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CARE OF OLDER PERSONS WITH VISION AND HEARING PROBLEMS

BY: Evangeline B. Mananquil, RN, MN

Objectives: After studying this module, you will be able to:


1. Describe vision and hearing problems among older persons. 2. Describe the incidence of altered vision and hearing in the Philippines. 3. Explain the causes that bring about these alterations. 4. Describe the impact of the above conditions on patient/family/caregiver; and 5. Enumerate ways caregivers can help clients with these problems.

Altered Sensory Perception Problems in 1. Vision 2. Hearing 3. Thought Processes

Understanding how to care for clients with vision and hearing problems will help in ensuring good care of older persons

organized thought processes Intact sensory organs needed Intact vision and hearing 1. To be able to respond to stimuli presented by ones environment 2. Makes possible verbal and written communication. 3. To enjoy meaningful activities and social interactions.

1. Increase risk of Injury- sensory deficits. 2. Isolation limited interactions. 3. Risk for emotional distress. 4. Prone to suffer mental health problems. Becomes a behavioral Boredom management problem. Shorter attention span. (Koplac, 1983) Difficulty in coherent thinking. Confused Needs more time and attention.

SAFETY SELF-CARE NEEDS

Spend more time!

VISION PROBLEMS
Impaired Vision Decreased or is lacking in the ability to see. Brought about by MAJOR VISUAL CHANGES usually starts at age 50- leading to visual impairment Preceded by functional changes

1. Decreased sensitivity to light.


Decrease in the size of the pupil. Increase in lens thickness

2. Increased sensitivity to glare.

3. Decreased in adaptability to changes in light.


Cones of the eye becomes slower in reacting to light.

4. Altered colored vision.


Lens becomes yellowish a one ages This filters out colors of short wavelength such as violet, Blue and green.

5. Presbyopia or farsightedness
Problem of accommodation Or the ability to focus clearly and quickly on objects at various distances.

VISION PROBLEMS RELATED TO DISEASES OF THE FOLLOWING:

1. Cataracts - common; due to the clouding or opacity of the normally clear, crystalline lens. 2. Glaucoma - blockage in the drainage of the aqueous humor Fluid in the anterior chamber of the ye. Usually reabsorbed by the venous circulation
What happened if there is increased production and failure of reabsorption? Increased intraocular pressure leads to 1. degeneration and cupping of the optic disc 2. Atrophy of the optic nerve head 3. Narrowing of the visual field.

Glaucoma insidious, chronic condition Called thief in the night because of the sudden loss of vision ( no noticeable symptoms. Starts 1. Decreasing peripheral vision but central vision remains intact 2. Does not limit the vision of the client.

3. Senile macular degeneration - results from a. Decreased blood supply b. Accumulation of waste products. c. Tissue atrophy
Macula is on the retina. Retina is where the focusing area is found. Degeneration of the macula results in a decline in central visual acuity that makes daily tasks requiring close vision hard to perform.

4. Diabetic Retinopathy Diminished retinal blood flow


Promoting Vision (good eyesight) 1. Decrease environmental risk. Prolonged exposure to UV rays 2. Regular biannual check-up. Early detection 3. Distinguish among an optician, an optometrist, and an opthalmologist.

Ophthalmologistmedical doctor who specializes in the care and management of eye problems

OPTOMETRIST is one who


refracts ones eyes to determine the best kind of eyeglasses to use.

OPTICIAN fits, adjusts and dispenses eyeglasses and contact lenses prescribed by optometrists and ophthalmologists.

CARING FOR CLIENTS WITH LOSS OF VISION

Independence MUST BE ALLOWED as much as possible in various levels of blindness Ebersole and Hess (2001)
1. a. b. c. d. When approaching a blind client Speak before touching so as not to startle him. Sometimes a handshake will do. Facing the client when talking for better communication. Never leave a blind client for long periods of time leads to panic and hallucination. Work out a daily routine. Work with schedule. Abrupt and unannounced changes can be disorienting. Remember they dont have dawn and dusk reminders anymore. Use other sensory stimulation such as touch, sounds and smell. Increased external stimulation is necessary especially if there are signs of apathy. (clocks and chime)

e.

BUT if the cause of visual impairment is a common disorder- additional interventions are quite necessary 1. Cataracts a. Immediate medical attention is needed. b. Surgery. Post-cataract removal management. b.1 No rubbing or pressing the eye. Limit activities. b.2 Discourage shampooing and showers. b.3 Always protective gear to the eye. b.4 Discourage reading during the first weekmovement of the eye can loosen the stitches.

c. Prevent increase intraocular pressure. c.1 Not allowed to bend or stoop. c.2 Avoid straining during bowel movement. c.3 No lifting of heavy objects.(not carry more than 5 kilos) c.4Avoid strong emotions during the early postoperative period.

