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Slide 1 Introduction to the Sensory System

Slide 2 Index

What is the sensory system?

• The senses

• What do the senses include?

Slide 3 What is the sensory system?

The sensory system is actually part of the nervous system, which you will see in one of the you tube videos in the resources. However in this topic I am going to talk about how important your sensors are to you and the people in your care.

What the sensory system does is process information that comes from your sensors and how these messages are sent to the brain.

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The sensory system consists of receptors that capture the senses and send the messages to the brain via nerve pathways to the parts of the brain that interpret sensory perception and send the appropriate response back to the part of the body it was sent from. Confused?

Well essentially a message gets sent along a pathway, you could call it a road if you like. Along this road or pathway there are a number of bus stations where the message is received and sent on down another pathway till it get to the right area in the brain that interprets the message. It is like a relay.

Slide 4 The senses

Now commonly you talk about the five dominant senses but in actual fact you have about 25 sensors. Which are the most dominant. So I will be talking mostly about the dominant sensors.

Slide 5 What do senses include?

Now the dominant senses are what we see through our eyes which of course is vision. What we hear through our ears, which is hearing and what we taste through our mouth and tongue.

Slide 6 What do senses include

What we smell though our nose as well and the Somatic System. Now normally you would think of touch as being the 5th sense but I am going to include it in the somatic system which includes touch, temperature, and pain, positon in the environment and balance and movement.

Now you may have heard of the vestibular sense? Well that is balance and movement but in this topic I am including it in the somatosensory system. So now we will move on to Segment 2 which is vision.

Segment 2

The Eye

Script

Slide 1 Index

In this segment I will talk about the 4 main structures of the eye, what happens to eyes as a person ages and the conditions that relate to the eye to help you understand different conditions you or your residents may have.

Slide 2 What the eye looks like?

The eye is a very is an amazing organ. It consists of many components but the bulk of it is made up of vitreous humour, a clear jelly like substance that is as clear as glass. Very simply put it is uneven ball about an inch or 2.5cm in diameter.

You will see on this diagram the front of the eye is made up of the iris which is the coloured part, the cornea which is a clear film that looks like a dome or you could call it the roof over the eye, the pupil which is the black part of the eye that lets the light in, the sclera which is the white part of the eye which is hard to see on this diagram but if you look at your eye you will see this. Then over the front of the eye is a thin layer of tissue called the conjunctiva. You may have had people in your care with conjunctivitis which is and infection in this part of the eye.

Now just behind the iris and the pupil is the lens. This lets the light in and helps it to focus it on the back of the eye. Now the inside of the eye has these special light sensing cells that make up the retina which converts the light into electrical impulses which are carried to the optic nerve which sends the messages to the brain so you can see the image. Also at the back of the eye in the centre there is a very sensitive pat called the macula. This is what gives you central vision. You can see this in the centre of the retina. The macula has small pit in its centre that gives you the clearest vision. Now it is important to know this little bit of information as I will talk about what happens to a person vision if the macula is affected as it commonly can be with people as they age.

You may also like to know that your eye colour is created by multiple genes that you inherit from bot your parents.

Slide 3 4 Main structures of the eye

So from the age of around 40 many peoples sight begins to deteriorate. Things don’t seem to be so clear. However with modern science and treatment these days it is possible for people to have good sight. David Zacks, a retina specialist and assistant professor of ophthalmology and visual sciences at the University of Michigan Kellogg Eye Center likens the eye to a video camera. You all know how these work. Although I have discussed the eye in the previous slide, it is helpful to review it this way. There essentially are 4 main structures to the eye that causes eyesight problems. The cornea, lens, retina and optic nerve. As I said in the last slide, the light enters the lens via the cornea and projects onto the retina which sends the messages to the brain.

So now lets look at each individually.

Slide 4

The Cornea

As I said the cornea is a clear film that looks like a dome or you could call it the roof that covers the eye. If the cornea gets damaged, the image you see will be affected. So the cornea must remain smooth. If the tear film is damaged it will affect the persons vision and will need time to heal. Commonly the person will have to wear a patch and apply eye ointment, usually an antibiotic, to make sure it heals.

Slide 5 Conditions of the cornea

So what can damage the cornea? Well a condition like Blepharitis which is inflammation of the eyelids can damage the cornea. It feel like a film over the eyes. It can be relieved by blinking but if it is severe enough then the cells that produce the tears can get damaged. This leads to dry eyes and a more serious symptoms can also occur, such as blurry vision, which is due to evaporation of the tears and drying out of the corneal surface. This condition can become chronic and is known as dry eyes.

Slide 6 Conditions of the cornea

Damaging to a cornea can occur from a scratch from tree branch, a finger nail or anything at all that could scrape across the eye. We have a normal reflex action where the eye closes when something is close to coming into the eye or it waters if a foreign body gets in it but sometime we are not quick enough or there are not enough tears to actually wash out the foreign body and damage occurs to the cornea. However a corneal scratch usually heals up quite quickly.

Slide 7 Conditions of the cornea

Now the cornea at birth in most babies is crystal clear and very pliable, which means flexible. However there is one exception and this is for children born with cataracts or some other eye condition. However as we age the cornea becomes less pliable meaning it becomes less able to bend or be flexible so it becomes hard and less able to change its shape and may cloud over

Slide 8 Presbyopia

Now there are some particular conditions that affect people’s vision when the lens is involved and you will see these in some of the people in your care or may even be happening to you or a family member.

The first I will talk about Presbyopia. Now this is because the lens loses its flexibility and can’t change shape to help you see the object or focus on the image close up. This also causes the muscles of the eye to weaken. The result of this is when the light rays enter the eye through the lens, and send the image to the retina at the back of the eye for you to see, it actually goes past the retina instead of hitting the retina. This makes it more difficult to see the image close up. Hence you may need glasses to see.

Now this happens from about the age of 40 and you yourself may find that you get tired or strained eyes or headaches and once you get eye glasses your eyes do not feel so tired and your headaches disappear.

Slide 9 Cataracts

Cataracts are another condition that affects the lens. This is where the lens becomes cloudy and what you see through the lens becomes very distorted and difficult to see. You may have seen someone in your care or even your family who has had a cataract.

Side 10 Treatment for cataract

Generally surgery is the option of choice for a cataract removal although in the past people used to wear very thick eye glasses. However surgery is very advanced now and the cloudy opaque and hard lens can be removed and the surgeon replaces it with an artificial lens, like eye glasses, and the person can generally see better.

Slide 11 Vision through a cataract

You can see in this picture, how a person’s vision is affected by a cataract. The image is not clear but a bit fuzzy and blurry.

Slide 12 Retina

The Retina is situated at the back of the eye. It is the light sensitive layer of the eye and covers around 65% of the surface of the back of these eye and is around 0.5mm thick so you can see it is a very thin layer. Just behind this thin layer are rods and cones which are the photo sensitive cells so light must travel through the retina to hit the rods and cones where the light is converted into energy signals so the message can be sent to the brain via the optic nerve. So the purpose of the retina is to receive the light that comes in through the lens and convert the light into signals that are sent to the brain. So it stands to reason that if the retina is damaged then it will interfere with sight.

Slide 13 What is a retinal detachment

One of the conditions that affects the retina is when it becomes detached or separated from the underlying supportive tissue. Now retinal detachment is relatively rare – about 3% of the population in the US and another 6% of the population may have retinal holes but these do not lead to a detachment.

It is more common in middle aged and older people however a recent study in Sweden revealed that babies born before 32 weeks gestation appear to be more at risk of a retinal detachment

Slide 14 Causes of retinal detachment

What causes a retina to detach? Well there are a number of reasons. One is as I mentioned in the previous slide, with near sightedness where the eyeball becomes longer so the retina becomes stretched and thinner so this is why middle aged and older people are at risk

Any injury to the eye or face can also cause the retina to detach.

Surgery to the eye can also be a factor. Some near sighted people undergo laser surgery to restore their sight and in rare occasions it can cause the retina to detach

Slide 15 Causes of retinal detachment

Cataract surgery can also be a contributing factor as can tumours in the eye.

Diseases like diabetes can cause a detachment either as a result of the disease or from the retinal neuropathy where new blood vessels grow under the retina and push the retina apart. A particular type of Anaemia like Sickle Cell anaemia can also be a contributor.

Slide 16 Signs & symptoms of retinal detachment

So how would you know your retina is detaching. Well they vary from person to person but may include such things as spots appearing in the vision or floaters which are black spots that float around the eye. Now mostly floaters are not the indication of a serious condition. Many people have them and they become particularly noticeable when looking at something while or perhaps the blue sky. So don’t become alarmed at floaters as most people learn to live with them, however if the appearance of floaters is sudden and may be accompanied by flashes of light then this may be an indicator.

Some people have blurry or poor vision that is not normal for them while other may see a shadow or a curtain descending from either the top of the eye or coming across the eye depending on where the detachment is.

So don’t confuse some normal aging changes or conditions which gradually appear with a detachment of the retina which is often more sudden.

Slide 17 Treatment of retinal detachment

So what is the treatment for a detached retina? Generally surgery is the only option for repairing a detached retina. However, this is not always successful and surgery doesn’t always guarantee a restoration of sight. A successful outcome depends on the location of the tear or detachment, the cause and the extent of the detachment.

