Common Aging Changes - Vision & Hearing PDF

NRSG370- Gerontological Nursing Common Aging Changes- Sensation - Vision / Hearing LEARNING OUTCOMES At the end of the session students should be able to: Describe age-related changes that affect vision and hearing Identify the risk factors that affect visual and hearing wellness Di...

NRSG370- Gerontological Nursing Common Aging Changes- Sensation - Vision / Hearing LEARNING OUTCOMES At the end of the session students should be able to: Describe age-related changes that affect vision and hearing Identify the risk factors that affect visual and hearing wellness Discuss functional consequences that affect visual and hearing wellness Describe the pathologic conditions that cause visual and hearing impairments in older adults Conduct a nursing assessment of vision and hearing Identify nursing interventions to facilitate vision and hearing wellness in older adults Introduction Sensory function is often taken for granted: o Protection from harm/ serious falls o Intact senses facilitate accurate perception of the environment o Sensory function is essential to communication o Sensory deficits compound problems that threaten the health, well- being, and independence of older persons- vulnerability to accidents, social isolation & declining physical function Intrinsic and extrinsic factors contribute to sensory problems – aging process, medications, diseases Common Aging Changes- Vision  Changes to the Body - Age related Changes that affect VISION Age-related changes Effect Loss of orbital fat Enophthalmos Decreased elasticity of - appearance of sunken eyes eyelid muscles Accumulation of dark Blepharochalasis - Drooping of upper pigment around the eyelid- eventually impair vision eyes Ectropion- Lower eyelid falls away from  Relaxation of lower conjunctiva- decreased lubrication -dry eyes eyelid Entropion- Lower eyelid becomes inverted & eyelashes irritate the cornea  Changes to the Body - Age related Changes that affect VISION Age-related changes Effect Cornea Arcus senile Accumulation of lipids in outer part of the cornea (Corneal arcus) -yellow or grey-white ring around the iris -does not affect - calcium and cholesterol salts vision Tear Duct/ Tear/ Conjunctiva Narrowing of tear duct opening Dry eye Reduced production of tears syndrome No. of mucus cells decrease in conjunctiva  Changes to the Body - Age related Changes that affect VISION Age-related Effect changes Cornea Opaque & yellow- Diminished acuity Accumulation of lipid deposit- increased scattering of lights- blurred vision Curvature of cornea- slower response to changes in illumination - refractive error Age related Changes that affect VISION Age-related Effect changes Lens Increase the size and density of the lens- tripling its mass by 70 years of age – Increased sensitivity to glare Lens stiffens- focusing on close objects harder. Denser and more opaque - seeing in dim light harder. lens yellows- changing the way the colors are perceived. Result: fewer rays reaching the retina.  Age related Changes that affect VISION Age-related Effect changes Iris/ Pupil Pupils- Less flexible, becomes smaller, reacts more sluggishly to light & dilates more slowly in dark. - Contains 2 sets of - Objects appear dimmer muscles - narrowing of the visual field (decreased peripheral - to regulate vision) pupillary size & - Persons > 60 – objects appear reaction to dimmer. light  Age related Changes that affect VISION Age-related changes Effect Ciliary Becomes smaller, stiffer & less functional (atrophy) – Altered colour perception Body Aqueous Decreased secretion of aqueous humour – affect the humour nourishment and cleansing of the lens & cornea Vitreous Gelatinous substance shrinks and increase size of the liquid portion- pulls away the retina fluid – floaters, blurred vision, distorted images or light flashes, reduce the light entering the retina  Age related Changes that affect VISION Age-related Effect changes Loss of Light perception threshold decreases photoreceptor cells in the retina Dark and light adaptation takes longer -Rods & Cones Difficulty with vision at night The number of nerve cells decrease Retinal neural -Neurosensory information from thalamus pathway passes through the optic nerve to the visual cortex. – slower processing of visual information. Age related Changes that affect VISION Age-related Effect changes Retinal blood Thinning & sclerosis of retinal blood vessels vessels - slower processing of visual information. Visual acuity Decreases by the age of 50 – due to reduced pupil size, opacification