Why Do Older Adults Get Irritated So Easily?

Foreign like to welcome everybody to this presentation on managing sensory issues in older adults. I'm your host, Dr. Donnelly Snipes. Today we are going to develop an understanding of the sensory changes that may be contributing to irritability in poor and poor health in older adults, whether that's somebody you're caring for or yourself. I know I'm getting older and I'm starting to experience changes, and I'm like, hey, where did that come from? Let's start out with some basics. Stress health and mental health. How are they all connected? Stress increases inflammation and blood sugar. Inflammation increases pain, brain fog, confusion, irritability, anxiety and depression and reduces immunity. When we are having difficulty with feeling safe in our environment, we are either sensory overloaded or sensory underloaded. It causes stress. So by understanding how to manage sensory changes in older adults, we can better create an environment that helps us all thrive. I do want to encourage us to change perspectives, especially if you are a caregiver for an older adult, whether that older adult has dementia or not. All of us experience changes as we age, and we need to recognize that what was true yesterday may not be true today. What smelled good yesterday may not smell good to us today. What was too bright or too loud yesterday may be fine today. And being sensitive to that, instead of saying, well, that doesn't make any sense going it, it is what it is today. This is bothering me, so got to address it. We also want to recognize that behavior is communication. People may not recognize sensory changes, but they do notice their distress. They may not recognize, hey, I can't taste sweet and salty as much anymore, but they do recognize when they eat food and it tastes completely bland, and they're like, ew, you know, I don't want, I don't want that. It tastes nasty. Helping people understand, you know, what's going on and ways to address it, that's what we're looking at. We can't fix the sensory system a lot of the time, but we can help people learn how to manage and navigate their environment. All of the following can increase stress and irritability in older adults. Cognitive overload. If you are in an environment in which it is noisy and lights are flashing and it's too bright, I think at any age we can get overwhelmed. And when we get overwhelmed, it causes what we call cognitive overload. Our brain is like, I can't take any more input. It increases the stress response, slower neural processing. This is so important. As we age, whether we like it or not, things start to slow down. So when we ask grandma A question or when we're trying to think of something oursel when we used to be able to think of things super quick. Now it may take a minute. That's because of slower neural processing. But that's also true with everything else. We can put our hand under cold water and it takes longer for our sense receptors to get that message to our brain that says, hey, that's cold water. Same thing with hot water, which is bad because that can lead older adults to more easily scold themselves. And we're going to talk about more of these and in as we get into it. But when you talk to somebody, if you say, hey, I'm going to touch you, give them a second to hear that, register that and process that. Or if you put your hand on somebody's shoulder, please let them know ahead of time and then give them a second for their receptors to actually get that message all the way up to the brain and sympathetic dominance. As we age, our stress response becomes more hyperactive. And there are a lot of reasons for that and that can be counteracted. That's a whole different video. But recognizing that older adults, especially ones who haven't taken steps to strengthen their relaxation response, may tend to be more tense, more hyper vigilant, and more prone to irritability when things are not feeling safe, when things are feeling out of control. So let's start talking about these senses. But people who are older have decreased visual acuity, blurred vision. When we turn 50, pretty much every eye doctor out there will tell you you're probably going to start having to get re reading glasses because your vision starts to get a little bit blurred. And that's frustrating. It really is. Especially if you're trying to read a menu and you forgot your glasses at how at the house or something. It can be really frustrating helping people plan for that. My daddy used to have literally 15 pairs of glasses throughout the house and in the car and every other place he could possibly think of. So he was never without reading glasses. I don't have 15 pairs, but I do have extra pairs. So if I'm not wearing my prescription glasses then, and I need to read something in the kitchen, I can put on the reading glasses and I can read the, the bottle. I can read whatever I need to read. And that reduces my stress. I know that's not a big stressor, it's not a huge monumental thing, but it's irritating. And irritation is a stress response. Why waste energy being irritated if there is a way you can prevent it? Other things that can help if you have decreased visual acuity is to make the stuff that you're writing higher, contrast white and black and make the font bigger. So if I'm putting something on the refrigerator that I want my granddad to be able to read, I want to make sure that I'm putting it. I usually use like 18, 20 point font and write it out. That way, even though his visual acuity isn't as good, he can still make out what. What's on there, even if he doesn't have his glasses on. Easy peasy. Some people carry little