Older Adults/ Sensory Alterations Flashcards
CNS
Normal Physiological Changes of Older Adults
Slow CNS Response decreased reflex response difficulty with balance diminished visual acuity (presbyopia) diminished hearing acuity (presbycusis) cerumen buildup decreased taste and smell
Blood Vessels
Normal Physiologic Changes of Older Adults
More rigid, less elastic
peripheral pulses are not always palpable
decreased ciliary action
GI
Normal Physiological Changes in Older Adults
Decreased nutrient absorption
Decreased Peristalsis
Diminished Saliva
GU
Normal Physiologic Changes of Older Adults
Decreased blood flow to the kidney Nephrons decrease by 50% Bladder Capacity decrease by 50% Male- prostate enlargement Female - atrophy of genitalia
Skin
Normal Physiologic Changes of Older Adults
Wrinkles Loss of skin elasticity decrease pigmentation easy bruising Thickening of nails thinning of hair
Bone/Muscle
Normal Physiological Changes of Older Adults
Decreased muscle mass Bone demineralization Decrease Flexibility of joints Slow mobility decrease in height
Health of Older Adult
Falls are most common cause of unintentional injuries attributed to chronic illness and medications (polypharmacy)
Mortality rate from Alzheimer’s disease is twice higher among 85-yo compared to mid 60s
Dementia
Chronic and gradually progressive cognitive impairment
Alzheimer’s disease is most common form of dementia among older adults (second most common is vascular dementia related to HTN and stroke; frontotemporal disorders)
Risk factor for delirium (can have both at the same time)
Life review or reminiscence therapy for mild/moderate dementia; validation therapy for end stage dementia
Delirium
Temporary confusion state brought by an acute illness with specific underlying causes (medications, electrolyte imbalance, infection, untreated pain, psychosocial factors or sleep deprivation)
Can present as a symptom of a systemic infection - often first symptom for pneumonia or UTI
Sudden Onset
Focus on re-orientation and prevention measures
Medical emergency and life threatening - requires immediate intervention, resolves when underlying reason is identified and treated
Depression
Distinct change of behavior with extreme or prolonged sadness brought by life events/stressors
Psychotherapy or counseling and/or antidepressant medication is treatment
Role of Nurses in Promoting Health and Preventing Illness
Assist older adults to function as independently as possible; support their strength and promote their return to health Regular dental and physical check-up Eat a healthy diet Daily exercise Consider supplements (e.g. Vitamin D) Drink Alcohol in moderation Don't smoke Health-related screenings and immunizations
Factors affecting sensory-perception
Developmental Considerations Culture Personality and Lifestyle Stress and Illness Medication
Presbyopia
Farsightedness caused by loss of elasticity of the lens of the eye, occurring typically in middle and old age
Cataract
Cloudiness of the lens, With advancing age, proteins int he lens clump together forming an opaque area causing glare and blurred vision
Detached Retina
Thin layer of tissue at the back of the eye pull away from its normal position. Presents as a curtain coming down across vision, sudden appearance of floaters
Diabetic/Hypertensive Retinopathy
Changes in the blood vessels of the retina, decrease in vision caused by hemorrhage and macular edema
Glaucoma
A slow, progressive increase in intraocular pressure, can damage the optic nerve resulting in peripheral vision loss and decreased visual acuity. Older adults are at higher risk
Temporal Arteritis
Autoimmune disorder that causes inflammation of the temporal artery, may cause blindness if blood supply to the optic nerve is affected
Age-Related Macular Degeneration (ARMD)
Associated with aging, it is a condition in which the macula loses its ability to function efficiently. The macula is the specialized portion of the retina responsible for central vision. Signs include blurring of reading matter, loss of central vision and distortion of vertical lines
Presbycusis
Sensorineural Hearing Loss
Decrease ability to hear high-pitched sounds i.e. chirping of a bird, ringing of a telephone. Loss of hair cells in the sensory receptors of the inner ear due to aging
Tinnitus
Ringing in the ears, can be due to damage to the hair receptors of the cochlear nerve and age related changes in the organs. Tinnitus is one of the symptoms of Meniere’s disease. Other symptoms: Severe dizziness, fullness or congestion in the hear and hearing loss
Burning Mouth Syndrome
dryness, scaling and itching of lips
Dryness and soreness of mouth
Feeling of thirst, numbness and tingling sensation on the tip of the tongue
Pain and bitter metallic taste
*Gustatory and olfactory changes include a decrease int he number of taste buds and sensory cells in the nasal lining. Reduced taste discrimination and sensitivity to odors are common
Peripheral/Diabetic Neuropathy
overreaction/under-reaction to pain in the distal extremities related to nerve damage from circulatory problems (other s/s: numbness, tingling sensation, sensitivity to touch, vibration and pressure)
Patient with diabetes- there are changes in the microcirculation causing damage to peripheral nerves
*Older adults experience tactile changes including decrease pain reaction, two-point discrimination and vibration sense
Phantom Limb Pain
The experience of chronic pain that can range from dull to ache to crushing pain where an amputated limb once was
Decrease in Vision
Nursing Considerations
Use of Corrective lenses
Provide adequate lighting and clear pathways of clutter
provide reading materials in larger print
encourage visit to ophthalmologist annually
Decrease in Hearing
Nursing Considerations
Use of hearing aids
Communicate in lower tone to speak
Decrease in taste and smell
Nursing Considerations
Add flavor with herbs and spices; make food warmer/colder
Decrease sense of touch
Nursing Considerations
Protect skin from temperature extremes
Assess extremities for breakdown
Ambulate with assistive devices
Delirium Management
The confusion assessment method tool: helps determine whether a patient’s confusion is dementia or delirium
Encourage rest/sleep
Keep room quiet and calm
Make sure they are comfortable
Encourage them to get up and sit in a chair
Encourage them to work with a physical or occupational therapist
Help eat/drink