of lens & vitreous , loss of photoreceptor cells in retina. Difficulty with vision at night & in dimly lit areas -require more illumination to see objects Visual Vision loss that can not be corrected by impairment eyeglasses Presbyopia - - Lens becomes increasingly stiff. people notice that seeing objects closer than 2 feet becomes difficult - A stiffer lens makes focusing on close objects harder. Caused by degenerative changes in the lens & ciliary muscles- larger, firmer and less elastic- difficulty in seeing nearby objects Eg., need to hold the reading material farther from the eye to focus clearly on the print. Correction: magnifying reading glasses- bifocals or glasses with variable-focus lenses. Changes to the EYE- Risk factors that affect vision Lifestyle and environmental factors  Poor nutrition  Cigarette smoking  Exposure to sunlight - Long-term exposure to sunlight leads to increased eye diseases  Warmer environment- presbyopia and cataract  Environmental conditions – wind, sunlight low humidity second-hand smoke –dry eyes  Poor lighting  Disease conditions- Parkinson’s disease or dementia, DM  Medications – NSAIDs, anticholinergics, amiodarone alpha blockers & oral / inhaled corticosteroids  Medications that cause dryness of the eyes are- Oestrogen, diuretics, antihistamines, anticholinergics, beta blockers& antiparkinsonian.  Anticoagulants.  Changes to EYES - Functional Consequences - Effects on Safety, Function, & Overall Health. Affects the following activities: Getting outside, Driving, Shopping groceries Going up and down stairs Moving safely in dark and unfamiliar environments Seeing markings on clock, TV, appliances, radios…etc Reading newspaper, small-print signs, posters labels on food items & medication containers. Changes to EYES- Functional Consequences  Consequences: Effects on Quality of life: Higher prevalence of falls, injury & Functional limitations - Anxiety, fractures depression & low level of Higher prevalence of chronic health psychological well-being conditions Psychosocial consequences- Higher mortality rate- due to Social isolation -Withdraw from social accidents & falls activities Diminished participation in family, social & community activities. Fear- from being blind, fall, insecure Increased risk of being admitted in the long-term facilities Negative or hopeless attitude about vision changes Poor quality of life Changes to EYES- Pathological conditions  Cataract: - Clouding of the lens Symptoms: and loss of transparency o Night vision decreased o Blurred vision, Cataract is the leading cause of o Increased sensitivity to glare, blindness –more than half of the cases o Trouble in seeing Street signs, Risk factors: o Double vision, o Seeing halos around bright Advanced age, exposure to sunlight, light, smoking, obesity, DM, Malnutrition, o Diminished color perception. trauma, radiation to the eye or head, Management: Corticosteroids.  Use of corrective lens  Cataract extraction with IOL. Changes to EYES- Pathological conditions Glaucoma: Degenerative eye disease- Damage to the optic nerve from an above-normal intraocular pressure (IOP).  The second leading cause of blindness in older adults. Incidence - age >40 / women Causes – increased size in lens, Iritis, Allergy, endocrine imbalance; emotional instability, Family hx, Drugs- anticholinergic properties- dilating pupil. Types: - Acute glaucoma - rapid increase in IOP - Chronic glaucoma – gradual increase in IOP  1. Acute glaucoma or Closed-angle glaucoma o S/S: severe eye pain, headache, nausea/vomiting, blurred vision, blindness  Changes to EYES- Pathological conditions Acute glaucoma contd…. Diagnosis: o Funduscopy- edema of the ciliary body & dilation of the pupil. o Perimetry- visual field test oTonometry–increased IOP-12-20 mm of Hg Normal - 21-25 mm of Hg- Potential glaucoma oGonioscopy: special lens and slit lamp -anterior chamber angle - Management - Medication:  Carbonic Anhydrase inhibitors- reduce formation of aqueous solution  Mannitol, Urea and glycerine - Surgery: Iridectomy Changes to EYES- Pathological conditions 2. Chronic glaucoma or Signs/ Symptoms: Open-angle glaucoma o Peripheral vision slowly but o Gradual loss of eye sight- not increasingly impaired- may need to aware change eye glasses frequently. o c/o visual problem o Gradually the central vision is lost o Tired feeling in eye, headache, Diagnosis: - Funduscopy-; misty vision, Perimetry; Gonioscopy o Seeing halos around lights. – o Management - Medication: specially in the morning, Miotic (azetazolamide) & o cornea -cloudy