Gerontological Nursing

Fourth Edition

Chapter 14
Sensation: Hearing, Vision,
Taste, Touch, and Smell

Copyright © 2019, 2014, 2010 Pearson Education, Inc. All Rights Reserved
Learning Outcomes (1 of 2)
14.1 Identify and explain the normal age-related changes
to vision, functional implications, related nursing
interventions and medications that may affect sensory
dysfunction.
14.2 Identify and explain the normal age-related changes
to hearing, functional implications, related nursing
interventions, and medications that may affect sensory
dysfunction.
Learning Outcomes (2 of 2)
14.3 Identify and explain the normal age-related changes
to taste and smell, functional implications, related nursing
interventions, and medications that may affect sensory
dysfunction.
14.4 Identify and explain the normal age-related changes
to physical sensation, functional implications, related
nursing interventions, and medications that may affect
sensory dysfunction.
Introduction
• Changes in vision, hearing, smell, taste, and touch occur
naturally throughout the aging process.
• Impairments in sensory functioning can greatly alter the
capabilities of older adults to complete everyday
activities, affecting quality of life and safety.
Vision (1 of 4)
• Visual impairment is defined as visual acuity of 20/40 or
worse while wearing corrective lenses.
• Legal blindness or severe visual impairment is 20/200 or
more as measured by a Snellen wall chart at 20 feet.
Vision (2 of 4)
• Visual impairment and blindness in the older person is
the result of four main causes:
– Cataracts
– Age-related macular degeneration
– Glaucoma
– Diabetic retinopathy
Vision (3 of 4)
• Older patients should be questioned regarding adequacy
of vision, recent changes in vision, visual problems, and
the date of their last complete visual examination.
Vision (4 of 4)
• The nurse should inspect the eyes for any abnormalities.
– Movement of the eyelids
– Abnormal discharge
– Excessive tearing
– Abnormally colored sclera
– Abnormal or absent pupillary response
Normal Changes of Aging
• Graying and thinning of eyebrows and eyelashes
• Decrease in endothelial cells on the cornea
• Thickening and hardening of lenses
– Appear yellowish and opaque
• Dilation and constriction of pupils occurs more slowly.
• Light sensitivity decreases
Visual Problems (1 of 2)
• Age-related macular degeneration (AMRD) is the leading
cause of blindness in adults over the age of 65.
• Cataracts are opacities of the lenses.
– Cloud the lens, decrease the amount of light able to
reach the retina, and inhibit vision
Visual Problems (2 of 2)
• Glaucoma is associated with optic-nerve damage due to
an increase in IOP (intraocular pressure), which can
ultimately lead to vision loss.
• Diabetic retinopathy is a microvascular disease of the eye
occurring in both type 1 and type 2 diabetes.
Nursing Diagnoses Associated with
Visual Impairment
• Nursing diagnoses associated with visual impairment are
diverse and depend upon the older person’s ability to
compensate for visual problems.
• The gerontological nurse should consider the older
patient’s functional ability and not just the results of visual
acuity testing using the Snellen chart.
Hearing
• Hearing loss can interfere with communication;
enjoyment of certain forms of entertainment such as
music and television; safety; and ultimately,
independence.
• Hearing impairments also may endanger individuals living
alone, due to the inability to hear a smoke detector or
security alarm.
Normal Changes of Aging (1 of 2)
• Auricle tends to wrinkle and sag
• Cerumen tends to be drier and harder; accumulates in
the ear canal
• Dryness of the canal may cause pruritus
• Epithelial lining of ear canal may be easily irritated and
injured
• Atrophy of organ of Corti and cochlear neurons
Normal Changes of Aging (2 of 2)
• Loss of sensory-hair cells
• Degeneration of the stria vascularis
• Gradual bilateral hearing loss
• Moderate exposure to loud noise may cause temporary
threshold shift (TTS)
Types of Hearing Loss
• A thorough history and physical examination is important
to help determine the cause of the hearing loss.
– Conductive hearing loss
– Sensorineural hearing loss
Assessing Hearing Loss
• Family members may be valuable resources in assessing
auditory acuity.
• Examination of the ear may reveal an external infection or
impaction.
• Basic screening tests:
– Whisper
– Weber
– Rinne