magnifying glasses, especially people who carry purses or fanny packs or something. They'll carry little magnifying glasses in their. In their bag. And that's another thing you can do if you don't want to carry reading glasses. There's also reduced contrast sensitivity. So difficulty distinguishing objects from backgrounds. Well, that makes it harder to find things. If I'm looking, you can't see my desk right now, but it's a hot mess. If I'm looking for my glasses on my desk and my contrast sensitivity is bad, I'm going to have a hard time differentiating my brown glasses from the brown desk. Paying attention to that. Having things in places where, you know, they are trying to have things that are more colorful. My phone, I have a purple case for my phone, so it's easier for me to find. I don't have a lot of stuff that's purple. It also makes it more likely for people to have difficulty with tripping over things because they don't see them. They. If the cat or the dog is blending into the carpet, and I'm not being sarcastic, it happens. I have a multicolored carpet. I don't. You can see it behind me. And there are some times where my dog and cat just kind of blend into it if I'm not paying attention. And I still have pretty good contrast sensitivity. But that creates a trip and fall hazard. And the smaller the things are and the closer they are in color to the background that they're on, the harder it will be for the person to see them. Which, again, if they're shuffling their feet or they're not paying attention, could make it really easy to trip. Even going from a solid floor to. To a carpet. Not a big carpet, just a little carpet. That little bump can cause a lot of people to trip because they don't discern that bump. Evaluating your environment for areas that it is important to have contrast sensitivity for safety is really the only thing you can do here. Increasing contrast can Also help if you want to have, you know, a really bright orange carpet or something. But a lot of people don't want to do that. So they have modifications. They will tape down their carpets, they will get rid of carpets. For example, reduce sensitivity to blue and green. And you're like, okay, so we're not as sensitive to blue and green. Well, that makes a big deal. If your medications are blue and green, you're supposed to take the blue pill in the morning and the green pill at night. And if you get them mixed up, it could be a big problem. It makes it a little bit more difficult for dressing. If you are trying to pick out, you know, a blue outfit and you can't discern the blue and green quite as well. Try to stick with clothing that is, you can either label the clothing with, on the, on the tag with a bag it for blue and a G for green. If a person has a lot of different blues and greens, or try to stick to one so only blue or only green. Or maybe pick things that can be mixed and matched that are blue and green that go well together. That way the person's not worried about, do I match other things that can be difficult with blue and green? Not so much. Because a lot of the things that we worry about for warning signs and things, they're red, they're yellow, and those receptors tend to persevere or stick around a lot longer. It's the blue and green that can be the problem with medication. Try to work with your doctor to see if, especially if you're getting generics. Sometimes you can get a generic that there. The generics may come in different colors, but if not, then it's really important to make sure that your medication is pre divided, if you will, or you mark on the top of the lid for the medication with a B for blue or an AM for morning, whatever you want to do, and a G for green or a PM for for that medication. That way the person's not holding the bottle going, well, I can't read this label because I don't have my glasses on. And I'm not sure if this is the blue or the green pill. It happens. So being sensitive to those sorts of things, just reducing stress in any way possible. The less stress a person has, the less often their stress response is going to be activated. So it can help them feel more relaxed. The less stress a person has, the less their A1C their blood sugar is going to be going all over the place. All of these can be really helpful at not only improving Physical health, but also improving mood. There is a loss of peripheral vision. And if you as an individual are starting to lose your peripheral vision, being aware of that. And for example, I've got a door right back here, and I really don't like it when people come in the door and it startles me because I can't see them coming in. If I were trying to reduce that stress, I mean, around here, they know not to come in without making noise or knocking first. But if I were trying to reduce that stress, I might shut the door and keep it locked. Or I might reorient my desk so I could see the door, which would probably be a better solution. For people who are in assisted living facilities, for example, there's a lot going on. If you're sitting in the day room or you're sitting in the dining room, people are walking behind you, people are walking around you. If this loss of peripheral vision is very stressful, encourage that person to sit with their back to the wall. So find one of those tables that's up against the wall. If you're trying to talk to somebody who may not have peripheral vision or as as much peripheral vision, coming around to the front so they can see you is going to. Before you start talking to them, definitely before you touch them, think about how you would feel. Maybe you've got great vision right now, but think about how you would feel with