Objective 10 Sensory Function Changes PDF

Objective 10: Sensory Function Changes Smell (Olfactory): Age Related Changes: SMELL • Decreased sensitivity to odors after 60; loss of cells in olfactory bulb of brain; decreased number of sensory cells in nasal lining. *Safety issues: affects ability to smell toxic fumes and smoke. Factors c...

Objective 10: Sensory Function Changes Smell (Olfactory): Age Related Changes: SMELL • Decreased sensitivity to odors after 60; loss of cells in olfactory bulb of brain; decreased number of sensory cells in nasal lining. *Safety issues: affects ability to smell toxic fumes and smoke. Factors contributing to loss of smell This Photo by Unknown Author is licensed under CC BY-NC • Chronic sinusitis, smoking, medications, periodontal disease, repeated viral infections. Changes in the sense of smell can be associated with Alzheimer’s disease & Parkinson’s disease. Age Related Changes: TASTE (Gustatory)  Age-related changes do not affect all taste sensations but decrease in taste perception.  Ability to detect sweet remains stable whereas bitter, salty & sour may decrease.  Dentures cover palate & interfere with tasting.  Change in appetite may occur related to both loss of smell & taste. Oral & nasal senses interact, heighten anticipation of desired food. This Photo by Unknown Author is licensed under CC BY-SA  Flavor enhancers can be helpful, however caution as they may increase amount of consumed sodium. Age Related Changes: SIGHT  Several diseases can affect vision of the older population.  Presbyopia, Glaucoma, Macular Degeneration, etc.  Eyes can’t adapt as well to environment.  Loss of elasticity in lens, can’t change shape to focus on near objects (Presbyopia).  Decreased ability to adapt to light.  30% of persons 60+ have some form of visual impairment. Age Related Changes: SIGHT Lens becomes thicker Color perception decreases Glare from sunlight & reflection on objects Decline starts as young as age 40 Affects more women than men Dry eyes is a common complaint Keep in mind a diagnosis of blindness does always not equate to complete vision loss Presbyopia Visual Age Related Changes • Often begins around 40 years of age, near vision deteriorates. • Loss of elasticity in lens Keratoconjunctivitis Sicca • Dry eyes due to decrease in tear production. • Contributing factors: medications, vitamin A deficiency, environment. • Common in women after menopause. Increased intraocular pressure (IOP) - Normal IOP 12-22 mmHg Diseases Affecting Vision: GLAUCOMA Cause: Variable & often unknown. Associated with diabetes. Risk Factors: • • • • Age is greatest predictor Family hx Steroid use Past eye injuries Most common type: Open angle glaucoma Managed with oral meds/eye drops to decrease intra-ocular pressure. Glaucoma Diseases Affecting Vision: CATARACTS  Occurs in those aged 65+  Most common risk factor is advancing age & heredity  Fatty deposits in the ocular lens  Lens opacity decreases visual acuity Cataracts S/S Treatment: Surgery, replacement of lens with an intraocular lens Clouding of the lens Nursing care & Education: No heavy lifting/straining post-op cataract removal, how to adapt to changes in vision and assessing for post surgery delirium Halos around objects as light is diffused Blurry vision & diminished color acuity Sensitivity to glare Diseases Affecting Vision: MACULAR DEGENERATION (AMD)  Macula (Central part of the eye/responsible for clarity in vision) degenerates  Loss of central vision, ONLY peripheral vision left intact.  Most common cause of legal blindness in the elderly  More common in fair haired blue eyed people  Risk Factors: Smoking & sun exposure Early S/S AMD • Difficulty reading and driving. • Awareness of blurry spot in middle of vision. • Increased need for bright light to see. • Colors appear grey, Treatment • Preventative mesures: Wearing sunglasses • No cure! • Treatment is aimed at slowing progresion Disease of the retinal microvasculature. Diseases Affecting Vision: DIABETIC RETINOPATHY Persistent elevated blood glucose levels, increases vessel permeability & deposits of blood & lipids leading to macular edema & hard exudates – vision loss. Interventions aimed at maintaining strict control of blood glucose and annual eye exams. 