have more stamina, concentrate best, and understand most
lucidly. Serious discussions and
presentations are best scheduled early in the day to capitalize on this
learning-style preference. This caveat
applies to one-on-one meetings and group interactions.
We would be remiss if we did not stress
that morning does not mean
What Do We Know About Psychological Preferences
of the Eldest Elderly?
Big picture versus
one-step-at-a-time!
Our research supports the notion that people become increasingly analytic and
auditory as they age (Dunn & Dunn, 1999). The strong auditory, bright
light, quiet, formal seating, and no-intake-while-concentrating preferences of
our eldest elderly study, support Dunn’s findings.
Summary
Just the facts ma’am: This first-of-its-kind research, focusing
exclusively on those 85+ year olds in residential care facilities, enables us
to better understand and communicate with our most elderly seniors. If we are
caring for them, let’s do it as well as we possibly can! Abiding by the following 10 Guidelines can
enhance the quality of their lives.
1.
Maintain
a quiet environment; isolate people who shout, speak loudly, or create noise.
2.
Provide
super-bright, white lighting.
3.
Keep
it cool, but have sweaters, and soft blankets readily available.
4.
Provide
varied comfortable seating with many pillows and cushions.
5.
Provide
alternate activities; honor choices.
6.
Establish
routines; maintain patterns.
7.
Schedule
cognitive activities in the late-morning for the majority; repeat them in the
evening for the night-owl minority.
8.
Make
appropriate A-V equipment available for enlarging print, playing music or
television, and enabling individual use of CDs and DVD machines in each
person’s quarters. The eldest elderly lived most of their long lives in a
different technological era. Their era was uncomplicated by television,
computers, cell phones, faxes, answering machines, e-mail, rapping, in-line
skating, SUV’s and bungee jumping. Take
time to introduce technology. Those who appreciate and can master it will be
helped immeasurably.
9.
Anything
important should be stated, accompanied by visual illustrations, recorded for
repetition, dramatized, and made available for people who forget.
10. Accept and plan for the
need for naps, discourse, comfort, old music, enlarged print, and many
individual preferences that may be viewed as eccentricities. They’ve earned it by surviving those of us
who never understood their unique learning-style differences!
It is our hope that others will join in
the hunt to improve the lot of the precious, but fading, most golden, segment
among us. Not a bad purpose, when you think about it. Especially if you are
lucky enough to join
that group
some day!
Acknowledgements
James L. Giordano and Dr. Lawrence Deckinger, who jointly headed the research team are
indebted to: the founder of
The president of Flushing House, a
26-year, not-for-profit retirement residence, is the Reverend Douglas L. Kurtz,
also president of the United Adult Ministries--the parent entity to Flushing
House and organizations serving the elderly. Reverend Kurtz has been a lifelong
champion of the elderly.
The authors also wish to acknowledge the
fascinating respondents and a receptive Flushing House management who allowed
us to spend unlimited interviewing and probing.
Dr. Bernard S. Gorman, Professor of
psychology and statistics of
Gary Price, Price Systems of Lawrence,
Kansas, processed our electronic data and supplied the benchmark data for the
population-at-large.
Liz King Giordano for delivering tireless
inspiration, support, typing and editing.
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