appearance, Carbonic Anhydrase inhibitors - Surgery: Iridectomy o Iris – fixed & dilated Changes to EYES- Pathological conditions  Care & Prevention of complications of glaucoma o Avoid situations that cause Physical straining &emotional stress Nsg. o Administration of Miotics Diagnosis: o Instruct client to share complete medical hx 1. Deficient - Asthma- pilocarpine hydrochloride with caution and blurring of knowledge r/t vision for 1-2 hours is normal S//E management of disease - Consider safety o Avoid sneezing, coughing, & straining- increase IOP 2. Anxiety and fear o Avoid self- Medication for colds- contain mydriatic agents- r/t loss of vision increase IOP 3. Constipation o Carry a card or wear a bracelet indicating glaucoma 4. Risk for injury r/t o Avoid overuse or abuse of eyes impaired vision o Periodic evaluation Changes to EYES- Pathological conditions Age-related Macular degeneration (AMD): Symptoms: AMD is the leading cause of severe, The gradual loss of permanent vision loss & Blindness in people over ability to see objects age 60 – more than half of the cases. clearly. Changes to the macula, a small central portion of the retina, wears down  The shape of objects - loss of central vision. appears distorted. Risk factors:  Straight lines look wavy or crooked.  Advanced age, exposure to UV sunlight, smoking, obesity, HTN, Family history of AMD, High cholesterol,  Loss of clear color vision. white skin, female, having light eye Color, Poor nutrition  A dark or empty area in the center of vision. Changes to EYES- Pathological conditions - AMD Dry form (atrophic). Wet form : Accumulation of Drusen  Blood vessels grow from - yellow deposits in the macula. underneath macula. These blood vessels leak blood As the condition gets worse, and fluid into the retina - vision is the light-sensitive cells in the distorted - straight lines look wavy. macula get thinner and Have blind spots and loss of eventually die. central vision. The blood vessels and their May have blind spots in the center of vision. As this gets bleeding eventually form a scar worse - lose central vision. - permanent loss of central vision. Changes to EYES- Pathological conditions  Age-related Macular degeneration: Management: NO specific treatment for dry AMD- potential benefit from vitamin supplements, a Mediterranean diet, avoid UV light and cessation of smoking Nutrients like lutein and zeaxanthin, omega 3 supplements or consumption of fatty fishes, vitamin C, E and zinc to reduce the risk of AMD Guidelines for Assessing VISION  Identify Risk Factors Nursing assessment of vision When you spend time outdoors: Vision screening tests Do you use sun glass or hat to Risk factors that affect vision protect your eyes from bright Influence of vision changes on light? performance of activities of daily living Do you smoke cigarettes? Attitude about eye examination and preventive measures Family h/o DM, HTN, Attitude regarding use of low vision Medications? aids Sensory Health Promotion Vision Routine examinations by ophthalmologist Early detection and treatment of problems Consideration of financial ability to receive treatment Prompt evaluation of symptoms that may indicate a visual problem Nutrients Beneficial to Vision Zinc: Promotes normal visual capacity and adaptation to dark o Supplementation can reduce visual loss in macular degeneration odeficiency can facilitate cataract development Selenium: May aid in preventing cataracts o supplementation with vitamin E can reduce visual loss in macular degeneration Vitamin C: Promotes normal vision o supplementation may improve vision in persons with cataracts Vitamin A: Maintains healthy rods and cones in retina Nutrients Beneficial to Vision Vitamin E: May aid in preventing cataracts; supplementation in large doses can prevent macular degeneration. Riboflavin: Aids in preventing cataracts. Ginkgo biloba: May prevent degenerative changes in eye. Flavonoid: Improves night vision and adaptation to dark o Promotes visual acuity; o Improves capillary integrity to reduce hemorrhage risk in diabetic retinopathy. Changes to the Body- Visual Nursing Diagnosis: Planning for Wellness Outcome:  Readiness for enhanced knowledge: Improved vision Improved visual function  Anxiety Impaired Social interaction Increased independence in ADL Ineffective coping Risk for injury Improved quality of life Self- care deficit Increased safety and Readiness for enhanced coping functioning Readiness for enhanced self-care Changes to the Body- Nursing Interventions for visual wellness Prevention and early detection of disease:  Limit exposure to sunlight; use sunglass and hat  Have eyes examined annually or more frequently if any changes in vision  Quit smoking  Control diseases –HTN, DM, other chronic diseases Nutritional considerations:  Include food high in lutein - fruits, corn, spinach, green leafy veg, egg yolks.  