Page 79 Complete Your CE Test Online - Click Here Nursing consideration: The older adult and the suspected abuser should be interviewed separately. This may reveal inconsistencies in reported histories or explanations of signs and symptoms of abuse. If the suspected abuser refuses to allow separate interviews, the suspicion of abuse increases [9,44]. Nurses must be aware of local older adult abuse/mistreatment reporting laws. Many states have mandatory reporting laws, and healthcare professionals must report suspected cases of older adult abuse [9]. Know your organization’s policies and procedures regarding the reporting of older adult abuse and familiarize yourself with contact information for local departments on Aging and Adult Protective Services. For state reporting numbers visit the National Center on Elder Abuse website at or call the Eldercare Locator at 1-800-677-1116. Nursing consideration: You do not need to prove that abuse is occurring. You do need to report your suspicions. Experts in abuse will follow up to investigate your suspicions. OVERVIEW OF ASSESSMENT OF BODY SYSTEMS As individuals age there are usual physiological changes that occur, but these changes can vary among individuals. The changes can have a toll on the body’s physiologic reserves necessary during periods of maximum stress, making recovery more prolonged and difficult. Basic physical assessment techniques such as inspection, palpation, and percussion are similar for all age groups. This overview of the assessment of body systems focuses on those issues that are particular to older adults. Vision, hearing, and touch Vision Vision can deteriorate with age, and many eye diseases have no early symptoms. These changes may develop painlessly and older adults may not be aware of changes to vision until the condition is quite advanced. Some structural changes in the eye cause older patients to be more sensitive to glare, which both increases the risk for falls if the patient views a shiny walking surface and the risks of driving at night [45]. The first step in assessing the vision of an older adult is observation. Older adults who have stained clothing, poorly combed hair, or excessive or poorly applied makeup may have vision impairment [9]. A Snellen chart may be used to assess visual acuity, or you may ask the patient to read from a newspaper or other printed material with various size prints. Vision should be assessed with and without the use of corrective lenses such as glasses and contact lenses. Nursing consideration: As always, include mediation evaluation as part of your assessment. Some drugs, such as Tamoxifen and thiazide diuretics can interfere with vision [9,17]. There are a number of normal age-related changes pertaining to the appearance of the eye and to vision. These include the following issues [14,9]: ● ● Eyebrows gray and thin as do eyelashes. The skin around the eye wrinkles as the subcutaneous tissue atrophies. The orbital fat decreases, giving the eyes a sunken appearance, and the eyelids sag. ● ● The eye becomes less sensitive to feelings of pain and discomfort. This can cause the patient to be unaware of infections or injuries to the eye. ● ● The lenses thicken and harden, which reduces accommodation and decreases near vision (presbyopia). The lens begins to appear “yellowish” and rather opaque. Visual acuity starts to decrease starting about the age of 50. This decrease becomes more rapid after the age of 70. ● ● The eye begins to lose its ability to adapt to changing degrees of light. Thus, as the adult ages, more light is needed to see objects in shadow or in dim light. ● ● The eye’s ability to adapt to a darkened room decreases with age. It takes more time for the eye to accommodate to darkness. ● ● The older adult’s pupils become sluggish as the pupils decrease in size and become less responsive due to age. Nursing consideration: There are several visual problems that are commonly seen in the older adult. Nurses must be aware of these problems and their signs and symptoms so that appropriate referrals may be made. Cataracts: Cataracts are the most common causes of correctable vision loss [13,14]. A cataract is an opacity of the lens that develops gradually and without pain. A cataract decreases the amount of light able to reach the retina, thus inhibiting vision. The patient experiences painless, gradual blurring and loss of vision, may see halos around objects, and have difficulty distinguishing colors. The pupil of the eye appears hazy. Cataracts are the leading cause of blindness in the world. Surgery is the treatment of choice and prognosis is usually good. Risk factors for cataracts include increased age, diabetes, eye trauma, long-term use of corticosteroid medications, smoking and alcohol use, and Caucasian ancestry [9,13,14]. Glaucoma: Glaucoma is a group of disorders characterized by an increase in intraocular pressure (IOP) that can damage the optic nerve. Untreated glaucoma can lead to peripheral vision loss and blindness. The onset can be slow and insidious (chronic open-angle glaucoma) or abrupt (angle-closure glaucoma), which is a medical emergency. Treatment includes medications and/or laser therapy. Risk factors include: increased IOP; older than 60 years of age; family history of the disease; personal history of hypertension, diabetes, myopia, and/or migraines; and African-American ancestry [9,13,14]. Age-related macular degeneration (ARMD): ARMD is the leading cause of blindness in persons over the age of 65. It is the atrophy of the macular region of the retina. The dry form of ARMD is characterized by the presence of yellow deposits (drusen) in the macula. Vision may become dim or distorted and blind spots may develop in the center of vision. In advanced cases, central vision is lost. The wet form of ARMD is characterized by the growth of abnormal blood vessels from the choroid underneath the macula. These blood vessels leak blood into the retina, causing vision distortions that make straight lines look wavy, or blind spots, and loss of central vision. Eventually scarring occurs, leading to permanent central vision loss. The wet form is not as common as the dry form, but it is responsible for the majority of severe vision loss associated with ARMD [9,13,14,46]. Diabetic retinopathy: This is a microvascular disease of the eye associated with diabetes. The ocular microvascular system is damaged and the transport of oxygen and nutrients to the eye is inhibited. Patients experience a gradual vision loss [9,13,14]. Hearing Hearing loss is quite common in the older adult patient. It is estimated that 314 in 1,000 people over age 65, and 40% to 50% of persons over the age of 75 have hearing loss. Older men of all ages are more likely to be hearing impaired than older women [9]. It is common for older adults to have difficulties hearing high-frequency sounds, such as consonants (especially p, s, and t) than low-frequency sounds, such as vowels. In addition to age, risk factors for hearing loss, include [9]: ● ● Chemical exposure. ● ● Environmental, e.g. a one-time exposure to something such as an explosion, or continuous exposure to loud sounds over an extended period of time like in a work environment. ● ● Diabetes and cerebrovascular disease. ● ● Head injury or stroke. ● ● History of middle ear infections. ● ● Impacted cerumen. ● ● Ototoxic medications. ● ● Smoking. ● ● Tumors. Normal aging changes that influence hearing include [9,14]: ● ● The skin of the external ear wrinkles and sags. ● ● Cerumen is drier and harder and tends to accumulate in the ear more than in younger adults. ● ● Loss of nerves, hair cells, and blood supply to sensory organs associated with hearing.