blinders on and how anxious you might feel walking through a restaurant or a store or even, you know, an assisted living facility. Just sitting down, watching tv. When you can't see who's coming up to your right or to your left, you. You feel very vulnerable. So the more we can do to help people feel empowered and feel safe in their environment, the better. You can use mirrors. Mirrors are great for making sure that people can see all around them. Putting those mirrors up, they're not super aesthetically pleasing, but like they have in hospitals, where they have the big circular mirror in the corner so you can look up and you can see who's coming behind you. That actually has been shown to reduce a lot of stress for people, if they are able, without turning their head, if they're able to periodically check mirrors to see what's going on around them. Decreased depth perception. And some of this kind of goes along with the contrast sensitivity. But decreased depth perception perception is stressful for a lot of people because they may not know where things are. You know, when they're trying to put their foot down, is it here or is it here? And people with decreased depth Perception are at much greater risk of accidents, falls, dropping things, maybe accidentally touching something hot because they didn't think it was quite so close, or even missing the counter. They're trying to put their dish on the counter and they just miss identifying ways that can help this person manage that. Again, going through and identifying all of the areas where there are dangers. If you are not aware of, of the depth, you know, how much room you have between this and that is really important. Navig A crowded dining room in an assisted living facility or a restaurant can feel very daunting if you don't have good depth perception because you can't really tell how far away you are. Best analogy I can make, and I have become extremely dependent on my backup camera in my car because it has little green, yellow and red lines that tell me how far I can back up. But prior to that, back in the olden days before we had those, I could not judge depth to save my life. I always felt like I was way closer to the car behind me when I was backing up than I actually was. So I wasn't sure how far to back up. How, how far can I go to be safe and still do what I need to do? As people get older, especially if they're having to use walkers or wheelchairs, that adds even more to this whole depth perception issue because they've got a much bigger apparatus that they've got to try to navigate through a crowded area. Trying to help people in ways that are meaningful can be really helpful. Identify areas where depth perception is causing them a problem. Problem. You can't possibly guess for everything, but in the bathroom, lack of a depth perception. If you're trying to step over the the edge of the tub, into the tub. Oh goodness. You may not know exactly where that floor is going to be and you can lose your balance. So making sure there are plenty of hand holds around is super important. When there's a lack of depth perception, making sure there's good contrast. For example, if there's a step, painting the edge of the step, or putting a piece of bright colored electrical tape on that step so somebody can see it and say, hey, you know, there's a step there is really helpful. Those are the the easiest solutions to decreases in depth perception. Making sure that people, if they do make a mistake, they fall down or they accidentally drop their dish because they didn't quite make it onto the counter, that's okay. Let's not embarrass them. They already feel embarrassed. Even if they're home alone. They're they may feel frustrated or embarrassed. So okay, you know, it happened, no big deal, I'll clean it up. Not shaming them because they made a simple mistake is super important. Not getting angry with them because they made a mistake. As people get older, especially men, when they are trying to use the bathroom, they may not have as good an aim for a lot of these visual reasons. And figuring out ways to adapt to that can be helpful. There are little guards that you can put on the side of the commode that you know, keep the urine more inside. There are other options that can be done, but not getting angry at people because they're missing the toilet, but asking yourself, getting curious behavior is communication. Getting curious about why is this happening? You know, the person's probably not intentionally getting urine everywhere, so why is this happening and what can I do? What would be more helpful in this situation? Another one before I move on. My, my depth perception starting to go some and when and, and a lot of you may be able to empathize with this. When I go to put on my eyeliner and my mascara, of course I can't have my glasses on, so I've got this makeup mirror and I'm trying to do it and about a third of the time I end up poking myself in the eye. You know, I'll admit it, it sucks. It's so frustrating. And then I put on my makeup on, then I've got to put my eyeglasses back on to see if I got it on right or if I look like a clown because my visual acuity is not so good. So what looks really good when my, when my glasses are not on? Looks like a three year old did it sometimes. So I need to be careful and, and accept that instead of getting angry, just recognizing, oh, okay, well, glad I double checked. People who are older tend to have increased sensitivity to glare. They may get more of a headache. It may make it more difficult to see or to read. The more they have to strain to see or to read, the more cognitive load you're adding to them. The more