Do you feel what I feel? Understanding Sensory Changes in the Aging Population

Sue Brooks MSN, RN, AOCNS® Clinical Nurse Specialist – ACE Unit and Patient Education Amanda Himes MSN, RN, BC Clinical Nurse Manager- ACE Unit Presenters

Acute Care of the Elderly  Spectrum Health Blodgett Hospital  21 Bed Inpatient Medical-Surgical Unit  Goal: Maintain the functional status of the older adult during acute hospitalization by focusing on their unique needs  Interdisciplinary Team Approach: Nurse Manager, Clinical Nurse Specialist, Educator, Pharmacist, Dietician, Physicians, Physical/Occupational therapy, Pastoral care, Nursing and Nursing Support

Sensory Changes  Vision  Hearing  Touch  Smell  Taste

Effects of age related sensory changes Barriers during communication and care – Misinformation – Confusion – Wrong assumptions Reduced independence – Reduced ability to provide self care Isolation

Vision  Thicker lens  Loss of elasticity in the lens of the eye  Pupil takes longer to dilate and contract  Reduced pupil size  Visual field becomes smaller  Eyelids start to lag  Decreased upward gaze  Problems with glare  Decrease in color vision

Vision - impact  Inability to adjust to glare and change in lighting conditions  Decrease in eyes ability to change the shape of the lens to focus on near objects  Medication labels  Safety risk for driving and maneuvering in the environment  Increased safety risk in changing environmental light

Hearing  Loss of sensory hair cells and nerve cells  Decreased movement of the bones in ears  Increased dryness of ear wax  Increase in number of coarse hair in the ears  Eardrum thickens  Loss of high frequency hearing  Decreased ability to process sounds after age 50

Hearing - impact  Decreases in sound moving across the ear canal  Decreased ability to hear sounds such as p,w,f,sh and women’s and children’s voices  More time needed to process and respond to sounds  Decreased hearing

Hearing - impact  Decreased quality of communication  Social isolation  Low self-esteem

Hearing - impact  “I went to a table to join four friends. When one of them asked me a question which I could not understand, the other repeated it for me. However, I was still unable to lip read it. They paused while one of them wrote it down. I was aware that the easy going conversation they had been enjoying before my arrival now ended.  Within a few minutes two of them left and after a brief pause the others explained they had pressing engagements. I sat alone.”

Responds inappropriately Is labeled confused Becomes frustrated Is labeled uncooperative Becomes angry Caregiver avoids Patient Cycle of Hearing Loss

Taste  Most changes in taste are due to:  Condition of the mouth  Medications  Decreased number of taste buds  Dry mouth  Decreased sense of smell  Disease  Use of tobacco

Taste - Impact  Decreased sensitivity to flavors  Swallowing ability  Difficulty with cooking  Decreased appetite  Eating spoiled food

Smell  Decrease in nerve fibers associated with smell  Decreased ability to identify odors

Smell - Impact  Impacts ability to taste  Inability to identify spoiled food  Inability to identify smoke or gas leaks  Limits enjoyment in eating  Limits pleasures of everyday life  Smell of spring rain, Christmas tree, flowers, coffee brewing

Touch/sensation  Decreased sensitivity to:  Temperature  Pressure  Touch  Decreased balance  Decreased sense of position of legs  Change in pain sensation

Touch/sensation - Impact  Increased risk for:  Falls  Burns  Lacerations  Calluses  Pressure ulcers

Hands on interactive experience Do you feel what I feel?

Vision  What are you experiencing?  Glaucoma  How would this impact your day to day life?

Vision  What are you experiencing?  Macular Degeneration  How would this impact your day to day life?

Vision  What are you experiencing?  Hemianopsia  How would this impact your day to day life?

Vision  What are you experiencing?  Cataracts  How would this impact your day to day life?

Vision  What are you experiencing?  Yellowing of the lens

Medication Experience

References  Capezuti, E., Zwicker, D., Mezey, M., & Fulmer, T. (Ed’s.). (2008). Evidence-based geriatric nursing protocols for best practice (3 rd ed.). New York, NY: Springer Publishing Company, LLC.