nursing
Dementia
NUR 2214 – Nursing Care of the Older Adult
Rasmussen University
Sunday, March 14, 2021
1
What is dementia
Dementia is a syndrome of gradual and progressive cognitive decline
Typically affects older adults
Worldwide, 50 million people have dementia.
Major cause of disability
This Photo by Unknown Author is licensed under CC BY-SA
Dementia is a syndrome of gradual and progressive cognitive decline. Dementia typically occurs later in life due to neurologic function caused by a disease process.
Dementia affects older adults but is not considered to be part of the normal aging process (Meiner, 2019).
Worldwide, about 50 million people have dementia and there are nearly 10 million new cases every year (WHO, 2020).
Dementia is one of the major causes of disability and dependency among older adults worldwide (WHO, 2020).
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What is Dementia
Signs and symptoms
Memory
Attention
Communication
Reasoning, judgment, and problem solving
| Clinical Feature | Dementia |
| Onset | Slow and gradual, with an uncertain beginning point |
| Duration | Usually permanent |
| Cause | Usually a chronic brain disorder (e.g., Alzheimer’s disease, Lewy body dementia, vascular dementia) |
| Effect at night | Often worse |
| Attention | Unimpaired until dementia has become severe |
| Level of consciousness | Unimpaired until dementia has become severe |
| Use of language | Sometimes difficulty finding the right word |
| Memory | Lost, especially for recent events |
(Meiner, 2019)
People with dementia may have problems with memory, attention, communication, reasoning, judgment, problem-solving, and visual perception.
Onset of dementia is slow and gradual and once a patient is diagnosed with dementia, it is usually permanent (Meiner, 2019)
Signs leading to dementia include getting lost in familiar areas, forgetting the name of a close family member or friend, or not being able to complete tasks independently (CDC, 2019)
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Types of Dementia
Alzheimer’s disease (AD)
Vascular dementia (VaD)
Lewy body dementia (DLB)
Frontotemporal dementia (FTD)
This Photo by Unknown Author is licensed under CC BY-NC-ND
Alzheimer’s disease is the most common cause of dementia and accounts for 60-80% of individuals with the disease. It presents as short-term memory deficits and impairment in at least one other cognitive domain (Meiner, 2019).
Vascular dementia is the second most common type of dementia, causing dementia in 20-30% of people. It is characterized as a loss of cognitive function resulting from ischemic, hypoperfusive, or hemorrhagic brain lesions resulting from cerebrovascular disease or cardiovascular pathologic conditions (Meiner, 2019)
Lewy body dementia is considered the third most common form of dementia, making about 10-25% of all cases. It is characterized as a progressive, degenerative brain disorder caused by abnormal small deposits in the brain matter (Meiner, 2019)
Frontotemporal dementia is a rare syndrome associated with non-AD pathologic conditions. It is characterized by focal atrophy of the frontal and anterior temporal regions (Meiner, 2019)
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Reversible dementia
Reversible dementia is a condition that is associated with cognitive or behavioral symptoms that can be reversed once the root of the issue is treated.
Commonly associated with:
Depression
Adverse effects of drugs
Drug/alcohol abuse
Space-occupying lesions
Normal pressure hydrocephalus
Nutritional deficiency
Reversible dementia is a condition that is associated with cognitive or behavioral symptoms that can be reversed once the root of the issue is treated. The most frequently observed potentially reversible conditions identified in patients with dementia are depression, adverse effects of drugs, drug or alcohol abuse, space-occupying lesions, normal pressure hydrocephalus, and nutritional conditions like vitamin B-12 deficiency (Tripathi, 2009).
Most reversible conditions are identified through a careful history, physical examination, psych evaluation, routine lab tests, and a MRI or CT of the brain (Tripathi, 2009).
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Stages of dementia
Mild cognitive impairment (MCI)
Mild dementia
Moderate dementia
Severe dementia
Obtained from:
https://www.kindlycare.com/stages-of-dementia/
The progression of dementia depends on the underlying cause of dementia.
MCI – characterized by losing things often, forgetfulness, and having trouble thinking of words.
Mild dementia – the older adult will still be able to function independently but will suffer more memory lapses that affect their daily life, such as forgetting words, memory loss of recent events, personality changes, trouble organizing or expressing thoughts, and difficulty with problem-solving and complex tasks.
Moderate dementia – older adults in this stage of dementia will need more assistance in their daily lives. During this stage, it is harder to perform ADLs as dementia progresses. Symptoms of this stage include increasing confusion, greater memory loss, needing assistance with ADLs like bathing, grooming and dressing, significant personality changes, and changes in sleep patterns
Severe dementia – older adults in this stage of dementia will have further mental decline and deteriorating physical capabilities. Symptoms of this stage include a loss of ability to communicate, need for full-time daily assistance, increased susceptibility to infections, and loss of physical capabilities such as the ability to swallow, to control the bladder, and bowel function.
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Risk Factors
Non-modifiable risk factors
Age
Family history
Ethnicity
Modifiable risk factors
Depression
Diabetes
Hypertension
Obesity
Age is the leading risk factor, most cases affect those 65 years and older (CDC, 2019).
Those who have a family history of dementia are more likely to develop dementia (CDC, 2019).
Older African-Americans are twice as likely to develop dementia than whites, and Hispanics are 1.5 times more likely to have dementia than whites (CDC, 2019)
Modifiable risk factors include depression, diabetes, hypertension, obesity, smoking, alcohol, high cholesterol, coronary heart disease, renal dysfunction, low unsaturated fat intake, and inflammation (Cunningham, 2015).
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Dementia and the Older Adult
Treatment
Cholinesterase inhibitors
Memantine
Non-drug approaches
Health promotion
3 primary strategies to prevent or delay the onset of dementia
This Photo by Unknown Author is licensed under CC BY-SA
In the case of most progressive dementias, there is no cure or treatment that slows or stops the progression of the disease. There are, however, drug treatments that may temporarily improve symptoms.
