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Geriatrics > Sensory Impairment > Flashcards

Sensory Impairment Flashcards

1
Q

what % of older adults have significant visual or auditory dysfunction not reported to their physicians,

A

75%

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2
Q

The prevalence of vision problems increases with age and many of the common causes are ?

A

treatable disorders

There are multiple rehab strategies to maximize the functional independence of an individual with low vision.

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3
Q

The combination of ___ and ___ impairment may predispose to falls and the development of functional dependence.

A

vision and hearing

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4
Q

functional changes and their physiological changes of the vision?

A
  1. visual acuity
    - Morphological change in choroid, pigment epithelium, or retina
    - Decreased function of rods, cones, or other neural elements
  2. EOM - Difficulty in gazing upward and maintaining convergence
  3. Intraocular pressure - Increased pressure
  4. refractive power
    - Increased hyperopia and myopia
    - Presbyopia
    - Increased lens size
    - Nuclear sclerosis (lens)
    - Ciliary muscle atrophy
  5. tear secretion - decreased tearing, lacrimal gland function, and goblet cell secretion
  6. corneal function - Loss of endothelial integrity and Posterior surface pigmentation
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5
Q

what is Presbyopia

A

a refractive error that makes it hard for middle-aged and older adults to see things up close; inability to focus sharply for near vision

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6
Q

cause of presbyopia

A

nuclear sclerosis of the lens and atrophy of the ciliary muscle.

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7
Q

T/F: vision impairment is associated with social isolation, anxiety, depression and a loss of independence

A

T

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8
Q

vision impairment can affect ____, leading to more frequent falls, and has been shown to negatively affect physical activity

A

balance

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9
Q

common causes of age-related visual changes

A
  1. Cataracts - Long term exposure to sunlight, DM, Long term steroid use, Smoking
  2. Glaucoma - undiagnosed HTN
  3. Macular Degeneration - Dry MC, wet type is 90% of age-related MD
  4. DM related Retinopathy
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10
Q

Screening for the Most Common Causes of Vision Impairment

A
  • Visual Acuity – Easy to perform testing in the office setting
  • Check Intraocular Pressure – Requires experience with Tono-pen or others
  • Ophthalmoscopic Exam – Pupil size in the elderly is usually reduced compared to younger individuals. Quality of evaluation based on user experience. Note Red Reflex
  • Ectropion, Entropion, Allergy, Dry Eye, Glasses
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11
Q

Aids to improving vision

A
  • Magnifying device
  • Lighting intensifiers without glare
  • Tinted glasses to reduce glare
  • Night light to assist in adaptation
  • Large-print newspapers, books, and magazines
  • Eyeglasses
  • Artificial Tears
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12
Q

what frequencing is usually lost in the elderly

A

high frequency

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13
Q

hearing loss may lead to what dx?

A
  • May lead to a false dx of dementia
  • May lead to depression and withdrawal from social settings
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14
Q

what medications can cause ototoxicity in hearing loss

A

aminoglycosides
macrolides

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15
Q

hearing loss screening tools

A
  1. Standard test measures
    - Sensitivity for tones and speech
    - Speech discrimination/understanding
    - Movement of tympanic membrane
  2. Binaural tests (both ears simultaneously)
    - Loudness comparison
    - Lateralization
    - Masking of level differences
  3. Difficult speech tests - dichotic tasks (processing different information at the same time)
  4. Welcome to Medicare Visit/Annual Wellness Visit screening for hearing impairment
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16
Q

Effects of aging on the hearing mechanism

A
  • Atrophy and disappearance of cells in the inner ear
  • Angiosclerosis in the inner ear
  • Calcification of membranes in the inner ear
  • Bioelectric and biomechanical imbalances in the inner ear
  • Degeneration and loss of ganglion cells and their fibers in 8th CN
  • 8th nerve canal closure, with destruction of nerve fibers
  • Atrophy and cell loss at all auditory centers in the brainstem
  • Reduction of cells in auditory areas of the cortex
17
Q

what screening is a required element of the initial Medicare annual wellness visit

