The "sensory kit": teaching about sensory changes in older adults.
OLDER ADULTS WITH SOME DEGREE OF SENSORY IMPAIRMENT EXPERIENCE A NUMBER OF CHALLENGES IN THEIR DALLY LIVING. A range of educational resources are available to help nursing students understand the challenges brought about by age-related physical and psychological changes and appreciate how environmental modifications may result in improved safety and function and greater independence for older adults. Some of these resources are sophisticated, high-tech, and expensive. This article describes use of the "Sensory Kit," an inexpensive collection of items contained in a small plastic bag. When used as part of a guided learning activity, the kit provides opportunities for active learning while helping students understand some of the sensory changes that many older adults experience.
Hi-Tech/Low-Tech Resources A number of resources have clear value, but their use with large numbers of students is limited due to costs and availability. For example, the Massachusetts Institute of Technology AgeLab's Age Suit is a state-of-the-art, hi-tech resource (2011). The suit allows a user to experience age-related functional changes by approximating the physiological state of persons in their mid-70s. With the University of New England College of Osteopathic Medicine's Learning by Living[c] program, medical students become nursing home residents for two weeks and experience the daily life of residents, which involves eating pureed foods and receiving assistance with the activities of daily living (Taggersell, 2009).
To meet the learning needs of large groups, low-fidelity simulation activities may offer cost-effective alternatives. Using only paper-based scenarios or relatively simple teaching tools, such activities can be effective for teaching complex concepts. One such resource is "Into Aging," an interactive game that helps students and health care professionals experience age-related physical and social changes (Hoffman & Dempsey-Lyle, 2003). Activities include eating thickened liquids, having one's teeth brushed by another person, and being addressed in elder-speak, a way of talking to older people that assumes cognitive impairment requiring the use of slow, simplified speech most often used with children (Paeala, Boult, & Hepburn, 2006).
Several authors have described low-fidelity experiential activities simulating age-related functional changes. Examples include encouraging students to apply elastic wraps to restrict knee or elbow movement; taping fingers to decrease dexterity; and simulating other functional restrictions using neck braces, goggles, or wheelchairs (Prathibha, Chutka, & Lesnick, 2006; Wood, 2003). Pacala et al. (2006) wrote about such strategies as using small pieces of colored candy to simulate the need for complex, multi-medication regimens; confining students to bed or to a wheelchair; and forcing mobility restriction by having students use canes or walkers.
These activities, when followed by student reflection or discussion, were especially powerful for understanding the ramifications age-related changes have on daily life. However, widespread use can be hindered by a lack of available resources and equipment, the costs of supplies, or the time required to prepare the activity.
The Sensory Kit In keeping with Kolb's theory of experiential learning (1984), use of the Sensory Kit provides opportunities for reflection, discussion of the significance of the experience, and actions that should be taken based on the experience. Many of its components have been used individually to teach students about discrete sensory changes in older adults. When gathered together, the items represent an inexpensive, portable, experiential learning activity that can provide a comprehensive learning experience. Faculty can prepare these kits in advance for use in the classroom. (See Table for items and suggested sources; see also www.geronursinged.org/ documents/SChandout.pdf for a photo of a sample kit.)
The Sensory Kit is most effective when used with a classroom presentation about age-related sensory changes, in-classroom activities, and out-of-classroom follow-up exercises. Its use could be combined with other experiential learning activities such as the "'Unfair Hearing Test," a resource providing participants with common words, presented as they may be heard by individuals with hearing loss or who use hearing aids (Sight and Hearing Association, 2007). The benefits of the Sensory Kit include its affordability, ease of assembly, and portability. Students are informed about each item's relevance, including a description of how items can be used to represent a particular age-related sensory change.
VISION Students are instructed to empty the bag of its contents and to look around the classroom through the two layers of the plastic sandwich bag. Next, they are encouraged to view the small piece of the telephone book, newspaper, or map included in their kit while looking through these two plastic layers. This visual exercise approximates 20/60 vision and mimics the experience of presbyopia, an age-related change in vision.
Although a mild loss of vision, presbyopia often interferes with quality of life by reducing the ability to read or perform simple visual tasks, even with the use of corrective lenses. It may also help students to learn that at this level of vision, nighttime driving can be significantly impaired (American Optometric Association [AOA], 2007). The students are encouraged to consider this level of visual impairment as it might relate to providing older adults printed educational materials, or the challenge of reading the labels on prescription and over-the-counter medications.
Following the reading exercise, participants are instructed to fold the plastic bag in halt" and repeat the exercise of looking around the classroom and viewing the small pieces of printed paper while looking through all four layers of the plastic bag. In this exercise, the student experiences a loss of vision that represents visual acuity of approximately 20/200, defined as legal blindness by the United States Social Security Administration (AOA, 2007).
Next, students are instructed to view the yellow, white, green, and blue pieces of paper through the yellow vinyl strips supplied in their Sensory Kit. Faculty instruct the students that when older adults develop some type of cataracts, their optical lenses (:an take on a murky, yellowish appearance that affects the quality of vision. This exercise helps students appreciate the difficulties of discerning the color of common objects, including medications. Medication colors may be simulated using the several small, pastel-colored candies included in the kit, highlighting the importance of providing clear instructions about medication use to older adults and avoiding statements such as, "take the blue pill at bedtime."