Slide 18 Retinal tear or detachment

This is what a retinal detachment or tear looks like. You can see how it has pulled away from the back of the eye. It also shows you how difficult it can be to repair and why sight is not always restored after surgery

Slide 19 The Macular

The macular is a small spot on the retina that is responsible for clear and detailed vision. So that means they may be able to see your face but not your eyes or a part of their vision is hidden or concealed. This makes it really difficult for a person to read or do craft work. It is also the area used to drive, and watch TV so you may find people tell you they can’t see, yet they can look you in the eye or get themselves around the facility or their home without any problem.

So they are not actually blind, though some are registered with the foundation for the blind but because they are likely to have a black spot or hidden area in the centre of the eye, it makes it difficult for them to see detail. Their peripheral vision will remain intact but it is the, that is what they see from the outer part of their eye but it is the central vision that gets lost or distorted.

So they cannot read unless they use their peripheral vision and the have the light shining on the page in the right spot for them to see but they can still see if they hold the photo or writing to the outer, upper or lower part of vision area. A person with macular degeneration will never go blind but one could say they will have permanent low vision.

Slide 20 Macular Degeneration

Macular Degeneration is the leading cause of vision impairment in people over 50. In fact it is estimated that 1 in 7 people over 50 will get it. It is a progressive disease that gradually leads to loss of central vision starting with not being able to see clearly to eventually be a black spot in the centre of the eye where the person cannot see much at all.

Slide 21 Types of macular degeneration

There are two types of macular degeneration. One is dry which results in a gradual loss of central vision and is the type that you will most likely see in people in your care.

The other type is wet. This results in a sudden loss of vision and is caused by abnormal blood vessels growing under the retina.

Slide 22 Treatment for macular degeneration

There is no known treatment for dry macular degeneration however early detection is important. The aim of early diagnosis is to try and keep the best vision possible. However wet macular degeneration is the subject of clinical trials to see the if they can prevent further damage so it is important to get your eyes checked regularly and do everything you can to maintain good vision for as long as possible.

Slide 23 Optic nerve

The optic nerve at the back of the eye in the centre. The nerve centre in the retina all converge in the centre and forms the optic nerve. This centre is very close to the macular which we talked about in the last slide.

Now you may have heard of the blind spot. Well this is the area where all the nerves gather to form the optic nerve. There are no light sensitive cells at this point as the nerve fibres are taking up this space.

Inside the optic nerve are two blood vessels. One is the central retinal artery which brings oxygen and nutrients to the retina and the smaller blood vessels and the central retinal vein that takes away the waste products like carbon dioxide.

Each eye has its own optic nerve but there is a point or a junction where they meet and join. Now we have a left and a right eye and each eye has nerves for each side. At this junction the left nerves go to left and send the right nerves to the right side and visa versa so that both eyes can see objects from both left and right.

Slide 24 Glaucoma

One of the conditions that affect the optic nerve is Glaucoma. You may have some people in your care with it. Now glaucoma is the name of a group of diseases that affect the optic nerve. What happens is the nerve fibres dies due to increased eye pressure which of course puts pressure on the nerve fibres so they die.

Now the eye needs some pressure or it will go flat so the eye has a little pump that releases fluid to keep the eye moist and the eye ball inflated. If for any reason this fluid cannot drain away through the normal channels in the eye that is in your eye needs to be able to drain away then the pressure in the eye will rise and irreversibly damage the optic nerve.

Slide 25 Glaucoma

Glaucoma is the no 1 cause of preventable blindness. Now unlike Macular degeneration where the centre of the eye develop a black spot and distorts vision to gradually excluding vision from the centre of the eye, Glaucoma starts from the side and works inwards so it is more gradual and often is not picked up by a person before damage has been done.

Slide 26 Causes of glaucoma

While the exact cause of glaucoma is not known there are some factors that are common to it. They are age, a family history and of course raised eye pressure. The best way to prevent glaucoma is to pick it up early and treat it and most optometrists routinely check for glaucoma as it is the best way to prevent blindness.

Slide 27 Treatment for glaucoma

Commonly eye drops are used. Usually the doctor will prescribe the smallest dose first. There are different types of eye drops but the important thing about these drops are that they have to be used as prescribed every day for life for failing to use them will cause the pressure in the eye to rise again and blindness will result.

Sometimes tablets are used but this is not that common.

Biggest problem for people is they have to keep instilling the eye drops for a condition that is not painful and they have no symptoms.

On the whole there are little or no side effects from the medications so if a person in your care complains or refuses to have the eye drops and tell you there is nothing wrong with them, you need to talk to the doctor about it to see if there is an alternative for the person or explain to them if they do not have the drops they will go blind as this I am afraid is the alternative.

Slide 28 Social Cost of Poor Sight

Not being able to see or see clearly is very disabling. Research has shown that People with poor sight have a high prevalence of chronic health conditions. At the top of the list is diabetes which affects much of the population. It is the very reason that all diagnosed diabetics in New Zealand have their eyes checked annually to keep close eye on the affects diabetes is having on their eyes and affecting their vision.

It is predicted that by the end of 2026 60% of people over 65 will have diabetes and while most of these will have reasonably good health, one in five will have a mental disorder. One of the contributing factors to a mental disorder can be depression purely related to the fact they cannot see. But on top of this there is also the compounding effects of diabetes on the nervous and circulatory system which affects their limbs. To learn more on this, go to the diabetes topic.

So with the early detection and treatment of diabetes and, as I mentioned earlier, the ability to preserver a person’s vision improves. However, diabetes is not the only cause of loss of sight. There are also those mentioned earlier like untreated glaucoma, detached retina and cataracts.

Poor eye sight also contributes to falls and injuries which compounds the problem for people especially if they are living on their own. It is not unusual for a person to have had a fall and to lie on the floor for some hours till someone is alerted to the fact they haven’t been seen around. People have personal alarms are at least able to call for help, if they wear it all the time, but if they don’t have one or don’t wear it continually it is easy to see how they could fall.

Now a person who is blind from birth may be able to find their way around the home fine. Likewise if a person loses their sight gradually and they have lived in the home for a long time they may be able to manage to get around the house but where it becomes more difficult is having to learn new skills as a sightless person as a person ages. Some people adjust very well while others don’t. When a person is put into a totally new environment it will take a while for them to orientate to the new space and sometime, and of course some people never do. Add this to a person having dementia and you can see the risk of falls and death can rise.

Slide 29 Social Cost of Poor Eyesight

Social isolation is high on the list of social costs. Not being able to get out and about or even around the house with little social contact means a person is left with little option but to survive on their own company, the radio or television. While some people cope well, others become depressed and withdrawn which leads to other health problems. Social isolation is not something people think about as a rule until faced with the fact of being on their own and the intense loneliness a person may feel. With more and more older people having family living away from parents either in another city or overseas, it is easy to see the social cost some older people are having to pay by being on their own.

All of this of course adds to a compromised quality of life. Imagine if you were a person who was used to getting in your car and doing everything you wanted to do, as most of you are, to now having to rely on someone else to take you places which is often in their time, not yours. It is easy to see how ensuing deterioration in mental health can occur.

Many people now continue working over the age of 65. What if you had to give this up because you have lost or are losing your sight? So they now no longer have a way of supplementing their income, they cannot go out whenever they want to because of not only sight deterioration or loss but lack of financial resources. Many older people lost their savings a few years ago with the financial collapse so what they had put aside for their retirement disappeared. They didn’t have the luxury of Kiwi Saver or a superannuation scheme to support them once retired.

Slide 30 Social Cost of Poor eyesight

Where a person lives is important to their physical and mental health. Most people want to live in their own home but for some people as they lose their sight, this is not possible. The safety risk becomes too high i.e. risk of falls, or not being able to cook or prepare meals for themselves affects a person health status. While home care is available for many people sometimes, this becomes a unsustainable and the only option is for residential care.

Some cultures also have a distorted belief around loss of sight that they had done something for this to happen to them when we know it is not so.

For others it may inhibit them from being able to go to places that nurture their spiritual beliefs or need. If they have regularly attended church or some other place of worship, and they can no longer get to worship for whatever reason, leaves them spiritually bereft or mourn the loss of their ability to get their spiritual needs met. While it is impossible for a person not to be a spiritual being, the way spirituality is nurtured differs from person to person and from culture to culture. Not being able to have these needs met has a huge social cost on a person.

So when you look at all the aspects of loss of sight, the devastation a person has from this loss effects their lives dramatically from physical and mental health, housing, income and their quality of life. Often people do not know what they have lost till they have lost it an cannot get it back

Segment 3 Slide 1 The Ear

Script

Slide 1 Index

In this segment I will talk about ears, how they work, the types of hearing lose, causes, conditions and social costs of hearing loss. I will also talk about hearing aids, their importance and how to care for them. I will also cover the importance of ears and balance and the social cost of balance disorders.

Slide 2 Function of the ear

The ear has two main functions. The first is it detects and receives sound so we can hear and the second it helps us maintain balance. So if the ear is not functioning properly the result is be hearing loss or we fall over or have the sense of falling over.

Slide 3 How the ear works?

Very simply the ear works by the little hair follicles inside the ear picking up the sound waves as they enter the ear and changes them to the nerves signal and then sends these signals to the brain for the brain to interpret the sound.

Slide 4 Hearing loss and age

Many people lose their hearing as they age which may start to decline from the age of around 50. Aged related hearing loss is known as presbycusis, which simply means “old man’s hearing” is the gradual loss of hearing as a person gets older.