Cholinesterase inhibitors (Aricept, Exelon, Razadyne) and memantine (Namenda) are used to treat the cognitive symptoms such as memory loss, confusion, and problems with thinking and reasoning (Alzheimer’s Association, n.d.).
Non-drug approaches to managing behavior symptoms promote physical and emotional comfort to alleviate some symptoms of dementia (Alzheimer’s Association, n.d.).
Evidence points to three primary strategies to prevent or delay the onset of dementia:
Taking care of the body to prevent diseases and manage comorbidities to protect the brain from disease (Grande, 2020).
Engaging in activities that enhance compensatory mechanisms to delay the onset of dementia (Grande, 2020).
Living a healthy lifestyle throughout life can considerably reduce the risk of dementia later in life (Grande, 2020).
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Dementia and the Older Adult
Living with dementia
Identify potential hazards in the home
Make everyday task more comfortable
Find support
This Photo by Unknown Author is licensed under CC BY-SA
Make the home safe by removing clutter and throw rugs, install secure locks on all outside windows and doors, and have adequate lighting in all rooms. Use safety devices such as emergency call buttons or automatic shut-off switches (NIH, 2019).
Make everyday tasks more comfortable by planning the day, having someone help with paying bills, or finding transportation to help get around (NIH, 2019).
Find family support by having someone you can trust to be an emergency contact and have them stop by for regular visits.
Find support within the community by learning about home- and community-based support services or talking with others who share the condition in support groups (NIH, 2019)
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References
Alzheimer's Association. (n.d.). What is Dementia. Alzheimer's Association. Retrieved March 10, 2021, from https://www.alz.org/alzheimers-dementia/what-is-dementia?utm_source=google&utm_medium=paidsearch&utm_campaign=google_grants&utm_content=dementia&gclid=Cj0KCQiA-aGCBhCwARIsAHDl5x9XePZRYIjunD2VsSni1UPoHCNwavJ7ZrlXVr0ODGjkVcg066162f0aAtqaEALw_wcB
Centers for Disease Control and Prevention. (2019, April 5). What is dementia? Centers for Disease Control and Prevention. Retrieved February 28, 2021, from https://www.cdc.gov/aging/dementia/index.html
Cunningham EL, McGuinness B, Herron B, Passmore AP. Dementia. Ulster Med J. 2015;84(2):79-87.
Grande, G., Qiu, C., & Fratiglioni, L. (2020). Prevention of dementia in an aging world: Evidence and biological rationale. Ageing Research Reviews, 64. https://doi.org/10.1016/j.arr.2020.101045
Meiner, S., & Yeager, J. (2019). Gerontologic nursing (6th ed.). [Bookshelf Ambassadored]. Retrieved from https://ambassadored.vitalsource.com/#/books/9780323498111/
Reed-Guy, L. (2018, September 29). The stages of dementia. Healthline. Retrieved March 11, 2021, from https://www.healthline.com/health/dementia/stages
Tripathi, M., & Vibha, D. (2009). Reversible dementias. Indian journal of psychiatry, 51 Suppl 1(Suppl1), S52–S55.
World Health Organization Staff. (2020, September 21). Dementia. World Health Organization. Retrieved March 14, 2021, from https://www.who.int/news-room/ fact-sheets/detail/dementia
Alzheimer's Association. (n.d.). What is dementia. Alzheimer's Association. Retrieved March 10, 2021, from https://www.alz.org/alzheimers-dementia/what-is-dementia?utm_source=google&utm_medium=paidsearch&utm_campaign=google_grants&utm_content=dementia&gclid=Cj0KCQiA-aGCBhCwARIsAHDl5x9XePZRYIjunD2VsSni1UPoHCNwavJ7ZrlXVr0ODGjkVcg066162f0aAtqaEALw_wcB
Centers for Disease Control and Prevention. (2019, April 5). What is dementia? Centers for Disease Control and Prevention. Retrieved February 28, 2021, from https://www.cdc.gov/aging/dementia/index.html
Grande, G., Qiu, C., & Fratiglioni, L. (2020). Prevention of dementia in an aging world: Evidence and biological rationale. Ageing Research Reviews, 64. https://doi.org/10.1016/j.arr.2020.101045
Meiner, S., & Yeager, J. (2019). Gerontologic nursing (6th ed.). [Bookshelf Ambassadored]. Retrieved from https://ambassadored.vitalsource.com/#/books/9780323498111/
Reed-Guy, L. (2018, September 29). The stages of dementia. Healthline. Retrieved March 11, 2021, from https://www.healthline.com/health/dementia/stages
Tripathi, M., & Vibha, D. (2009). Reversible dementias. Indian journal of psychiatry, 51 Suppl 1(Suppl1), S52–S55.
World Health Organization Staff. (2020, September 21). Dementia. World Health Organization. Retrieved March 14, 2021, from https://www.who.int/news-room/ fact-sheets/detail/dementia
See the Following for Additional Examples
Hearing and vision impairment of the aging older adult
By:
Picture: https://www.nih.gov/sites/default/files/news-events/research-matters/2016/20160614-adults.jpg
13
Vision loss
Reasons for vision loss in the older adult:
Age-related macular degeneration
Glaucoma
Cataracts
Age-related macular degeneration: Clinical symptoms will usually begin to present at the age of 50 and above. This issue can affect vision negatively, make it hard to see in areas that are not well lit, and can be tested using an Amsler grid. A positive result means you will have some sort of ARMD.
Glaucoma-Clinical symptoms in the early stages of Glaucoma are absent. As it progresses affected patients will begin to lose peripheral and central vision loss as the disease progresses. Once the vision loss occurs it is permanent so seeking help is very important to stop any more damage to eye's health. African Americans over the age of 40 are at the highest risk.