• Gold standard:Audiometry testing
Hearing Aids
• Amplify sounds and deliver them directly into the ear
• Gerontological nurses should be aware of the cleaning,
inserting, and troubleshooting involved with hearing aids.
• All nursing personnel, including nursing assistants,
should know how to care for hearing aids.
Assistive Listening Devices
• Amplification devices
• Wireless transmission using infrared technology or FM
radio listening systems
• Telecommunications device for the deaf (TDD)
• Use of computers and e-mail
Common Hearing Problems in Older
Adults
• Tinnitus – Abnormal ear or head noises
– Objective – Pulsatile sounds caused by turbulent
blood flow within the ear; clicking or low-pitched
buzzing indicative of spastic muscles within the ear or
spontaneous vibrations of the hair cells
– Subjective – Perception of sound when there is no
actual sound stimulus
Nursing Diagnoses Associated with
Hearing Impairment
• Nursing diagnoses associated with older patients with
hearing impairment are diverse and depend upon the
ability to compensate for hearing problems.
• Self-Care Impairment due to hearing loss
– Encompasses a variety of nursing goals and
interventions including communication, safety, self-
care activities, mood, and leisure activities
Taste
• Taste deficits can result in weight loss, malnutrition,
impaired immunity, and worsening of medical illness.
• A diminished sense of taste, or hypogeusia, is a normal
sensory change usually occurring after the age of 70.
Nursing Assessment of the Older Patient
with Taste Disturbances (1 of 2)
• A thorough assessment of the head and neck should be
performed to rule out obvious deformity, injury, infection,
or obstruction.
• Mucous membranes should be assessed for dryness,
ulceration, or presence of candidiasis.
Nursing Assessment of the Older Patient
with Taste Disturbances (2 of 2)
• Hypogeusia can lead to malnutrition because a
decreased ability to sense flavor in foods can lead to lack
of motivation and enjoyment in preparing and consuming
a well-balanced diet.
Nursing Diagnoses Associated with
Taste Impairment
• Deficits in Self-Care due to Taste Impairment
• Altered Nutrition: Less than Physiologic Requirements
Smell
• Hyposmia may be due to age-related changes or
olfactory-nerve damage.
• Upper respiratory infections, head trauma, inflammatory
conditions, and neurodegenerative diseases are the
major causes of olfactory damage.
• Loss of sensation can affect the older adult emotionally
and psychologically.
Nursing Assessment of the Older
Adult with Disturbances of Smell
• Gerontological nurse can examine the mucous
membranes of the nares using an otoscope and
speculum
– Membranes should be free from polyps, slightly red in
color, and without ulceration or copious exudates
• Scratch-and-sniff tests available in some smell-
assessment clinics
Nursing Diagnosis
• Nursing diagnoses associated with older persons with
hyposmia include Deficits in Self-Care Deficit due to
impaired sense of smell.
• Additional assessment should focus on safety and
nutrition.
Physical Sensation (1 of 2)
• As people age, tactile sensation diminishes, due to
slower conduction of nerve impulses and diminished
function of peripheral nerves.
– As a result, older adults have decreased perception of
pain, vibration, touch, and temperature extremes.
Physical Sensation (2 of 2)
• Institutionalized older persons deprived of caring touch
and nurturing physical contact experience a diminishing
quality of life, a lessening of their desire to relate to
others, and a weakening of what may already be a fragile
relationship with physical reality.
Nursing Assessment of the Older
Person with Tactile Impairment
• Touch is usually assessed using a wisp of cotton.
– Older persons are asked to close their eyes and nod
or say “yes” when they are touched on the face, upper
back, and extremities.
– A cotton swab can also be used with the wooden end
pressed lightly against the skin for a sensation of
“sharp” and the cotton end for the sensation of “dull.”
Nursing Diagnoses Associated with
Tactile Impairment
• Deficits in Self-Care related to tactile impairment
• For older patients with impaired sense of touch, nursing
interventions may focus on continuous monitoring of the
intactness of the skin, assessment of safety risks, and the
development of a safety plan with instructions to minimize
injury.
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