NCMB312 LECTURE
WEEK 5: NURSING CARE OF THE OLDER ADULT IN CHRONIC ILLNESS
PROFESSOR: MR. EDWIN MALIC
WEEK 5: NURSING CARE OF THE OLDER ADULT IN
CHRONIC ILLNESS
Disturbance in Sensory Function
Sensory Impairment
1. Visual
2. Hearing
3. Taste
4. Smell
- Good Vision and hearing are extremely valuable
assets that are often taken for granted
- People are better able to protect from harm when they
can see, hear and communicate
- The reduced ability to protect oneself from hazards
because of sensory deficits can result in serious fall
Gerontological Nurses must be aware of the factors that
influence sensory function in older adult and help to ensure
that vision and hearing problems are properly evaluated and
corrected when possible
Effects of Aging on Vision and Hearing
Presbyopia
- reduced elasticity and stiffening of the muscle fibers of
the lens of the eyes
- begins in the fourth decade of life
- interferes with the ability to adequately focus that can
be a factor for older adult requiring some form of
corrective lenses
● Visual acuity progressively declines due to reduced
pupil size
● Dark and light formation takes longer. Sensitivity to
glare increases due to cataract formation
● Visual fields become smaller, reducing peripheral
vision.
● The eyes produces fewer tears and drier
● Visual limitations can make communication
problematic
● Remaining aware of current events through
newspaper and socialization through playing cards
and other games may be hampered
Presbycusis
- (age-related sensorineural hearing loss) reducing
ability to hear s, sh, f, ph, and w.
● Hearing changes are also common and may
negatively impact communication
● Older people may be self-conscious of this limitations
and avoid situations in which they must interact
● Telephone conversations can be affected by this
problem
3RD YEAR 1ST SEM 2023
● Assessing the underlying cause of hearing problem is
the first step in the management or correction of the
problem
Sensory Health Promotion
Promoting Vision
- Despite age related changes, most older person have
sufficient visual capacity to meet normal self-care
demands with the assistance of corrective lenses
- Routine and thorough eye examinations
- Stress importance of annual eye exam
- Evaluate financial ability
- Review diet
- Variety of disorder can threaten the older individual’s
vision
Nutrients Beneficial to Vision:
- Essential Fatty Acid healthy retinal function
- Flavonoid improves night vision and adaptation to
dark; promotes visual acuity; improves capillary
integrity to reduce hemorrhage risk in diabetic
retinopathy
- Vitamin C promotes normal vision, supplementation
may reduce the risk of cataract
- Vitamin E may aid in preventing cataracts;
supplementation in large dose can prevent macular
degeneration
- Selenium may aid in preventing cataracts;
supplementation with vitamin E can reduce visual loss
in macular degeneration
- Vitamin B complex prevent elevated levels of
homocysteine, associated with vascular problems
affecting retina
- Zinc promotes normal visual capacity and adaptation
to dark; deficiency can facilitate cataract development
Promoting Hearing
- Some hearing deficits in old age can be avoided by
good care of the ears
- Prompt and complete treatment of ear infection,
prevention of trauma of the ear
- Nurse should examine ear frequently for cerumen
application
- Forceful steam of solution should not be used
- Avoid use of cotton tip applicator for cerumen
removal, hairpins or similar device should not be used
- Ear irrigation can help to remove cerumen
accumulation; however, care must be taken to protect
the older person
- Provide health education about the effects of
environmental noise on hearing ear plugs or other
sound reducing device should be used
 Visual Deficits Glaucoma
Cataract