Lutein supplements 10 mg/ day – safe and effective in preventing cataracts and AMD  Encourage to take daily supplement of vitamins to prevent AMD Changes to the Body- Nursing Interventions for optimal illumination Older adults - need at least 3 times as much light as younger adults do. - function best in environments with bright, non-glaring, indirect source of light. Sources of illumination should be placed 1-2 ft away from the object to be viewed. Moderate overhead lighting can be used to enhance brighter foreground lighting and prevent sharp contrasts. To reduce glare from reading material, place the light source to the left side of right handed readers and to the right side of left handed readers. Avoid glossy paper for reading materials. Changes to EYES- Nursing Interventions – environmental adaptation Adaptive measures and environmental Colour Contrast: modifications:  Use a toilet seat that Do not rearrange furniture without informing or contrast with the showing the older person. bathroom wall sand Advise older person to pause in doorways when floor going from light to dark rooms (and vice versa), to allow time for their eyes to adjust to the light  Use utensils with brightly change coloured handles Teach older people to use their hands an feet as  Use decorative or probes to feel for curbs, steps, edges of chairs lighted plates over light When walking with an older person, stop when switches and wall necessary to allow a change in focus from near to sockets far and from light to dark.  Use brightly coloured Provide good lighting in stairways and hallways grooming utensils. Place night lights in hallways and bathrooms.  Use pens with black ink rather than blue ink.  Hearing Common Aging Changes Changes to the EAR- Age related Changes that affect Hearing External Ear: Growth of longer and thicker hair (especially in men) Thinning and drying of skin lining the canal Cerumen be dried and difficult to expel – potential for cerumen accumulation and block the canal. Middle Ear:  Thinner & stiffer eardrum due to replacement of collagenous tissue by the elastic tissue. Calcification of the ossicles – interfere with the transfer of sound vibrations from the tympanic membrane to the oval window. Changes to the EAR- Age related Changes that affect Hearing Middle Ear: Inner ear:  Degenerative changes in  Age-related changes include: the Middle ear muscle and  Loss of sensory hair cells  Reduction of blood supply ligaments  Diminished endolymph - Interfere with the protective production response and diminish the  Decreased basilar membrane flexibility elasticity of the tympanic  Degeneration of ganglion cells membrane.  Loss of neurons in cochlear nuclei Changes to the EAR- Risk factors that affect hearing Major Risk factors are: Genetic predisposition to otosclerosis Life style – smoking Environment - Exposure to noise (occupational, recreational, Chemical) Medications – Ototoxic medications- Aminoglycosides, Aspirin, Chemotherapeutic agents, Hydroxychloroquine, Loop diuretics, Macrolides, Quinolones ( Ciprofloxacin, ofloxacin)  Impacted cerumen- Impacted wax. S/S Pain, otitis, tinnitus, dizziness, fullness, coughing Disease conditions - otosclerosis, Meniere disease, DM Changes to the EAR - functional Consequences  According to the site of impairment: a. Conductive Hearing Loss: - Due to abnormalities of the external & middle ear that interfere with sound conduction b. Sensorineural hearing Loss - Due to abnormalities of the sensory and neural structures of the inner ear, which usually are age related or noise induced. c. Mixed Hearing Loss - Both conductive & sensorineural impairments. Changes to the EAR- Hearing Deficits Incidence/prevalence- More than 1.5 billion people worldwide Inner ear problems caused by Vascular disorders Viral infections Presbycusis Otosclerosis Tinnitus Infections Changes to the Ear - Functional Consequences  Presbycusis  A neurodegenerative disease and a communication disorder  Diminished ability to hear high-pitched sound, especially in the presence of background noise.  Typically starts at in the 4th decade.  