Week 9: Vision and Hearing Flashcards
What does vision change with age?
- Changes in eye structure begin early, are progressive and affect both function and structure.
- Presbyopia (decreased near vision) is a common change of aging.
What are extraocular changes with age?
- Eyelids lose elasticity contributing to drooping.
- Entropin
- Ectropion
- Xerophthalmia
Entropin
Inward turning of the lower lid
Ectropion
Outward turning of the lower lid
Xeropthalmia
Excessively dry eyes
What changes occur to the cornea with aging?
Cornea becomes flatter, less smooth, thicker and loses luster.
What are ocular changes that occur with aging?
- Increased astigmatism
- Chambers that control movement of aqueous fluid decrease in size and volume capacity, leading to development of glaucoma.
- Glare is a major problem.
- Decrease ability of the lens to accommodate.
- Development of cataracts from ultraviolet exposure.
What are intraocular changes that occur with age?
- Deterioration of vitreous humor may lead to development of “floaters” (lines, webs, spots, dots)
- Retinal changes affect color, with red, orange, and yellow seen more easily
- Color clarity diminishes by 59% in the eighth decade, secondary to yellowing of the lens
- Drusen spots may appear on the macula
What are changes in vision that occur with age?
- Vision loss is NOT an inevitable part of aging, but age-related changes contribute to decreased vision
- Even older persons with good visual acuity need accommodations to enhance vision and safety.
Visual impairment in older adults are associated with
- Cognitive and functional decline
- Decreased quality of life
- Depression
- Increased risk for injury and falls
How can visual impairment be prevented?
- Have yearly dilated eye examination
- Get routine eye examinations
Types of Glaucoma
- Primary Open Angle Glaucoma
- Acute Angle Closure Glaucoma
Primary Open Angle Glaucoma
- Progressive, asymptomatic with visual field loss.
- Increased intraocular pressure damages optic nerve.
- Vision loss can be prevented if detected early.
Those with primary open angle glaucoma may complain of what?
- Headache
- Poor vision in dim lighting
- Tired eyes
Acute Angle Closure Glaucoma
- Emergency
- Angle of iris obstruct flow of aqueous humor.
- May be related to infection or trauma.
- Intraocular pressure rises rapidly.
What are signs and symptoms of acute angle closure glaucoma?
- Eye is red and painful
- Severe H/A
- N/V
What should be avoided in patients with acute angle closure glaucoma?
Anticholinergics
Screening of Glaucoma
-Adults over the age of 65 or those at risk should have an annual eye examination with dilation.
What is the treatment for glaucoma?
- Oral or topical eyedrops to decrease intraorific pressure (beta blockers are first line therapy)
- Trabeculoplasty
- Filtration surgery
Cataracts
- Opacity of the lens causing the lens to lose transparency and scatter light.
- Often caused by oxidative damage.
What is a cardinal sign for cataracts?
Appearance of halos around objects as light is diffused.
How is cataracts treated?
Requires surgery under local anesthesia.
95% return to excellent vision.
What should you teach patients about cataracts?
- Education regarding vision and adaptation to light changes.
- Post-surgery: avoid heavy lifting, straining and bending at the waist.
What is diabetic retinopathy?
…
Diabetic retinopathy incidence
- Most diabetic patients will develop retinopathy within 20 years of diagnosis
- Leading cause of new blindness between ages 20-74
What are the four stages of diabetic retinopathy?
- Mild nonproliferative retinopathy
- Moderate nonproliferative retinopathy
- Severe nonproliferative retinopathy
- Proliferative retinopathy
Screening for retinopathy
- Early detection is essential
- Annual fundoscopic dilated eye examination
Retinopathy Screening: Fundoscopic evaluation includes
- Flame shape hemorrhages
- Cotton wool spots
- Hard exudates
- Dilated capillaries
- Microaneurysms
What is the treatment for retinopathy?
-Maintain strict control of blood sugar, cholesterol and blood pressure.
Age-Related Macular Degeneration
-Progressive loss of central vision.
What causes age-related macular degeneration?
- Systemic changes in circulation
- Accumulation of cellular waste
- Tissue atrophy
- Growth of abnormal vessels in choroid layer beneath the retina
- Fibrous scarring affects nourishment of photoreceptor cells.
Age-related macular degeneration screening
- Early diagnosis is key
- Amsler grid to determine clarity of vision helps identify central vision problems
What is the treatment for age-related macular degeneration?
- Photodynamic therapy
- Laser photocoagulation
- Anti-vascular endothelial growth factor therapy
Detached retina
- Emergency medical treatment (surgery) required to save vision
- Actual areas of the retina are torn that lead to retinal detachment.
- May have gradual increase in floaters and/or light flashes in the eye.
Dry eye (keratoconjunctivitis sicca)
- A common complaint rather than a disease.
- D/t decreased tear production with age.
Dry eye can be related to
- Medications
- Sjogren’s syndrome
Treatment for Dry Eyes
- Artificial tears
- Consider Vitamin A deficiency
What are signs and behaviors that may indicated vision problems?
- Pain in eyes
- Difficulty seeing in the dark
- Double vision/distorted vision
- Migraine headaches with blurred vision
- Flashes of light
- Halos surrounding lights
- Difficulty driving at night
- Falls or injuries
Special considerations in long-term care in relation to vision
- Cognitive impairment interfere with ability to communicate visual disturbances.
- If a person has glasses, he or she should wear them.
- Routine eye care is a gap in care that can lead to functional decline, decreased quality of life and depression.
- 1/3 of vision problems in LTC settings are reversible.
Consequences of Hearing Impairment include
- Diminishes quality of life
- Decline in function
- Increased hospitalizations
- Miscommunication
- Depression
- Falls
- Loss of self-esteem
- Safety risks
- Cognitive decline
- Increases feelings of isolation
- May be diagnosed with dementia inappropriately
Types of Hearing Loss: Sensorineural
-Damage to inner ear or neural pathways
Types of sensorineural hearing loss
- Presbycusis
- Noise induced
Presbycusis Hearing Loss
- Most common form of hearing loss that worsens with age.
- First sign is difficulty hearing in noisy environments, affects high frequency.
Noise Induced Hearing Loss
- Second most common cause of hearing loss
- Mechanical injury to the sensory hair cells of the cochlea, continuous noise exposure.
- Expected to rise
- Consider better ear protection devices.
Types of Hearing Loss: Conductive
-Abnormalities of external and middle ear that reduce transmission of sound.
What are causes of conductive hearing loss?
- Otosclerosis
- Infection
- Perforated eardrum
- Fluid in middle ear
- Tumor
- Cerumen accumulation
Cochlear implants
- Increased use for sensorineural hearing loss where hearing aids aren’t effective.
- Bypasses damaged portions of the ear and directly stimulates auditory nerve.
For those with cochlear implants, what should be avoided?
MRI’s
Promoting Healthy Aging: Hearing
- Screening for hearing impairment is essential primary care for older adults
- Assessment includes focused history and physical examination and screening assessment
- Self-assessment instruments may be helpful (Box 12-5)
- May require referral to an audiologist
- Removal of cerumen impaction (Box 12-3)
- Follow best practices for communicating with older adults
