Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
30 Cards in this Set
- Front
- Back
|
Normal changes in vision associated w/ aging:
|
-Vision changes occur slowly
-Presbyopia: the lens is less able to change shape to focus on near objects (i.e. accommodation); begins around age 40 -Substantial decrease in light to the retina in older adults -Decrease in contrast sensitivity caused by retinal changes |
|
|
Normal changes in vision associated w/ aging CONT...
|
-Decrease in pupil size & increase absorption of light to the lens (i.e. forms a cataract)
-Changes in the lens and dev'l of opacities in the cornea increase sensitivity to glare. Results in blinding effect that decreases visual acuity. -Reduction in ability to adapt to changes in illumination -Due to pupil's ability to adjust its size, development of cataracts, and neural changes of the retina. |
|
|
Visual Impairment:
|
-A functional limitation of the eye(s) or visual system and can manifest as reduced visual acuity or contrast sensitivity, visual field loss, photophobia, diplopia, visual distortion, visual perception difficulties, or any combination of the above.
|
|
|
Visual Impairment CONT...
|
-A visual impairment can cause disability(ies) by significantly interfering w/ one's ability to function independently, to perform ADLs, and/or to travel safely through the environment
|
|
|
Levels of Visual Impairment:
|
≥ 20/28 = Near-Normal
20/70 to 20/160 = Moderate-low vision ≥ 20/200 = Severe/"legal" Blindness 20/500 - 20/1000 = Profound/Blindness |
|
|
Risk Factors for Older Adults:
|
-Cataract
-Age-related macular degeneration -Glaucoma -Diabetic retinopathy |
|
|
Cataracts - Definition & Risk Factors:
|
-A clouding of the normally clear ocular lens usually caused by a clumping of proteins in the nucleus of the lens
-World's leading cause of blindness -Risk Factors: age, DM, smoking, ETOH, trauma, meds, exposure to UVB radiation |
|
|
Cataracts - Treatment:
|
-Smoking cessation
-UV protection -Adequate lighting -Extracapsular cataract extraction w/ intra-ocular lens implant -Usually done when the cataract is interfering w/ the older adults functional vision -May need to document the vision behind the cataract is functional prior to procedure -Pre-op assessment standards have recently changed due to the limited risk to this procedure |
|
|
Age-Related Macular Degeneration - Definition & Risk Factors:
|
-Progressive disease in which light-sensing cells are damaged in macula
-Affects central vision -Risk Factors: advancing age, Caucasian, FMHx, CVD, smoking, HTN |
|
|
Two Classifications of AMD -
1) Non-exudative/Non-neovascular (Dry): |
-More common type of AMD
-Characterized by drusen (yellow deposits of debris) develops between the choroid & the retina in addition to atrophy of the retinal epithelial pigment layer below the retina causing loss of photoreceptors to the central part of the eye |
|
|
Two Classifications of AMD -
2) Exudative/Neurovascular (Wet) |
-Characterized by neovascularization or growth of abnormal blood vessels leading to blood and protein leakage below the macula in addition to scarring
|
|
|
Treatment of AMD: Non-exudative/Non-neovascular
|
-Evidence has shown benefit for pts w/ intermediate or advanced AMD in one eye who took high dose regimen of antioxidant (Vit C&E, beta carotene) & zinc supplementation; less benefit when using either supplement alone
-Found not to prevent or delay onset, but only progression |
|
|
Treatment of AMD: Exudative/Neovascular
|
-Retinal photodynamic therapy
-Antivascular endothelial growth factors -Pegaptanib (Macugen), Ranibizumab |
|
|
Glaucoma - Definition & Risk Factors:
|
-Increased ocular pressure that damages the optic nerve
-Loss of peripheral vision -Risk Factors - Age, FH, AA, Mexican-American |
|
|
Glaucoma - Angle Closure Glaucoma:
|
-Increased intraocular pressure that can lead to irreversible damage to the optic nerve
-The only type of glaucoma that can be cured -Only accounts for 10% of all glaucoma -Eye Emergency!! |
