CARE FOR OLDER

ADULTS WITH VISUAL

AND HEARING

ER Group

VISION
30% of those over age 65 have some level of visual
impairment
Implication of Vision Change:
Inability to read medication labels
Difficulty navigating stairs of curbs
Difficulty driving
Crossing streets
Reduces ability to remain independent

DISEASES THAT ALTER

VISION SEEN MORE
FREQUENTLY AS PEOPLE
AGE:

Cataracts clouding of lens; painless

Macular Degeneration most common cause of legal blindness
Glaucoma increased IOP
Diabetic Retinopathy end organ damage; uncontrolled DM
Hypertensive Retinopathy end organ damage; uncontrolled
HPN
Temporal Arteritis autoimmune; sudden vision loss
Detached Retina curtain coming down across vision

CASE ON CATARACT:
A 65-year-old man presents complaining of generally
decreased vision and difficulty driving at night due to
glare from oncoming headlights. He describes having
trouble reading the small print on his television
screen. He is healthy and has no history of any other eye
problems. His best corrected visual acuity is noted to be
20/50 in the right eye and 20/40 in the left eye. On
examination, a yellowish opacification of the lens in
the left eye is noted. On ophthalmoscopy, the red reflex
in the left eye is obscured centrally, and the details of the
fundus are indistinct. No other abnormalities are found.

INTERVENTIONS
Cataract needs to be removed only when vision loss interferes
with everyday activities, such as driving, reading, or watching TV.
Phacoemulsification small incision on cornea, soften and break
up lens
Extracapsular surgery longer incision, removes cloudy core of
lens in one piece
After the natural lens has been removed, it is often replaced by an
artificial lens called an intraocular lens (IOL).

INTERVENTIONS
Ensure adequate lighting, easy reach for call bell, announce
presence and absence
Encourage wearing of prescribed eye glasses
Assess for increasing difficulty walking (i.e. bumping on
objects or tripping due to failure to see obstruction along the
way)
Provide clearer and larger print on medication labels and
instructions
The patient must always be asked sensitively whether help
is required and then be allowed to take the nurses arm or
hand.

INTERVENTIONS
Review medications particularly drug to drug interactions
(i.e. glaucoma control drugs)
Refer patients with impaired mobility for low vision and
rehabilitation services; patients who meet the criteria for
legal blindness should be offered referrals to agencies that
can assist them in obtaining federal assistance.
Integrate patients family into the plan of care
Refer patient to services that assist in performing activities
of daily living, if needed.

HEARING
Hearing loss is the 3rdleading chronic condition affecting
adults over 75 years of age.
Changes common in older adults:
Presbycusis loss of high frequency, sensorineural hearing
Conductive hearing loss cerumen impaction, ruptured
eardrum, otitis media, otosclerosis
Sensorineural hearing loss hereditary, infections, ototoxic
drugs, cardiovascular conditions, trauma, Menieres disease

IMPLICATIONS OF HEARING
CHANGES
Impairs ability to communicate with others
Adds to social isolation
Leads to depression or low self esteem
Unable to hear instructions (i.e. how to take medications)
Unable to hear car coming when crossing the road
Unable to hear phone or doorbell ringing
Unable to hear when emergency situations occur

CASE ON PRESBYCUSIS:
Greta Hale, an 82-year-old grandmother of five, looks
forward to visiting her large family but often feels like an
outsider when she does. On holidays, she often sits alone
while younger generations buzz about, preparing for
meals, telling jokes, and engaging in lively debates. "My
hearing is not so good anymore," she explains. Otherwise
spry and healthy, Ms. Hale wants to participate but avoids
doing so because, she admits, "I don't always understand
what people are saying. I think maybe it's just easier for
them to pretend I'm not there." She considers this one
of the more difficult aspects of aging.

INTERVENTIONS:

Adaptive techniques. When speaking with a patient

who has a hearing impairment it's important
* to face him directly and make sure you have his
attention.
* to speak at a normal volume while clearly
enunciating (but without using exaggerated lip
movements).
* not to cover your mouth with your hand.
* to rephrase sentences instead of repeating them.
* to make sure that hearing aids are in place and
that batteries are charged.
*to make sure to include the elderly in

INTERVENTIONS:
Environmental modifications include strategies to
enhance comprehension and minimize background
noise. There should be enough light to allow faces to
be clearly seen because visual cues are helpful.
Assistive devices, hearing aids and cochlear implant
Encourage SO to speak frequently to the client in the
aforementioned manners