This is called sensorineural hearing loss and is usually caused by damage to the hair follicles or cilia’s in the cochlea. Another reason is that the ear drum, becomes thickened and makes it less able to transmit the mechanical sound waves to the cochlea

Slide 5 Types of hearing loss

Not there are two types of hearing loss. One is sensorineural which affects the inner ear and there is not cure for. With the exception of a few people who may qualify for a cochlea implant, the vast majority of people who have a sensorineural hearing loss, the loss is permanent and there is no cure for it. These people may require hearing aids to help them hear.

There are a number of causes of this which I will look at in the next slides

The other type of hearing loss is conductive and this is curable and usually caused by a mechanical problem. Once this problem is fixed, the hearing will return which I will discuss in later slides

Slide 6 Conditions Causing Inner Ear Damage – Sensorineural Hearing Loss

There are many causes of sensorineural hearing loss but perhaps the most common is exposure to loud or constant noise. This can be caused through the work a person has done where their ears were not protected with ear muffs. This includes working with machinery where there is constant noise e.g. working on a digger or jack hammer, or playing in a rock band or even listening to loud music through head phones. Anything that causes this constant noise will damage the ears.

It can also be caused by the loud noises like an explosion of some sort. You may have experienced this yourself if there was a loud bang, like a bomb going off or being around a loud fire cracker. You may even have commented that it left your ears ringing. It can also rupture your ear drum which is the thin layer. People involved in war and conflict are at risk of hearing loss through the bombardment of mortar. While the soldiers may have ear muffs on the civilians will not be that prepared so anyone who has been involved wars area at risk of suffering sensorineural hearing loss through ongoing ringing or buzzing in the ears.

Head trauma can also cause hearing loss. It can be caused by a penetrating injury to the brain or ear in particular or by nerve damage as the result of the head injury. A perforated ear drum could also happen as a result of the trauma. Ongoing problems from the trauma like tinnitus (ringing in the ears) that will result in hearing loss.

When a person has a traumatic head injury the following may happen, skull fracture, bruising, blood clots and tears happen to and in the brain. Also nerve damage can occur from the cutting, shearing the brain suffers as a result of the blow to the head.

Sometimes a virus or some other disease can affect hearing. These are diseases like diabetes, measles, mumps, meningitis, and encephalitis for example.

Slide 7 Conditions Causing Inner Ear Damage – Sensorineural Hearing Loss

Drugs can also affect the ears and cause hearing loss. Drugs like large doses of asprin when doses exceeding 10 to 12 tablets a day; non-steroidal anti-inflammatory drugs like ibuprofen; some antibiotics like Streptomycin and Gentamycin; drugs used to treat heart failure and hypertension like frusid and medicines used to treat cancer.

Autoimmune inner ear diseases can also affect the ear. Examples of such diseases are rheumatoid arthritis, lupus erythematosus or ulcerative colitis.

Hereditary factors area can affect the ear as well. This occurs where there is a gene mutation, where the gene it altered in some way, and causes these conditions. Examples of these are Otosclerosis which is where there is abnormal bone growth in the ear and Pendred syndrome which is a malformation in bones in the ear.

Slide 8 Conditions Causing Inner Ear Damage – Sensorineural Hearing Loss

Tinnitus in some cases, may have hereditary or genetic factors as it may well affect many people in a family. This is a constant ringing in the ears that has not been caused by loud noise or working in a noisy environment however the end result, sensorineural hearing loss is the result.

Aging of course can also affect hearing loss. This is called Presbycusis and start from around the age of 50 as I mentioned in an earlier slide.

Meniere ’s disease is another disease that causes hearing loss. This only affects one ear and it is characterised by vertigo where the head spins and the person feels like the are falling over, fluctuating hearing loss, tinnitus or ringing in the ears and sometimes the person may feel like there is a fullness in the ear. Now this can affect people of any age but more commonly people in their 40’s or 50’s are more likely to get it.

Now this is not all the conditions that can cause sensorineural hearing loss but it gives you an idea of the many things that can affect the ear.

Slide 9 Conditions causing hearing loss (conductive hearing loss)

Now lets talk about conductive hearing loss and what causes this. Well as I said earlier these are conductive hearing loss affects the outer or middle ear. The most common would be wax build up in a person ear. Everyone secretes different amounts or cerumen which is commonly called wax in the ear. Some people never have a problem but others do. Simply when the wax build up in the ear and it is removed the person can hear again. So you need to be aware of people in your care who are prone to wax build up. You will be able to pick this up by their gradual inability to hear.

A point to note here that people with hearing aids are prone to wax build up. This is because the aids in the ear prevents the wax from coming out of the ear and can also block the hearing aid as well so take special care to check and clean hearing aids and remove any wax build up on them. Likewise, check the persons ear or get the doctor or nurse to check how much wax is in their ear and is it covering the ear drum. The wax will need to be removed at least once a year or more often if they secrete a lot of wax. The best way to remove wax is by a specialist ear nurse clinic who will remove it with special suction tool. The doctor or nurse may also syringe the ears with water but this is not the preferred method for clearing excess wax from ears.

Another problem could be a foreign body in the ear. It could be a beans or peas or something really small that blocks the ear canal. More likely to happen in children than adults but worth keeping in the back of your mind.

However in adults the end of a cotton bud is common. This is another reason you should only clean the outer ear with a flannel and not a cotton bud. Apart from the fact you could damage the ear, the tip of the bud could come off and get stuck in the ear.

Perhaps a less common foreign body may be the dome of a hearing aid. Modern hearing aids have small flexible plastic domes on the ear piece. Sometimes these become loose and get lodge in the ear canal.

Don’t try to remove a foreign body yourself as without the proper equipment or light, you could end up pushing it into the ear further and or cause more damage to the ear.

Otitis Externa or swimmers ear is another condition that affects hearing loss. It is actually an ear infection that is caused by water. However the common symptoms are pain and tenderness in the ear but if the ear canal swells it can cause conductive hearing loss. Again when the swelling goes down, hearing returns.

Slide 10 Social Cost of hearing loss

The social cost of hearing is immense. Not being able to hear is very debilitating. Considering that 30% of people over 65 will have some form of hearing impairment gives an idea of the vast number of people hearing loss affects. So when a person has hearing loss they are likely to miss opportunities for communication, information exchange, humour, and emotion which will eventually lead to Social isolation. By not hearing or being tired of getting things wrong through mis-communication becomes just too hard so people just stop going out as it becomes just too hard to try and follow conversations and many public places like restaurant and cafés have very poor acoustics which makes following a conversation just too hard. Talking on the phone becomes a mission too so they will revert to emails or not using the phone and a way of communication. They will miss calls too as they don’t hear the phone ringing.

It can cause stress in the family as the frustration of trying to carry out a conversation with a person with hearing loss becomes just too difficult. People give up ringing on the phone as it is likely they may not hear the phone ring so it goes unanswered or the person can’t hear to have a conversation.

Slide 11 Social Cost of hearing loss

The likelihood of maintaining and income can be reduced if hearing is essential to the job and of course this follows on to reduced productivity. So the employer, the employee and peers all become frustrated with not being able to communicate effectively.

As people get older then it may mean they are not able to live on their own and it may lead to assisted living in retirement villages or with family members earlier than a non-hearing impaired person

It goes without saying that there is a reduction in Quality of Life. Not being able to hear what is going on around you is very disabling severely restricts a person in so many ways.

Slide 12 Social Cost of hearing loss

For some people, depression follows as it becomes just too difficult to live without being able to hear or communicate. Not being able to hear and getting things mixed up can actually lead people to think the person has dementia when they don’t; they just cant hear. However for some it can actually lead to dementia. The world just becomes too hard.

Slide 13 Hearing Aids & hearing loss

Now not everyone will wear hearing aids but if a person does, it is important that you know how to care for them. They are very expensive so you need to take good care of them. They can cost up to $10,000 and often there is no subsidy for them. Those who are covered by ACC will receive part payment but those who are not have to cover the full cost and if a person is on a pension that is a lot of money to find. So you need to take good care of them. If the person has dementia and is at risk of losing their hearing aid you need to make sure they are put in correctly and remove when they go to bed and put in a safe place. This may be in the office. Do not leave it in their room. Disability from hearing loss is around 10% of the population globally.

Slide 14 Cleaning Hearing Aids:

Cleaning them and removing the wax is very important as they will end up with a conductive hearing loss as well as a sensorineural hearing loss. To clean them you should wipe the external part of the hearing aid with a clean dry cloth or tissue to remove any wax or dirt from it.

Clean the ear pieces as well as if you don’t keep it free of wax it will affect the quality of the sound the person will hear. Now each hearing aid is different so you need be shown or find out how to clean the hearing aid properly so now go to the resources section and watch the video Cleaning Hearing Aids. It covers all the different hearing aids your clients or residents may be wearing.

This video will show you how to clean a hearing aid

Slide 15 Inserting and removing a hearing aid

It is important that you make sure the hearing aid device in both inserted properly and removed properly and that you don’t damage it. As I said earlier, a hearing aid is very expensive and often people have to pay for it themselves so take care of them as if they were your own and you were spending your own money.

Slide 16 Hearing Aid Batteries:

Making sure the batteries are always working as well is important or it is like having an ear plug in their ear. A hearing aid battery has a life of around 100 hours but this is only guide to when a battery will need changing. Always make sure there is a stock of replacement batteries to so you will probably need to have a system in place for this with the family.

How to check a hearing aid battery? Close the door on the hearing aid and enclose it in your hand with your fist closed. If there is life in the battery, it will squeal if there is no life in the battery it will be silent. It is important to check it each day before putting in a person’s ear.

