Sensory changes and safe mobility in older adults

presbycusis

most common age related hearing loss

hearing in oldler adults

doesn’t always decline, high frequency sounds are often lost first, background noise becomes harder to filter, blockage to hearing (ear wax), hearing loss is often underreported, untreated hearing loss is associated w/ depression, social isolation and cognitive decline

tinnitus

ringing/ buzzing, common age related change and may worsen communication difficulty, can be b/c of meds and ototoxicity (lasix water pills IV can cause this)

behavorial cues that suggest hearing deficits

frequenylu asking you to repeat yourself, answering inapproperiately/ off topic, turning one ear towards the speaker, watching lips, increased Tv volume, appearing confused

hearing assessments

ask, inspect, preform (whisper test), assess for ototoxic med or impact on function, know when to refer

communication tech for hearing loss high yield

get attention (persons name), face pt and mout visible, speak clearly at moderate pace, lower background noise, short sentences and confirm understanding (teach back), large font and simple language

cerumen impaction

wax wax build up

otosclerosis

change in bone in ear (not just elderly pop problem)

vision in older adults

presbyopia, reduced pupil size, decreased tear production, decreased contrast sensitivity, eyelid laxity, reduced depth perception, increased glare sensitivity

presbyopia

reduced near vision, often needs reading glasses

abnormal vision findings/ red flag

sudden loss of vision, new floaters/ flashes of light, eye pain, redness or halo around lights, progressive perpheral vision loss, difficultu reading even w/ glasses, frequent bumping into objects or misjudging steps

visual acuity screening

snellen eye chart or near vision testing

visual fields screening

peripheral vision screening

extraocular movement (EOM)

CN III, IV, VI function

pupuils (PERRLA) screening

assess rxn and symmetry

functional impact on ADLs

med management, cooking, driving

common older adults eye disorder

cataracts, glaucoma, age related macular degeneration, diabetic retinopathy

cataracts

gloudy lens, glare, blurred vision

glaucoma

often silent early, peripheral vision loss, increased IOP, vision loss irreversible, early screening is critical

age related macular degeneration (AWD)

central vision loss, trouble reading

diabetic retinopathy

vision specific nursing interventions

lighting, reduce clutter, large prints and visual aids, encourage routing eye exams, promote use of corrective lenses

age related changes that affect mobility

musculoskeletal, neurological, cardiovascular, sensory, medication related

mobility assessment

history of falls, gait and balance (shuffling, wide based gait), standardized tools (timed up and go test), orthostatic vital signs, footwear and assistive devices, environment

interventions to enhance safety

fall risk red flag

recent falls, near falls, unsteady gait or use furniture for support, dizziness or orthostatic hypotension, new sedating meds, poor lighting or cluttered home environment, urgency/ incontience, foot pain or poorly fitting shoes

which medication is the most associated with increased fall risk in older adults

antihistamines (benadryl), unless it is an IV then IV