Cataracts: Clinical presentation of this problem include vision loss, glare, and halos. Patients usually get these issues treated when they begin to experience reduced vision because of the cataracts. At the age 70 years and older there is a very high chance that older adults will develop cataracts. The severity will of course be different from patient to patient.
Pelletier, A. L., MD, Rojas-Roldan, L., MD, & Coffin, J., DO. (2016, August 1). Vision loss in older adults. https://www.aafp.org/afp/2016/0801/p219.html
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Eye tests to screen for vision problems
Visual field test
Slit-Lamp Exam
Tonometry test
Visual field test: Tests peripheral vision and can help to see if the patient has reduced vision because of a stroke or glaucoma.
Slit-lamp exam: This test shines a small beam of light into the usually done by a optometrist or ophthalmologist. This test is used to diagnose cataracts, glaucoma, ARMD, and other eye diseases.
Tonometry test: This test is used to find out what the intraocular pressure of the eye and help to diagnose and monitor glaucoma.
15
Vision loss prevention
Smoking Cessation
Staying at a healthy weight
Wear eye protection to protect the eyes from harmful UV radiation.
Exercise
Smoking cessation: If people can stop smoking they can reduce the risk of developing ARMD by a factor of four. The reason smokers at risk for ARMD is smoking causes cellular change, oxidative stress, and vascular constriction.
Maintain a healthy weight: Obesity can have so many negative affects on the body including issues with the eyes. This is usually because of high blood pressure and diabetes caused by being overweight.
Sunglasses: Uses protective eyewear when outside in the sun is important throughout life. People who do not are at an increased risk for cataracts and ARMD because the UV light can cause changes in the lens and retina. Make sure to buy sunglasses that protect against UV-A and UV-B light. It is also important to get glasses that wrap around the periphery of the eye so that the sun can't slip past the protection directly into the eye.
Picture: http://www.joshworth.com/jw/wp-content/uploads/2012/02/realsuninglasses.jpg
Johns Hopkins medicine. (2021). Best way to age-proof your vision.
https://www.hopkinsmedicine.org/health/wellness-and-prevention
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Ages most affected by Hearing Loss
45-54 = 2 %
55-64 = 8.5%
65-74 = 25%
Age > 75 = 50%
As you can see as patients can start to present symptoms of hearing loss as early as 45 years old. As the patient ages they are at an increased risk for hearing loss issues. Knowing these values will help to know the amount of potential risk of the older adult.
National institute on deafness and other communication disorders (NIDCD). (2016, March). Hearing Loss and older adults.
https://www.nidcd.nih.gov/health/hearing-loss-older-adults
Picture:
http://t2conline.com/wp-content/uploads/2017/07/Age-related-hearing-loss.png
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Hearing tests to identify any problems present
Whisper test
Tuning fork
Physical exam
Whisper test: Is a common test. The way it is performed is the doctor will stand behind the patient and whisper a letter and a number and the patient will repeat it out loud. Patients with hearing loss will have trouble performing this test.
Tuning fork: This type of test can also help to see if a patient has some kind of hearing loss and can also identify if it is conductive or neurosensory.
Physical exam: Is a test where the health care professional will actually look inside the ear with an otoscope and see if there are any issues. Generally this test looks for cerumen impaction or tympanic membrane perforation.
Mayo Clinic. (May, 2019). Hearing loss.
https://www.mayoclinic.org/diseases-conditions/hearing-loss/diagnosis-treatment/drc-20373077
Picture:
https://88ebd614d6d385cab1fa-690979800f2b6f086ae14b7920465b0b.ssl.cf2.rackcdn.com/migrated/sites/advantageent.com/assets/hearing-exam-2.jpg
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Hearing loss treatment and prevention
Treatment
Hearing aids
Lip reading
Education
Avoid long term exposure to noise
Hair cells when damaged can't be repaired
Hearing aids: There are three different types behind the ear, in the ear, and canal aids. These work by receiving external noises and amplifying it so that the ear is able to ear what is actually being said. These types of devices are expensive so sometimes patients don't have access for these devices.
Lip reading: Is a great way to help improve communication for patients that have hearing impairments. It is also not to hard to learn and is free for patients that have financial barriers.
Long term exposure to noise: Long term exposure especially at higher decibels can be very harmful to the ears because it can damage hair cells in the inner ear and once they are harmed they do not repair themselves. It is very important to avoid places that are loud and if unavoidable wearing ear protection to reduce the amount of noise that enters the ear is very important.
National institute on deafness and other communication disorders (NIDCD). (2016, March). Hearing Loss and older adults.
https://www.nidcd.nih.gov/health/hearing-loss-older-adults
Picture:
https://northlandaudiology.com/wp-content/uploads/2016/11/hearing-loss1.gif
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Reference Page
Johns Hopkins Medicine. (2021). Best way to age-proof your vision.
https://www.hopkinsmedicine.org/health/wellness-and-prevention
Mayo Clinic Staff. (May, 2019). Hearing loss.
https://www.mayoclinic.org/diseases-conditions/hearing-loss
National institute on deafness and other communication disorders (NIDCD). (2016, March). Hearing Loss and older adults.
https://www.nidcd.nih.gov/health/hearing-loss-older-adults
Pelletier, A. L., MD, Rojas-Roldan, L., MD, & Coffin, J., DO. (2016, August 1). Vision loss in older
adults. https://www.aafp.org/afp/2016/0801/p219.html
Seltman, W. (September, 2019). Intraocular pressure and your eye health.
https://www.webmd.com/eye-health/intraocular-pressure-eye-health
See the Following for Additional Examples
Vision & Hearing
Impairments
in the
Older Adult
By:
Hello everyone. Thank you for joining me today.