A

hearing loss screening

Weber / Rinne
Whisper test

All patients with hearing loss should be referred to an audiologist for audiometric testing

18
Q

what is common in older adults that can lead to significant hearing loss

accumulation of something

A

cerumen

19
Q

what is presbycusis

A

Hearing loss in older adults is usually of the sensorineural type

20
Q

Strategies to Improve a Health Professional’s Communication With an Older Patient Who Has a Hearing Impairment

A
  • Decrease level of background noise and complexity of the environment by moving to a quiet room.
  • Define if pt has a hearing aid and if it is functioning.
  • Offer to use a voice amplifier for the visit.
  • Examine ears to define if there is a remedial solution (eg, cerumen impaction).
  • Speak slower instead of louder.
  • “teach back” as technique to affirm if the patient heard and understood important aspects of the instructions.
  • Make topic of convo clear at the start
  • Consider engaging an audiologist, a speech-language pathologist, or an occupational therapist to assist in the assessment and in developing a treatment plan.
  • Consider a hearing aid app for the individual’s smartphone (eg, Petralex hearing aid in year 2017).
  • Consider the need for an alternative communication pathway (eg, communication board) for those individuals with a severe impairment.
21
Q

Every pt who has communication difficulties caused by a permanent hearing loss should have what other evals to assess the roles of amplification and aural rehabilitation.

A

ear, nose, and throat eval to r/o remediable disease and then an audiological evaluation

22
Q

In those with severe impairment, in addition to a hearing aid, what other tx may be necessary

A

aural rehabilitation with speech reading

the reduction of hearing-loss-induced deficits of function, activity, participation, and quality of life through a combination of sensory mgmt, instruction, perceptual training, and counseling

23
Q

Factors to Consider in Evaluation of an Older Adult for a Hearing Aid

A
  1. Exclude CI medical or other correctable problem.
  2. Greatest satisfaction is achieved with aid if loss is 55–80 dB; only partial if >80 dB.
  3. Less satisfaction is achieved when poor discrimination is present.
  4. Aid is specifically designed for face-to-face conversation; patient’s expectations should be realistic.
  5. Aid may need to be combined with lip reading.
  6. Loudness perception abnormalities may make the aid unacceptable.
  7. More severe hearing loss requires aid worn on the body rather than behind-the-ear device.
  8. Assess for monaural or binaural aids.
  9. Assess for patient’s ability to handle aid independently.
  10. Assess patient’s motivation, expectations, and attitude in using an aid.
24
Q

what tx is safe and effective for older adults with sensorineural hearing loss/cannot be corrected by hearing aids

A

surgery - Middle ear implant devices and cochlear implants

25
Q

T/F: a cochlear implant is an electronic device that fully restores healing

A

F: partially restores hearing

26
Q

difference between hearing aids vs cochlear implant?

A
  • hearing aids - amplify sound
  • cochlear implant - bypasses damaged portions of the ear to deliver sound signals to the hearing (auditory) nerve
27
Q

how does a cochlear implant work?

A
  1. use a sound processor that fits behind the ear.
  2. The processor captures sound signals and sends them to a receiver implanted under the skin behind the ear. The receiver sends the signals to electrodes implanted in the snail-shaped inner ear (cochlea).
  3. The signals stimulate the auditory nerve, which then directs them to the brain.
  4. brain interprets those signals as sounds, though these sounds won’t be just like normal hearing.
28
Q

how long does it take for most ppl with cochlear impalnts to make considerable gains in understanding speech?

A

1 year

It takes time and training to learn to interpret the signals received from a cochlear implant.

29
Q

keep in mind loss of the sense of: (4)

A
  1. touch
  2. taste
  3. smell
  4. spatial awareness

Geriatrics (12 decks)

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