Factors That Complicate Eye Examination in the Older Adult PDF

Factors That Complicate Eye Examination in the Older Adult Aging adults undergo and adjust to many physical and emotional changes. Although many of these changes may be unrelated to their eyes or vision, they can make an eye examina- tion more difficult and more time-consuming than is customary for...

Factors That Complicate Eye Examination in the Older Adult Aging adults undergo and adjust to many physical and emotional changes. Although many of these changes may be unrelated to their eyes or vision, they can make an eye examina- tion more difficult and more time-consuming than is customary for younger patients. The widely varying reasons for this are broadly classified in Box 8-1. Knowing how to recognize and overcome these problems can make the examination both more effective and more efficient. This chapter describes eye examination techniques adapted specifically to older patients. HEARING IMPAIRMENT Hearing impairment is a common problem associated with aging. It is more prevalent among older patients than is visual impairment, and it can greatly impede the clinical assess- ment of vision.16 Depending on the population being served, 25% or more of those 65 years or older and 50% or more of those older than 80 years are hearing impaired. Hearing impairment associated with aging usually manifests as difficulty with higher pitched sounds that is made worse by back- ground noise. Simply speaking louder does not always work with hearing-impaired older adults, especially if a louder voice results in a higher pitch. It also means that assistive listening devices may not work as well as expected by not adequately screening out back- ground noise or helping isolate desired fre- quencies. These may be among the reasons why older adults who have hearing aids sometimes choose not to wear them. Whether or not the patient is wearing a hearing aid, communication can always be improved by reducing background noise, facing the patient, and speaking with deliberate clarity. Close the door and eliminate as much ambient noise as possible. Leave the room lights on so the patient can see the examiner’s face and lips. Use as few words as possible, with as few syllables as possible. Add slight emphasis to word sounds that are easy to hear and slight pauses to separate word sounds that are hard to hear. Sounds associated with the letters h, t, and d are relatively easy to emphasize with a little extra push from the diaphragm. Softer sounds associated with the letters z, sh, r, m, and n are hard to emphasize but become easier to hear when followed by a slight pause. A good example of this is heard in the way a sergeant calls a room full of soldiers to attention. He does not shout, “Room, attention.” He shouts, “Hroomm… ahTenn… Hutt.” Of course this extreme is not necessary with patients, but clinicians can speak purposefully from the diaphragm, adding emphasis to hard sounds and pauses to soft sounds. A clinical example of this technique is “Hwhitch is PbeTTer… Hwon… or Two (Box 8-2)?” If despite these measures a hearing problem persists, a readily available assistive listening device known as the Pocketalker can be kept in the examination room for use as needed. The Pocketalker (Williams Sound Co., Eden Prairie, Minn.) is a small, single-unit amplifier and microphone that fits in the pocket and assists hearing in noisy backgrounds. It amplifies the higher frequencies and picks up sound closer to its source, providing a better speech-to-back- ground-noise ratio. As Figure 8-1 shows, the user places it in a breast pocket as close as possible to the mouth to selectively amplify the voice. Lightweight headset earphones are avail- able for added convenience and for use over a patient’s existing hearing aids if necessary (see Chapter 9 for further discussion of auditory impairments in the older adult)