Today I will be giving an in-service training on vision and hearing impairments in the older adult population. I know what you are thinking, not ANOTHER in service training. Let’s approach this differently. I want you to close your eyes for a minute. Then watch the next slide of this presentation closely. Please save your questions for the end of the presentation. When you are ready to proceed to the next slide, please click the mouse button.
Note. [Illustration], by Elena Lenoleum, 2015, Shutterstock
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Imagine this slide is an overall representation of the quality of life of the older adult experiencing vision impairments. At first, it appears out of focus and difficult to understand. A few key changes are made and suddenly everything is in focus and easily interpreted. I want you to imagine that the patient care that you give can make this dramatic change in the lives of older adults. You can take their world from being difficult and frustrating, to a lot clearer and a better quality overall. Is that the kind of care you want to provide? Well then, keep listening. It is important to understand the common impairments that older adults experience. Today we will go over these impairments, and the effects that they have on the lives of older adults. We will also go over the challenges associated with teaching older adult clients about these impairments. Finally, we will discuss the strategies, best practices, and techniques for teaching clients about these vision and hearing impairments and how to help them improve their quality of life.
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Vision Impairments
Macular Degeneration
Glaucoma
Presbyopia
Cataracts
Temporal Arteritis
Dry eyes
Diabetic retinopathy
The most common types of vision loss within the older adult population are age-related macular degeneration, glaucoma, cataracts and diabetic retinopathy. The leading cause of vision loss in Americans over the age of sixty-five is age-Related Macular degeneration. This accounts for almost half of all the cases of decreased vision in older adults. It happens when the part of the eye that is responsible for straight ahead vision (the macula) breaks down over time and the result is a loss of central vision.
Older adults with glaucoma lose portions of their vision over time, and this usually occurs with no warning signs or obvious symptoms. For many older adults, a gradual decrease in peripheral vision is the first sign of glaucoma. It is very important to know that there are two types of glaucoma. The two types are open-angle and closed-angle. Closed-angle glaucoma is a medical emergency. It occurs when the drainage area in the eye which is formed by an angle closes or becomes blocked.
Cataracts effect more than 20 million Americans. Cataracts can be described as a clouding of the lens of the eye. This clouding causes vision to become blurry. It is one of the main causes of visual impairment among aging Americans.
Diabetic Retinopathy affects more than 30 percent of Americans diagnosed with diabetes. 30 percent. That is a huge number that have some form of diabetic retinopathy. This translates to an estimated 7.6 million Americans with this problem. It is a major cause of blindness in older adults and is attributed to high blood sugar. High blood pressure causes damage to the blood vessels, and that damage affects the retina and can result in the total detachment of the retina.
Note. [Illustration], by Elena Lenoleum, 2015, Shutterstock
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How does vision loss affect the older adult?
Falls
Independence
Psychosocial
Poor visual acuity, a reduction in visual field, and a decreased perception of depth are known to be associated with an increased risk of falls among older adults. Vision is an important factor in maintaining balance. Glaucoma, cataracts, macular degeneration and other vision issues often impact adults’ visual acuity, including contrast sensitivity and depth perception. In a typical home, stairs, carpets and rugs, electrical cords and toilet seats can be hazardous for someone whose sight is impaired.
Vision loss affects the older adult's ability to work or care for themselves and can have a large affect on daily activities such as reading, driving, and hobbies outside of the home. Vision loss makes it hard to perform the most basic activities of daily living. Things we may take for granted such as eating and getting dressed. In addition, the older adult may no longer feel safe going shopping, and overseeing their own medication management.
All these changes in safety and independence can have a detrimental consequence on the older adult’s psychosocial health. Older adults can experience depression, social isolation, and anxiety when faced with this change in their quality of life. It is important to help the older adult as a whole person and not to ignore their mental health. The older adult may be more willing to get help for the vision loss if you first focus on the psychosocial aspect of care.
Note. [Illustration], by Elena Lenoleum, 2015, Shutterstock
25
How to Overcome Challenges?
Font Size Matters!
Common Vocabulary
Bright colors
Adequate lighting
Keep it simple
Question & answer format
Now that you know the common vision problems that older adults may experience, and you have learned the way it affects them, it is time to learn how to overcome the challenges you may experience when teaching older adults about these impairments. This may be the most important part of today’s in-service, so if you have been tuning me out, now is the time to listen! Do we need to go back to the title slide and do the imagination exercise again? Because we can. No? Okay. Moving along. When you are providing instructions to the older adult, imagine you are seeing it through their eyes. They are experiencing visual impairment, should we give them a printout with size 9 text and expect them to read it? Absolutely not! This is not rocket science people. Haha. What I am saying is, the font size matters! Let's beef it up to a good size and use some attractive bright colors.
I know we are all nurses here, but do you really think the older adult wants us using words such as “The light-sensitive cells in the macula break down slowly over time?” I will give you a hint, they do not know what that means, and we need to use common vocabulary! Let’s use words that are understood by most people. Let’s back up the use of medical words with bringing it down to a level that people without a degree in nursing can understand. Some people did not want to endure the torture of nursing school, we must remember that. ;)
Keep it simple. It is as simple as that. Explain the problem, explain the cause, explain the solution. That’s it! Make sure there is adequate lighting when explaining and showing the older adult this information.
Finally, use question and answer format. It is a great way to relay the information. For example, “Will glaucoma require me to have surgery?” Answer “If medication and laser treatments do not help to treat your glaucoma, your doctor may recommend surgery. Surgery is not a cure for glaucoma, but it can help to prevent your vision from getting worse.”
Note. [Illustration], by Elena Lenoleum, 2015, Shutterstock
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Strategies for Success!
Eye Exams
Nutrition
Protective Equipment
Health History
Risky behaviors
Statistics
How can we help older adults achieve a life with optimal vision and correct problems before they cause to much damage? Stress the importance of annual eye exams. This will allow the older adult to be seen regularly, and make changes as needed to their prescriptions and follow up visits. Are they using their assistive devices such as glasses or contacts? If not, why not?
