Sensory Changes in the Older Adult Flashcards
What term refers to the reception of information by the ears, skin, tongue, nostrils, eyes and other specialized sense organs. Key sensing processes include vision, hearing, touch, taste and smell?
Sensation
Define sensory loss
a decreased ability to respond to stimuli that affect our senses (hearing, touch, etc.)
What decade do sensory changes occur in the 5 senses?
- Vision: mid 50s
- Hearing: mid 40s
- Taste: mid 60s
- Smell: varies based on cause
- Touch: mid 60s
What are 3 external changes associated with vision?
- Graying and thinning of the eyebrows and lashes
- Subcutaneous tissue atrophy, leading to wrinkling of the skin around eyes
- Decreased orbital fat which results in drooping eyelids and sunken appearance of eye
As one ages the lens thickens and hardens which results in what 3 things?
- Loss of lens clarity
- Reduced color discrimination
- Reduced drainage of aqueous humor
Reduced drainage of aqueous humor leads to an increased risk of what?
glaucoma
As one ages they are more prone to presbyopia (decreased near vision) why is that?
the lens is less pliable
What 3 changes occur in regards to the pupil as one ages?
- reduces in diameter which reduces the amount of light to the retina
- decreased dilation and constriction
- reduced ability to respond to changes in light
As one ages their eye color tends to change to what color?
gray or light blue
Describe 4 problems older adults experience as they begin to lose their sensitivity to light
- they require a higher brightness contrast in order to resolve small objects
- decreased color perception
- reduced ability to adapt in the dark
- unable to recover from glare easily
Blindness is defined as visual acuity of 20/__ by a Snellen chart
200
At what age does blindness peak?
85
In the elderly there are 4 disoereds that cause visual impairment, what are they?
- Macular degeneration
- Cataracts
- Glaucoma
- Diabetic retinopathy
What is the leading cause of blindness in adults over 65?
Age-Related Macular Degeneration (ARMD)
The macula is used to see what type of detail?
fine details
What are the 2 types of ARMD?
wet and dry
What is wet ARMD aka?
neurovascular exudates
Describe the pathophysiology behind wet ARMD
Blood or serum leeks from new blood vessels causing scar formation and visual impairments
Describe the pathophysiology behind dry ARMD
There is atrophy of the macula resulting in retinal pigment degeneration which leads to slow, progressive sight loss
What are the risk factors for ARMD?
- Over age 50
- Cigarette smoking
- Family history
- Exposure to UV light
- Caucasian
- Light-colored eyes
- HTN or cardiovascular disease
- Dietary deficits of antioxidants (vitamin C & E) and zinc
What can defined as a defect of vision in which objects appear to be distorted?
Metamorphopsia
Vision impairments associated with ARMD are due to what defect?
Central scotomas
What are cataracts?
Opacity or yellowing of the lenses (clouding of the lens in the eye)
What the risk factors for cataracts?
- Increased age
- Smoking
- Alcohol use
- Diabetes
- Hyperlipidemia
- Eye trauma
- Exposure to the sun and UVB rays
- Long-term corticosteroid medications
- Caucasian
What is glaucoma caused by?
an increase in intraocular pressure (IOP) resulting in optic nerve damage and vision loss
Glaucoma is the ____ most common cause of vision loss
2nd
What are the 2 types of glaucoma?
- open angle
- angle closure
Describe the cause of open-angle glaucoma
There is a slowed flow of aqueous humor through the trabecular meshwork
Describe the manifestation of open-angle glaucoma
Painless, gradual loss of vision, that is characterized by midperipheral visual fields lost
Describe the cause of angle-closure glaucoma
sudden infection or trauma
Describe the manifestations of angle-closure glaucoma
- Unilateral headache
- Visual blurring
- Nausea
- Vomiting
- Photophobia
What are the risk factors for glaucoma?
- Increased ocular pressure
- Older than age 60
- Family history
- Personal history of myopia, diabetes, hypertension, migraines
- African-American ancestry
Describe the pathophysiology behind diabetic retinopathy
There is damage to the ocular microvascular system (because of diabetes mellitus) which impairs perfusion to the eyes
What are the 2 types of diabetic retinopathy?
Nonproliferative and Proliferative
What is the main difference between nonproliferative and proliferative diabetic retinopathy?
proliferative is progressive and advances rapidly
What are 2 external changes associated with hearing?
- Auricle wrinkles and droop
- Cerumen (wax) becomes dryer leading to an accumulation in the ear canal
What are 4 changes that occur within the inner ear?
- Increased pruritis (itching)
- Atrophy of organ of Corti and cochlear neurons
- Loss of sensory hair cells
- Degeneration of stria vascularis which lines the outer wall of the cochlea
Older people have a harder time hearing what letters?
p, w, f, sh
__% people 65-74 are hearing impaired
__-__% of people over age 75 are hearing impaired
30
40-66
Is hearing loss more common in white or African-American people?
white
What essentially leads to hearing loss?
a decrease in the elasticity of the eardrum
What are the risk factors to hearing loss?
- Long-term exposure to excessive noise
- Impacted cerumen
- Ototoxic medications
- Tumors
- Diseases affecting sensorineural hearing
- Smoking
- History of middle ear infections
- Chemical exposure
What are the 3 types of hearing impairments?
- temporary threshold shift (TTS)
- conductive
- sensorineural
Describe temporary threshold shift (TTS)
a temporary shift in the auditory threshold. It may occur suddenly after exposure to a high level of noise
Sounds less than __ decibels result in temporary loss, but sounds greater than __ decibels with repeated exposure
75
85
Describe the mechanism behind conductive hearing loss
Sounds are not transmitted to the inner ear for one reason or another (impacted cerumen, otitis media, tumor, otitis externa, etc.) which results in problems with reception and amplification problems
Describe the mechanism sensorineural hearing loss
the root cause lies in the inner ear (cochlear), vestibulocochlear nerve (CN VIII), or central processing centers of the brain
What is Tinnitus?
ringing in the ears
What are the 2 categories of tinnitus?
objective and subjective
Describe objective tinnitus
The patient hears pustatile sounds caused by turbulent blood flow within the ear
Describe subjective tinnitus
The patient perceives sound without any sound stimulus
What are some contributing factors to taste alterations?
- oral conditions (poor dentition, improperly fitting dentures, infections)
- impaired olfactory function
- disease
- surgical interventions
What taste buds are affected the most with aging?
Salt and sweetness
What is Xerostomia?
dry mouth, resultant from salivary gland dysfunction
What are some potential causes of xerostomia?
- systemic disease
- radiation
- medication
_____ syndrome is a systemic autoimmune disease in which immune cells attack and destroy the exocrine glands that produce tears and saliva
Sjogren’s
Age-related smelling changes affects __% of adults over the age of 60
50%
What 4 tactile sensations are most affected with age?
- temperature
- vibration
- pressure
- pain
What is Phacoemulsification?
modern cataract surgery in which the eye’s internal lens is emulsified with an ultrasonic handpiece and aspirated from the eye
What is Cholesteatoma?
a destructive and expanding growth consisting of keratinizing squamous epithelium in the middle ear and/or mastoid process
What is Hypogeusia?
diminished taste