Now if a person can manage their own hearing aids, they will know when the battery needs to be changed as it will make a ringing noise in their ear to alert them. However people in your care who wear hearing aids may not be able to tell you the battery needs changing so you will need to check it for them.

To replace a battery, open door of hearing aid and remove the old battery. Remove the tag on the back of the battery and wait approximately 2 mins before inserting the battery into the aid. Close the door of the aid ensuring it is closed.

Slide 17 Storage of Hearing aids:

When not in the ear, they should be in a airtight container or drying box. If the hearing aids get moisture in them it will not only shorten the life of the aid but also affect the functionality of the aid. Always make sure the door is opened on the hearing aid when not in use to prevent the battery being drained. Before storing the hearing aid in a dry store box, remove the battery. Leave in box overnight to dry the hearing aid which will extend the life of the aid.

Slide 18 Moisture and hearing aids

Moisture in hearing aids will do a number of things apart from shortening the life of the aid so never give a person a shower or bath while the hearing aid in as they are at risk of getting moisture in them. Also remove them at night as it is very uncomfortable to sleep on. Moisture in hearing aids will do a number of things. They could stop working and then start up again later in the day or another day, lose clarity will distort the sound they do her, will cut out loud noises or the sound will come and go – fade in and fade out. This makes hearing more of a handicap to a person than it needs to be.

The problem is that you are not able to check this as you are not the wearer of the hearing aids. If the person can tell you these things then you would have an idea that they need to have the hearing aids services but what if the person has communication problems or memory loss? Then it I likely you will think the person is more confused or not listening when in actual fact they can’t hear.

Slide 19 Balance

Now we have talked about hearing but if you remember in the first slide I said the ears about balance as well. So what is balance?

Well it is your ability to stand upright. It is the ability for you to see clearly while you are walking or moving about. It allows you to orientate or familiarise yourself with gravity so you don’t fall over.

Slide 20 what does balance do?

It determines the direction you go and how fast you move. It also allows you to make adjustments to your posture to accommodate or stabilise you for a variety of conditions and activities. Without balance life is very difficult.

Slide 21 what does being out of balance do to the body?

You probably take balance for granted till until you are affected by being out of balance. Not being able to balance your body can cause great distress not only emotionally but physically as well. Being unsteady on your feet through being dizzy can not only contribute to falls.

Slide 22 What does being out of balance do to the body? It also affects your hearing and vision as well as your concentration and memory. So as you can see, it is not about feeling a bit dizzy. It affects many other areas of your body and can be very debilitating

Slide 23 Where it the balance centre

The balance centre is actually inner ear.

Slide 24 How does the balance centre work?

There are three loops in the inner ear that are known as canals.

These canals are filled with fluid and nerve senses in the inner ear. As the head moves, the fluid in the canals shifts and sends messages to the brain through the sensors within them. So any interference with these canals through sickness, disease or age will affect the person’s ability to stand up and walk around in the space they are in.

Slide 25 What can affect balance

There are many things that can affect balance. It can be from medications, low blood pressure, head injury can interfere with affect the inner ear.

So if a person is started on a new medication and they report they are feeling dizzy, then you must make sure you report it to your Registered Nurse or Doctor immediately as the medication may need to be discontinued.

People with a history of low blood pressure or what is called postural hypotension will fall over if they stand up quickly so they need to sit on the bed and get their balance before they stand up because their head starts to spin they do so quickly. So you need to make sure that people with this history always get out of bed or out of a chair in stages. That is, getting of bed, sit them up first before you stand them up to walk. If getting out of a chair, stand them up slowly and make sure they have their balance before they start to walk.

If they have had a head injury, then be aware that they may become or get dizzy and be alerted to it so they don’t fall over.

Slide 26 What can affect balance

Also conditions like Meniere’s Disease can cause dizziness. So if a person is known to have Meniere’s disease then they will have periods when they may not be able to get out of bet because the dizziness is so bad and they are likely or will feel like they are falling over, walking sides ways even when they are infact walking straight. Their balance is so upset that their whole body is affected.

Benign Positional Paroxysmal Vertigo is the most common form of dizziness. It is a condition that whenever the person moves their head up or down or sideways, or turn over in bed or sit up, their head will spin. If they are standing up they could fall over.

Sometimes vertigo can be accompanied by nausea and vomiting but it passes once the dizziness goes. You may suffer from motion sickness when you travel in the car, plane or boat. This is due to the conflicting messages received by the brain which is interpreting it as being out of balance. As I said earlier, balance involves so many parts of the body, the eyes, ears, skin, muscles and joint nerve receptors as well as the brain so as you can see it is very complex.

While dizziness and vertigo is problematic for the person it is rarely serious and often will pass over time.

Slide 27 Social cost of balance disorders

So if we look at the social impact of balance disorders they are very similar to hearing loss. Depending on how long the dizziness lasts the person may not go our or may be afraid to go out of the home fearing a dizzy attach may make them fall over or feel nausea so the best option is not to go out. Over time people will lose their social skills

If they are still earning an income, it may prevent them going to work so they use up all their sick leave. Eventually they may have to go on a benefit or seek some other options for employment like working from home, if they can. This would allow them to work when they are well and at their own pace.

Their quality of life would be affected with not being able to go out and do the things they would normally have done. Travelling in a car, boat, plane or even going on an amusement park ride that the person would love to do, are all out of the reach due to motion sickness. They would remain a spectator and not able to fully enjoy life.

Spending a lot of time lying down or in bed will obviously impact on a person’s life and could lead to depression which will compound the whole problem.

While balance issues usually pass and there are not long term problems from it, it is easy to see the impact it can have on a person and their lives.

Slide 28 The ear explained

Now to we have been talking about the ear in the last slides but now I will explain it by looking at a diagram of the ear. As you know the ear is responsible for hearing and balance. Now with hearing, the sound comes into the ear canal. This is called the middle ear. Obviously the ear lobe is called the outer ear. You can see in this picture where wax builds up and how it can interfere with a person’s hearing and cause a conductive hearing loss. Now behind where the wax builds up is the tympanic membrane which is what gets damaged when the eardrum is perforated.

You can also see the Eustachian tube that drains fluid to the throat. So it stands to reason if you have a blocked Eustachian tube it will affect your hearing and create a conductive hearing loss. Once these conditions clear up or are fixed, hearing will usually return.

Now with sensorineural hearing loss this affects the inner ear. You can see in this picture what the inner ear looks like. Inside the inner ear the sounds travels in to the cochlea, the area that receives the message and send it to the brain via the nerves.

Inside the cochlea, the bit that looks like a snail, are minute hairs that move in relation to the pressure of the sound waves it received. The cochlea turns the sound waves into nerve impulses and sends a message to the brain.

Now if these little hairs get bent or broken they then send random impulses to the brain and cause tinnitus or a ringing or buzzing in the ear which is called tinnitus. As I mentioned in the earlier slides, tinnitus can be caused by a number of conditions. Tinnitus is very common and not everyone ends up with hearing loss but many do.

Now balance is in the three loops more or less at the entrance of the cochlea. As I said earlier these canals have fluid and nerve sensors in them and as the head moves, the fluid moves, stimulates the nerve sensors and sends the message to the brain.

Segment 4 Slide 1 Smell & Taste

Script

Slide 1 Index

Now I am going to talk about the taste. Now taste and smell are of course interrelated but I will talk about them separately but you will see intricately they are connected so I will be talking about what are taste buds, where are they found. the types of taste buds and the negative and positive emotions related to food.

Slide 2 Taste buds

The mouth is part of the digestive system so I will not talk about the anatomy of the mouth but I will talk about the mouth in relation to taste which is part of the sensory system. So we are going to talk about the tongue where most of the taste buds are found however there are also some found on roof of the mouth, the throat and the cheeks but we will not be talking about that today.

When you are born, you have many taste buds which is why young children sometimes refuse certain foods especially those with a very strong flavour. Their taste buds are very sensitive but it is also why you should introduce a variety of foods in both texture and flavour for babies early so they can get used to different flavours.

In the young taste buds are replaced around every two weeks but that is not the case as a person ages they in fact diminish and are not replaced. This starts at around the age of 40.

Slide 3 Taste Buds

They don’t all disappear at the same time but gradually beginning with disappearing from the sides and roof of the mouth first till eventually most of your taste buds are on your tongue and those that remain eventually become less sensitive. This is why the elderly like to have more sugar and salt to stimulate their taste buds and may complain that food is tasteless.

Slide 4 Taste buds

Taste buds are tiny receptors that are found on the tongue, throat, roof of the mouth or palate and the cheeks as I mentioned.

Now these receptors are protein molecules usually found inside or on the surface of a cell that receive chemical signals. When these tiny receptors detect chemicals that have been dissolved in saliva from the food or fluid that comes into the mouth they send messages to the gustatory centre, which is the centre in the brain responsible for the perception of taste.

Slide 5 What taste buds do?

So what do taste buds actually do? Well the detect the food or fluid as being salty, sweet, bitter, sour or umani – which is Japanese word translated as a pleasant savoury taste.

Now you probably take taste for granted so let’s explain it a bit more. When you put a salted potato chip in your mouth, you will taste the salt on the chip (as well as the crunch). Now when you put a salt and vinegar chip in your mouth you will taste the sharp or sour taste of the vinegar as well as the salt. So it is easy to explain the taste by what has stimulated your taste buds as taste salty, bitter or sour with this experience.

