NORMAL CHANGES IN

SENSATION
 Background
The majority of older adults will experience some changes in
their sensory capacity (vision, hearing, smell, taste and
peripheral sensation) as a normal part of aging. Some sensory
changes, for example changes in hearing, can severely impact
an older person's communication skills. This section on sensory
changes addresses common changes seen with advancing age
and the disease states and injury that occurs more frequently in
aging and that impact the sensory system.
Vision
30% of those over age 65 have some level of visual impairment.
Cataracts are the 5th most common chronic condition in adults
over age 75.
Definitions
• Normal vision: Visual Acuity of 20/20 or better
• Visually Impaired: Visual Acuity of 20/50 or worse
• Legally Blind: Best corrected vision of 20/200 or worse
• Totally Blind: No light perception
Vision Changes common in older adults Presbyopia: A loss of
elasticity in the lens of eye leading to a decrease in the eyes ability
to change the shape of the lens to focus on near objects such as fine
print and decreased ability to adapt to light .

Implication of Vision Change

Impact on Safety
Inability to read medication lables
Difficulty navigating stairs of curbs
Difficulty driving
Crossing streets
Impact on Quality of Life
• Reduces ability to remain independent
• Difficulty or unable to read
• Falls
Hearing
Hearing loss is the 3 rd leading chronic condition affecting adults
over 75 years of age

Definitions
Hearing Impaired: Defined in Decibels (dB) or level of loudness
Mild hearing impairment 20 to 40 dB
Moderate 40 to 55 dB
Moderately severe 55 to 70 dB
Severe hearing impairment 70 to 90 dB
Greater than 90 dB is profound deafness, unable to hear sound
Hearing Changes common in older adults
• Presbycusis: Loss of high frequency, sensorineural hearing loss.
Has a gradual onset is progressive and is bilateral. Due to gradual loss
of hair cells, and fibrous changes in the small blood vessels that
supply the cochlea. Difficulty hearing high pitched sounds such as s, z,
sh, and ch. Background noise further aggravates hearing deficit.
• Conductive hearing loss: Involves the outer and or middle ear.
Causes of conductive hearing impairment include: cerumen
impactions or foreign bodies; ruptured eardrum, otitis media, and
otosclerosis.
• Sensorineural hearing loss: involves damage to the inner ear, the
cochlea, or the fibers of the eighth cranial nerve. Causes of
sensorineural hearing loss include: hereditary causes, viral or bacterial
infections, trauma, tumors, noise exposure, cardiovascular conditions,
ototoxic drugs
Implications of Hearing Changes
Impact on quality of life
Impairs ability to communicate with others
Adds to social isolation
Leads to depression or low self-esteem
Safety issues
Unable to hear instructions, such as how to take medications,
Unable to hear car coming when crossing the road, horns honking
Unable to hear phone or doorbell ringing or knocking at the door (if
emergency occurs may be unaware)
Smell and Taste
The sense of smell and ability to identify odors decreases due to
normal changes in aging. This can be problematic for safety
reasons. An inability to smell smoke for instance could put an
older adult at risk.
Changes in smell and taste common to older adults
Common changes in smell include a decline in the sensitivity to
airborne chemical stimuli with aging.
Common changes in taste include a decreased ability to detect
foods that are sweet. Most changes in taste are thought to occur
due to decreased sense of smell, medications, diseases and
tobacco use.
Implications of Taste and Smell Changes
Inability to smell
Effects quality of life -- Scents such as smell of Christmas tree, flowers or coffee
brewing may not be detectable. Diminished taste of favorite foods or beverages.
Nutritional decline - inability to smell food aromas may reduce nutritional intake
Safety hazard -- inability to smell smoke in a fire or a gas leak.
Decreased sense of taste
May result in inability to recognize spoiled food resulting in nausea, vomiting or
infectious diarrhea.
 
Peripheral Sensation
Peripheral neuropathy is one of the most common neurological
disorders encountered in a general medical practice with estimates
of 2% to 7% of all patient populations having symptoms of
neuropathy (Smith and Singleton, 2004). An assessment of 894
participants in the Women's Health and Aging Study indicated that
58% of women showed evidence of neuropathy by age 65 (Vinik,
2004).
Changes in peripheral sensation common to older adults
Peripheral nerve function that controls the sense of touch declines
slightly with age.
Two-point discrimination and vibratory sense both decrease with age.
The ability to perceive painful stimuli is preserved in aging.
However, there may be a slowed reaction time for pulling away from
painful stimuli with aging.
Implications of Peripheral Sensation Changes
Falls - due to inability to recognize position sense or inability
to ascertain where feet are on floor.
Calluses or serious foot lesions .
Nursing Care Strategies
Vision : Notify the primary care provider of any acute change in
vision.
Encourage the use of good lighting in patient rooms
Encourage the use of the patient's eyeglasses.
Encourage annual eye exams either with an Optometrist or
Ophthalmologist
Hearing
• Assess for cerumen impactions. Request cerumen softening drops
followed by irrigation (if needed) or ENT consultation.
• Get the person's attention and face them before speaking to assist
the individual with lip reading, a common compensatory
mechanism for older adults.
• Do not shout at people with hearing impairments, but rather use
lower tones of your voice.
• Provide written instructions (use large black marker if person also
is visually impaired)
• Notify the primary care provider of any sudden change in hearing.
• Referral to audiologist and/or ENT as indicated.
Taste and Smell
• Take all complaints of inability or decreased ability to smell
or taste seriously.
• If this is an abrupt change in taste or smell notify primary
care provider. Patient may need an ENT referral.
• Patient teaching should focus on safety issues with odors of
gas and spoiled food. Educate seniors to have carbon
monoxide detectors in their home and to evaluate food with
other methods other than sense of smell and taste .
Peripheral Sensation
• Examine feet daily and inform primary provider if lesions,
calluses or red areas.
• Clean and thoroughly dry feet prior to applying lotion.
• Ensure or have family bring in adequate foot wear that
protects the individual's feet
• Implement fall precautions and initiate referral to physical
therapy for diabetics with peripheral neuropathy.
 CATARACTS
A cataract is a clouding of the normally clear lens of your eye. For people
who have cataracts, seeing through cloudy lenses is a bit like looking
through a frosty or fogged-up window.
Clouded vision caused by cataracts can make it more difficult to read, drive
a car (especially at night) or see the expression on a friend's face.
Most cataracts develop slowly and don't disturb your eyesight early on. But
with time, cataracts will eventually interfere with your vision.
At first, stronger lighting and eyeglasses can help you deal with cataracts.
But if impaired vision interferes with your usual activities, you might need
cataract surgery. Fortunately, cataract surgery is generally a safe, effective
procedure.
Signs and symptoms
Clouded, blurred or dim vision
Increasing difficulty with vision at night
Sensitivity to light and glare
Seeing "halos" around lights
Frequent changes in eyeglass or contact lens prescription
Fading or yellowing of colors
Double vision in a single eye
 
