Module 5 - Geriatric Sensory Changes Flashcards
(107 cards)
1
Q
Intact senses facilitate …
A
accurate perception of the environment
2
Q
How do sensory changes occur in the geriatric population and how does it impact people?
A
The sensory changes are not noticed abruptly and the declines are individualized on a person by person basis
These impaired sensory affect everyday experiences
3
Q
Sensation is essential for …
A
communication (sharing experiences, joys, burdens, etc)
4
Q
Sensory decline is ___!
A
individualized!
5
Q
Sensory changes do what to problems?
A
They compound problems that can threaten health, well being, and independence
ex: Can they read discharge instructions? Hear your education? Act and know what to do at home?
6
Q
What sort of factors contribute to sensory issues?
A
intrinsic and extrinsic factors!
7
Q
What is one of the most significant sensory changes with age?
A
Vision
8
Q
Presbyopia
A
reduced elasticity of the lens with age leading to farsightedness
9
Q
Around what age do you start to notice vision changes and reduced elasticity?
A
40-70
10
Q
What sort of eye changes effect vision with aging?
A
Presbyopia
Decreased pupil size
Opacification of the lens and vitreous
Decreased tear production
Headaches
Loss of photoreceptors cells in the retina
Sensitivity to glare (ex: may be from cataract)
Depth perception becomes distorted
Peripheral vision reduced
11
Q
How does decreased pupil size impact sight?
A
It makes it so we have differing light and dark adaption
12
Q
How does opacification of the lens and vitreous impact vision?
A
It decreases visual acuity
13
Q
How does decreased tear production impact vision?
A
Leads to dryness
This dryness can lead to infection
14
Q
What may be causing headaches with age?
A
Muscle strain
15
Q
How does loss of photoreceptors in the retina impact vision?
A
- Light perception decreases
- Dark and light adaption takes longer (compound with pupil decrease)
* This can lead to difficulty driving at night
16
Q
More ___ is needed for reading with age
A
light
17
Q
How can depth perception distortion have major impacts on elders?
A
It makes their position difficult and could lead to falls or accidents
18
Q
Effects of blindness increases after what age?
A
65
19
Q
Half of all individuals diagnosed as legally blind are …
A
65 y/o or older
20
Q
How can vision changes impact communication?
A
It could make it harder to recognize gestures or facial expressions which are important to interpretation of words
Or, if there was hearing loss it could be hard to hear inflection, tone, and the vision loss makes it more difficult to lip read.
21
Q
How to promote vision sensory health?
A
- Routine self care
- Eye examinations - including a glaucoma test
- Early detection and treatment
- Evaluation of financial ability for exam and treatments
- Prompt evaluation of symptoms
- Use bright light
- Avoid fluorescent light
- UV filter coating on lenses and sunglasses
22
Q
What are some symptoms requiring prompt evaluation to mitigate vision loss?
A
Blurred or double vision
Redness of conjunctiva (from entropion or ectropion lids)
Spots/Many Floaters
Headaches
Infection
23
Q
What sort of colors can aid in elder vision?
A
Red, Yellow Black - avoid purples and blues because they are harder to discriminate from each other with the loss of acuity
24
Q
Arcus Senilis
A
A hazy gray, white, or blue opaque ring appearing in the peripheral cornea
Should be looked for as it indicates potential high cholesterol or cardiac disease
25
Ways to Compensate for Visual Deficits?
Face the person when speaking
Use several indirect lights instead of single glaring one
Avoid glare from windows
Use Large Print
Put frequently used items in the visual field - anything they may need when alone
Avoid low tone colors
Use contrasting colors (even on stairs)
Provide safe environment
Identify personal belongings via a design on them
Remove mats, rugs and cords and anything that may be a tripping hazards
26
Older adults may have detachment of the ___
retina
27
Retinal Detachment
Retina detaches from the back of the eye - either with symptoms being gradual or sudden - and prompt treatment is needed to prevent further damage or blindness
28
Tell Tale Sign of Retinal Detachment
Perception of spots that move across the field of vision
29
S/S of Retinal Detachment
Perception of movement of spots across the eye
Blurred vision
Feeling like there is a cloud developing over the eye
Feeling like they see flashes of light
Potential blindness/Decrease in vision
30
Individuals after treatment for retinal detachment may be given an eye patch, why may this lead to problems?
While needed, this can be frightening to them and the eye patch and loss of vision can lead to confusion d/t sensory loss.
31
Corneal Ulcer
Inflammation of the cornea accompanied by some loss of the corneum
Can be hard to treat and can cause corneal scarring and perforation
32
Corneal ulcers can be difficult to ___
treat
33
Risk Factors for corneal ulcers?
Febrile States
Irritation
Dietary Deficiencies
Lowered Resistance
CVA
34
Treatment and early care is particularly important with corneal ulcers, what are some ways to treat this condition?
Give sunglasses for photosensitivity
May have to give sedatives
Provide antibiotics to deal with the aftermath for the cornea in terms of abrasion
Treat the underlying cause!