However umani is different and is described as a brothy or meaty taste that lasts a long time, is mouth-watering and forms a coating on the tongue according to . It is a savoury taste. So think back to something you have eaten where the flavours has stayed around in your mouth for a long time. An example may be when you have a food combination of tomato, parmesan cheese and mushrooms.

So essentially umani is created by a combination of foods that create this sensation which acts on all the taste buds to create this savoury sensation. It is considered useful in the elderly who have diminished taste buds as it works on all taste buds to create a sensation which enhances food satisfaction.

Slide 6 Where are taste buds found?

So where are taste buds found? Well as I mentioned in slide 2 they are found on the tongue, the cheek, throat and roof of the mouth or the palate however by far the majority are found on the tongue so let’s just look at the tongue.

It used to be thought that specific areas of the tongue were responsible for detecting certain flavours that is sweet/salty at the front and sour and bitter at the back of the tongue but it is now known not to be correct and taste, in fact, can be perceived equally from any area of the tongue

However the sides of the tongue are more sensitive than the middle of the tongue.

While the whole tongue can detect all different tastes, the back of the tongue though is more sensitive to bitter tastes. It is thought that this is so to protect us from eating poisonous or spoilt food to allow us to spit it out before it goes down our throat into our stomach. You may have noticed when you put something sour or bitter in your mouth, you may not taste it immediately. It has to touch the back of the tongue first.

Slide 7 What are taste buds?

So what are taste buds? Well they are sensory cells connected to different nerve fibres. Each taste bud has between 10 and 50 sensory cells which are very tiny and generally cannot be seen by the naked eye. Now when you see the taste buds on your tongue you cannot actually see what is inside them but if you could you would see a cell that looks like a flower bud. At the opening is a tube or funnel like opening that is filled with fluid. Inside this tube is tiny little hairs called taste hairs.

Slide 8 So what are the types of taste buds.

Taste buds are called Papaillae and are found in clusters or groups, on the tongue and as I said other areas of the mouth. All mammals have taste buds in their mouth, in the throat, and at the entrance of the gullet and windpipe but in this segment I will be only talking about the taste buds in and around your tongue. Each adult has between 2000 and 4000 buds in total but as I said earlier, as you get older, these start to reduce.

Slides 9 Types of Papillae or taste buds

There are 4 different types of Papillae or taste bud. They are Fungiform, Foliate, Circumvallate and Filiform. Now a papillae is a small projection that is raised like a very small pimple or nipple. Some of these are so small you cannot see them and taste buds live inside these papillae

Slide 10 Fungiform Papillae

Firstly lets look at Fungiform Papillae or taste buds. These are found scattered all over the tongue but you will find most of them on the tip and the edge of the tongue. At the front of the tongue each papillae has between 1 and 8 taste buds and at the mid region of the tongue each papillae has between 1 and 9 taste buds per papillae.

Now the function of fungiform papillae is to detect not only taste but also touch of food as it comes into the mouth and the temperature so you know when it enters the mouth and if it is the right temperature for you to eat. Obviously if it is too hot you will spit it out. They also respond to sweet and sour. So the fungiform papillae not only tell you when the food is the right temperature to eat they also react to the sweet and sour taste of the food as well as what it feels like in the mouth.

Slide 11 Foliate Papillae

Now these are found around the edge of the tongue at the back. They look like a leaf as they fold in on themselves. Each person has around 20 on both sides of the tongue.

Each of these papillae has several hundred taste buds and is estimated at around 117 taste buds per papillae. They are scatter over the surface of fungiform papillae and have both taste buds and taste receptors in them which means they are not involved in the actual taste of the food but also how it feels in the mouth.

Slide 12 Circumvallate Papillae

These are found on the base of the tongue near the throat. They are round and raised and if you look at the back of the tongue you will be able to see them with the naked eye. These are the only taste buds that are visible to the naked eye. They are shaped like a V at the back of the tongue. Because they are large, they also may become inflamed if you have a sore throat.

Now each person has between 7 and 12 of these papillae which may not seem like a lot but inside of each of these papillae are several thousand taste buds – around 252 in each.

These are sensitive to sour and bitter taste and it is thought that these taste buds are your protection against eating bad food or being poisoned as when the food touches these taste buds you have an urge to spit it out. You may well have experienced a new taste or even watch a baby trying a new food. The food gets into the mouth and then you or the baby has a natural instinct to spit it out until your taste buds adapt or get used to the taste.

Slide 13 Filiform Papillae

There are more filiform papillae than any other papillae on the tongue. They are shaped like a long thin V and don’t contain any taste buds, which must seem odd seeing we are talking about taste buds.

But they are all part of the taste sensation. What they do is keep the tongue clean and is the abrasive part of the tongue. They are responsible for the white furring that you see on the tongue and can indicate whether you are sick or not. This white furring is actually the build-up of filiform scales combined with white blood cells that coat the tongue. The filiform papillae combine with the antibacterial action of saliva

So as you can see the taste buds in our mouth and on our tongue have affects our enjoyment of food.

Slide 14 Negative Emotions on Food

Taste is strongly connected to emotions. If you have had a bad experience around food you are less likely to experiment with it again. For example, if you ate chicken and you developed food poisoning then you are likely to be wary of chicken and think that all chicken is going to make you sick, regardless to the fact you have had chicken on many other occasions and not become unwell.

Another example is being forced to eat something as a child that you didn’t like the taste of so that memory stays with you and you are more reluctant to try it again saying “I don’t like that” however when you do actually taste it as an adult it can be quite enjoyable. You may not like silver beet or kale because you were made to sit at the table to eat it and your memory of this is so strong but as an adult you may find it is actually very palatable.

You may think that a certain type of meat like offal i.e. liver, kidneys etc are repulsive to eat merely because of where they come from on the animal. So your memory or the emotion you attach to a particular food will influence your enjoyment of the food.

Slide 15 Positive Emotions Relating To Food

On the other hand the food you enjoyed or tasted nice and gave you a good experience you are more likely to eat. For example you may find the experience of being with your grandparents when your grandmother she made a pea and ham soup, and you really enjoyed eating it and being with her so every time you smell pea and ham soup cooking it brings back that memory and you want to have some.

Another example may be when you were at a restaurant and it was tranquil and pleasant and you enjoyed being with people or person you were with that each time you have the same meal you ate at that time it will trigger an pleasant emotional response with in you.

Or you may have been given food as a reward like a sweet or chocolate when you have been good or a special treat when you were to undergo something unpleasant to take the pain or nastiness away from the experience so you want to recreate these experiences to reward yourself or take the pain or unpleasant experience away.

Segment 4 Slide 1 Smell & Taste

Script

Slide 1 Index

Now I am going to talk about the taste. Now taste and smell are of course interrelated but I will talk about them separately but you will see intricately they are connected so I will be talking about what are taste buds, where are they found. the types of taste buds and the negative and positive emotions related to food.

Slide 2 Taste buds

The mouth is part of the digestive system so I will not talk about the anatomy of the mouth but I will talk about the mouth in relation to taste which is part of the sensory system. So we are going to talk about the tongue where most of the taste buds are found however there are also some found on roof of the mouth, the throat and the cheeks but we will not be talking about that today.

When you are born, you have many taste buds which is why young children sometimes refuse certain foods especially those with a very strong flavour. Their taste buds are very sensitive but it is also why you should introduce a variety of foods in both texture and flavour for babies early so they can get used to different flavours.

In the young taste buds are replaced around every two weeks but that is not the case as a person ages they in fact diminish and are not replaced. This starts at around the age of 40.

Slide 3 Taste Buds

They don’t all disappear at the same time but gradually beginning with disappearing from the sides and roof of the mouth first till eventually most of your taste buds are on your tongue and those that remain eventually become less sensitive. This is why the elderly like to have more sugar and salt to stimulate their taste buds and may complain that food is tasteless.

Slide 4 Taste buds

Taste buds are tiny receptors that are found on the tongue, throat, roof of the mouth or palate and the cheeks as I mentioned.

Now these receptors are protein molecules usually found inside or on the surface of a cell that receive chemical signals. When these tiny receptors detect chemicals that have been dissolved in saliva from the food or fluid that comes into the mouth they send messages to the gustatory centre, which is the centre in the brain responsible for the perception of taste.

Slide 5 What taste buds do?

So what do taste buds actually do? Well the detect the food or fluid as being salty, sweet, bitter, sour or umani – which is Japanese word translated as a pleasant savoury taste.

Now you probably take taste for granted so let’s explain it a bit more. When you put a salted potato chip in your mouth, you will taste the salt on the chip (as well as the crunch). Now when you put a salt and vinegar chip in your mouth you will taste the sharp or sour taste of the vinegar as well as the salt. So it is easy to explain the taste by what has stimulated your taste buds as taste salty, bitter or sour with this experience.

However umani is different and is described as a brothy or meaty taste that lasts a long time, is mouth-watering and forms a coating on the tongue according to . It is a savoury taste. So think back to something you have eaten where the flavours has stayed around in your mouth for a long time. An example may be when you have a food combination of tomato, parmesan cheese and mushrooms.

So essentially umani is created by a combination of foods that create this sensation which acts on all the taste buds to create this savoury sensation. It is considered useful in the elderly who have diminished taste buds as it works on all taste buds to create a sensation which enhances food satisfaction.

Slide 6 Where are taste buds found?

