1. Chapter 25 Vision and Hearing

2. 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.

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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.

10. 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.

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

12. 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.

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

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

21. 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.

22. 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

23. 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

24. 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.

25. 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

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

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

28. 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

29. 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

30. 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

31. 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

32. 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