Week 9: Vision and Hearing

Question 1

What does vision change with age?

Answer 1

• Changes in eye structure begin early, are progressive and affect both function and structure.
• Presbyopia (decreased near vision) is a common change of aging.

Question 2

What are extraocular changes with age?

Answer 2

• Eyelids lose elasticity contributing to drooping.
• Entropin
• Ectropion
• Xerophthalmia

Question 3

Entropin

Answer 3

Inward turning of the lower lid

Question 4

Ectropion

Answer 4

Outward turning of the lower lid

Question 5

Xeropthalmia

Answer 5

Excessively dry eyes

Question 6

What changes occur to the cornea with aging?

Answer 6

Cornea becomes flatter, less smooth, thicker and loses luster.

Question 7

What are ocular changes that occur with aging?

Answer 7

• 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.

Question 8

What are intraocular changes that occur with age?

Answer 8

• 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

Question 9

What are changes in vision that occur with age?

Answer 9

• 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.

Question 10

Visual impairment in older adults are associated with

Answer 10

• Cognitive and functional decline
• Decreased quality of life
• Depression
• Increased risk for injury and falls

Question 11

How can visual impairment be prevented?

Answer 11

• Have yearly dilated eye examination

- Get routine eye examinations

Question 12

Types of Glaucoma

Answer 12

• Primary Open Angle Glaucoma

- Acute Angle Closure Glaucoma

Question 13

Primary Open Angle Glaucoma

Answer 13

• Progressive, asymptomatic with visual field loss.
• Increased intraocular pressure damages optic nerve.
• Vision loss can be prevented if detected early.

Question 14

Those with primary open angle glaucoma may complain of what?

Answer 14

• Headache
• Poor vision in dim lighting
• Tired eyes

Question 15

Acute Angle Closure Glaucoma

Answer 15

• Emergency
• Angle of iris obstruct flow of aqueous humor.
• May be related to infection or trauma.
• Intraocular pressure rises rapidly.

Question 16

What are signs and symptoms of acute angle closure glaucoma?

Answer 16

• Eye is red and painful
• Severe H/A
• N/V

Question 17

What should be avoided in patients with acute angle closure glaucoma?

Answer 17

Anticholinergics

Question 18

Screening of Glaucoma

Answer 18

-Adults over the age of 65 or those at risk should have an annual eye examination with dilation.

Question 19

What is the treatment for glaucoma?

Answer 19

• Oral or topical eyedrops to decrease intraorific pressure (beta blockers are first line therapy)
• Trabeculoplasty
• Filtration surgery

Question 20

Cataracts

Answer 20

• Opacity of the lens causing the lens to lose transparency and scatter light.
• Often caused by oxidative damage.

Question 21

What is a cardinal sign for cataracts?

Answer 21

Appearance of halos around objects as light is diffused.

Question 22

How is cataracts treated?

Answer 22

Requires surgery under local anesthesia.

95% return to excellent vision.

Question 23

What should you teach patients about cataracts?

Answer 23

• Education regarding vision and adaptation to light changes.
• Post-surgery: avoid heavy lifting, straining and bending at the waist.

Question 24

What is diabetic retinopathy?

Answer 24

…

Question 25

Diabetic retinopathy incidence

Answer 25

- Most diabetic patients will develop retinopathy within 20 years of diagnosis - Leading cause of new blindness between ages 20-74

Question 26

What are the four stages of diabetic retinopathy?

Answer 26

1. Mild nonproliferative retinopathy 2. Moderate nonproliferative retinopathy 3. Severe nonproliferative retinopathy 4. Proliferative retinopathy

Question 27

Screening for retinopathy

Answer 27

- Early detection is essential | - Annual fundoscopic dilated eye examination

Question 28

Retinopathy Screening: Fundoscopic evaluation includes

Answer 28

- Flame shape hemorrhages - Cotton wool spots - Hard exudates - Dilated capillaries - Microaneurysms

Question 29

What is the treatment for retinopathy?

Answer 29

-Maintain strict control of blood sugar, cholesterol and blood pressure.

Question 30

Age-Related Macular Degeneration

Answer 30

-Progressive loss of central vision.

Question 31

What causes age-related macular degeneration?

Answer 31

- 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.

Question 32

Age-related macular degeneration screening

Answer 32

- Early diagnosis is key | - Amsler grid to determine clarity of vision helps identify central vision problems

Question 33

What is the treatment for age-related macular degeneration?

Answer 33

- Photodynamic therapy - Laser photocoagulation - Anti-vascular endothelial growth factor therapy

Question 34

Detached retina

Answer 34

- 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.

Question 35

Dry eye (keratoconjunctivitis sicca)

Answer 35

- A common complaint rather than a disease. | - D/t decreased tear production with age.

Question 36

Dry eye can be related to

Answer 36

- Medications | - Sjogren’s syndrome

Question 37

Treatment for Dry Eyes

Answer 37

- Artificial tears | - Consider Vitamin A deficiency

Question 38

What are signs and behaviors that may indicated vision problems?

Answer 38

- 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

Question 39

Special considerations in long-term care in relation to vision

Answer 39

- 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.

Question 40

Consequences of Hearing Impairment include

Answer 40

- 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

Question 41

Types of Hearing Loss: Sensorineural

Answer 41

-Damage to inner ear or neural pathways

Question 42

Types of sensorineural hearing loss

Answer 42

- Presbycusis | - Noise induced

Question 43

Presbycusis Hearing Loss

Answer 43

- Most common form of hearing loss that worsens with age. | - First sign is difficulty hearing in noisy environments, affects high frequency.

Question 44

Noise Induced Hearing Loss

Answer 44

- 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.

Question 45

Types of Hearing Loss: Conductive

Answer 45

-Abnormalities of external and middle ear that reduce transmission of sound.

Question 46

What are causes of conductive hearing loss?

Answer 46

- Otosclerosis - Infection - Perforated eardrum - Fluid in middle ear - Tumor - Cerumen accumulation

Question 47

Cochlear implants

Answer 47

- Increased use for sensorineural hearing loss where hearing aids aren’t effective. - Bypasses damaged portions of the ear and directly stimulates auditory nerve.

Question 48

For those with cochlear implants, what should be avoided?

Answer 48

MRI’s

Question 49

Promoting Healthy Aging: Hearing

Answer 49

- 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