1. Sensory Loss In Older Adults - Taste, Smell & Touch - Behavioral
Approaches For Caregivers
As we age, our sensory systems gradually lose their sharpness. Because our brain requires a
minimal amount of input to remain alert and functioning, sensory loss for older adults puts them at risk
for sensory deprivation. Severe sensory impairments, such as in vision or hearing, may result in
behavior similar to dementia and psychosis, such as increased disorientation and confusion. Added
restrictions, such as confinement to bed or a Geri-chair, increases this risk. With nothing to show the
passage of time, or changes in the environment, the sensory deprived person may resort to repetitive
problem behaviors (calling out, chanting, rhythmic pounding/rocking) as an attempt to reduce the
sense of deprivation and to create internal stimulation/sensations.
This article is the third in a series of three articles that discuss the prominent sensory changes that
accompany aging, and considers the necessary behavioral adjustments or accommodations that
should be made by professional, paraprofessional, and family caregivers who interact with older
adults. Though the medical conditions are not reviewed in depth, the purpose of this article is to
introduce many of the behavioral health insights, principles, and approaches that should influence our
care giving roles. This article addresses age-related changes in taste, smell, and touch, and a related
subject, facial expressiveness.
I.TASTE AND SMELL
A. Changes in taste and smell with aging:
1. Less involved in interpersonal communication, leading to decreased quality of life, and contributing
to depression and apathy;
2. The decline in taste sensitivity with aging is worsened by smoking, chewing tobacco, and poor oral
care. This results in more complaints about food tasting unpleasant or unappetizing, and sometimes
causing the person to stop eating altogether;
3. With aging, there is a decline in the sense of smell, resulting in a decreased ability to identify odors.
Also the person with a declining sense of smell is more tolerant of unpleasant odors, and this can be
further exacerbated by smoking, some medications, and certain illnesses.
B. Effects of taste and smell changes on demented elderly:
1. Individuals with Alzheimers Disease lose their sense of smell more than non-dementia individuals,
due to change in their recognition thresholds. This is because there is a concentration of tangles and
plaques characteristic of Alzheimers Disease found in olfactory areas of the brains of patients with
this disease, compounding the declining sense of smell that accompanies old age;
2. The impairment in the ability to distinguish flavors in foods for those with dementia results in
diminished eating pleasure, and a loss of appetite. Recommendation: more attention to and greater
awareness of the importance of eating, and reminders of having eaten, which can minimize the risk of
malnutrition and dehydration;
3. The impaired sense of taste and smell can result in a serious inability to sense danger, such as gas
leaks, smoke or other odors, which would obviously interfere with taking necessary steps for safety.

2. Also, problems with taste may cause the person to overcook or use spoiled foods, raising the risk of
food poisoning. Recommendation: use smoke detectors, clean out refrigerators regularly, and check
drawers for food hoarding.
II. TOUCH
A. Changes in sense of touch with aging:
1. The sense of touch includes perception of pressure, vibration, temperature, pain, position of body
in space, and localization of a touch. Some of this sense of touch diminishes with aging, but affects
no more than 50% of older adults;
2. The most pronounced changes occur in the feet, and changes become less apparent as we move
up the body. A decline in the sense of perception in the feet contributes to increased danger of falling
or tripping over objects. Changes in hand sensitivity will often lead to dropping of objects;
3. Because the sense of touch is the most intact of all senses in older adults, and least impacted by
advancing years, it can be the more important means of communicating, whether to gain his or her
attention, to reassure him or her, to let the person know that you are there to help, and to guide the
person in an activity;
4. Touch is therapeutic since older adults may be touch deprived. In medical and institutional settings,
such as nursing homes, there may be even fewer opportunities for touch and physical contact.
Recommendation: take extraordinary steps to make appropriate physical contact with the older adult
for reassurance, to gain attention, to confirm communication, and to provide a greater sense of safety
and security.
III. FACIAL EXPRESSIVENESS
1. Some neurological disorders, like Alzheimers
disease, Parkinsons, and other types of dementia result in decreased facial expressiveness. This
makes it difficult to discern emotional reactions or expressions that would otherwise be apparent in
those without such disorders;
2. Because we depend so much on non-verbal communications and facial expressiveness, it is
difficult to know if the other person is hearing and understanding what we are communicating. This
makes it less enjoyable and less rewarding to communicate with someone who does not show the
expected emotional reaction, such as a smile, a laugh, a grimace, or even a shrug.
Recommendation: even in the absence of facial expressiveness, do not avoid communicating with
this person, but do not be upset or disappointed when the emotional reaction does not appear.
Caregiver disappointment and rejection only contributes further to apathy and withdrawal.
PRINCIPLES FOR CAREGIVERS
The following principles apply to caregiving approaches with older adults who have diminished
sensory function. Increased sensitivity and insight to the needs of these individuals improves their
quality of life and improves our effectiveness:
1. Observe his or her behavior, and look for cues and signs of pain or discomfort;
2. Help the person work through the emotional impact of the sensory changes, allowing expression,
acceptance, and support of the grief and sadness accompanying these losses;

3. 3. Do not try to fix the unpleasantness; acceptance and support goes a longer way toward healing
than a quick fix or a patronizing attitude;
4. Reduce excess disability by maximizing whatever functioning is still left, such as proper eyeglass
prescriptions, or functioning hearing aids;
5. Consider assistive devices (phone amplifiers, large text books, headphones, and the Braille
Institute for a variety of useful visual aids).
6. Remember that the need for touch increases during periods of stress, illness, loneliness, and
depression;
7. Touch is especially important when communicating with blind, deaf, and cognitively impaired
individuals;
8. Use touch often, but only to the extent that the person is comfortable with it;
9. Do not give the person a pat on the head, or a tap on the cheek, as this can be perceived as
condescending.
Normal aging brings with it a general decline in sensory functioning. To minimize the emotional,
behavioral and attitudinal impact these losses have on older adults, caregivers should develop
insights and approaches that take the special needs into account, and try to turn unpleasant,
frustrating situations into more caring, helpful, and sensitive interactions. As caregivers can integrate
behavioral principles in the delivery of the health care with older adults, we can have a positive impact
on the management of these losses.
Copyright 2008 Concept Healthcare, LLC
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