stress you're adding to them, the more irritability you may see. Try to avoid lots of glare. Try to avoid having flickering lights. Pay attention. If you've got fluorescent lights, which I know a lot of ALFs do, a lot of public facilities do. Okay, what can you do to help that person manage the glare? Some older adults feel more comfortable if they've got sunglasses on. Not super dark sunglasses, but like blue blocker sunglasses. They do have clear blue blockers. Now that Some people find is very helpful at reducing glare and reducing that cognitive overload. Try different things with the individual. If it is in a particular environment, maybe there's glare at the table they're sitting at or where they're watching television. Try helping them reorient things. I know for me, if I'm doing work on the, on the pass through in the, in the kitchen, there's a window right behind me and the glare off my computer screen is just blinding. So it's important for me to turn my computer a little bit and then my eyes just kind of relax and there's sort of this whole relaxation, ah moment that I have. And people who are older have slower adaptation to light and dark environments. That goes back to our slower sensory processing. Your pupils get bigger in the dark and shrink in the light. And when you are older, it takes your brain longer. When you walk from the dark to the light, it takes your brain longer to register, hey, I need to change the pupil size to adjust. I even notice it in my dog now. He's 14 and he's got some cataracts and stuff. But he's gotten to the point where if he's walking from one room that's bright to maybe the stairwell that's dimmer, even if it's not dark, he stops at the top of the stairs and waits until his eyes adjust. That's okay. We don't want to get frustrated with people because they're not keeping up with us. We don't want to get angry with them because they're seeming to lollygag. It's taking their brain longer to adjust to the, to the light changes, and that's okay. Think about after you've been in a movie theater for two hours. You know, your eyes adjusted to the darkness and you walk outside and it's two in the afternoon and it's just bright as all get out. Think about how long it takes for your eyes, even as a young person, for your eyes to adjust to that light and how bad the glare feels. Well, you have older adults who even smaller changes are impacting them, and they're having that same same effect. When they go from dark to light, it can feel blinding. And when they go from light to dark, it can feel like they're going walking into the abyss because it takes their eyes longer to adjust. At night, make sure that there are plenty of night lights, preferably red in color, to preserve their. Preserve their melatonin and their circadian rhythms. That's why our exit signs are red. But make sure that there's enough illumination that people can see if possible. For some people they may need illumination along the floor, like along, along the baseboards so they can see their way maybe into the bathroom. These days we have motion sensored lights that can be super helpful for a lot of older adults. But again, we don't want them to walk into the bathroom at 11 o' clock at night to go pee. Super dark. They walk into the bathroom and all of a sudden 200 watts of light blast them in the face. Not that ain't gonna work for so many reasons. It's stressful, it's blinding and it also screws up their circadian rhythms. So let's not do that. Night lights are really good hearing. A lot of people who are older have high frequency hearing loss, which means they don't hear those higher sounds. Babies crying, sometimes they may not hear as much. Dogs whining, things that may grate on your very last nerve. At least they do for me. Older adults may not hear them as much, which is good. But that means they also may not hear certain sirens or certain alarms or maybe even certain ringtones on their phone. So we want to make sure that we are adjusting the environment to be conducive to that individual. The sound of a ringing bell, for example, a lot of older adults struggle to hear because it's the, that high in pitch. There can be difficulty with speech discrimination, especially in noisy environments. I've got that now and I'm expecting it to get worse as I get older. I'll be sitting in the living room watching television and it sounds like, Who was it? Charlie Brown? Sounds like Charlie Brown's teacher. I can't understand what they're saying. I have to have the subtitles on. Even though I'm watching an English show, I'm having the English subtitles on so I can understand what they're saying. Because there's so much background noise and everything else that they put into these shows now, it can be hard for me to differentiate and understand, discern what's being said. It can be really frustrating for older adults. That adds to cognitive load. It can also lead people to give incorrect answers. They thought you said one thing when you said something different. And then people start thinking, oh, this person may have dementia. They're answering in nonsensical ways. Well, let's get them into a quiet environment and talk to them. It could be that they just couldn't hear what you were thinking saying. So they gave the best answer that they could come up with. You know, they they responded to what they thought you said. If you say something to someone and they respond with something that doesn't make any sense, that's okay. Instead of getting offended, instead of getting angry, instead of going, what? Ask them again and try to make sure you're looking at them so they can see your. See your mouth. Even if they're not lip