Causes
Most cataracts develop when aging or injury changes the tissue that makes
up your eye's lens.
Some cataracts are related to inherited genetic disorders that cause other
health problems and increase your risk of cataracts. Cataracts can also be
caused by other eye conditions, medical conditions such as diabetes, trauma
or past eye surgery. Long-term use of steroid medications, too, can cause
cataracts to develop.
 
Treatment
The only effective treatment for cataracts is surgery.
GLAUCOMA
Glaucoma is not just one eye disease, but a group of eye conditions resulting
in optic nerve damage, which may cause loss of vision. Abnormally high
pressure inside your eye (intraocular pressure) usually, but not always,
causes this damage.  Glaucoma can damage your vision so gradually you
may not notice any loss of vision until the disease is at an advanced stage. 
Symptoms
Eye pain
Nausea and vomiting (accompanying the severe eye pain)
Sudden onset of visual disturbance, often in low light
Blurred vision
Halos around lights
Reddening of the eye
Treatment
The goal of glaucoma treatment is to lower pressure in your
eye (intraocular pressure). To treat your condition, doctors may
lower your eye pressure, improve drainage of fluid in your eye
or lower the amount of fluid produced in your eye.
Glaucoma can't be cured, and damage caused by the disease
can't be reversed, but treatment and regular checkups can
prevent vision loss in people with early glaucoma. If vision
loss has already occurred, treatment can slow or prevent further
vision loss.
HEARING LOSS
Hearing loss, also known as hard of hearing, anacusis,
or hearing impairment, is a partial or total inability to hear. It
may occur in one or both ears.
 
Causes
Advanced age is the most common cause of hearing loss. One
out of three people aged 65-74 has some level of hearing loss.
After age 75, that ratio goes up to one out of every two people.
Researchers don't fully understand why hearing decreases with
age. It could be that lifetime exposure to noise and other
damaging factors slowly wear down the ears' delicate
mechanics. Genes also play a role.
Symptoms of Hearing Loss
In many cases, hearing fades so slowly, its departure goes
unnoticed. You may think that people are mumbling more, your
spouse needs to speak up, and the telephone is an inferior
communication device. As long as some sound still comes in, you
may assume your hearing is fine.
Treatment
People with permanent hearing loss need to learn how to function
with the hearing they still have. Most people with permanent
hearing loss can benefit from using a hearing aid -- yet only one
in five eligible people use them. Hearing aids are tiny instruments
you typically wear in or behind your ear that make sounds louder.
Things do sound different through a hearing aid, so it's important
to talk with your doctor to set realistic goals.
DIABETIC RETINOPATHY
Diabetic retinopathy (die-uh-BET-ik ret-ih-NOP-uh-thee) is a
diabetes complication that affects eyes. It's caused by damage to the
blood vessels of the light-sensitive tissue at the back of the eye
(retina).
At first, diabetic retinopathy may cause no symptoms or only mild
vision problems. Eventually, it can cause blindness.
Symptoms
Spots or dark strings floating in your vision (floaters)
Blurred vision
Fluctuating vision
Impaired color vision
Dark or empty areas in your vision
Vision loss
Causes
Over time, too much sugar in your blood can lead to the blockage
of the tiny blood vessels that nourish the retina, cutting off its
blood supply. As a result, the eye attempts to grow new blood
vessels. But these new blood vessels don't develop properly and
can leak easily.
Treatment
Focal laser treatment. This laser treatment, also known as
photocoagulation, can stop or slow the leakage of blood and fluid
in the eye. During the procedure, leaks from abnormal blood
vessels are treated with laser burns.
Scatter laser treatment. This laser treatment, also known as
panretinal photocoagulation, can shrink the abnormal blood
vessels. During the procedure, the areas of the retina away
from the macula are treated with scattered laser burns. The
burns cause the abnormal new blood vessels to shrink and scar.
Vitrectomy. This procedure uses a tiny incision in your eye to
remove blood from the middle of the eye (vitreous) as well as
scar tissue that's tugging on the retina. It's done in a surgery
center or hospital using local or general anesthesia.