Center of Gerontological Nursing

SN402 Gerontological Nursing

Week 11
Promotion of wellness in physical function:
Vision, hearing, communication

Rick Kwan, RN PhD

Assistant Professor
 Intended Learning Outcomes
• Describe age-related changes that affect hearing,
vision
• Identify risk factors that can affect hearing/visual
loss
• Recap the functional consequences that affect
visual and hearing loss
• Understand assessments of vision / hearing
• Identify interventions to promote visual/hearing

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Age-related changes in eyes

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Age-related changes in eyes
 Risk factors of visual wellness
Lifestyle & Environmental Factors
• Long-term exposure to UV light predispose to cataract
• Smoking includes 2nd hand smokes
• Warmer temperatures, wind, low humidity predispose to dry
eye
Pathological conditions
• Alzheimer, Parkinson disease, diabetes, and hypertension.
Medications that are associated with adverse effects on vision
• Such as aspirin, haloperidol, NSAID, tricyclic antidepressants,
digitalis & anticholinergics
Nutritional factors
• Poor nutrition (esp. vitamin A deficiency)

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Age-related causes of visual impairment

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 Nursing assessment of vision
Physical Exam

Snellen Chart
For distance acuity
Confrontation Test
For peripheral vision
Amsler grid
For macular
degeneration
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 Nursing assessment of vision
Observation
• Inspection external ocular structures: Eyebrow,
eyelids, lashes, eyeballs, conjunctiva , sclera,
conjunctiva and sclera
• Invite the client to walk:
• How well does the older adult navigate the clinical
environment?
• Does he appear to feel his way using hands/feet?
• Change of color of floor tiles is associated with change in
depth?
• Does he has difficulties finding beds/familiar faces?

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 Nursing assessment of vision
Interview/self-report Questions such as :
i. Ask about past and E.g. Do you have a history of
present risk factors for diabetes or hypertension?
vision impairment.
ii. Ask if person knows E.g. Do you experience any
uncomfortable symptoms,
her/his any vision such as dry eyes?
changes.
iii. Ask about the impacts of E.g Have you stopped doing
vision changes on daily any activities because of
life and psychosocial vision problems?
influences.
iv. Ask about the person’s E.g When was the last time
attitudes about you had your eyes checked
intervention.

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Negative functional consequence: vision
• How does vision impairment affect quality of life of
elderly people?

• What are nursing implications related to caring for

elderly people with vision problems?

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Negative functional consequence: vision

• Daily activities e.g. getting outside,

Effects on shopping for groceries, getting up and
down stairs, seeing markings on
Safety & Daily appliances
Activities
•  Risk of falls, fracture and other
serious injury secondary to falling

• Withdraw from preferred leisure

Effects on activities require good visual skills
Quality of Life • Some develops fears of blindness
• Fear of falling

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Age-related changes in ears

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Prevalence of hearing loss

The above graph shows that hearing loss

is mostly occurring in elderly 13
 Pathological Auditory Condition
• Tinnitus
• Symptoms : Persistent sensation of ringing, roaring,
blowing, buzzing or other types of noise.
• Risk factors : Ototoxic medications and Meniere
disease.
• Exacerbating effects : Caffeine, alcohol and nicotine.
• Contributing conditions : Hypertension, cere-
brovascular disease, inflammatory or allergic conditions
of the nose and adjacent structures, and large amount
of exposure to noise.
• Management : Avoid the exacerbating effects - Teach
people to avoid smoking cigarettes, drinking alcoholic,
or caffeinated beverages.
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 Risk factors of hearing wellness
Lifestyle and Environmental Factors
• LT or intermittent exposure to noise noise-induced hearing loss
• Expose to toxic chemicals, e.g. solvents, pesticides, CO & mercury
• Cigarette smoking
Impacted Cerumen
• Age-related changes and use of hearing aids attribute to dryer,
harder and coarse cerumen
• Impacted cerumen can cause pain, infection, tinnitus, dizziness, or
chronic coughing.
Medications
• risk of ototoxicity, e.g. aspirin, furosemide, erythromycin, Ibuprofen.
Disease Processes
• Otosclerosis, Meniere, and acoustic neuromas.
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Negative Functional consequence: hearing
• Presbycuses – 1) problem of speech
comprehension due to: difficult in code higher-
frequency sounds; 2) Too sensitive to
Effects on background noise and environment conditions.
Communication • Conductive hearing loss – reduced intensity of
sounds & difficulty in hearing vowels & low
pitch tones ; 2) Reduced sound threshold.
• Affect usual daily and leisure activities, e.g.
appreciate music and obtain information.
• Interfere with performance on mental status
examination  mistakenly perceived cognitive
Effects on impairments.
Overall • Psychosocial issues : boredom, apathy, social
Wellness isolation.
• Safety and functioning : less responsive to
warning signals
• Stigmatizing
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 Assessment of Vision & Hearing

Aims to identify :