readers, believe it or not, we do pick up a little bit on that. Make sure that they can see you talking to them and try to eliminate as much background noise as possible for your. Older adults with hearing loss, especially in group environments, try to have areas where people can sit in small groups, like smaller rooms where people can sit in small groups and talk among each other and then have. If there's another group in the same room, they're way the heck across the room. So there's not as much noise. Cross contamination, so to speak. There are a lot of apps on the phone for people who have hearing aids that can. It lit. The app listens to what's being said and then transmits what's being said directly to the person's hearing aid. So that's another thing that can be really helpful, especially in group environments or family environments where there's, you know, a lot of stuff and people going on constantly. They have a slower auditory processing speed, just like all of our other senses. They hear something, two, three, they receive it. It takes them a minute to go from hearing it to processing what's being said. If I tell my husband's grandfather, hey, pop, it's time for dinner, I can guarantee there's going to be a second, maybe two second delay, and then he'll go, okay, coming, coming on in. And that is because of the sensory processing. It's not because he is cognitively impaired. It's not because he's being disrespectful. It's because it just takes a minute. So we need to give people that extra time. And if you're not, if you're processing at a faster pace than they are, it can be really easy to get irritable with people and go up and, you know, bug them and say, did you hear me? Are you going to respond? Well, yeah, give them a second. Give them a minute. Respecting a person's space and their processing time is really important because it makes people feel like a child when they tell you something and you haven't even processed it yet. And they're already, you're already up in their face going, are you going to answer me? It can be, it can feel very unsafe Giving them some time. If they're trying to think of something, don't complete their sentences for them. Give them time to think of the word. You know, obviously if they're starting to get really distressed, you can, you can jump in there and, and offer a suggestion, but we don't want to infantilize people just because they are, are moving a little slower than we are. Certain sounds are perceived as too loud or unpleasant. It could be sounds coming from the television. It could be who knows what sounds. Recognizing that for me, I know you guys are learning way more about me than you ever wanted to know, but I love listening to the birds chirp. But for some reason the, the call of the Carolina wren. It sounds just like a car alarm to me and it annoys me to death. I don't mind hearing it once or twice, but I have multiple Carolina wrens that will perch outside my window for hours and do the Same repetitive like 6 note high pitched sound. And it drives me crazy and sorry little rents. So what do I do? I can turn on white noise, pink noise, brown noise, any kind of noise. I can turn on music I can put in earplugs if it bugs me that much. That helps me block out unpleasant sounds. And I don't like white noise because it has too much of the high pitch in it and I can still hear that high pitch. I prefer pink noise, which is more of the midline, or brown noise, which tends to be have more bass in it. But whatever works for you. Think of brown noise like rumbling thunder. People who are older have difficulty localizing sounds. If you call their name, hey Grandma, I'm over here. They're like, huh? What? It's not that they are confused. They are having difficulty figuring out where did that sound come from because those auditory receptors aren't working quite as well. So making sure that you give visual cues when, whenever possible, making sure that they know where they're supposed to go. For example, in fire drills have lights and signs that point them the way because the visual will help them feel safer instead of trying to figure out where's that sound coming from. And tinnitus. Now, a lot of younger people have tinnitus too. But as we get older, we are at greater risk for tinnitus or ringing in our ears. It can be a ringing, a buzzing, a hissing. It differs for different people. Most of the time there is no permanent solution for that. But they do have apps or you can find music, something that you can play in the background. For me, when my tinnitus starts acting up. I have to have the television on and it helps it because it's really loud. It's almost like the silence is deafening. And I never really understood what was going on until I started learning more about tinnitus. But that's what's going on. So it, when there's nothing going on in the background, the ringing in my ears is just overwhelming. People who have tinnitus also have more difficulty sleeping because that tinnitus can keep them up. It can be very stressful and it doesn't go away. So you have this constant stressor, this thing that's constantly grading on your nerves for, for a lot of people. And you know, I, I'm grateful mine's not that bad, but one of my friends has, has it really bad. And it's a constant struggle for them to manage their stress and not get frustrated and irritable because they're constantly hearing that validating for people that their tinnitus is real. The ringing in their ears. Yeah, it's annoying as crap. I can't imagine what you're going through completely. But let's look at what the options are. And like I said, apps can be really helpful. If they've got hearing