Cycloplegics, Sedatives, Antibiotics, and Heat
Potentially a corneal transplant may be done in more advanced corneal ulcers
35
S/S of Corneal Ulcers
Eye may appear bloodshot or you may see the inflammation/sore
Increased tearing
Pain
Photophobia
36
What is the leading cause of vision loss in the eldery?
Cataracts
37
Cataracts
Dense cloudy area forming on the lens leading to loss of transparency and thus vision loss
38
What is one of the biggest cause for Cataracts?
Ultraviolet light exposure (while not using protection like sunglasses)
While everyone has exposure, this is more so for people with excessive exposure
39
S/S of Cataracts
Visual acuity is not affected much! But many patients have decreased night vision
Seeing Halos around lights/Diplopia
Lens becomes opaque
Glare from sunlight and bright light are bothersome
Night vision and night driving difficult
No Pain associated, but further opacity leads to visual acuity affects
Red reflex is reduced
40
Cataracts generally occur in what eyes?
Generally affects both eyes simultaneously
41
Types of Cataracts
1. Secondary Cataracts
2. Traumatic Cataracts
3. Congenital Cataracts
42
Secondary Cataract
Most common in the elderly
43
Traumatic Cataract
Most common after an eye injury
44
Congenital Cataract
Often noted right after birth, and most likely occurring in both eyes
45
What might be seen on examination of a cataract"?
Decreased red reflex
46
Factors that contribute to cataract formation?
1. Age
2. DM
3. Smoking
4. HTN
5. Kidney Disease
6. Physical or Chemical Injury
7. UV/Sunlight
8. Prolonged corticosteroid use
47
What is the number 1 contributing factor to cataracts?
Age
48
How is the decision for cataract surgery decided?
It is NOT based on age
Rather it is based on opacity that leads to limitations
You need to monitor and evaluate for what treatment is necessary
49
Cataract surgery complications increase in occurrence with ___
age
50
Potential cataract surgery/implant complications
active bleeding
loss of vision
infection
loss of vitreous humor
slipping of the implant
51
How long is a cataract surgery?
it is a one day procedure done outpatient (they go home same day), but they are given meds that may impacts other parts of the body (like urinary retention)
52
Methods of Care for Patients Post Cataract Surgery
Assess the older adult environment! - Remove obstacles like scattered Rugs
Prevent squeezing of the eyelids
Avoid vigorous laughing, bending over, lifting, sneezing, coughing, straining for BM/constipation
Use eye shield or patch
53
When should a post cataract surgery patient contact their provider?
Severe pain
Pressure in the eye
Loss of vision
Any unusual symptoms
54
What is the second leading cause of blindness in older adults?
Glaucoma
55
Glaucoma
Degenerative eye disease where the optic nerve is damaged from increased intraocular pressure
It is irreversible
56
What are the symptoms of Glaucoma?
There are none until it is already occurring and vision is loss
57
What is the cause/etiology of Glaucoma?
There is no exact cause, just increased IOP causing damage
58
Risk Factors for Glaucoma include...
Size of the Lens
Iritis
Allergy
Endocrine Imbalance
Emotional Stability
Family History
59
Why should medications with cholinergic activity not be given to a patient with glaucoma?
It can exacerbate glaucoma, because the meds dilate the pupil - so they should not be used
60
What is the general cause for ACUTE glaucoma
rapid increase in intraocular pressure
61
What is the general cause for CHRONIC glaucoma
Gradual intraocular pressure with increased pressure on the optic nerve
This type tends to be irreversible
62
2 Types of Glaucoma
1. Acute (Angle-Closure) Glaucoma - EMERGENCY
| 2. Chronic (Open Angle) Glaucoma
63
Acute Angle Closure Glaucoma requires treatment how fast?
Within 24 hours, it is an emergency, in order to prevent vision loss
64
Acute Angle Closure Glaucoma
Rare
Often seen Unilaterally (only in one eye)
Seen in those who are farsighted and have a family history of glaucoma
5%
65
Symptoms of Acute Angle Closure Glaucoma
Acute Pain
H/A
N/V
Loss of Vision
Pupils unreactive and partially dilated
*all occur within 24 hours of onset*
66
What reading does a tonometer get indicating potential acute glaucoma?
20-25 mmHg
67
What is a normal eye pressure reading with a tonometer?
10-20/21 mmHg
68
Chronic (Open Angle) Glaucoma
Chronic and progressive - 90% of glaucoma cases
Increase in IOP from accumulation of aqueous humor over time leads to this
Aqueous humor is NOT stagnant - it flows at a very slow rate
69
What type of glaucoma is more common
Chronic Open Angle Glaucoma
70
S/S of Chronic (open angle) Glaucoma
*More acute in the morning*
Tunnel vision
Seeing halos around lights
Blurred vision
Decreased peripheral vision
Difficulty adjusting to darkness
Frequent change in prescription
Cupping of the optic disk
Atrophy of the optic nerve
IOP > 22 mmHg
Cornea may appear cloudy and iris may be fixed or dilated
71
Which eyes tend to get chronic open angle glaucoma?
It tends to be unilateral
It is also so gradual that people tend not to notice until the problem exists
72
Mydriasis
dilation of the pupil of the eye
73
Why should Anticholinergic medications be avoided with Chronic (Open Angle) Glaucoma?