So where are taste buds found? Well as I mentioned in slide 2 they are found on the tongue, the cheek, throat and roof of the mouth or the palate however by far the majority are found on the tongue so let’s just look at the tongue.

It used to be thought that specific areas of the tongue were responsible for detecting certain flavours that is sweet/salty at the front and sour and bitter at the back of the tongue but it is now known not to be correct and taste, in fact, can be perceived equally from any area of the tongue

However the sides of the tongue are more sensitive than the middle of the tongue.

While the whole tongue can detect all different tastes, the back of the tongue though is more sensitive to bitter tastes. It is thought that this is so to protect us from eating poisonous or spoilt food to allow us to spit it out before it goes down our throat into our stomach. You may have noticed when you put something sour or bitter in your mouth, you may not taste it immediately. It has to touch the back of the tongue first.

Slide 7 What are taste buds?

So what are taste buds? Well they are sensory cells connected to different nerve fibres. Each taste bud has between 10 and 50 sensory cells which are very tiny and generally cannot be seen by the naked eye. Now when you see the taste buds on your tongue you cannot actually see what is inside them but if you could you would see a cell that looks like a flower bud. At the opening is a tube or funnel like opening that is filled with fluid. Inside this tube is tiny little hairs called taste hairs.

Slide 8 So what are the types of taste buds.

Taste buds are called Papaillae and are found in clusters or groups, on the tongue and as I said other areas of the mouth. All mammals have taste buds in their mouth, in the throat, and at the entrance of the gullet and windpipe but in this segment I will be only talking about the taste buds in and around your tongue. Each adult has between 2000 and 4000 buds in total but as I said earlier, as you get older, these start to reduce.

Slides 9 Types of Papillae or taste buds

There are 4 different types of Papillae or taste bud. They are Fungiform, Foliate, Circumvallate and Filiform. Now a papillae is a small projection that is raised like a very small pimple or nipple. Some of these are so small you cannot see them and taste buds live inside these papillae

Slide 10 Fungiform Papillae

Firstly lets look at Fungiform Papillae or taste buds. These are found scattered all over the tongue but you will find most of them on the tip and the edge of the tongue. At the front of the tongue each papillae has between 1 and 8 taste buds and at the mid region of the tongue each papillae has between 1 and 9 taste buds per papillae.

Now the function of fungiform papillae is to detect not only taste but also touch of food as it comes into the mouth and the temperature so you know when it enters the mouth and if it is the right temperature for you to eat. Obviously if it is too hot you will spit it out. They also respond to sweet and sour. So the fungiform papillae not only tell you when the food is the right temperature to eat they also react to the sweet and sour taste of the food as well as what it feels like in the mouth.

Slide 11 Foliate Papillae

Now these are found around the edge of the tongue at the back. They look like a leaf as they fold in on themselves. Each person has around 20 on both sides of the tongue.

Each of these papillae has several hundred taste buds and is estimated at around 117 taste buds per papillae. They are scatter over the surface of fungiform papillae and have both taste buds and taste receptors in them which means they are not involved in the actual taste of the food but also how it feels in the mouth.

Slide 12 Circumvallate Papillae

These are found on the base of the tongue near the throat. They are round and raised and if you look at the back of the tongue you will be able to see them with the naked eye. These are the only taste buds that are visible to the naked eye. They are shaped like a V at the back of the tongue. Because they are large, they also may become inflamed if you have a sore throat.

Now each person has between 7 and 12 of these papillae which may not seem like a lot but inside of each of these papillae are several thousand taste buds – around 252 in each.

These are sensitive to sour and bitter taste and it is thought that these taste buds are your protection against eating bad food or being poisoned as when the food touches these taste buds you have an urge to spit it out. You may well have experienced a new taste or even watch a baby trying a new food. The food gets into the mouth and then you or the baby has a natural instinct to spit it out until your taste buds adapt or get used to the taste.

Slide 13 Filiform Papillae

There are more filiform papillae than any other papillae on the tongue. They are shaped like a long thin V and don’t contain any taste buds, which must seem odd seeing we are talking about taste buds.

But they are all part of the taste sensation. What they do is keep the tongue clean and is the abrasive part of the tongue. They are responsible for the white furring that you see on the tongue and can indicate whether you are sick or not. This white furring is actually the build-up of filiform scales combined with white blood cells that coat the tongue. The filiform papillae combine with the antibacterial action of saliva

So as you can see the taste buds in our mouth and on our tongue have affects our enjoyment of food.

Slide 14 Negative Emotions on Food

Taste is strongly connected to emotions. If you have had a bad experience around food you are less likely to experiment with it again. For example, if you ate chicken and you developed food poisoning then you are likely to be wary of chicken and think that all chicken is going to make you sick, regardless to the fact you have had chicken on many other occasions and not become unwell.

Another example is being forced to eat something as a child that you didn’t like the taste of so that memory stays with you and you are more reluctant to try it again saying “I don’t like that” however when you do actually taste it as an adult it can be quite enjoyable. You may not like silver beet or kale because you were made to sit at the table to eat it and your memory of this is so strong but as an adult you may find it is actually very palatable.

You may think that a certain type of meat like offal i.e. liver, kidneys etc are repulsive to eat merely because of where they come from on the animal. So your memory or the emotion you attach to a particular food will influence your enjoyment of the food.

Slide 15 Positive Emotions Relating To Food

On the other hand the food you enjoyed or tasted nice and gave you a good experience you are more likely to eat. For example you may find the experience of being with your grandparents when your grandmother she made a pea and ham soup, and you really enjoyed eating it and being with her so every time you smell pea and ham soup cooking it brings back that memory and you want to have some.

Another example may be when you were at a restaurant and it was tranquil and pleasant and you enjoyed being with people or person you were with that each time you have the same meal you ate at that time it will trigger an pleasant emotional response with in you.

Or you may have been given food as a reward like a sweet or chocolate when you have been good or a special treat when you were to undergo something unpleasant to take the pain or nastiness away from the experience so you want to recreate these experiences to reward yourself or take the pain or unpleasant experience away.

Segment 6

Script

How taste and smell work together

Slide 1 Index

As I said in the last two segment, taste and smell are very intricately connected. While they have two separate actions they come together to bring our enjoyment of life together so to talk more on this this segment will explain what happens, even though I have touched on them in the last two segments.

Slide 2 How taste and smell work together

Now think about when you are about to eat something. The smell of it cooking will waft up your nose. You will inhale them and sometimes stiff to enable you to get more of the smell. Now this small will either be pleasurable or unpleasant. At times we like to take an extra sniff to get more of it to enhance the pleasure or decipher exactly what the smell is.

So when you sniff or inhale chemicals are released that stimulator the small patch inside your nose that is home to the olfactory sensors. Once the sensors pick up the odour it will then send a message to the olfactory bulb, which as you will remember is a bulb shaped organ centred at the top of the nose.

Slide3 How taste and smell work together

Now lets look at how taste is connected to smell.

When you chew food, chemicals are released that triggers taste sensors. Now at the back of the throat on the roof of the mouth, there is channel there that connects to the nose. It is at this point that taste and smell combine and send a message to the olfactory bulb which then goes to the brain.

Slide 4 How smell and taste affect you

If you look at the top image can see how the nose is sniffing the strawberry so the smell will travel up the nose and on the way it is coming into contact with the sensors as it heads towards the olfactory bulb and on to the brain.

If you look at the bottom picture you will see the girl eating the strawberry. As she bites into the strawberry it releases chemicals at the back of the throat and at the same time this combines with the sensors at the back to the nose and they both go to the olfactory bulb then on to the brain.

Now if you look at the olfactory bulb is close to an area of the brain called the limbic system. You will see a red arrow pointing up to the limbic system. in the brain. This is a very powerful centre and is responsible for many things but among them it is the seat of emotions, memory, learning and motivation. Now can you see the powerful effect that smell and taste has on you? Every smell you have smelt, every food you have eaten is stored in the memory bank of the limbic system. It the emotions you have attached to the smell or taste is pleasant or unpleasant, this will influence you relationship with that smell or taste. Very powerful isn’t it.

So if there is a food or smell you do not like, and other people do then maybe you have had a negative experience with it.

Now if you have never smelt gas you will not know it could be toxic to you or have lost your sense of smell, then will not know it is a hazard to you.

Slide 5 Social Cost of Smell & Taste Disorders

Taste and smell disorders are often under reported so it is not really known just how big a problem taste and smell disorders are. However it is known that disorders relating to taste and smell are usually a secondary process related to an underlying disease. Conditions affecting the brain like Parkinson’s Diesase and Alzheimer’s Disease are probably the most common diseases.

While we are clumping both taste and smell together, it is actually taste disorders that are more prevalent than smell disorders.

Slide 6 Social Cost of Smell and taste disorders

One the major social cost is inadequate nutrition. Your senses are what helps us to enjoy you food, the smell of it cooking will stimulate our taste buds to prepare you to eat. If you can’t smell it and prepare your taste buds to eat it, then you can’t taste it. You will get no pleasure out of food and likely not to want to eat, eat the food that does not support your body and become under nourished as a result. Just imagine what this would do to your psychological well-being if you got no enjoyment out of food because.

These senses need stimulating. People working in residential or home care where food is not prepared and cooked on the premises or people who reside a long way from the kitchen and can’t smell the food cooking, will eventually lose their enjoyment of food. While having meals delivered either from meals on wheels or frozen meals are a great service for providing food, it can inhibit the enjoyment because the taste buds have not been prepared to eat the food and you wonder why they don’t want to eat?