aids, they can actually, especially Bluetooth hearing aids. They can pipe music in if you will to counteract that ringing in their ears. They can get white noise machines. There are a variety of things they can do. This is especially important at night to help them get to sleep and stay asleep. Taste is another sense that starts to go as we get old. It doesn't all suck, but hey, we're going to adapt. There's a decline in the number and size of taste buds, which is sad. If you're like me and you really love food. The decline in taste buds can be really disheartening. There's a reduction in saliva production, limiting people's ability to taste. Saliva helps us break down our food and it helps the food make contact with those taste buds. But when we start getting dry mouth and a reduction of saliva production, we actually don't taste as well. There's a loss of sweet and salty sensitivity. But bitter and sour are preserved. Really. I mean, really. All right. Thankfully for me, I've always loved lemons and sour things, so that's a good thing. But if you are somebody who has always loved sweets or you're like my father in law who just thrives on salty stuff, it really is frustrating when a normal amount of sugar or salt, you can't hardly taste it anymore. People who are older tend to because of this, tend to over season their foods with sugar or salt to compensate for reduced taste sensitivity, which can send their blood sugar or their blood pressure into the stratosphere. We do want to be sensitive to this and help people use different spices in order to bring out the flavor whenever possible. And that is not my forte, but you can go online and learn, learn more about that. However, being sensitive, what, what used to taste really sweet to me when I was in my twenties doesn't hardly taste sweet anymore. Well, part of that may be physical. It may be a reduction of those sweet and salty receptors. And being cognizant of that is important for health. Diminished flavor perception due to concurrent smell loss. And we're getting ready to get down to smell. When you can't smell, if you've ever had a sinus infection and you can't smell anything, you know, when you were trying to eat, it didn't, it tasted bland, it didn't taste like anything, or maybe it even tasted gross. Our brain connects what we smell and what we taste. So when you can't smell, you're not going to taste or you're not going to taste much. If your sense of smell is going down, that further impairs your ability to taste food. Talk with your dentist about things that can help if you've got dry mouth. And to keep your saliva going, help people identify other herbs and spices that they may like that can help replace, if you will, the, the sweet and salty, or maybe enhance the sweet and salty without adding extra sugar and salt. And pay attention to loss of smell. Now, some of it is just biological. You're going to lose some of your olfactory receptors. But a lot of older adults also tend to have stuffy noses or, you know, frequent sinus infections. Those things are going to make it, make them less willing or less encouraged to eat. Recognize that. Again, try to put yourself in their position. Think back when you had a sinus infection and you couldn't smell. Even if they don't have a sinus infection, they can't smell as well. Think about how sometimes food just may not seem appealing because you're not smelling it. When you walk into a restaurant and you can smell that food, you can smell the basil, you can smell whatever. You start salivating and your brain starts saying, ooh, that's good. Well, if you can't smell, you're not going to start salivating. If you're not salivating, you know, you see where we've got a problem here. Being sensitive to people is important. Not getting angry with them, if they pick at their food, if they don't seem to want to eat, try. If they're having difficulty getting an appetite, presenting foods that are high in aroma, obviously an aroma that they like. For me, I hate fennel. I don't like fennel. So if you bring me something that smells like fennel, you can guarantee I ain't going to eat it. But brownies. Now, you bring me something with chocolate in it, I'm all about it. But if I can smell it, that's going to trigger a lot of hormonal changes, it's going to trigger salivation, it's going to trigger some of my olfactory, and gustatory, as they say, receptors making, encouraging people to focus when they're eating, on smelling their food. You know, when you drink coffee, smell it, take it up to your mouth and take a big old whiff before you drink it, and it actually enhances the flavor. Touch. Reduced sensitivity to touch due to fewer sensory receptors in the skin. So not only does it take longer for the message that, hey, I'm being touched to get from the touch to the brain, but there's also fewer receptors to even get the message. Being patient with people is really important that we have that delayed tactile processing that we've been talking about. When somebody puts their hand on a hot stove, if they've got delayed tactile processing, they're going to leave their hand on that hot stove longer than they would if they were younger, if they had faster nerve processing, which is a danger they may not realize. I know sometimes I'll grab things off the stove or something that I thought weren't too hot. I thought probably wouldn't burn me, but oh yeah, they did. Oops. However, an older adult who's grabbing something out of the oven, they may grab this ceramic pot and start taking it to the, to the table. And they never get the message in their, in their brain that, hey, this is too hot, until they've got burns on their hands. And