Nutrition plays a part in eye health and should be a focus of older adults with or without visual impairments. Stress to the older adult the importance of consuming a diet that is rich in vitamins E, C, and zinc.
Wearing protective eye equipment when working with hazardous materials, or for occupations that put them at risk.
Use of adequate lighting when doing activities such as reading, writing, and focusing.
Finally, older adults understand statistics and sometimes being honest about the numbers will really put things into perspective for the older adult. This will allow them to realize the importance of the recommendations you are making.
Note. [Illustration], by Elena Lenoleum, 2015, Shutterstock
27
Hearing Impairments
Conductive hearing loss
Excess Cerumen
Fluid
Deformations
Benign tumors
Sensorineural hearing loss
Presbycusis
Loud Noises
Congenital
Hearing impairment is the most common type of impairment related to senses that older adults experience. Nearly one in every three older adults in the United States ages 65-74 will experience hearing loss. That is powerful to know. Think about it. How can we make sure our patients understand their care and what they need if they can not hear us? The most common type of hearing loss in older adults is presbycusis. Presbycusis is a type of sensorineural hearing loss. It is recognized by the gradual loss of hearing in both ears. Other causes of sensorineural hearing loss are long term exposure to loud noises, and congenital birth defects of the ear. Conductive hearing loss is common among older adults and there are often ways to correct these problems for the older adult. Some of the causes of conductive hearing loss are excess cerumen, fluid buildup, deformations, and benign tumors.
When an older adult first complains of hearing loss, we should always start with the least invasive treatment. That can involve something as simple as looking in the ear to check if there is a buildup of excess cerumen.
Note. [Illustration], by Elena Lenoleum, 2015, Shutterstock
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How does hearing loss affect the older adult?
Falls
Independence
Psychosocial
Hearing loss caused by damage to the inner ear is known to be associated with an increased risk of falls among older adults. The inner ear is not only part of the hearing system but also holds an organ system used for balance which is called the vestibular system. It relays signals to the brain about the direction and speed your head is moving/turning and detects when you move in a straight line.
Hearing loss may affect the older adult's ability to work or drive safely and can have a large affect on daily activities such as listening to music, watching television, and some hobbies outside of the home. Hearing loss makes it hard to communicate with loved ones. Things we may take for granted such as talking on the phone will become difficult.
All these changes in safety and independence can have a detrimental consequence on the older adult’s psychosocial health. Older adults can experience depression, social isolation, and anxiety when faced with this change in their quality of life. It is important to help the older adult as a whole person and not to ignore their mental health. The older adult may be more willing to get help for the hearing loss if you first focus on the psychosocial aspect of care.
Note. [Illustration], by Elena Lenoleum, 2015, Shutterstock
29
How to Overcome Challenges?
Delivery matters
Common Vocabulary
Slow down
Adequate lighting
Keep it simple
Question & answer format
Now that you know the common hearing problems that older adults may experience, and you have learned the way it affects them, it is time to learn how to overcome the challenges you may experience when teaching older adults about these impairments.
When you are providing instructions to the older adult, imagine you are hearing it through their ears. Are they using their assistive hearing devices? That is the first thing we need to check. They are experiencing hearing impairment, should we stand out of their line of sight and speak quietly? Absolutely not! What I am saying is, the delivery matters! Let’s face our older adults when we are speaking with them. Let’s slow down a bit and take our time. Use a bit of a lower tone because higher pitched tones are often difficult to hear for the older adult experiencing hearing impairments.
We need to use common vocabulary! Let’s use words that are understood by most people. You can use proper medical terminology when advising them our the impairment, but lets back that up with putting it in an easy-to-understand format.
Keep it simple. It is as simple as that. Explain the problem, explain the cause, explain the solution. That’s it! Make sure there is adequate lighting when explaining and showing the older adult this information.
Finally, use question and answer format. It is a great way to relay the information.
Note. [Illustration], by Elena Lenoleum, 2015, Shutterstock
30
Strategies for Success!
Hearing Exams
Protective Equipment
Health History
Risky behaviors
Statistics
How can we help older adults achieve a life with optimal hearing and correct problems before they cause too much damage? Stress the importance of annual hearing exams. This will allow the older adult to be seen regularly, and make changes as needed to their prescriptions and follow up visits.
Wearing protective ear equipment when around loud noises, or for occupations that put them at risk for loud noises. If the activity puts them at risk for further hearing loss, they need to wear protective equipment!
Use of assistive ear devices when doing activities such as listening to music, watching television, and speaking on the phone.
Finally, older adults understand statistics and being honest about the numbers will really put things into perspective for the older adult. This will allow them to realize the importance of the recommendations you are making.
Note. [Illustration], by Elena Lenoleum, 2015, Shutterstock
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References
Elderly Cartoons. (2015). Illustrations. Shutterstock. www.shutterstock.com/g/lenoleum
Mayo Clinic Staff. (2020). Dry macular degeneration. https://www.mayoclinic.org/diseasesconditions/dry-macular-degeneration/symptoms-causes/syc-20350375
Mayo Clinic Staff. (2020). Glaucoma. https://www.mayoclinic.org/diseasesconditions/glaucoma/symptoms-causes/syc-20372839
Mayo Clinic Staff. (2019). Hearing loss. https://www.mayoclinic.org/diseasesconditions/hearing-loss/diagnosis-treatment/drc-20373077
Meiner, S., & Yeager, J. J. (2019). Gerontologic nursing (6th ed.). St. Louis, MO: Elsevier.
Thank you all for attending this in-service on visual and hearing impairments in the older adult. I hope you learned a lot today. I would like to thank the sources that I gathered a lot of great material from. Without them, none of this would be possible.
