Chapter 25 Vision and Hearing

Introduction Sensory function is often taken for granted. Protection from harm is important. Intact senses facilitate accurate perception of the environment. Sensory function is essential to communication. Sensory deficits compound problems that threaten health, well-being, and independence. Intrinsic and extrinsic factors.

Effects of Aging on Vision Aging vision changes: Reduced elasticity and stiffening of the muscle fibers of the lens Decreased ability to focus (presbyopia) Reduced pupil size Opacification of the lens and vitreous Visual acuity declines

Effects of Aging on Vision (cont.) Loss of photoreceptor cells in the retina Light perception threshold decreases Dark and light adaptation takes longer Difficulty with vision at night Increased sensitivity to glare Distortion in depth perception Peripheral vision reduced

Effects of Aging on Vision (cont.) Incidence of blindness Communication problematic Facial expressions and gestures may be missed or misinterpreted Limitation of lip reading and written communication

Effects of Aging on Hearing Communication problematic (cont.) Changes may negatively impact communication Sensorineural hearing loss (presbycusis) Impacted cerumen Self-conscious of limitation and avoid interactions Underlying cause determined by professional

Other changes Number of functioning taste buds decreased Sweet and salty flavors Pressure not sensed as easily in late life Decreased tactile sensation Difficulty discriminating between temperatures Some olfactory function loss

Promoting 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; supplementation can reduce visual loss in macular degeneration; deficiency can facilitate cataract development. Selenium: May aid in preventing cataracts; supplementation with vitamin E can reduce visual loss in macular degeneration. Vitamin C: Promotes normal vision; supplementation may improve vision in persons with cataracts. Vitamin A: Maintains healthy rods and cones in retina.

Nutrients Beneficial to Vision (cont.) 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; promotes visual acuity; improves capillary integrity to reduce hemorrhage risk in diabetic retinopathy.

Question Is the following statement true or false? Arteriosclerosis, hypertension, diabetes, and nutritional deficiencies can threaten an older adult’s vision.

Answer True Rationale: A variety of disorders can threaten the older adult’s vision. Arteriosclerosis and diabetes can cause damage to the retina; nutritional deficiencies and hypertension can result in visual impairment.

Promoting Hearing Good care of ears throughout the lifetime Prompt/complete treatment of infections Assessment for impacted cerumen Irrigation Education Environmental noise, trauma, and regular audiometric examinations

Assessing Sensory Problems Nurses need to be skilled at assessment of sensory function and presence of deficits Correct implementation of assistive techniques to promote maximum sensory function Nursing diagnoses

Cataracts Clouding of the lens and loss of transparency Leading cause of low vision in older adults Risk factors Signs and symptoms Treatment/management Need for surgery must be evaluated on an individual basis Types of surgery

Glaucoma Damage to the optic nerve from an above normal intraocular pressure (IOP) Second leading cause of blindness in older adults Incidence Causes Signs and symptoms Diagnosis Treatment/management

Glaucoma (cont.) Acute (closed or narrow angle) Severe eye pain, headache, nausea, and vomiting Rapid increase in tension and edema Need for early treatment to prevent blindness Diagnosis with tonometry to measure IOP

Glaucoma (cont.) Chronic (open angle) Most common form Need for early prevention to prevent blindness Vision loss due to glaucoma cannot be restored Signs and symptoms Treatment/management Nursing interventions

Glaucoma (cont.) Care and prevention of complications Avoiding situations or activities that increase IOP Avoid emotional stress Carry card or wear bracelet Avoid abuse and overuse of the eyes Patient compliance can be challenging

Question Is the following statement true or false? Patient compliance with treatment for glaucoma can be challenging for the older adult population.

Answer True Rationale: Compliance with the treatment regimen for glaucoma can be a challenge for the older adult. The silent nature of glaucoma, difficulties in instilling eye drops, and the cost of the medications may contribute to a lack of adherence to the plan of care.

Macular Degeneration Most common cause of blindness in adults over the age of 65 Damage or breakdown of the macula leading to loss of central vision Causes Treatment/management Interventions

Question Which type of visual problem is associated with macular degeneration? Loss of peripheral vision Loss of central vision Perception of spots moving across the eye Pain with movement of the eye

Answer B. Loss of central vision Rationale: Macular degeneration is the most common cause of blindness in people over age 65 and involves damage or breakdown of the macula, which results in loss of central vision.

Detached Retina Forward displacement of the retina Signs and symptoms Gradual or sudden Prompt treatment to prevent continued damage and eventual blindness Treatment/management Nursing interventions

Corneal Ulcer Inflammation of the cornea accompanied by a loss of substance Predisposition factors Signs and symptoms Treatment/management Early care effective

Hearing Deficits Incidence/prevalence Inner ear problems caused by Vascular disorders Viral infections Presbycusis Otosclerosis Tinnitus Infections

Care of the Person with a Hearing Deficit Encourage audiometric testing Problem may not be age related and could be readily treatable Learning to live with a hearing deficit Physical, emotional, and social health can be seriously affected Nursing interventions

Hearing Aids Can benefit some, but not all older adults Need for complete audiometric examination by an otologist Purchase only by prescription Hearing can improve but will not return to normal Difficulties with using a hearing aid Education

Hearing Aid Care Turn the aid off or remove the battery when the aid is not being worn. Store it in a safe, padded container. Clean the aid at least weekly. Wipe the aid off and use a toothpick, pipe cleaner, or pick that may have come with the aid to clean the channel. Do not use alcohol to clean the aid as this can cause drying and cracking. Avoid having hairspray, gels, or other chemicals come in contact with the aid. Protect the aid from exposure to extreme heat (e.g., hair dryers), cold weather, or moisture

Hearing Aid Care (cont.) When changing the battery, turn off the aid first Keep several new batteries available. Typically, a battery will last about 80 hours

Nursing Considerations for Sensory Deficits Attention to stimulation of all senses on a daily basis Interventions to compensate for visual changes and limitations Interventions for those with a hearing issue Touch as a means of sensory stimulation as well as expressions of warmth and caring