that's going to be very painful and unpleasant. We all know how first and second degree burns hurt. They have increased pain sensitivity from neuropathy, arthritis, or skin thinning. As we get older, not only do we lose sensory receptors, but our skin also thins and we become more prone to getting bruises and those sorts of things. Being aware of this, when you touch somebody who is older, being gentle, being very gentle so you don't hurt them. Making sure again. And I'm thinking assisted living. If you are trying to talk to somebody, you want to Walk around where they can see you before you touch them, you want to make sure it's okay to touch them, but if you touch them, you know, put your hand out and leave it there for a second so they can like, recognize, okay, I'm being touched. That can help. I've worked with adults in assisted living facilities, and sometimes you go over and you're trying to comfort them and, and you put your hand on their shoulder and it doesn't seem to phase them for the first two, three seconds. And then all of a sudden it's like, oh, okay, I can feel that pressure. And the oxytocin receptors and all that other stuff starts activating. Be slow in what you do. Be mindful in how you're touching people. And, and again, make sure that you're taking into consideration all of their senses, not just coming up behind them and saying, hey, Sam, how's it going? And then patting them on the back. That may scare the living daylights out of them because they're not expecting it. They didn't hear you coming up from behind, they didn't expect to be touched. Etc, go around to the front. Always make sure they can see you. There also may be impaired temperature sensitivity, increasing the risk of burns, chills, or poor regulation. Many older adults have difficulty with temperature regulation. You may be sitting in there thinking, oh my gosh, it is a sauna in here. And grandma and grandpa are sitting on the, on the couch under a blanket going, is anybody else cold? It happens. And part of that is because as our skin thins, we have more difficulty and as we lose more body fat, we have more difficulty retaining our own temperature. But some people may not recognize that they're too cold. And we do need to be cognizant of that. If we're taking care of somebody who is older, especially one who may have some cognitive decline, we may need to be more cognizant of their physical, their physical temperature. And when older adults, maybe it's the middle of summer and they're walking around with a jacket on, okay, you know, what is that behavior saying? That behavior is telling me that grandma's cold, okay? I'm not going to challenge them for being dressed inappropriately. I'm going to think behavior's communication. What's that behavior? Communicating. It's communicating to me they're cold. So maybe I may ask them, is there something else I need to do to help you feel more comfortable? Do you need more blankets in your room? And finally smell there. For older adults, there is a partial or complete Loss of smell, which is one of the reasons that a lot of older adults stop eating as much. And I know we talked about this a couple slides ago, but we do want to be sensitive to that. They may not smell their own odor, and they're not trying to be gross. They're not trying to be disrespectful in any way, but they may not realize that they smell. They may not realize that they've overdone it on their cologne. They can go to the other end. They, you know, take a bath, and they put on all kinds of aftershave and stuff, and you can smell them from 100 yards away. It can go either way because maybe they. They put on enough so they could smell it, which was enough for half a town talking to them about that. If necessary, we need to approach in a very respectful manner. We don't want to make fun of them for putting on too much cologne or aftershave or something. We don't want to make fun of them for having a body odor. You know, that that's rude and. And just horrible. We want to recognize that they can't smell it. They don't smell it to the same degree we do. And being sensitive to it. We have always had dogs, and my mother used to swear that she could, as soon as she walked in, she could see, smell that we had dogs. I. To this day, I can't smell dog. I. I don't smell it when it come. When I walk into the house, there are other things I smell, but I don't smell dog. And maybe those receptors just got blunted many years ago. I don't know. But I need to be conscious of it personally when I've got. I feel when I've got company coming over to make sure it's like, well, I don't smell dog, but, you know, let's put a little Febreze around just to make sure. The reduced ability to discriminate between odors, what is a noxious odor versus what is an okay odor, can also be problematic. If you're losing your ability to really smell very well, then when you're smelling the food to see if it's rotten, you may. Especially if you're not smelling well, you may think, oh, this is fine. I can. I can still eat it. It's not spoiled yet. When in reality, you know, it is food poisoning waiting to happen. Encouraging people as they get older, especially if we're dealing with food, to write on a. On the container that they put in the refrigerator, the storage container, the date that it went in there is going to be really helpful. That way they're not relying on smell. They know after three days, hey, this has got to go. And distortions of smell perception, odors, things smell wrong. Or you may have phantom smells. I know I mentioned that before class. I've started having these occasional phantom smells and I'm like, where in the world is