TOUCH To understand the issues related to touch, participants put on one of the vinyl gloves supplied in the kit. They are instructed to pick up the piece of sandpaper and to compare the texture of the sandpaper using both the gloved and ungloved hand. This simple exercise demonstrates the common changes in peripheral sensation, associated with age-related reductions in touch receptors as well as those that may accompany neuropathic changes in touch related to diabetes and other chronic diseases. To emphasize the significance in sensations, students are directed to put on the second glove and manipulate items in the sewing kit, trying to thread a sewing needle and pick up small buttons.
SMELL AND TASTE The sense of smell and taste are closely associated with one another, and can significantly diminish with the aging process. For health-related reasons, health care providers may recommend to older adults that they limit the amount of salt or sugar they add to their food. To help students understand how these dietary recommendations may affect older adults" nutritional status or food-related quality of life, they are asked to eat a piece of chocolate included in their kit while holding their nostrils closed with the thumb and finger of one hand. This activity typically results in a diminished taste sensation for chocolate, one of the many foods whose taste is enhanced through stimulation of receptors in the nose.
This learning activity helps students appreciate decreases in smell and taste that can result from aging, as well as from Parkinson's disease and other disorders with neurological components. As part of the discussion, students should be encouraged to consider how older adults could enhance the taste and flavor of food without adding sugar or salt, using, for example, lemon or lime juice, freshly ground pepper, garlic or onion powder, or herbs.
MOBILITY As they leave the classroom after completing the sensory-related activities, students are asked to place the kit's split peas in their shoes and leave them in there while walking to their next activity. This exercise mimics the sensation that may be associated with the age-related reduction of subcutaneous fat pads on the soles of older adults' feet, and help students understand how painful conditions such as arthritis and bunions could limit mobility. Students are asked to take note of how this exercise may affect their gait or pace of ambulation.
Understanding Sensory Change Throughout the learning activities associated with the use of the Sensory Kit, students are encouraged to consider how changes in sensory perception could affect the quality of life of an older adult, and how they may influence activities such as navigating the environment, managing medications, and maintaining nutritional well-being. The students ale encouraged to describe specific approaches they might use to enhance the quality of life for older adults, based on their newly acquired knowledge regarding the sensory changes associated with the aging process.
Sensory changes are a normal part of aging, and era1 affect an older adult's independence, safety, and quality of life. Helping students understand the link between age-related sensory changes and the functional and behavioral status of older adults may help them develop improved geriatric assessment skills. With an improved understanding of how age-related sensory changes affect the daily activities of older adults, students can develop a habit of including relatively simple interventions in their daily work, such as helping an older adult clean eyeglasses or developing a simple system for correctly identifying daily medications. Use of the Sensory. Kit within the framework of content addressing a variety of age-related changes may improve a nursing student's understanding of health and functional needs of geriatric clients.
American Optometric Association. (2007). Care of the patient with visual impairment. Optometric clinical practice guideline. Retrieved from http://www.aoa.org/documents/CPG-14.pdf
Hoffman, T. L., & Dempsey-Lyle, S. (2003). Into aging: Understanding issues affecting the later stages of life (2nd ed.). Thorofare, N J: Slack.
Kolb, D. A. (1984). Experiential learning: Experience as the source of learning and development. New York: Prentice-Hall.
Massachusetts Institute of Technology. (2011). AGNES: Age gain now empathy system. Retrieved from http://agelab.mit.edu/agnes-age-gain-now-empathy-system
Pacala, J. T., Boult, C., & Hepburn, K. (2006). Ten years' experience conducting the aging game workshop: Was it worth it? Journal of the American Geriatrics Society, 54, 144-149.
Prathibha, V., Chutka, D. S., & Lesnick, T. G. (2006). The aging game: Improving medical students' attitudes toward caring for the elderly. Journal of the American Medical Directors Association, 7, 224-229.
Sight and Hearing Association (2007). Know noise: Unfair hearing test. Retrieved from www.sightandhearing.org/products/knownoise.asp
Taggersell, K. (2009). UNE medical students are learning by living. University of New England. Retrieved from www.une.edu/ia/conmmnications/magazine/summerO9/upload/ summer09geriatric.pdf
Wood, M. D. (2003). Experiential learning for undergraduates: A simulation about functional change and aging. Gerontology & Geriatrics, 33(2), 37-48.
Catherine Van Son, PhD, RN, is assistant professor and John A. Hartford Foundation/Atlantic Philanthropies Claire M. Fagin Fellow at Washington State University, College of Nursing, Spokane, where Cynthia Fitzgerald, PhD, FNP, is an assistant professor. For more information, contact Dr. Van Son at email@example.com.
Table. Contents of the Sensory Kit with Sources Item Quantity Size Source Plastic bag with 1 sandwich grocery zip-lock closure Plastic bag with 1 2 in. x 2 in. craft/jewelry store zip-lock closure Latex-free examination 1 pair medium drug store glove Colored paper (green, 1 each 1 in. square office supply blue, white, yellow) Sandpaper 1 1 in. square hardware Telephone book page / 1 piece 1 in. square driving map / newspaper Box of 50 vinyl report 1 piece 1 in. x 6 in. office supply covers Wrapped chocolate 1 piece small grocery Pale, pastel-colored 1 package small grocery wrapped candy Split peas 1 tsp. grocery Travel sewing kit 1 bulk online (or single needle wrapped with 12 in. piece of thread, placed in piece of paper, and some small, white shirt buttons)