- Degenerative eye disease in which the optic nerve is

damage from above normal intraocular pressure
- clouding of the lens or its capsule that causes the lens
- Drugs with anticholinergic properties can exacerbate
to lose its transparency
glaucoma due to their effects of dilating pupil
- leading cause of low vision in older adult
- exposure to ultraviolet B increases the risk of
Acute Glaucoma
developing cataract
- (closed angle or narrow angle glaucoma)
- Diabetes, smoking, high alcohol consumption and eye
- patient experience severe eye pain, headache,
injury are also contributing factor
nausea and vomiting
- Everyone develops some degree of lens opacity with
- vision becomes blurred and blindness may result if
age, although it is more severe in persons who have
not corrected
had significant exposure to sunlight
- diagnosis is confirmed by placing tannometer on
anesthetized cornea to measure IOP reading between
Symptoms:
20-25 mmhg is considered potential glaucoma
- As opacification continues vision is distorted, night
- Medication are used (mannitol, carbonic anhydrase)
vision decreased, and object appear blurred
- iridectomy may be performed after acute attack
- May have trouble seeing street signs while driving
and feel that there is a film over the eye
Chronic Glaucoma
- Glare from sunlight and bright lights is extremely
- (open angle glaucoma)
bothersome
- More common than acute glaucoma
- Color of the pupil change from black to white
- Peripheral vision becomes slowly but increasingly
- Some individuals may report an improvement in the
impaired
ability to see small prints and object
- As impairment progresses people may complain of
tired feeling in their eyes, headache, misty vision, or
Treatment and Cataract Surgery
seeing halos in the light
- Although surgery to remove the lens is the only cure
- Cornea may have a cloudy appearances, and the iris
for cataract it affect the people differently
maybe fixed and dilated
- People with single cataract may not necessarily
- Treatment aimed toward reducing IOP (iridectomy)
undergo surgery if vision in the eye is good these
- Open angle glaucoma, the most common form of the
individual should concentrate on strengthening their
disease, can be asymptomatic until advance stage
existing visual capacity
therefore, glaucoma screening is important
- Sunglasses, sheer curtain over windows furniture
placed away from bright light
- Regular evaluation of an ophthalmologist are
essentials
- Cataract surgery is an outpatient procedure
- Patients can simply resume non strenuous activity
within a day
- Simple surgical procedure and several weeks of
rehabilitation can result in years of improved vision
and higher quality of life

