Sensory Changes in the Older Adult

Objective Tinnitus

Although rare, audible to the person and examiner. Low pitched Causes include vascular & musculoskeletal cranial disorders.

Vision Changes

30% over age 65 with some level of visual impairment Visual acuity is related to the older adult's ability to perform ADLs Pupils decrease in size and less light enters Lens increase in density and rigidity Dryness occurs from diminished tear production Eyelids lose tone Decrease in peripheral vision and night vision Difficulty identifying green, blue, violet due to yellowing of lens Narrowing of blood vessels in retina

Moderate hearing loss

41-55dB

Moderately severe hearing loss

56-70dB

Severe hearing loss

71-90dB

Nursing Care Strategies: Hearing

Assess for cerumen impaction Face the client before speaking Do not shout, but rather use normal volume Provide written instructions Assure appropriate care for hearing aids; remove batteries at night; check for aids in bed linens Notify physician of any acute change in hearing Refer to audiologist/ENT as indicated

Subjective Tinnitus

Audible only to the individual Ringing, buzzing, or humming sounds

Expected Outcomes of Care

Baseline visual acuity and hearing acuity for all older patients will be performed prior to discharge from the hospital, home care, or nursing home Evidence of fall precautions for all older patients with sensory impairments Avoidance of falls and injuries to extremities with decreased sensation Avoidance of accidental exposure to toxins in the air or food due to diminished sense of smell or taste

Meniere disease

Caused by excessive fluid within inner ear Tends to affect older women Symptoms include tinnitus, vertigo, hearing loss, nausea & vomiting, loss of balance, spasmodic eye movements Rule out metabolic imbalance (diabetes), hypothyroidism, neurologic disorders, polypharmacy

Cataracts

Clouding of the lens presents as painless, progressive blurring of vision Unilateral or bilateral Light cannot be transmitted to retina Cient requires brighter light to read; glare sensitivity, loss of color perception With age, more than 90% will develop cataract formation

Nursing Care Strategies: Vision

Comprehensive assessment, history and physical exam Continue treatment of chronic eye conditions Report acute changes to physician Use appropriate lighting and assistive devices Avoid glare when possible Use magnifiers when needed Annual eye exams Add contrast to fixtures in room

Diabetic Neuropathy

Damage to peripheral nerves from microvascular changes occurring with diabetes; loss of sensation in the feet of diabetics. Stroke (CVA)

Implications of Smell and Taste Changes

Effects quality of life: Diminished smell and taste of favorite foods and beverages Nutritional decline Safety hazard: Unable to smell smoke, gas leak Inability to recognize spoiled food resulting in G.I. complications Social isolation

Specific Senses

Senses related to specific organs and sensory cells, such as vision, hearing, taste, smell, balance

Nursing Care Strategies: Peripheral Sensation

Examine feet daily and inform physician of any problems Provide excellent skin care Adequate foot wear; diabetic socks Refer older adults with decreased sensation/diabetes to podiatrists for ongoing foot care Refer to diabetes educator Implement fall precautions and initiate a referral to physical therapy for diabetics with peripheral neuropathy

Implications of Peripheral Sensation Changes

Falls due to the inability to recognize position sense or inability to know where feet are positioned on the floor Foot lesions, infections Burns

Presbyopia

Farsightedness caused by loss of elasticity of the lens of the eye, occurring typically in middle and old age. Most common visual impairment Diminished ability to focus clearly on close objects, read fine print Accommodation is impaired due to thickening of lens and loss of elasticity Delayed recovery from glare Requires the use of bifocals, reading glasses Usually occurs during fourth decade of life

Macular degeneration: Wet type

Forming of abnormal blood vessels with hemorrhage causing rapid and severe vision loss

Implications of Hearing Changes

Impact on quality of life: Impaired communication with others; social isolation; depression and low self-esteem. Safety issues: Unable to hear instructions, such as how to take medications; unable to hear a car coming when crossing the street; unable to hear the doorbell, phone, knocking on the door, emergencies. Review the "Hearing Screening in Older Adults" assessment tool; Tinnitus Questionnaire in Meiner text (pg. 651).