 Modifiable risk factors interfering with visual &

hearing wellness
 Actual visual problems or hearing deficits.
 The impacts of vision changes & hearing deficits on
safety, independence, or the quality of life.
 Opportunities for promoting visual & hearing
wellness
 Barriers to implementing interventions
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 Nursing assessment of hearing 1
Physical Assessment
• Otoscope
• To identify impacted wax and other factors that can
interfere with hearing.
• Pure-tone audiometry

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 Nursing assessment of hearing 2
Interview
•Hearing Handicap
Inventory for the Elderly
(HHIE)

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 Nursing assessment of hearing 3
Observation
• This can be done during
the interview or
providing care

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 Wellness outcomes

Wellness outcomes - Identify wellness outcomes is an

essential part of the planning
• Vision / Hearing Compensation Behavior such as
wearing corrective glasses and improving light;
wearing hearing assistive device and avoid noisy
environment;
• Improve visual and auditory function
• Improve independence in activities of daily living.
• Increase safety
• Improve quality of life :  communication and social
interaction.

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 Interventions: Hearing 1
• Assistive devices
• Hearing aids
• +/- cochlear implants

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 Interventions: Hearing 2
• Adaptive techniques
• 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
• To rephrase sentences instead of repeating them
• To make sure that hearing aids are in place that batteries
are charged
• To make sure that glasses are worn when needed

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 interventions: Hearing 3
• Environment modifications
• Maximize visual cues
• Minimize background noise (radios/TV/open doors)
• Ensure no excessive cerumen

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 Interventions: Hearing 4
• Prevention of hearing
loss when being young
• Early detection and
treatment

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 Evaluation for hearing interventions

• Indicators of successful intervention

• Improved ability to communicate.
• Effective use of hearing aids and amplification devices.
• Increased participation in social activities
• Environmental modifications to eliminate background
noise.
• Appropriate participation in aural rehabilitation program

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Process of Communication

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 Consequences of visual/hearing
Impairment
• Sensory loss can affect the communication of
elderly & social participation of older people

• Affect the quality of life of the elderly

• Dual sensory loss(more than one sensory loss)

more serious consequences even depression

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 Communication skills
Get elderly people s’ attention before speaking
Remove obstacles in front of your face
Use facial expressions and gestures
Give clues when changing the subject
Rephrase a sentence when not understood
Do not assume the person can lip read
Do not shout
Be sure proper light is on your face and not behind you
Be patient, positive, and relaxed
When in doubt, ask elderly people for suggestion

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 Communication skills
Positive talk , say complimentary things when appropriate
e.g say saw progress and good.
Questioning sincerely.
Listening attentively.
Encouraging and praising generously .
Being at eye level with eye contact.
Facial expressions , e.g smile.
Make use of appropriate touch to both physically and
psychologically support.
Avoid personal assumptions of older people e.g. lonely,
demotivated, lacked autonomy, demanding, & manipulative.
(Gilbert, 2009 & Tuohy, 2002)

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Attitudes behind communications
with older people

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 • Acknowledge feelings (to show
appreciation)
• Perception (to understand)
Listen Understand • Paraphrase (to show understanding)
Attentively Fully
• Summarize (to focus)
• Reframing (to change perception)
• Common interests and grounds (to
Empathize connect)
Sincerely • Find options of care (to seek solution)
• Follow through (to show
responsibility)

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 References
• Amella, E.J. (2006). Presentation of illness in older adults: If you think you know what you’re looking
for, think again. AORN Journal, 83(2): 372-389.
• Bickley, L. S., & Szilagyi, P. G. (2009). Bates’ Guide to Physical Examination and History Taking (10th)
Lippincott Williams & Wilkins. Philadelphia PA, 602.
• Doerflinger, DME (2009). Older adult surgical patients: presentation and challenges. AORN, 90(2), 223-
240.
• Dubin, S. (1992). The physiologic changes of aging. Orthopaedic Nursing,11(3): 45-50.
• Farley A et al (2006). The physiological effects of ageing on the activities of living. Nursing Standard, 20
(45): 46-52.
• Gilbert, D. A., & Hayes, E. (2009). Communication and outcomes of visits between older patients and
nurse practitioners. Nursing research, 58(4), 283.
• Nelson, R. (2008). Improving communication skills enhances efficiency and patient-clinician
relationship. Arch Intern Med, 168(13), 1364.
• Park, E. K., & Song, M. (2005). Communication barriers perceived by older patients and
nurses. International Journal of Nursing Studies, 42(2), 159-166.
• Tuohy, D. (2003). Student nurse–older person communication. Nurse Education Today, 23(1), 19-26.
• Wallhagen, M. I., et al. (2006). Sensory Impairment in Older Adults: Part 2: Vision Loss. AJN, 106(10),
41-48.. (Must Read)
• Whiteside, M. M., et al. (2006). Sensory Impairment in Older Adults: Part 2: Vision Loss. AJN,
106(11), 52-61. (Must Read)
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