It may cause mydriasis that exacerbates glaucoma
74
How is Chronic Open Angle Glaucoma Diagnosed?
A fundoscopic exam showing that the optic disk is cupping and there is atrophy of the optic nerve from IOP greater than 22 mmHg
75
Acute Angle Closure Glaucoma is a...
medical emergency!
76
What kind of physician should see an Acute Angle Closure Glaucoma patient?
Ophthalmologist (refer to them)
77
How do we treat glaucoma?
Medications
Surgery and or Lasers
78
What kind of medications are used for Glaucoma?
Beta blockers - to reduce aqueous humor (ex: Diamax/Timolol)
Pilocarpine - Prevent papillary constriction/mydriasis
79
What is the end result of glaucoma that is caught early?
If it is caught early there will be a good outcome but they will be on lifelong medications
There is some lifelong vision impairment
80
Why is it so important to make sure patients continue to take their lifelong glaucoma medication?
Visual loss from glaucoma can never be replenished or restored, so it is important to continue medications - they may not see a visual increase from meds or eye drops, but it prevents further loss
81
What kind of medication side effects or medications do we avoid with Glaucoma?
1. Anticholinergics
| 2. Anything that raises blood pressure like mydriatics or stimulants
82
Macular Degeneration
Breakdown or degeneration of the macula which causes CENTRAL VISION TO DECREASE
83
What causes macular degeneration?
Systemic changes in circulation, accumulation of cellular waste products, tissue atrophy, and growth of abnormal blood vessels in the choroid layer beneath the retina
84
The most common cause of blindness in older adults is?
Macular Degeneration
85
Forms of Macular Degeneration
1. Dry ARMD (80-90%)
| 2. Wet ARMD (10%)
86
Dry ARMD
Dry Age Related Macular Degeneration
Layers of the macula become thinner and function less and less, the color changes, and providers can note yellow deposits (called Drusen) accumulating under the retina which cause the degeneration
87
Drusen
yellow deposits/waste piles that develop under the retina and cause dry age related macular degeneration
88
Wet ARMD
Wet Age Related Macular Degeneration
Abnormal, leaky blood vessels exist behind the retina
New blood vessels end up growing between the retinal layers and blood gets trapped in the layers of the retina and macula leading to scar tissue and preventing retinal cell function
89
What is the main symptom of macular degeneration/ARMD
Loss of Central Vision
90
S/S of ARMD
1. Difficulty reading, sewing, and performing central vision tasks
2. Decreased color vision
3. Wavy appearance of straight lines on paper or in the environment
91
Amsler Grid
A diagnostic test where people with ARMD will have the straight lines in the center of the grid be perceived as bent or missing
92
What is another test for macular degeneration to use other than the Amsler grid?
Color vision test
93
Risk Factors for ARMD
Age
Smoking
More common in Caucasians
Family history of ARMD
94
Ways to mitigate ARMD
Avoid smoking
Regular exercise
Checking and maintaining cholesterol levels
Healthy diet rich in fish and green leafy vegetables
Eye exams regularly - since early and intermediate ARMD has no symptoms!
95
Tests that can help diagnose ARMD
Amsler Grid
Color Vision Test
Fluorescent Angiogram
Optical Tomography
96
Fluorescent Angiogram
can pass through the blood vessels in the eye and look for concerns (good for wet ARMD)
However, can cause N/V or an allergic reaction to the dye
97
Optical Tomography
Sound waves getting images of living tissues (can diagnose ARMD)
98
Treatments for ARMD
Laser Treatments - not all responsive to this procedure though
Vision Rehabilitation - link the pt with a variety of services (PT, occupational therapy, etc) - individual training occurs then also on adaptive devices
99
Low Vision Optical Aids
Magnifying device
Telescopic lenses for distance
Microscopic for close
Large print (books, newspapers, magazines, telephones, clocks, playing cards)
High intensity reading lamps
100
S/S of Hearing Loss
Need for increased volume
Tilting head toward the person speaking
Cupping hand around one ear
Watching the speaker's lips
Speaking loudly
Not responding when spoken to
101
Causes for Hearing Loss (Aside from Age)
Exposure to noise
Recurrent Otitis Media
Trauma
Medications
```
Chronic Illness like:
DM
Tumors
Hypothyroidism
Vascular Problems
Viral Infections
```
102
Presbycusis
Age related hearing loss - gradual hearing loss in both ears related to age
103
How does Smell Perception relate to age?
Declines after 60 with rapid decline after age 80 due to cell loss in the olfactory bulb and sensory cells
104
Smell often correlates to ____. What does this cause?
Smell often correlates with appetite, this can cause a decrease in appetite alongside a decrease in smell
105
How does Taste Perception relate to age?
Gradual decline occurs due to age related changes and some environmental/lifestyle factors
106
What causes taste perception's gradual decline?
1. Taste Bud Atrophy with age
2. Amylase decreases in saliva (decreased digestive ability)
3. Perception decline accelerated with dental problems, smoking, and medicines that alter taste perception.
107
Sensory deficits can ...
impact the quality of life!