Implications of Vision Changes

Impact on safety: Unable to read medication labels; difficulty navigating stairs or curbs; driving; crossing streets; falls Impact on quality of life: Reduces ability to remain independent; difficulty or unable to read; impaired provision of ADLs/IADLs

Glaucoma

Increase in intraocular pressure due to blockage in drainage of the aqueous humor (fluid) in the anterior chamber of the eye Higher risk over age 60 Loss of peripheral vision; intolerance to glare Chronic open-angle: Most common form; develops slowly Closed-angle: Acute process with complete blockage; requires prompt medical care

Xerostomia

Lack of saliva production; "dry mouth" Salivary flow from parotid does not change. CAUSES: meds, dementia, depression, radiation therapy to head and neck. Dry mouth can lead to respiratory infections, impaired nutrition, difficulty communicating.

Changes in Smell/Taste

Loss of cells in olfactory bulb of brain; less cells in nasal lining to detect odors; decline in the sensitivity to airborne chemical stimuli Atrophy of taste buds with a loss of efficiency and decline in number; decreased ability to detect foods that are sweet/salty Diminished thirst sensation due to alterations in oral mucosa and tongue Changes in taste can be due to meds, diseases, smoking

Physiological changes of external ear

Loss of elasticity, elongated lobe, auditory canal narrows, hair becomes coarse and stiff; cerumen glands atrophy

Presbycusis

Most common cause of hearing loss High frequency loss; sound waves are not interpreted correctly due to gradual loss of hair cells and fibrous changes in the blood vessels supplying the cochlea Difficulty hearing sounds such as t, p, and s Background noise further aggravates hearing deficit Rule out infections, vascular disease, head injury

Macular degeneration

Most common cause of legal blindness in older adults Loss of close vision and central visual acuity; peripheral vision maintained Risk factors: smoking, excessive sunlight, lack of zinc and antioxidants

Peripheral neuropathy

Nerve pain in distal extremities related to nerve damage from circulatory problems or vitamin deficiencies (B6, B12, folate).

Retinal Detachment

Sensory layer of the retina separates from the pigmented layer Tears or holes form in the retina from trauma, hemorrhage, lesions; Can show up as floaters, flashes, loss of vision Appears as a "curtain coming down" across visual field Requires bed rest and eye protection until surgery can be performed

Diabetic Retinopathy

Retinopathy caused by elevated blood glucose causes microaneurysms in the retinal capillaries Vascular changes then cause the retina to swell Usually does not present with early signs of retinal changes Accounts for 7% of blindness in U.S.

Hypertensive Retinopathy

Retinopathy caused by poorly controlled hypertension; usually treated with laser photocoagulation and strict B/P control

General Senses

Senses include: touch, pressure, pain, temperature, vibration, and proprioception

Tinnitus

Subjective sensation of noise in the ear, such as ringing, buzzing, or hissing. Prevalence increases with advancing age Common causes are noises, toxins that damage the hair receptors of the cochlear nerve, or age-related changes in the organs of hearing and balance. Considered a symptom, not a disease Unilateral tinnitus is related to more serious diseases, such as Meniere disease, tumors

Nursing Care Strategies: Smell and Taste

Take all complaints of inability or decreased ability to smell or taste seriously If there is an abrupt change, notify physician Patient teaching should focus on safety issues with odors of gas, smoke and spoiled food Educate older adults to have carbon monoxide/smoke detectors in their home

proprioception

The ability to sense stimuli arising within the body regarding position, motion, and equilibrium.

Macular degeneration: Dry type

Thinning of macular tissue with gradual loss of vision

Follow-Up Monitoring

Vision assessment every year Audiology evaluation at least every two years and for training in use of hearing assistive devices Referral to dentist or ENT for acute changes in smell or taste Referral to a podiatrist for continual care (Medicare covers cost every 10 weeks)

Physiological changes of inner ear

decrease in vestibular sensitivity

Profound hearing loss

higher than 90dB

Mild hearing loss

the softest sounds heard are 26 to 40dB

Physiological changes of middle ear

thickening of tympanic membrane, degeneration of ossicular joints