There has often been criticism of people feeding their meals on wheels to the cat or dog, but just imagine what it would be like to have a meal just put in front of you, day after day, without your senses being prepared to eat it. Likewise, if people are situated a long way from the kitchen as can be the place in residential care, or just delivered to you on a try as often happens in residential care and in the public system, how tasteless and boring it would become.

So take a little time to see how you can make meal times more enjoyable by stimulating a person’s taste buds and sense of smell to make it a more pleasurable experience and do what you can to make it a social experience.

Slide 7 Social cost of smell and taste disorders

The social cost of loss of sense of smell in particular can also lead to a life threatening situation. If a person cannot smell that food it spoiled or smell there is a fire or gas leak, then there could be a catastrophic event that could result in death.

Now the degree of catastrophe could be to the degree of disability the person has. Those most at risk are those that have a total loss of smell and taste. Not much enjoyment in life there is there? Now it could be that they have a partial loss to several odours and tastes which means that there sense of smell and taste is not totally gone or it could be to specific odours.

As I have said previously, everyone is different. Some are not even aware their sense of smell or taste has diminished or even disappearing. There has not been a lot of research done in this area so it is something you need to be aware of particularly if a person is not eating their food, or eating foods that don’t support them well. Maybe they need to be brought closer to the kitchen where food is being cooked to help to stimulate their taste buds and sense of smell.

Segment 7

Slide 1 Index

Today we are going to talk about touch but in order to understand touch you need to have an understanding of the Somatosensory System which includes touch as well as the receptors that make up the sensory system and how they all work together

Slide 2 – Somatosensory System

As I said in the introduction, touch is part of the somatosensory system which is actually part of the nervous system. If you think about all the senses we have talked about so far vision, hearing, smell & taste you will see they are all connected to pathways that sends messages to the brain. So in order to understand touch you need also to know about the sensors or nerve receptors that are in the body both externally and internally in your body.

However mostly when I talk about touch, I am actually talking about external sources.

Slide 3 Somatosensory system

Touch is vitally important for us to make sense of the world in which we live in. It helps us see where we are in relation to our environment, keeps us safe from hurting ourselves. Without touch we would not be able to feel things our body comes into contact with that keep us safe. You see touch tells us when something we touch is hot, cold, light or hard pressure and when it hurts. So the somatosensory system helps us detect pain, temperature and pressure often through touch.

Slide 4 What does touch detect?

Well as I mentioned in the last slide it tells us when things are too hot or too cold externally so you can keep our body at the right temperature.

You can also detect whether a surface is rough or smooth. So an example of this might be if a floor surface is rough may cause an injury or on the other hand may stop you from slipping on a surface. Or if the floor surface is smooth it may cause you to slip over if it was wet but it may feel nice to walk on. All the time your skin sensors is picking it up.

The sensors also work to tell you when there is too much pressure on your skin or too little or just the right amount of pressure. This also keeps you safe and comfortable.

Slide 5 What does touch detect?

Touch on the skin also allows you to feel a tickle. Sometimes this is pleasant and other times you may detect it as unpleasant. For some people having their feet tickled is pleasant while for other is it unpleasant.

You can also detect pain. If you stand on grass that has prickles in it, you will jump up and down and want to get away from it. It is these sensors telling you that they hurt and once you move away from the prickles and remove them, your sensors are not being stimulated and you don’t feel pain. There are also pain sensors in your organs so if you have, for example, appendicitis, the pain receptors will tell you that you have internal pain.

Your sensors are also responsible for telling you when you have an itch and when this happen you will want to scratch it.

They also detect vibration. Now everything on earth vibrates to some degree or other. Some are quite strong like when you are riding in a bus or sitting on a vibrating chair so your somatosensory system is picking up on it. Some are more subtle and you can hardly feel it. You may have hugged a tree sometime and felt the gentle vibrations in the trunk coming up from deep in the earth.

Now our somatosensory system picks up on everything you touch or feel either externally through your skin or internally through your organs.

Slide 6 How does touch work?

Well to “feel” touch we need to look at how it all works. There is a network of nerves that form a pathway throughout your body that end up feeding messages to your brain. Once the message is received by the brain it will interpret the message and return it to the part of the body it came from for your body to respond. This could be to go “ouch” if it hurt, or to tell you remove the part of the body that had touched by something hot or for you to smile when your are tickled by a feather or something you like.

Now there isn’t a direct one road system to the brain. The messages have to travel through a network of several neurons, or nerves, to get to the brain. It is a bit like running a relay if you like. So for example, when you run a relay, you may have something in your hand or a method of tagging the next person that is to run after you so you might tap their hand or hand them a baton. Well this is the same, the message will come from the source, say you prick your finger with a needle, and the message will be sent to the next link in the chain; then the next link; then the next link and so forth. When it finally reaches the destination, the brain, on receiving the message that you have pricked your finger with a needle, will interpret it as pain and send a message back down the pathway for you to say “ouch”. Yes it does happen that fast.

Slide 7 How does touch work?

Now each sensation has different nerve receptors so there is not just one nerve throughout the body. So receptors receive the message and sensors interpret what is felt and adapt to the stimuli. Some of these are known as rapidly adapting sensors which means it adapts really quickly to the stimuli. For example, if you pick up a hot coal from the fire, you will react very quickly and pull your hand away. Some receptors are slowly adapting which means it takes a longer to reach the brain. An example of this is when you sit on a vibrating chair, the receptors slowly react to the vibration.

Slide 8 Receptors

Now let’s talk about these receptors a bit more. There are 4 main receptors, mechanical which is often referred to as kinaesthetic or touch, temperature, pain and positional so I will talk about each separately.

Slide 9 Mechanical Receptors

This is the area that is sensitive to pressure you feel on your skin, vibration you feel through your body, texture that is felt by touch and tenderness/softness. So you see anything that involves a person being touched comes under this area.

Now touch is very important when looking after the elderly or disabled as many people do not or have not been touched for some time, often for many years. This relates to a condition known as sensory deprivation which means, their senses have been deprived, depressed or rundown, so they can under react or over react to sensory stimuli when it is received.

Slide 10 Negative side of sensory deprivation

When a person suffers sensory deprivation or lack of their sensors being stimulate it can and does have a negative impact on a person.

Touch is vitally important to the human race. We need touch. The healing power of touch is well research. Babies who do not receive touch have stunted growth and in some cases die.

Not receiving any touch leads to loneliness and depression in some people when their sensors have been deprived which can be explained as under reacting. Others may become angry and aggressive purely because they have not felt touch on their body which can be described as over reacting.

You also need to be careful how you touch people when providing care as some people have very sensitive skin and when you touch them you could actually hurt them. So it is important to be very gentle when carrying out care so it becomes a pleasurable experience and not an unpleasant experience. If it causes them pain, then it could be another reason for them to become angry or aggressive and they may even hit out at you.

So if a person has not been touched for a while, tread carefully as to suddenly touch a person who has not been touched much in their life or for a while may seem like an electric shock to their body and for some it can be a form of abuse.

Slide 11 Positive side of touch

Now there is a positive side to touch as well. It is well known how touch can improve your health. There are a lot of therapies based on touch that helps to heal people.

Touch also help people recover from illness quicker. Remember as I said that babies have been known to die through lack of touch, well the opposite happens with touch.

A person’s heart rate will reduce which reduces anxiety and stress in people.

Don’t underestimate the power of healing from touch. I know you get very busy in your day, but you know a gentle hug can do wonders to a person in care or isolated at home. It may well be the one thing that makes their day.

Slide 12 Temperature Receptors

Now I am going to talk about the Temperature receptors. These receptors work with body temperature and tell you whether you are feeling hot or cold due to the environmental temperature so you can adjust your clothing to accommodate the temperature and feel comfortable.

Remember though that your temperature receptors may detect the heat or cold in the environment you are working in differently to people in your care. You will be walking around doing your work which helps keep you warm but many of those in your care spend a lot of time sitting in a chair and they may feel a lot cooler than you even on a hot day. So take this into account when you are dressing people – they are more likely to need more clothes on than you are wearing.

These receptors also regulate your internal body temperature. This is controlled by the brain, the hypothalamus to be precise

Slide 13 Temperature

Now the normal average body temperature is around 37 degrees centigrade but it can vary slightly between people

Now our body temperature is regulated through sweating. When we become too hot, the body releases perspiration in an attempt to bring the temperature down.

When it is too cold, you start shivering to keep the body warm.

However in extremes of cold the physiology of your body does change further and it can lead to death as the body loses its fight to keep you warm. This is quite a complex area and I am not going to go into this today. Just know that the body is trying to maintain homeostasis or balance all the time in very many ways. Temperature being one of them.

Slide 14 Body Temperature with age

However there is a difference between how these receptors work as you age. The sensors become impaired which means as you get older your internal body temperature may not rise when they become ill with an infection. So taking a person’s temperature if you suspect influenza may not be a good indicator and you will have to look for other indicators like do they have aching joints, have a cough, feel generally unwell and take to their bed. You know, all the signs that would indicate the person is not well.

Also it takes an older person twice as long as a young person for their body temperature to return to normal after exposure to extreme temperatures of hot or cold

Slide 15 Body temperature with age

With the body being less efficient at regulating the body temperature you may not see shivering as a sign of being cold or perspiration when they are hot. Nor are you likely to see a raised body temperature from infection as I said earlier so you need to use other tools to identify if a person is unwell.