2. Glaucoma
Requires continual lifelong treatment. Visual loss- is quite permanent. 2.1 Eye drops (miotics)are usually prescribed. Prevent increased IOP. Continuously given even if symptoms are relieved. Given as scheduled. 2.2 If symptoms will not be relieved by mioticssurgery is required. Post-operative care is the same with cataract extraction.

3. Diabetic Retinopathy no early and advanced symptoms 3.1 DM clients- undergo annual opthalmoscopic examination.
3.2 Control the main cause. DM- maintaining blood sugar (foremost goal) Maintaining balance between food intake and energy use.

Goal of Care for the visually challenged older person:


Physical Modifications

1. Adequate lighting especially for reading, sewing, writing and similar activities. 2. Suggest use of a magnifying glass to enhance vision. 3. Avoid bright glare. 4. Soft light on at night especially in the bathroom, kitchen or areas mist visited. Or flashlight near the clients bed.

5. Special dial phones. Touch phones are easier to use. 6. Dont re-arrange things around the house without explaining. 7. Written communication- use large prints.

NORMAL IOP 10-20 mmHg

Behavioral Modifications
(changes in behavior that will facilitate adaptation to visual impairment)

1. Face the person when speaking. 2. Pockets in their clothing for carrying treasured things. 3. Important to have a transistor radio. 4. Provision of detailed instructions for any activity to be done. 5. If client wants to be independent/alone- advise him/her to pause in doorways when going from light to dark rooms or vice-versa. Teach him to use feet/hands as probes to feel for steps, edges of floors, and the like.

HEARING PROBLEMS
1. RECEIVES 2. INTERPRETS 3. SENSE WARNING SIGNALS
Impaired Hearing is lack of or decrease in ability to hear.

Behavioral Cues for a Hearing Deficit


1. Inappropriate responses to questions, especially in the absence of lip reading. 2. Inability to follow verbal directions without cues. 3. Short attention span. Easy distractibility. 4. Frequent requests for repetition or clarification of verbal communication. 5. Intense observation of the speaker. 6. Mouthing of words spoken by the speaker. 7. Turning of one ear toward the speaker. 8. Unusual physical proximity to the speaker. 9. Lack of response to environmental noises. 10.Too loud or inarticulate speech. 11.Abnormal voice characteristics, such as monotony. 12.Perception that others are talking about him or her.

HEARING LOSS

1. CONDUCTIVE HEARING LOSS


talks normally But can hear better if others talk loudly

Due to abnormality in the external ear canal, tympanic membrane and/or middle ear ossicles

2. SENSORINEURAL HEARING LOSS


Talks loudly because he cannot hear his own voice. PRESBYCUSIS

LESS COMMON CAUSE 1. DM 2. Renal failure 3. Radiation therapy

CARING FOR CLIENTS WITH HEARING IMPAIRMENT 1. ELIMINATION OF RISKS FACTORS a. Cerumen Impaction due to thinner and drier skin in the ear canal and increased keratin. b. Ototoxicity due to drugs b.1 aspirins b.2 most antibiotics 2. ENVIRONMENTAL MODIFICATIONS 2.1 eliminate background noise.
2.2 a. b. c. enhance your voice No shouting Lowering pitch of voice Moderate volume.

2.3 Face clients when talking. 2.4 Use of gestures and body language. 2.5 Rephrasing messages. 2.6 Use of written communication.

3. Use of hearing aids


3.1 Initially; Aid should be worn 15 to 20 minutes daily. 3.2 Gradually increase time until 10-12 hours. 3.3 Inform the client that hearing aid will initially make them uneasy.

3.4 Insert aid with canal portion pointing into ear; press and twist until snug. 3.5 Whistling sound- indicates incorrect ear mold insertion. 3.6 Turn aid slowly to 1/3 or volume. 3.7 Adjust volume to a level comfortable for talking at a distance of one yard. 3.8 Concentrate on conversations. 3.9 sit close to speaker. 4.0 Be observant to non-verbal cues.

4.1 Remove aid when bathing. 4.2 Dont wear aid under heat lamps or hair dryer or in very wet, cold weather. 4.3 Be patient and realize the process of adaptation is difficult but ultimately rewarding.

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