TRANSCRIBED BY: MICHAEL GABRIEL JIMENEZ

Care and prevention of complications
- Avoid physical straining and emotional stress. Milotics
maybe instilled into the eyes
- Mydratriacs, stimulants, and agents that elevate the
BP must be avoided.
- Abuse and overuse of the eyes must also be
prevented
- Patient compliance with treatment
- Nurses need to teach about the disease and its care
and counsel them about the importance of
compliance
Macular Degeneration
- Macular degeneration is the loss of central vision,
glaucoma is indicated by IOP. Cataracts and
presbyopia are other related problems of the eyes
- Common cause of blindness
- Involves damage or breakdown of the macula
- Most common is involutional macular degeneration
which associated with aging process although it can
result from injury, infection, or exudative macular
degeneration
Key concepts
- Loss of central vision accompanies macular
degeneration
- Routine exam can identify macular degeneration and
promote treatment
- Laser therapy has been use of some form of macular
degeneration
- Magnifying glass high intensity reading lamps and
other aids can prove helpful to this condition
Hearing Deficits
- Exposure to noise
- Recurrent otitis media and trauma
- Diabetes, tumors hypothyroidism and other disease
process can contribute to hearing impairment
TRANSCRIBED BY: MICHAEL GABRIEL JIMENEZ
- Vascular problem, viral infection and presbycusis
- Otosclerosis or osseous growth causes fixation of the
footplate of the stapes in the oval window of the
cochlea
- Tinnitus or ringing or other sound in the ear can be
associated with age related changes
Patient Care
- Encourage audiometric examination
- Older persons must learn to live with varying degrees
of hearing deficits
- Anger, impatience, and frustrations can result from
repeatedly unsuccessful attempts to understand
conversations
- Being self-conscious of their limitation can may make
them avoid social contact to escape embarrassment
and frustration
Hearing aids
- Can benefit persons with some hearing disorder but
they may not solve all hearing problems
- A hearing should not be purchased without being
specifically prescribe
- The aid must be checked regularly
- When used appropriately, hearing aids may correct
hearing problems and allow older individuals to
maintain communication and social relationships
Hearing aid care
- Turn the aid off or remove battery when not being use
- Clean the aid weekly
- Protect from exposure to extreme heat, cold weather
or moisture
- When changing the battery turn off the aid first
- Keep several new batteries available. Typically,
battery will last about 80 hours
Communication tip
- Talk slowly, distinctly, and in low frequency voice
- Face the individual when talking, using visual speech,
allow the person to lip read
Taste And Smell
- The senses of taste and smell work together. Most
tastes are linked with odors. The sense of smell
begins at the nerve endings high in the lining of the
nose.
- Smell and taste play a role in food enjoyment and
safety. A delicious meal or pleasant aroma can
improve social interaction and enjoyment of life
- Sensitivity to the five tastes often declines after age
60. In addition, your mouth produces less saliva as
you age. This can cause dry mouth, which can affect
your sense of taste.
- Certain things can speed up the loss of taste and
smell. These include diseases, smoking, and
exposure to harmful particles in the air
If your senses of taste and smell have diminished, talk to
your provider. The following may help:
- Switch to a different medicine, if the medicine you
take is affecting your ability to smell and taste.
- Use different spices or change the way you prepare
food.
- Buy safety products, such as a gas detector that
sounds an alarm you can hear.
Chronic Confusion
Delirium
- Caused by disruption in brain function due to
medication side effects, circulatory disturbances,
dehydration, low or high blood pressure, low or high
blood glucose, surgery, stress, etc.
- Onset- rapid; change noted within a days
- Mental status- short term memory impaired more
than long term, disoriented, confused, distorted
thinking, incoherent speech, may be suspicious of
others, see or hear things that are not there (illusions,
hallucinations), exaggeration of personality features
- Level of consciousness- changed, can be highly
agitated of very dull
- Behavior- can be hyperactive, be less active than
normal, or fluctuate between both extremes
- Recovery- disease can be reversed and normal
mental status restored if cause is treated promptly
- Delirium is reversible in most common circumstances
and treatment depends on the cause
- Treating the symptoms rather than cause or accepting
the symptoms as normal and failing to obtain
treatment can result to worsened mental status and
continuation of physical condition that could be life
threatening
Dementia
- Irreversible condition, progressive, impairment in
cognitive function affecting memory, orientation,
judgment, reasoning, attention, language, and
problem-solving.
- Cause by damage or injury to the brain an estimated
5 % older adults suffer from some form of dementia
Alzheimer’s Disease
- Most common form of dementia
- Characterized by two changes in the brain
TRANSCRIBED BY: MICHAEL GABRIEL JIMENEZ
- Presence of neuritic plaques w/c impair the function
the function of nerve cells in the brain
- Brain change in neurofibrillary tangles in the cortex
- Cause- damage to brain tissue due to Alzheimer’s of
other degenerative diseases, circulatory problems,
lack of oxygen, infection, trauma, hydrocephalus,
tumor, alcoholism, etc
- Onset- slow, months to years before symptoms are
evident
- Mental status- poor short- and long-term memory,
disoriented, confused, difficulty finding proper word to
use; impaired judgment, problems with arithmetic and
problem solving
- Level of consciousness – normal
- Behavior- inappropriate, maybe unsteady on feet,
have difficulty with coordinated movements
- Recovery- progression disease may be slowed but
disease cannot be reversed usually continues to
worsen
- Delirium alters the level of consciousness, whereas
dementia does not
- Greater risk of suicide for a person with dementia at
early stage
- Diagnosis is aided by brain scans that can reveal
changes in the brain
Stages of Alzheimer’s
- Stage 1 normal adult –no impairment
- Stage 2 normal older adult –self report of memory
impairment; no objective cognitive impairments noted
- Stage 3 compatible with AD- cognitive impairment
recognized by others; anxiety; impaired performance
in demanding work and social settings
- Stage 4 withdrawal denial, depression; inability to
perform IADL and complex task; flattening of affect;
cognitive impairment evident on exam
- Stage 5 moderately AD – disoriented to time and
place; needs assistance in clothing selection
- Stage 6 moderately severe AD- Forgets name of
spouse and other family members; personality and
emotional changes; inability to perform many ADLs;
agitation
- Stage 7 severe AD-Loss of verbal and psychomotor
skills; incontinence; needs total assistance
REMEMBER!
- Other disease can mimic Alzheimer; therefore, a
comprehensive evaluation is essential to rule out
other possible causes of dementia before diagnosis of
Alzheimer’s disease is made
Other dementias:
1. Vascular dementia
2. Frontotemporal dementia
3. Lewy body dementia
4. Crutzfeldt-Jacob disease
5. Wernicke’s encephalopathy and Parkinson’s
 6. Aids
7. Trauma and toxins
Caring for person with dementia
Ensure patient safety
- Items to trigger memory are useful
- Noise can further stimulate and further decrease
function
- Inedible items can be ingested should be lock at
cabinet
- Windows and doors should be protected
- Rather than restrain provide a safe area they can
wander
- Wear ID bracelets and have recent photo all the time
Promoting therapy and activity
- Occupational therapy and expressive therapy can
benefit those with early dementia
- Reality orientation
- Maintain contact and derive stimulation such as
music, petting animal touching various object
Modified communication techniques
- use simple sentence that contain only one idea or
instruction
- Speak in calm manner using adult tone not baby talk
- Avoid words that can be misinterpreted
- Offer opportunities for simple decisions
- Avoid arguments, distraction can help
- Recognize efforts with positive feedback
- Observe non verbal expressions and behaviors
Providing physical care
- They may not be complained that they are hungry
- Need close observation and careful attention to
physical need a subtle changes in behaviors
Using complementary and alternative therapy
- Nutritional supplements (b6, b12, c and e, FA,
selenium)
- Ginkgo biloba has been show to improve circulation
and mental function but risk of intraocular hemorrhage
and should be careful with anticoagulant drug
- Qigong for of therapeutic exercise by Chinese
Respecting the individual
- Individuality
- Independence
- Freedom
- Dignity
- Connection
- Supporting the patient’s family
- Health teaching
TRANSCRIBED BY: MICHAEL GABRIEL JIMENEZ
Communicating with Older Persons
- “Communication is the cohesive force in every human
culture and the dominant influence in the personal life
of every one of us.”
- “The form and function of communication vary with
the basic personality types and age characteristics of
the persons involved.”
- The mental facilities of the elderly change as a person
ages, especially those that pertain to communication,
like senses to memory.
Ways to communicate with seniors?
- Allow extra time for older patients. …
- Avoid distractions. …
- Sit face to face. …
- Maintain eye contact. …
- Listen. …
- Speak slowly, clearly and loudly. …
- Use short, simple words and sentences. …
- Stick to one topic at a time.
Information Sharing
- Help older people make informed decisions by
sharing information in the way they prefer writing or
demonstrating something can be helpful.
- Avoid sharing too much, too quick.
- Unfamiliar situations can be overwhelming, so slow
down and allow people time to process the
information.
- Verbal communication - involves sending and
receiving messages by means of Words
- Some verbal communication is formal, structured, and
precise; Some is informal, unstructured, and flexible
nurses must be effective in both formal and informal
communication and Must know how and when to use
each type
- Nonverbal communication Takes place without words
- research shows that 7 % o f communication comes
From the actual words we use; the other 93% is
nonverbal
- Approximately 38% of communication is transmitted
by Paralinguistic cues (i.e., tone, pitch and volume of
voice), and 55% is transmitted by body cues.
Formal or Therapeutic Communication
- Therapeutic communication -a conscious and
deliberate process used to gather Information related
to a patient’s overall health status (physical,
psychosocial, spiritual, etc.) And to respond with
verbal and nonverbal
- Approaches that promote the patient’s well-being or
improve the patient’s understanding of ongoing care.
- Careful use of words and language is an art.
- Knowledge of the individual’s educational background
and interests provides Nurses with a starting point for
conversation.
 - Social discussions often center on past employment,
family, or other interests.
- Increased knowledge of the individual enhance the
nurse ability to respond empathetically
- Effective verbal communication requires the ability to
use a variety of Techniques when sending and
receiving messages.
- Nurses should know as much as possible about the
other person involved
- A person’s age, marital status, cultural or ethnic
orientation, educational background, interests, and
the ability to hear and see influence the
communication techniques used and the words
chosen
- As nurses, we need to be careful to choose words
that the patient can understand—not so simple that
we are “ talking down” to the patient, but also not so
technical or “medical” that the meaning is unclear.
- Avoid acronyms such as TURP or CBC unless you
are sure that the person understands them.