Slide 16 Risks to older people

So you see the risks to older people are they may become dehydrated in extreme heat through their body being over heated and not drinking enough. They may become very unwell or even die from hypothermia and being too cold or a serious infection may go undetected because there temperature hadn’t risen and you were not alerted to other signs of infection.

Slide 17 Body Changes with age

Now the elderly are at risk because of the changes that happen to their body. Older people often don’t feel thirsty and don’t drink enough. It is not that they don’t drink or don’t want to drink, they just don’t feel thirsty so you need to think for them and make sure they get enough fluid. See more of this in the Hydration topic

The rate in which their blood vessels dilate, that is get bigger to send more blood around the body to keep them warm, or constrict, that is get smaller to control the blood circulating around the body to keep them cool, takes longer as people age and this also plays a part in keeping the body temperature regulated or in homeostasis.

Your ability to perspire also reduces which is another body temperature regulator so you are likely to see this as an indicator of an overheated body as you would see in a younger person.

The amount of body fat also reduces with age as well and of course fat is a heat regulator. The less body fat you have the more likely you are to feel the cold. This decreased fat production puts older people at extreme risk of heat loss so you need to make sure they are always warm – not over heated, just warm.

Slide 18 Monitoring risks?

So what must you do to ensure a person’s body temperature is kept constant? Well firstly make sure they get enough fluid. So what is enough? Well apart from their normal cups of tea or coffee, offer water or fruit drinks in between normal tea breaks especially in summer when it is hot and dehydration is a risk.

Make sure people are dressed appropriately for the season. If it is cold then make sure they have sufficient clothing to keep them warm – don’t dress them in summer clothes even if they look nice. Why do I mention this? Well when my mother was in care, I rang to say I would be taking her out and could she be ready please. It was a really cold day. When I arrived, she looked nice, that is for sure, but she was dressed in a light sleeveless singlet top and summer weight jacket! I had to redress her so she was warm before I could take her out.

If hot, don’t over dress them so it over heats them. Don’t base this on your body temperature though as you are walking around and they may not be. This is the same for disabled people who are not able to move around.

Have you ever had a lie down in the middle of the day and noticed how cold you become after the nap? Well people in your care often have a nap in the afternoon or spend extended time on their bed or sitting in a chair. Their body is not moving around to keep warm like you are.

Recognise that people in your care may not be able to tell you they are hot or cold and you need to think for them. Make sure they are kept comfortable.

Slide 19 Social Issues with older people

There are many social issues that surround older people especially those who live on their own. Keeping warm and heating their home may be a problem as they may not have the money to pay for power or are frightened of not being able to pay for power or of getting it cut off so they won’t put their heater on.

Through their inability to recognise they are too hot or too cold they don’t put extra clothes on to keep warm and are at risk of their temperature dropping extremely low leading to a hypothermic condition that could cause death.

Conversely when there is a heat wave they could be at risk of dying from hyperthermia and dehydration. They may have too many clothes on and don’t think to take them off to cool their body down. They may not even feel hot either.

Mobility issues are another problem as they may not be able to dress or undress themselves or get to where their clothes are

So it is important for you to know about body temperature to ensure your clients are not suffering from hypothermia or hyperthermia.

Their inability to recognise being thirsty is another issue which could compound the problem with an overheated body.

Slide 20 Pain Receptors

Now as part of the somatosensory system we also have pain receptors and these are in our skin which is externally and internally in our organs. There is also somatic pain which relates to the body like bones and joints.

Slide 21 Pain Receptors with age

So from the age of around 50 your sensitivity to pain reduces. Which means you could sustain and injury and not actually be aware of it. It is also estimated that 88% of people live with pain and 20% of these people take regular pain relief several times a week. For some people as they get older, pain especially somatic pain which is in bones and joints, is a fact of life

Slide 22 External Pain

So externally you need to be careful with older people’s skin and be very gentle as you could injure them without realising until a bruise is appears. So you must remember that because skin sensitivity reduces to pain the risk to injury increases. It is abuse when such things as grip marks from your hands appear on a person skin because they were unable to say you were hurting them or they felt pain.

On the other hand older people also may develop a hypersensitivity to light touch because their skin is thinner. So there are many things you need to be aware of with touch but know that without touch people do and can die and that also, everyone is different.

Slide 23 Internal Pain

Now internal pain often called visceral pain and relates to internal organs. It could be hard to detect and be more generalised for example you may have a bout of the flu and you have general aches and pain that moves around in the body or it could be specific to one organ like the bowel. If a person is constipation or have a bowel obstruction this would be visceral pain. Now in older people they may not complain of pain but you may see a change in their behaviour before you see other more indicative signs of pain.

Visceral pain can also be used to describe how people feel about an emotional experience. It may not be a rational pain but none the less real to the person.

Slide 24 somatic pain

Now somatic pain is generally described as musculo-skeletal pain that is pain affecting the bones and joints. It could be that they have osteoarthritis where the bones are rubbing together that cause’s constant pain that grinds them down and they need constant pain relief.

It is also possible for a person may suffer an injury or even a fracture and may still use the limb. So you need to be aware that when a person falls over, it is possible that they may not feel pain.

So the way you may interpret pain as you get older may be different to how you felt it as a younger person so take this into account when looking after older people.

Slide 25 Common types of pain

Arthritis and joint pain is the most common pain felt by people as they age. Lingering pain from injury like a rotator cuff injury in the shoulder or surgery like a hip fracture or knee surgery and peripheral neuropathy from diabetes are common conditions in people as they age. One must also not forget that emotional pain from such things as depression is also common.

Slide 26 Risks of Reduced pain sensitivity

Now I mentioned earlier that that from the age of 50 pain sensitivity reduces so let’s talk about the risks that can occur to a person whose pain receptors are not functioning that well. Well the obvious one of course is the damage to the skin. Have you ever heard a person really complain of pain from a skin tear? Probably not. They often don’t even know they have sustained an injury until you see it or they see the blood.

There is also the potential of a more serious health condition going unnoticed as a person has not complained of pain. You may notice something in their behaviour but not necessarily in them complaining of pain. Constipation is one that comes to mind and can often go unnoticed which is why it is important to keep a accurate record of someone bowel movement. When a person is constipated you may see a change in their behaviour and when you clear the constipation, the behaviour changes to back to normal.

Another area where there is the potential for more damage to occur from because a person has not been aware they have a fracture which I mentioned earlier. It has happened, albeit not that often in my experience, but a person with a fractured leg may continue to walk around on it or keep using a fractured arm.

To understand more about pain go to the Pain topic.

Slide 27 Position Receptors

These are receptors that give a body a sense of where they are in space. Now you know where your body is and have no difficulty walking or keeping your balance in this space because your receptors are telling you where you are. Nor are you at risk of falling because of this awareness and you have good balance. You freely move in the space around you.

Slide 28 Positional Receptor requirements

Now your sense of space, balance and movement involve many other senses like your eyes, ears, muscles, joints and sense of touch as well as your brain to tell you where you are placed. However for your positional receptors to work correctly other areas of the body need to be working as well in harmony.

So in order for you to know where you are in the space and balance your sensory system needs to give accurate information, your brain needs to be able to process and interpret this information and your muscle and joints need to be able to coordinate the process.

Slide 29 So what can upset your positional receptors?

Well as I said, all your senses are involved for your positional receptors to work. So if you have inner ear problems like vertigo where you head spins when you get up you are likely to have balance problems. Have you ever experienced travel or motion sickness? Well this is where your inner ears are affected by constant movement which causes you to become dizzy, sweaty, nauseous and eventually sick. Well some people live with vertigo from inner ear conditions like Meniere’s disease.

If your have poor vision and cannot see where you are this will also upset where you see yourself to be in the space you are in and you may lose balance as well. Have you ever got up in the night when it was very dark and you couldn’t see anything around you? Did it affect how you felt in the space you were in? Did you stumble? Did you put your hands out to feel things that were familiar to you so you could get your bearings and balance? Well this is how vision can upset your positional receptors.

If you have muscle or joint problems this can affect your balance and affect your positional receptors. This results in you stumbling or falling. Have you ever broken your leg and had crutches for a while? When you started to walk again, did you find it difficult and have a sense of falling? If you have not been able to use both legs for a while, then your positional receptors have been affected and you have to orientate your body to space again. Your joints, muscles, ligaments and tendons have all been at rest and they need to be ignited to work again so until that happens you will stumble and feel like you are falling till balance or equilibrium has been established again.

Have you looked after people who have spent an extended time in bed or you may have yourself? Did you notice when they stood up to weight bare their balance was upset and it took a while to orientate their body to the space? This is because you have to re-establish your positional receptors to the space.

Slide 30 Why Somatosensory System is Important

Without the somatosensory system you are not able to make sense of the environment in which you live. It balances you with time and space so you know exactly where you are in the environment.

It also provides a bridge between the environment and the organising centres of the brain so you can function fully and it inter-relates what you touch, your body positon, and temperature both internally and externally, and pain all in a bid to keep you safe and comfortable and alerts you when you need to make some adjustments. When any of your somatosensory system is upset then you are out of balance.

So you see you have a wonderful body that supports you through life but as you get older, it doesn’t always function as well as you would like it to. You may feel let down, but it is just part of the aging process. When you understand some of these issues in both yourself and the people in your care, it makes it easier to accept and ultimately enable you to give much better care because you understand what is happening to the body and in particular the senses and how important they are for the total enjoyment of life.

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