I would like to thank my professor, Candace Farkas. I wish you the best and thank you for a great quarter of learning about the older adult.
Note. [Illustration], by Elena Lenoleum, 2015, Shutterstock
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See the Following for Additional Examples
Prevailing Disorders of the Senses in Older Adults
This Photo by Unknown Author is licensed under CC BY-NC
Student name
Have you casually popped in on a beloved baby boomer ? The television is set at max volume ( with subtitles), aroma of burnt coffee fills the air, and the smoke alarm is chirping consistently. Chances are the older adult, was having a hard time hearing their favorite show- that coffee pot alarm did go off- and the batteries in the smoke alarm were due for changing months ago. The nurse in study knows, by age 65 one third of older adults will have some form of vision loss, and nearly two thirds of older adults have some significant hearing loss. As the baby boomers are living longer than ever before, health promotion and disease prevention becomes more relevant. Moreover, the nurse in study can expect an overwhelming percentage of her first clients to have some sort of sensory loss. Therefore, this presentation will reveal some of the most common diseases, their consequences, and importance of support systems of the aging baby boomer.
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Prevailing Eye Diseases
Age related Macular degeneration (AMD)
Cataracts
Glaucoma
AMD
Glaucoma
Some might rank vision as their most valuable sense. The eye changes with age which in turn, causes decreased acuity. Three common prevailing disorders of the elderly include: age related macular degeneration, cataracts, and glaucoma. Age-related macular degeneration (AMD) is an uncurable eye disease that can blur the sharp, central vision, diminish depth perception, and lead to blindness (National Institute on Aging , 2018). Dry macular degeneration is most common and is caused by gradual blockage of retinal capillaries. Wet macular degeneration is less common and is caused by growth of thin walled blood vessels. A cataract is a cloudy area in the lens of your eye, and more than half of all Americans over the age 80 either have cataracts, or have had surgery to correct it (National Institute on Aging , 2018). Cataracts surgery is considered when the visual acuity becomes affecting activities of daily living. Surgery involves removal of the cataract lens and replacing it with an intraocular plastic capsule (phacoemulsification). Surgery is recommended, it will enhance visual acuity and essentially, improve one's quality of life. Glaucoma is a disease that damages the optic nerve due to increase intraocular pressure. Increased pressure on the optic nerve results in, reduced vision and leads to blindness (National Institute on Aging , 2018). There are two categories of Glaucoma, open- angle and closed- angle . In primary open angle glaucoma, the trabecular meshwork offers increased resistance to fluid outflow, which leads to increased intraocular pressure build up inside the eye. In closed-angle closure, both the uveoscleral drain and the trabecular meshwork become blocked. Usually, this is caused by a damaged iris blocking the outlet.
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Health Promotion and Maintenance
Eat right to protect your sight
Limit exposure to UV rays with use of sunglasses
Routine & Comprehensive exams
Report any changes!
Live your best life by taking care of your ears and eyes while you're young. Maintain regular eye exams, keep blood pressure, blood glucose, cholesterol, and A1c, in normal ranges. Many common eye diseases, such as, often have no warning signs. A dilated eye exam is the only way to detect these diseases in their early stages. However, for many it is too late. Management and or treatment of sensory loss requires professionals such as: an audiologist, ophthalmologist, and or speech pathologist . Avoid smoking, maintain a healthy weight, and wear sunglasses( look for blockage of 99-100 of UVA- & UV-B). Maintaining a balanced diet is key. Think rainbows people! Dark leafy greens, such as spinach, kale, or collard greens are a great source of antioxidants. In addition, Omega-3 fatty acids, such as salmon, tuna, and halibut may help protect adult eyes from AMD and dry eye syndrome (Center for Disease Control and Prevention, 2019).
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The prevalence of hearing loss doubles with every age decade
Sensorineural
Conductive.
Presbycusis
Hearing loss leads to decreased function
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Hearing loss happens for different reasons. Sensorineural hearing loss occurs when there is damage to the inner ear or the auditory nerve. Conductive loss occurs when sound waves cannot reach the inner ear. Presbycusis, or age related hearing loss occurs in both ears, and comes on gradually. Doctors do not know why presbycusis affects some people more than others, but it seems to be a hereditary factor. Another reason for hearing loss with aging may be years of exposure to loud noise. Having trouble hearing can make it hard to understand and follow a doctor's advice, to respond to warnings, and to hear doorbells and alarms. It can also make it hard to enjoy talking with friends and family. All of this can be frustrating, embarrassing, and even dangerous.
The prevalence of hearing loss doubles with every age decade, and nearly two-thirds of Americans older than 70 years have a clinically significant hearing impairment. Moreover, Adults over the age of 70, account for about 80% of the 2.8 million Americans with low vision, defined as vision loss (excluding blindness) not correctable with refraction, medication, or surgery ( Whitson, 2014).
Studies show hearing loss is associated with decreased functional and psychosocial impairments; such as increased self isolation, depression, and even an increase in dementia (Crews, J.E., et al. 2004).When the brain is overwhelmed- it struggles to make sense of the world – and it’s ability to perform dwindles. Surprisingly, the opposite is true too, social isolation deprives the brain of crucial stimulation in order to keep cognitive function. It should be said, “ hearing loss results in a faster rate of brain atrophy mostly over the hearing portion of the brain, which is also involved in functions like memory, learning and thinking” (Brody, 2017).
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Health promotion/ maintenance
Refrain from loud noises at work and socially
Use ear plugs or sound
hearing aids
Annual hearing checks
Noise induced hearing loss is almost as common as presbycusis. Individuals exposed to frequent loud noises ( construction, factories, military) have a higher risk of suffering permanent damage. Moreover, these individuals working in loud environments need to protect their ears with some sort of noise reducing mechanism. Few adults get their hearing checked regularly, unless they are experiencing significant hearing loss. To get ahead of things, adults aged 18-40 should get a routine earing check every 5 years. Beginning at the age of 60 yearly hearing exams are recommended. To ensure those already diagnosed with hearing loss and wearing hearing aids, receive max benefits, regular hearing checks are a must. Moreover, if there is a sudden change in hearing ability, seek medical advice. Delaying treatment could potentially result in complete hearing loss (Center for Disease Control and Prevention, 2019).