that coming from? And it's absolutely nauseating. And it was very confusing when I had it. I knew what it was, but I couldn't figure out, you know, I was determined to figure out what that smell reminded me of. And I never did figure it out. But then sometimes things just smell wrong. You have coffee and I love coffee, so I use that as an example a lot in addition to chocolate. But sometimes you smell, smell and taste coffee and it smells amazing. And it tastes amazing. And the next day you may have that same coffee and it just, it smells wrong. It smells off, it tastes off. And that can happen when we're sick. That can happen as a result of aging. And we need to figure out how to adjust people's foods, especially in order to ensure they are still eating and nourishing themselves. We need to help them figure out how to adjust their environment. Maybe their smell perception varies on a day to day basis. Some people smell perception varies based on their stress. I know when I was younger, mine varied based on my hormones. When my estrogen was high, I had a bionic nose, I could smell anything. Now I don't smell much, but it was important to be able to adjust so you don't have a permanent stuff smell somewhere. You want to make sure that they have the ability to have little plugins or air fresheners or whatever it is that can help them change the smell. If there's something that smells bad, all right, let's change it to something that smells good to you today, may not smell good to you tomorrow, but it smells good to you today. And, and that can be really empowering because we all know how to unpleasant it is to sit somewhere that you think stinks. Environments that are responsive to sensory changes in needs reduce stress, irritability and depression. We know that there is a direct correlation between systemic inflammation and anxiety and depression. We know there is a direct correlation between stress and systemic inflammation. So if we can reduce stress, we can help to reduce systemic inflammation that contributes to mood, behavioral and immune system issues. Reducing stress improves multiple physical health parameters, including people's circadian rhythms, including people's blood pressure, including people's blood sugar. All of those are impacted. When our stress response is activated frequently or constantly, it helps us improve our relationships. Well, guess what? When I'm not stressed all the time, when I'm feeling safe and empowered in my environment, when I'm not worried that somebody's going to walk up and scare me, I've got a lot more energy to spend focusing on people. Or maybe if I feel safe in my environment. I don't mind socializing, but I don't like going to places where I'm constantly, you know, hypervigilant. And in adjusting these environments to manage sensory changes helps people live their richest, most meaningful life because they are using their energy to do things that help them feel safe and empowered and fulfilled instead of using their energy constantly to be on the defense. Offensive. Are there any questions? I agree so much with you, Frederick. Telling people ahead of time, I don't hear very well, look at me when you're talking and slow down a little bit is so helpful. Even on these videos. A lot of people don't realize you can go into the settings icon and you can turn it down. I know I talk fast, but you can turn it down on the replay. So I'm going at three quarter speed. There's one YouTuber that I watch that goes even faster than I do and in order to watch his videos, I have to turn it down to three quarter speed in order to get anything out of it without getting completely stressed out. But it helps in relationships, definitely. If you tell people ahead of time, hey, I need you to do this instead of expecting them to know or to read your mind, then they feel empowered to have a more meaningful conversation with you. My husband's grandfather went to an assisted living facility to do a tour and they gave him what's called the mmsc. It's a basically a dementia screening test and he is all but deaf. His hearing aids are cranked up as much as they can be and they just really aren't even cutting it anymore. He's in his mid-90s, but he's fine. He just doesn't care. He doesn't pay attention. So on the MMSE, he scored, I think he scored a 7 and you need to score at least a 15 between 15 and 30 to qualify for assisted living instead of memory care. And we all knew that there was nothing wrong with his cognition. He's still smart as the whip, but he couldn't hear anything. And instead of telling people, I can't hear you, I need you to slow down and I need you to look at me and get rid of the background noise, he just sat there and nodded and sure, whatever. Which resulted in a very false positive for. For his test. So it is important to self advocate in a lot of ways. If somebody's cologne is too strong and perpetually too strong, it may be a conversation you need to have with them in a gentle, kind way, just letting them know, hey, you know, I tend to. I can. I get headaches sometimes, and I would appreciate it if you didn't wear cologne when you came to visit me or something. But we do need to let people know what our needs are as older adults. We need to be able to say, this is what I need. Or I need you to give me a second to process what you're saying. Slow down a little bit, and let me get it. So that's. That's a great tip, though, Frederick, to let people know ahead of time. I want to be. I want to interact with you. That. That would be great. And this is what you need to know about. All right, everybody, thank you so much for attending today. I very much appreciate it. Come here.