3rd leading cause of blindness in Canada. Develop it after 20 years of dx of diabetes Safety! Implications of Visual Changes • Reading labels on medications • Difficulty navigating stairs & curbs (in addition to changes with proprioception) • Driving • Crossing streets • Falls Quality of Life • Impacts ability to remain independent • Difficulty or unable to read Communicating & Vision Changes 01 02 03 04 05 06 Box 3.6 pg. 33: Tips for communicating with older persons with visual changes Have the persons attention before speaking Position self at eye level Speak using a normal tone Use dark printing Do not rearrange placement of personal items in the room Strategies to Enhance Vision Eye examinations (early detection) Sunglasses Reduce glare (shades / blinds) Adjust lighting as needed in environment Smoking cessation Protect eyes from injury Age Related Changes: HEARING 54% of Canadians aged 40 – 79 experience at least mild hearing loss 93% of those 70 – 79 years of age  Most common cause sensorineural. Conditions Affecting Hearing: PRESBYCUSIS High-frequency tone impairment Sensorineural Decreased sound waves to the brain Slowly progressive, more severe in men Reduced ability to hear high frequency sounds e.g. consonants, chirping of birds, rustling of leaves Takes a person longer to decipher language Conditions Affecting Hearing: CERUMEN IMPACTION  Wax build-up due to reduction in activity of cerumen glands, they atrophy.  Wax thicker & dryer- needs careful removal (safety).  Wax causes obstruction, hearing loss that can be reversed. This Photo by Unknown Author is licensed under CC BY-SA Conditions Affecting Hearing: TINNITUS Perception of high pitched sound–related to sensorineural loss. Ringing in the ear (buzzing, hissing, bells, roaring, pulsating). Causes: • • • • • • • • loud noises Excess wax Disorders of cervical vertebrae & TMJ (temporomandibular joint) Thyroid diseases CVD Tumors Anxiety, depression Adverse effects meds e.g. adverse effect of aspirin. Older adults deaf since childhood, learn to decipher audible speech (hearing aids), sign language, lip read. Prelingual Deafness Aging changes / diseases challenge individuals ability to communicate. Vision losses, mobility issues in hands (CVA, arthritis) impair signing. Characteristics of Hearing Loss Hearing only sounds (not able to decipher). Hearing only parts of sentences or certain consonants. Hearing only when one is facing you directly when speaking. Hearing nothing at all. Partial hearing loss; total hearing loss. Sometimes mis-labelled as dementia. Sensory Overload Occurs when there is a bombardment of noise / overstimulation. • e.g. too many people talking at one time; too many varieties of contrasting sounds at one time. Often arises suddenly / abruptly. Older adults with dementia are particularly sensitive. Safety! Implications of Hearing Loss Quality of Life • Can’t hear instructions. • Crossing the road e.g. horns etc. • Can’t hear phone, doorbell, may be unaware if emergency occurs. • Communication with others. • May lead to social isolation. Assessment / Strategies: HEARING LOSS Hearing tests/screens Assessment Physical exam of ear structures Interview…note behavioral cues Speak to person’s line of vision. Make sure body language matches message being conveyed. Strategies Minimize outside noises. Ensure hearing aid(s) are used, if required. See box 3.4 pg 3 “Raising voice: NOT effective – More consonants drop out of the speech & person hears mostly vowel sounds. Reduced sensitivity due to decrease in the distal sensory neurons. • E.g. finger tips, palms, lower extremities Age Related Changes: TOUCH At risk for injury (esp. those with diabetes, residual affect of CVA). Implications: • • • • Falls Calluses, foot wounds Risk for injury Need for education, assessment, and proper footwear, etc. Sensory Deprivation 1. Reduced sensory capacities (physiological changes). 2. Elimination of patterns & meaning from input (limited cognitive stimulation). 3. Restrictive, monotonous environment (little or no human interaction). Effects of Sensory Deprivation • • • • • Reality orientation impaired / inappropriate Cognition lessens or is skewed Behavioral changes Problems with sleep – wake cycle Physical deterioration Important to adapt environment to promote highest level of independent functioning. SAFETY & Sensory Losses Older adults are at higher risk for Falls (can’t see objects; can hear sounds). May misread labels/signs. At risk for eating non-edibles / foods intended for animals e.g. pet food. Undercooking food. Appropriate lighting. Appropriate voice pitch and volume …. Use normal volume ..don’t shout. Interventions Assistive devices e.g. glasses / hearing aids / large signage. Colour contrasts that work best: Reds & oranges as opposed to blues & beiges. Educate & take measures (prevent injury).