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Guidelines for communicating with our most elderly.

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 dements 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. See <http://rapidintellect.com/AEQweb/win2003.htm>

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:

1. reactions to the immediate environment while learning--sound versus silence; bright versus nonconformity, and preference for structure versus choices;

2. sociological preferences for learning--alone, with peers, with either a collegial or authoritative adult, and/or in a variety of ways as opposed to patterns or routines;

3. physiological characteristics--perceptual strengths (auditory, visual, tactual, and/or kinesthetic strengths), time-of-day energy levels, intake (snacking while concentrating), and/or mobility needs; and

4. global versus analytic versus integrated processing styles (see Figure 1).

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).

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 a 13 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+)

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 St. John's University and a Flushing, NY retirement residence. This research, which reveals how the eldest elderly learn (or don't learn!) inspired the posting of Guidelines for Communicating ... with that vulnerable group. These Guidelines are being made public for the first time here.

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 Box 1. Those differences became major considerations in the formulation of our Guidelines. These guidelines allow tailoring to specific needs of each person in our population based on individual PEPS responses. This report generalizes our findings to inform readers about how a majority of our eldest elderly differs from younger senior citizens (Bovell, 2000; Bovell & Ansalone, 2001; Van Wynen, 1999, 2001)--and ourselves. 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.

Ten 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 6:00 a.m. as the preferred time to work and communicate with our elderly. Our follow-up interviews revealed that for our population, between 10:00 a.m. and 12:00 noon provided an ideal time to accomplish what is important. Although this population may be up with the roosters, they are not actually ready to crow or engage in challenging activities at that hour. The minority of night owls require engagement at their best times--which can be accomplished by recording or videotaping whatever you do during the morning and using it in the evening at their best time-of-night (on the A-V units we suggested be available in each person's quarters). On the other hand, there always are staff members who are most alert at night and willingly will accommodate the energy levels of night owls! Just ask!

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 St. John's University's Center for the Study of Learning and Teaching Styles and the president of Flushing House for their encouragement, support, and continuing input to the research process. The founder of the Center is Dr. Rita Dunn who personally has mentored more than 100 doctoral studies, Professor Dunn has written 23 textbooks and more than 350 published works on learning style, and lectures internationally. She is the undisputed worldwide authority on the subject.

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 Nassau Community College, a distinguished project researcher for the National Science Foundation, provided invaluable input in the statistical analyses.

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.

References

Bovell, C. (2000). Analysis of the learning styles of older students enrolled in nontraditional college programs (Doctoral dissertation, St. John's University).

Bovell, C. and Ansalone, G. E. (2001). An exploration of adult learning styles: Doesn't Everyone learn similarly? Michigan Community College Journal, 7(2), 41-59.

Cohen, L. (1986). Birth order and learning styles: An examination of the relationship between birth order and middle school students' preferred learning style profile. (Doctoral dissertation, University of Minnesota, 1986).

DeBello, T. C. (1990). Comparison of eleven major learning styles models: variables, appropriate populations, validity of instrumentation, and the research behind them. Reading, Writing, and Learning Disabilities, 6, 203-222.

Dunn, R., Dunn, K. (1993). Teaching secondary students through their individual learning-styles: Practical approaches for grades 7-12. Boston, MA: Allyn & Bacon.

Dunn, R., & Dann, K. (1999). The complete guide to the learning styles inservice system. Boston, MA: Ailyn & Bacon.

Dunn, R., Dunn, K., & Price, G. E. (1984, 1989, 1996, 1998). Productivity Environmental Preference Survey. Lawrence, KS: Price Systems.

Dunn, R. and Griggs, S. (1995). Multiculturalism and learning style: Teaching and counseling adolescents. Westport, CT: Prageger Publishers.

Dunn, R. and Griggs, S. (2003). Synthesis of the Dunn and Dunn Learning-Style Model Research: Who, What, When, Where, and So What? St. John's University.

Lam-Phoon, S. (1986). A comparative study of the learning styles of Southeast Asian and American Caucasian college students of two Seventh-day Adventist campuses (Doctoral dissertation, Andrews University, 1988). Dissertation Abstracts International, 48(09), 2234A.

Learning Styles Network (2003). Research. http://www.learningstyles.net Research with the Dunn and Dunn Model (2001, 2003). Jamaica, NY: St. John's University's Center for the Study of Learning and Teaching Styles. http://www.learningstyles.net/main.html

Van Wynen, E. (1999). Analysis of current and previous learning styles of older adults in a residential setting and the effects of congruent and incongruent instruction on their achievement and attitudes (Doctoral dissertation, St. John's University). Recipient: Sigma Theta Tan International Honor Society of Nursing for best doctoral proposal, 1998.

Van Wynen, E. A. (2001, September). A key to aging: Learning-style patterns of older adults. Journal of Gerontological Nursing, 27(9), 6-15.

Vark, a guide to learning styles, http://www.Vark-learn.com/English/index.asp

James L. Giordano, LaGuardia Community College, NY E.L. Deckinger, formerly of St. John's University, NY

Giordano, M.S, is Instructor of Accounting and Managerial Studies. He is a candidate in St. John's University's Instructional Leadership Doctoral Program. Deckinger, 19. C. S, retired after 18 years as marketing professor, St. John's University, after 45 previous years as executive with Grey Advertising in New York. He currently is an 11-year resident at Flushing House, a retirement residence.
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Author:Deckinger, E.L.
Publication:Academic Exchange Quarterly
Date:Dec 22, 2003
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