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Demoralizing Effects
Inability to drive
Depression
Enjoying life
Relationships
Fear of falling
With many of the sensory issues previously mentioned usually, next comes the inability to drive (Keeffe, J.E., et al. 2002). The freedom and ability to get on the go - wherever- and whenever is over . Transportation is limited and on someone else’s time. The impracticality of the ability to drive is hard on the older adult socially and emotionally.
When the older adult looses their sight or hearing, they loose their ability to enjoy activities they once loved. The older adult may face difficulties trying to thread a needle, read a book , or listen to their favorite record. Once enjoyable activities now seem pointless and frustrating. The nurse should offer large print materials for the visually impaired, provide adequate lighting or an audio book on tape. For the hearing impaired : speak at a moderate pace , volume and low tone. Most importantly, inquire about hearing aids; and if they exist; check if they are working. Think realistically by, increasing volumes on alarms/ ringers, offer closed captioning, and check smoke alarms.
Relationships with family members can become altered because, increasing communication barriers are present. Conversations can be embarrassing or even confusing because of missed ques, facial expressions or oversight of whispered comments. Decreased communication performance and psychosocial functioning impacts one’s quality of life. To some degree, a valued existence usually revolves around “ life’s simple treasures” such as: intimate/social relationships, hobbies, family engagements, memories, and living vicariously through grandchildren.
Last but not least, comes the issue of safety with sensory impairment. A fall that is bound to end in a hospital visit is a new fear of the older adult. The inability to see or even, hear in an environment sounds scary. Have you ever played pin the tail on the donkey, how did you adapt? Visual and hearing deficits impair balance, increase cognitive over-load , and distract attention from surroundings. Moreover, an inaccurate perception of surroundings can lead to falls. Older adults with significant hearing loss have an 87% increased likelihood of reporting 2 or more falls at follow-up. The study also showed, visual impairment associated with increased risk of fall (Bamini, et al., 2016).
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Support systems make a world of difference
Family education of client’s needs
Support groups
Nurse/ client therapy sessions
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People caring for the older adult with sensory impairments should be aware of the social, physical and cognitive stresses. The nurse’s ability to educate family/ caregivers on patterns of these restrictions will lead to the proper nursing interventions that enhance the limitations created by vision and hearing loss. Social support consists of addressing tangible needs, such as assistance with transportation, home and personal care, as well as emotional support such as being listened to, understood, and comforted. Social support has been recognized as an important social determinant of health because it assists individuals in reaching their physical and emotional needs, and it reduces the effects of stressful events on their quality of life (Dai, Y., et al., 2016). Sometimes, the client just needs someone to vent to. Talking about their vision or hearing loss and listening to their struggles or disabilities will help develop strategies to implement. Suggesting social or even online support groups to help with coping and psychosocial aspects. Most importantly, educating family members of client needs, plan of care, and assigning tasks to multiple individuals ( if applicable), in order not to overwhelm one with all care. As rates of mental illnesses rises in older adults. Nurses must advocate a research local programs in client’s area specializing in mental care.
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Community Resources
Senior centers
Respite care
Meals on wheels
Home health care
Community resources are available to support the health needs of the older adult with various health disparities. Care-giver burnout is a state of physical, emotional, and mental exhaustion that could potentiate physical or verbal abuse towards the older adult client. Respite care entails the provision of care-relief in the client’s home or where the older adult client is institutionalized in a facility for a short-time frame or intermittent periods .Home health care, and other community resources provide unique means for care to be continued inside the home. Senior centers are community based centers that provide critical resources to older adults who are fairly independent and do not require more intense care provisions as other older adults (Nursing Care of the Older Adult, 2019).
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Remember..
Be realistic
Implement effective strategies to improve plan of care
Be a listening ear
Just for fun:
Sensory impairments affect so much more than the activities of daily living they have a direct impact on social and psychosocial aspects as well. When entering the sensory deficits’ home be realistic. Think practical and realistic. It may be beneficial for the client to buy a landline phone with big numbers, or numbers in braille. Books on tape are a great distraction and can be done as a group. Get the family involved, their involvement makes a world of difference. Teach the family how the older adult communicates best. Not pushy, but informative. The new nurse should keep in mind, hearing aid batteries need to be changed every 3-10 days. These suckers are small, and can commonly be put in backwards. Please, check batteries, and placement before suggesting the device is malfunctioning. It should also be considered, hearing devices are not cheap, should not be worn in water, and now come in models with rechargeable batteries. When choosing a hearing aid it might be a good idea to think through which battery works best for the client. Lastly, the burden and prevalence of sensory impairments will continue to increase as the older adult ages, and such projections are not new. Loosing the ability to sense the world as you once did is understandably hard to accept, but with the right help it’s about adapting, not quitting.
