| As we age, our sensory systems gradually lose | | | | daily living, reduced connection with outside world); |
| their sharpness. Because our brain requires a | | | | 3. And, a fearfulness and reduced tendency to |
| minimal amount of input to remain alert and | | | | venture outside. |
| functioning, sensory loss for older adults puts | | | | C. What are the effects of vision changes on |
| them at risk for sensory deprivation. Severe | | | | demented elderly? |
| sensory impairments, such as in vision or hearing, | | | | 1. With the losses in visual acuity, other problems |
| may result in behavior similar to dementia and | | | | in cognitive functioning are heightened, such as |
| psychosis, such as increased disorientation and | | | | difficulty processing unfamiliar faces and settings; |
| confusion. Added restrictions, such as confinement | | | | 2. Because the person with dementia already has |
| to bed or a Geri-chair, increases this risk. With | | | | difficulty learning new behaviors, he or she is less |
| nothing to show the passage of time, or changes | | | | able to learn new habits to compensate for the |
| in the environment, the sensory deprived person | | | | visual losses (e.g., learning to use visual aids to |
| may resort to repetitive problem behaviors (calling | | | | identify articles of clothing or other possessions; |
| out, chanting, rhythmic pounding/rocking) as an | | | | 3. There is likely to be an increased disorientation |
| attempt to reduce the sense of deprivation and | | | | and confusion, as the search for structure and |
| to create internal stimulation/sensations. | | | | external cues is strained. |
| This article is the first in a series of three articles | | | | PRINCIPLES FOR CAREGIVERS |
| that discuss the prominent sensory changes that | | | | The following principles apply to caregiving |
| accompany aging, and considers the necessary | | | | approaches with older adults who have diminished |
| behavioral adjustments or accommodations that | | | | sensory function. Increased sensitivity and insight |
| should be made by professional, paraprofessional, | | | | to the needs of these individuals improves their |
| and family caregivers who interact with older | | | | quality of life and improves our effectiveness: |
| adults. Though the medical conditions are not | | | | 1. Observe the behavior of the person, and look |
| reviewed in depth, the purpose of this article is to | | | | for cues and signs of pain or discomfort; |
| introduce many of the behavioral health insights, | | | | 2. Help the person work through the emotional |
| principles, and approaches that should influence our | | | | impact of the sensory changes, allowing |
| caregiving roles. This article addresses age-related | | | | expression, acceptance, and support of the grief |
| visual changes. | | | | and sadness accompanying these losses; |
| CHANGES IN VISION THAT ACCOMPANY | | | | 3. Do not try to fix the unpleasantness; |
| AGING | | | | acceptance and support goes a longer way |
| A. The changes in vision that accompany aging | | | | toward healing than a quick fix or a patronizing |
| include: | | | | attitude; |
| 1. A loss of elasticity of the lens; this means the | | | | 4. Reduce excess disability by maximizing |
| person is no longer able to focus or | | | | whatever functioning is still left, such as proper |
| accommodate to changes in lighting conditions. | | | | eyeglass prescriptions, or functioning hearing aids; |
| (Starting in our 40's, glasses are needed to see | | | | 5. Consider assistive devices (phone amplifiers, |
| fine print). It also means the older person cannot | | | | large text books, headphones, and the Braille |
| adjust to sudden changes in lighting, resulting in an | | | | Institute for a variety of useful visual aids). |
| uneasiness when leaving a bright room to enter a | | | | Approaches for impairments in vision: |
| dark hallway, or finding seats in the dark in | | | | 1. Address the person before you touch him or |
| recreation rooms, or theater. Going in the reverse | | | | her, identify yourself, let him or her know when |
| direction can be equally difficult: from a dark room | | | | you are leaving, speak normally, and do not shout; |
| to a bright area. | | | | 2. Describe his or her surroundings to help orient |
| 2. Decreased pupil size; the light reaching the | | | | and familiarize the person to the environment, tell |
| retina is reduced, requiring more light to see. This | | | | him or her location of belongings, and if things |
| results in the need for lighting 3x to 4x what | | | | have been moved; |
| younger people need to see clearly | | | | 3. Use as much contrast as possible, e.g., red |
| 3. A loss of transparency; with age, there is a | | | | objects on white background is better than black |
| yellowing of the lens in the eyes, making color | | | | on a gray background, or blue on green |
| discrimination more difficult, especially blue and | | | | background, (consider switch plates on walls, |
| green. Warmer colors, such as reds and yellows | | | | toothbrushes, combs); |
| are perceived best, explaining why bright colors | | | | 4. Avoid moving quickly from a bright room to a |
| are preferred. | | | | darkened room, or v.v. Make sure the |
| 4. More susceptibility to glare, and longer time is | | | | visually-impaired person takes the time for the |
| needed to recover from the effects of glare; | | | | pupils to adapt to the changes in lighting; |
| 5. Eye diseases and disorders, such as cataracts | | | | 5. Introduce yourself every time you come into |
| causing a clouding of the lens; glaucoma, resulting | | | | contact with the person, and explain what you |
| from increased pressure of fluids in the eye, | | | | are going to do because there are no visual cues; |
| damaging the optic nerve and impairing vision. | | | | 6. Help to identify others in their environment with |
| Glaucoma, the number one cause of blindness in | | | | colored clothing, name tags with large print, etc. |
| U.S., in advanced stages results in yellow halos | | | | 7. Clean eyeglasses regularly, provide adequate |
| around images. Macular degeneration may occur, | | | | lighting, and avoid glare; |
| where vision is distorted, and images appear | | | | 8. Provide night lights, and arrange furnishings in |
| different sizes or different shapes, and are | | | | the environment for safety and ease of mobility. |
| missing a central element. Visual disorders may be | | | | Even with normal aging, functioning of our five |
| secondary to stroke, in which the eye can see | | | | senses is not like it was when we were younger |
| the image but the brain cannot interpret the | | | | adults. This article offers caregivers who work |
| images. Diabetes may result in disrupted blood | | | | with visually-impaired older adults some insights |
| flow to the retina, causing diabetic retinopathy and | | | | into the special needs and adjustments that will |
| a loss of vision, and blindness, in extreme cases. | | | | turn unpleasant, frustrating situations into more |
| B. What are the effects of visual loss on the older | | | | caring, helpful, and sensitive interactions. By |
| adult? | | | | integrating these behavioral approaches in the |
| 1. An increased dependency on others; | | | | delivery of the health care with older adults, we |
| 2. A sharply reduced quality of life (changes in | | | | can favorably impact the management of these |
| activities in daily living and instrumental activities of | | | | conditions. |