Bilateral age-related hearing loss Changes to the Ear - Pathological Consequences Tinnitus: Nursing responsibility:  Encourage the client to discuss the  Is the persistent sensation symptom with primary care practitioner. of ringing, roaring, blowing, buzzing or other types of  Refer the case to a specialist if tinnitus is noise that do not originate unilateral in the external environment.  Teach the client about the exacerbating effects of conditions:  Is a symptom associated smoking, drinking alcohol & with– Impacted cerumen, caffeinated beverages- can be autoclasis, Meniere disease assessed through self-care actions.  May use masking techniques to block  Occurs in conjunction with out ringing in the ear like playing radio.. sensorineural hearing loss Guidelines for Assessing Hearing & Behavioural cues r/t hearing  Identify Risk Factors Behavioural cues about psychosocial consequences: Family h/o hearing loss or Avoidance of group settings deafness Lack of interest in social activities, especially H/o exposure to loud noise those requiring verbal communication. in your job or leisure activities Behavioural cues about assistive devices: H/o DM, hypothyroidism or Not using hearing aids that has been Meniere disease purchased Taking any Medication Failure to obtain batteries for a hearing aid. h/o impacted wax in ear Expression of embarrassment about using assistive devices Guidelines for Assessing Behavioural cues r/t hearing Inappropriate or no response to questions Inability to follow verbal directions without cues Short attention span , easy distractibility Frequent request for repetition or clarification of verbal communication. Intense observation of the speaker Turning of one ear toward the speaker Unusual physical proximity to the speaker Lack of response to loud environmental noises Speech that is too loud or inarticulate Misperception that others are talking about him / her Changes to the Body- Hearing Nursing Diagnosis: Planning for Wellness Outcome:  Readiness for enhanced communication Improved communication  Anxiety Impaired Social interaction Increased social interaction Ineffective coping Improved quality of life Risk for injury Risk for loneliness Increased safety and functioning Changes to the Body- Nursing Interventions for hearing wellness Prevention of hearing Loss:  Limit exposure to loud noise  Use ear protectors whenever exposed to loud noise  Quit smoking Early detection and treatment for hearing loss:  Evaluation of medical conditions that cause hearing loss  Check for impacted wax  Obtain evaluation for hearing loss  Obtain professional recommendations for hearing aid, assistive hearing device  Consider using amplifying devices (phone, radios, door bells) or sound substitution devices ( flashing lights) as needed for safety & improved quality of life. Changes to the Body- Impacted cerumen o Occurs in high risk people -older adults, cognitively impaired people using hearing aids. o 19- 65% of patients over 65 years old & often underdiagnosed. o Impacted cerumen – hearing loss, diminished cognitive function, and symptoms like pain, itching, tinnitus, cough, dizziness and sensation of fullness. o May interfere with hearing & performance by reducing the intensity of sound. Assessment: Otoscopic examination - at interval of 3 to 12 months for older adults/ or - those who use hearing aids. Changes to the Body- Impacted cerumen  Patient teaching: Teach older adults and care givers: Prophylactic use of cerumenolytic agents – to reduce the risk of developing impacted cerumen  Do not insert cotton- tipped applicators or any other foreign object in to ear canal Make sure hearing aids are properly cleaned and cared for. Have ear check up q 3- 12 months. cerumenolytic agents- water based ( water, saline, cerumenexH2O@, Sodium bicarbonate) and oil based ( Olive oil, almond oil, mineral oil) Nursing Interventions for Cerumen impaction  Methods to remove impacted Potentially harmful cerumen: interventions: Irrigation, Cerumenolytic agents and Manual removal. o Use of cotton-tipped swabs  Instillation of cerumenolytic agent 15 minutes or for several days prior to the removal o Daily use of olive oil drops or spray  NO ear irrigation for patients with h/o ear surgery, any abnormality of ear canal or non- o Home use oral jet irrigators intact tympanic membrane, and DM. o Ear candling- risk for burns,  for preventing recurrence – use self irrigation otitis media, tympanic with a bulb syringe and regular use of membrane perforation & cerumenolytic agents conducive hearing loss) Reference: Elipoulos, C., 2017. Gerontological Nursing. 9th ed. New York: Wolters Kluwer Medical. Touhy, T., 2019. Ebersole & Hess' Toward Healthy Aging. 10th Ed. [S.L.]: Mosby