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References
Bamini Gopinath, Catherine M. McMahon, et, al. (2016). Hearing and vision impairment and the 5-year incidence of falls in older adults. Age and Ageing, 45(3), 409–414. https://doi.org/10.1093/ageing/afw022
Brody, J. E. (2017). Vision and hearing loss are tied to cognitive decline. Retrieved from https://www.nytimes.com/2017/09/25/well/vision-and-hearing-loss-are-tied-to-cognitive-decline.html
Center for Disease Control and Prevention. United States Department of Health and Human Services. (2015). Common eye ddisorders. Retrieved from https://www.cdc.gov/visionhealth/basics/ced/index.html#a 4
Center for Disease Control and Prevention. United States Department of Health and Human Services. (2019) Simple tips for healthy eyes. Retrieved from https://www.cdc.gov/visionhealth/risk/tips.htm
Correia, C., eat al. (2016). Global sensory impairment in older adults in the United states. Journal of the American Geriatrics Society, 64(2), 306–313. https://doi.org/10.1111/jgs.13955
Crews, J. E., & Campbell, V. A. (2004). Vision impairment and hearing loss among community-dwelling older americans: implications for health and functioning. American journal of public health, 94(5), 823–829. https://doi.org/10.2105/ajph.94.5.823
Dai, Y., Zhang, C.-Y., Zhang, B.-Q., Li, Z., Jiang, C., & Huang, H.-L. (2016). Social support and the self-rated health of older people. Medicine, 95(24). https://doi.org/10.1097/md.0000000000003881
Keeffe, J. E. (2002). Vision impairment and older drivers: who's driving? British Journal of Ophthalmology, 86(10), 1118–1121. https://doi.org/10.1136/bjo.86.10.1118
National eye institute . ( 2019). Eye health data and statistics. Retrieved from NEI.NIH.gov: https://www.nei.nih.gov/learn-about-eye-health/resources-for-health-educators/eye-health-data-and-statistics
Neigmond, P. (2014). A coping plan can help fend off depression from vision loss. Retrieved from National Public Radio https://www.npr.org/sections/health-shots/2014/08/11/338592866/a-coping-plan-can-help-fend-off-depression-from-vision-loss
Whitson, H. E., & Lin, F. R. (2014). Hearing and vision care for older adults: sensing a need to update Medicare policy. JAMA, 312(17), 1739–1740. https://doi.org/10.1001/jama.2014.13535
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Coronary Artery Disease in Older Adults
Rasmussen University
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What is coronary artery disease (CAD)?
CAD is when there is plaque buildup on the wall of the arteries that supply blood to the heart. Plaque is made up of cholesterol (lipid) deposits. With this buildup, it causes the arteries to narrow over time.
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What are the risk factors?
The modifiable risks include:
Smoking
High blood pressure
High cholesterol
Diabetes
Unhealthy diet
Overweigh/obesity
Physical inactivity
High stress
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Risk factors that are modifiable, means that it can be changed or altered. These factors are important in preventing or decreasing the risk of coronary artery disease.
Smoking dramatically increases the risk of coronary artery disease, and heart disease in general.
“Uncontrolled high blood pressure can result in hardening and thickening of your arteries, narrowing the channel through which blood can flow.” (Mayo Clinic, 2020)
High cholesterol promotes the formation of plaque in the blood.
Uncontrolled diabetes leads to abnormal cholesterol levels and high triglycerides
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What are the risk factors? (cont.)
The non-modifiable risks include:
Age
Gender
Race
Family history
Risks factors that are non-modifiable, mean that they can not be changed or altered to prevent or decrease the risk of coronary artery disease.
“Getting older increases your risk of damaged and narrowed arteries. Men are generally at greater risk of coronary artery disease. However, the risk for women increases after menopause. A family history of heart disease is associated with a higher risk of coronary artery disease, especially if a close relative developed heart disease at an early age. Your risk is highest if your father or a brother was diagnosed with heart disease before age 55 or if your mother or a sister developed it before age 65.” (Mayo Clinic, 2020)
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Other medical conditions that have an increased risk CAD
Sleep apnea
High-sensitivity C-reactive protein (hs-CRP)
High triglycerides
Homocysteine
Preeclampsia
Autoimmune diseases
Lupus
Rheumatoid arthritis
Sleep apnea affects the breathing pattern’s while a person is sleeping. This causes sudden drops in oxygen levels in the blood.
Triglycerides are a type of fat (lipid) and high levels of triglycerides raises the risk of CAD.
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Possible complications
Chest pain (angina) – Coronary arteries narrow, the heart does not receive enough blood when needed and causes chest pain.
Heart attack – A complete blockage of the heart artery can cause a heart attack and the lack of blood flow to the heart damages the muscle.
Heart failure – Deprivation of oxygen/nutrients, the heart will become too weak to pump an adequate amount of blood to meet the body's needs.
Abnormal heart rhythm (arrhythmia) – Interference with the heart's electrical impulses, such as not enough blood, causes abnormal heart rhythms.
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Non-surgical treatments to improve heart health
Quitting smoking
Monitor and manage high blood pressure, high cholesterol, and diabetes
Achieve and maintain a healthy weight
Be physically active
Eat a healthy diet
Low-fat
Low-salt
Fruits, vegetables, and whole grains
Reduce and manage stress levels
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Making healthy lifestyle changes promotes healthier arteries and are non-invasive treatment methods.
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Surgical Treatments
Angioplasty and stent placement
(percutaneous coronary revascularization)
Coronary artery bypass surgery
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Angioplasty and stent placement
Coronary artery
bypass
During an angioplasty, a long, thin tube (catheter) into the narrowed part of the artery. A wire with a deflated balloon is put through the catheter into the narrowed area. Once put in place, it is then inflated, to push the deposits against the artery walls. A stent is usually left inside the artery, some release medications, to keep it open.
During a coronary artery bypass, a graft is created to bypass the blocked/narrowed coronary arteries through another vessel from another part of the body. This will allow blood to flow around the blocked/narrowed artery. This is an open-heart surgery and is more common for clients that have multiple blocked/narrowed coronary arteries.
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References
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Mayo Clinic. (2020, June 05). Coronary artery disease. Retrieved from
https://www.mayoclinic.org/diseases -conditions/coronary-artery-disease/symptoms-
causes/syc-20350613
Meiner, S., & Yeager, J. (2019). Gerontologic nursing (6th ed.). [Bookshelf Ambassadored]. Retrieved
from https://ambassadored.vitalsource.com/#/books/9780323498111/