A Teaching Strategy for Older Audiences

Diminishing functional and sensory abilities present unique challenges for nurses when teaching older adults. The bulletin board display is one method that can facilitate learning in older individuals: they can learn at their own pace and develop specific questions for health care professionals. On the basis of developmental theories, knowledge of common physical changes associated with aging, and visual art-based strategies in bulletin board design, nurses can use bulletin boards as an effective educational tool for older adults. Through health education, older adults are empowered to maintain self-care and make informed decisions about their health. Although younger generations commonly use computers to access new health information on the Internet, only 22% of adults older than age 65 have Internet access (Pew Internet & American Life Project, 2004). Older adults’ diminished functional and sensory abilities can present challenges to nurses when trying to meet older adults’ health education needs. Hearing loss can make group learning in an environment with extraneous background noise difficult or frustrating for older adults. Although intelligence does not decline with age, older adults need more time to process and comprehend information (Bastable, 2003; Gausman Benson & Forman, 2002). The use of multiple senses (i.e., auditory, visual, psychomotor) when teaching can facilitate learning; however, this can also be overwhelming or distracting to older individuals (Meiner & Lueckenotte, 2006). Group learning can facilitate older adults’ socialization. However, the faster pace of group learning and use of audiovisual methods designed to Christine M. thoMas, Dnsc bulletin boards A Teaching Strategy for Older Audiences Journal of GerontoloGical nursinG 45 educate younger individuals can frustrate or confuse older adults (Mauk, 2006; Meiner & Lueckenotte, 2006). Bulletin boards, in combination with one-to-one education sessions or small education classes, can increase repetition of information to improve health literacy and help older adults formulate questions for their health care professionals (Shohet, 2002). The self-paced nature of bulletin boards is a good way to supplement other educational strategies when teaching older adults (Thomas & Wolfe, 2005). Bulletin boards are visual displays that provide information using pictures only, words only, or picture and words for people of all ages (Raines & Williamson, 1995). Health information presented in a bulletin board format can provide education in an informal, relaxed, and non-threatening manner. Older adults can spend as little or as much time as they like viewing the bulletin board. Also, bulletin boards can be viewed multiple times to reinforce learning or remind older adults about recommended health regimens. While waiting for appointments or tests, older adults can read bulletin boards about important health issues, which can help them develop specific questions to ask the health care staff. However, as with any nursing intervention, the special needs of the target population must be considered for effective patient teaching and learning to occur (Rankin, Stallings, & London, 2005). This article addresses design issues to consider when using bulletin boards to provide health information for adults older than 65. Older Adult HeAltH The population of adults older than 65 is projected to increase from the current 12% to 21.3% by 2049 (Centers for Medicare and Medicaid Services, 2004; Keehan, Lazenby, Zezza, & Catlin, 2004). Adults older than 65 spend almost four times more on health care and have three to four times the number of hospitalizations as individuals younger than 65 (Bernstein et al., 2003; Centers for Medicare and Medicaid Services, 2004; Keehan et al., 2004; U.S. Department of Health and Human Services, 2004). Although the majority of health care contacts are with individuals older than 65 with chronic conditions, most health educational formats are developed on the basis of younger individuals’ preferences and abilities (Shohet, 2002). The use of multiple audio, visual, and kinetic methods to educate young individuals helps stimulate their senses and increase memory and comprehension (Rankin, Stallings, & London, 2005). However, the use of multiplesensory stimuli can overwhelm older patients and cause significant stress that could limit learning (Meiner & Lueckenotte, 2006). Nurses need to make ageappropriate accommodations for older individuals’ strengths and limitations to facilitate learning so these individuals can be active participants in their health care decisions. cognitive considerations As with any population, nurses must prepare educational materials according to the interests and needs of the patient. Although intelligence does not usually change during healthy aging, disease and disability can affect older adults’ cognitive abilities and learning (Meiner & Lueckenotte, 2006). Adults older than 65 experience more acute and chronic illnesses and must learn more new medical information and procedures than younger adults (U.S. Department of Health and Human Services, 2004). Highly literate older adults can become low-literate because of cognitive changes associated with diseases (Kerka, 2003). Kidney and liver disease can affect cognitive processes by altering blood chemistry and electrolytes. Cardiac and lung diseases can impair cerebral blood flow and oxygenation needed for thinking and learning. Hearing impairment, pain, and high levels of stress associated with illness can negatively affect learning and comprehension for older adults (Meiner & Lueckenotte, 2006). Therefore, most adults older than 65 need more repetition and time to learn and retain new health information than do younger adults. Bulletin boards can facilitate learning for older adults through repetition and reinforcement of information given by their health care providers. Psychosocial considerations Knowles’ (1970) adult learning theory stresses that adults are more oriented to problem-centered learning than subject-centered learning, use past experiences as a resource for learning, and learn information that has immediate application versus information that may be useful sometime in the future. When adults self-identify a lack of information, they seek out sources of information to fill in knowledge gaps to maintain competence and independence (Knowles, Figure 1. Font and text examples.