|
|
Treatment - Angle Closure Glaucoma:
|
-Keep pt in supine position, don't cover eye, IOP reduction, suppression of inflammation, and the reversal of angle closure
-Initial intervention includes acetazolamide, a topical beta-blocker, and topical steroid |
|
|
Glaucoma - Open Angle Glaucoma:
|
-Accounts for > 80% of all glaucoma
-Usually affects both eyes and is asymptomatic until very late -Cannot be cured but can be managed -Can led to permanent blindness if left untreated |
|
|
Treatment - Open Angle Glaucoma:
|
-Topical ocular medications aimed to lower IOP in pts w/ ocular HTN and optic nerve damage
-Alpha-adrenergic agonists, beta-adrenergic antagonists, carbonic anhydrase inhibitors, parasympathomimetics, prostoglandin analogues, & sympathomimetics |
|
|
Diabetic Retinopathy - Definition & Risk Factors:
|
-Blood vessels may swell and leak fluid or abnormal new blood vessels grow on the surface of the retina
-Most common cause of retinal hemorrhages -Occurs in Type 1 and 2 Diabetics -Risk factors: long duration of DM, poor control, elevated HTN, hyperlipidemia |
|
|
Diabetic Retinopathy - Non-Proliferative:
|
-Characterized by dilated retinal veins, intra-retinal hemorrhages, microaneurysms, hard exudates, and macular edema
-In severe non-proliferative diabetic retinopathy, the risk of progression to vision-threatening proliferative retinopathy w/in 1 year is 50-75% |
|
|
Diabetic Retinopathy - Proliferative:
|
-Characterized by neovascularization, vascular fibrosis, and pre-retinal and vitreous hemorrhages
|
|
|
Diabetic Retinopathy - Treatment:
|
-Mild/Moderate/Severe non-proliferative retinopathy: no specific treatment
-Proliferative retinopathy is treated w/ laser surgery to shrink the abnormal blood vessels |
|
|
Guidelines for Vision Screening in Older Adults:
|
-AAFP: screened w/ snellen chart (interval not stated)
-USPSTF: Visual acuity screening by snellen chart should be part of periodic health exam for those > 65 -Institute for Clinical Systems Improvement: Routine visual acuity screening > 65 (interval not stated) -American Academy of Ophthalmology: > 65 w/ no risk factors or identifiable eye disease should have comprehensive medical eye evaluation every 1-2 yrs |
|
|
Hearing Loss: Effects of HL
|
-Social isolation
-Depression -Low self-esteem -Alterations in fxl status -Cognitive impairment |
|
|
Age-Related Hearing Changes -
Sensorineural loss or Presbycusis |
-Age-related damage to the cochlea and degeneration of outer hair cells
-Decreased speed of central processing information -Loss of high frequency sounds -Reduced hearing sensitivity and speech understanding in noisy environments -Difficulty localizing sound sources |
|
|
Age-Related Hearing Changes -
Conductive loss |
-Thickening of TM
-Ceruminosis: decrease in ceruminous glands & production of drier cerumen (impaction) |
|
|
Hearing Evaluation:
|
-Get a thorough medical eval to r/o treatable HL
-Required before purchasing a hearing aid or person must sign a waiver -Medical eval by MD, preferably an otolaryngologist -NP can provide medical clearance in certain states for Medicaid *Refer to an audiologist for hearing loss evaluation |
|
|
Hearing Aids:
|
-Medicare and many private insurers (except in NH, RI, AR) do not pay for some hearing tests and hearing aids
-Medicaid may depending on state |
|
|
Adaptive techniques - For Listener:
|
-Sit w/ back against wall, in the middle seat around the table
-Sit facing the person talking to see expressions, read lips -Wear glasses -Wear and adjust hearing aids, if used -Eliminate background noise, if possible |
|
|
Adaptive techniques - For Speaker
|
-Speak clearly , enunciate at normal volume
-Well lit room: listener can see speaker's mouth -Do not cover mouth while speaking -Discuss procedures before putting mask on For different health care settings: -Label pt's chart so staff know -Use pocket talkers -Have manual for resident's hearing aid -Do not lose hearing aid! |