Six Tips To Effectively Communicate

1. Personal Appearance
- Appropriate clothes, hair and body scent can make a
person with dementia more relaxed and comfortable
with you because that may remind them of someone
they knew.
2. Approach Individuals from the front
- People will become more familiar with you when they
feel like they are being respected. By approaching
them from the front, you will give them a chance to
process who you are and what you are asking.
3. Body Language/ Eye Contact
- A person with dementia will be able to detect your
body language, sudden movements which can cause
distress on the person and can make it hard to
communicate. Demonstrating what is being asked will
give the person a visual perception. Respect the
person’s personal space but make sure to drop down
to eye level, this will allow the individual to feel more
comfortable and in control of the situation.
4. Facial Expressions
- Tense facial expressions can also cause distress. Soft
facial expressions and smiling will give the person
enjoyment. So remember, something as simple as
starting a conversation with a smile can go along way!
5. Touch
- Physical contact will give the person a sense of care
and affection. Simply by holding someone’s hand,
rubbing their shoulder or giving them a hug will
provide reassurance and comfort.
6. Dance/Music
- Music and dance can spark memories of happy times
in a person’s life. Make sure to know what type of
music a person enjoyed growing up and allow them to
create moments of joy.

TRANSCRIBED BY: MICHAEL GABRIEL JIMENEZ