After studying Module 5: Lecture Materials & Resources, discuss the following: Define presbycusis, name signs and symptoms, etiology and differential diagnosis. Create 3 interventio

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# 1

Hearing & Eye Age-Related Diseases

        Presbycusis, also known as age-related hearing loss, is a debilitating disease with a complicated etiology that affects tens of millions of people worldwide and roughly half of those over 65 in the United States (Say et al., 2021). The loss is usually bilateral, causing difficulty hearing high-pitched tones and conversational speech (Meiner & Yeager, 2019). The causes of age-related hearing loss are thought to be genetic and environmental. Men are more affected by this condition than women. This condition's origin is yet unknown.

        Some signs and symptoms that could be seen in patients with this condition are not answering when spoken to, talking loudly, paying attention to the speaker's lips, turning up the radio or TV volume, putting one palm over one ear, and tilting the head to one side when someone is speaking (Meiner & Yeager, 2019). The causes of presbycusis are multifaceted. In addition to physiologic and anatomical alterations brought on by aging-related deterioration, genetic factors are among the additional contributing elements (Cheslock & De Jesus, 2022). It is believed that glutamate signaling, glucocorticoids, and sex hormones all contribute to it. Hearing loss occurs more frequently in postmenopausal women who use progestin and a combination of hormone replacement therapy. Presbycusis has also been linked to exposure to loud noises and ototoxic substances such as salicylates, loop diuretics, aminoglycosides, and some chemotherapeutic drugs. Ototoxicity has also been linked to certain occupational and environmental exposures to toxins such as toluene, styrene, lead, carbon monoxide, mercury, and other toxins (Cheslock & De Jesus, 2022). This problem has also been associated to a history of ear infections and the presence of several systemic disorders.

        Studies aimed at establishing a clear association for the cause have not been successful. As a result, the diagnosis entails eliminating other potential causes of hearing loss, such as infections, head trauma, metabolic disorders, vascular diseases, and heart disease (Meiner & Yeager, 2019). It is important for nurses when caring for patients with this condition to speak clearly and use a normal tone of voice. Patients and their families need to be instructed on how to use and where to obtain assistive listening devices (Meiner & Yeager, 2019). Nurses must educate patients and family members that when using hearing aids, they need to perform daily listening and battery checks. These devices must be stored in a hearing aid drying container with batteries removed.

        Vision is an important sense that is needed to complete ADLs. Age-related changes and macular or retinal diseases that occur can affect seeing (Meiner & Yeager, 2019). For example, age-related Macular Degeneration (AMD) is the leading cause of blindness in those over 50 years of age. Damage to the macula in AMD results in alterations to the center of the field of vision. AMD symptoms include a black spot in the center of the field of vision, a loss of color vision, words that appear blurry, and straight lines that appear wavy. Retinal detachment is another condition that occurs when the sensory layer of the retina and pigmented layer separate. Aging can cause rips or perforations in the retina, and when fluid leaks between the layers, detachment occur (Meiner & Yeager, 2019). Flashes of light, vision loss, and a veil or curtain blocking vision are all symptoms. Hypertension retinopathy is caused by chronic uncontrolled hypertension (Meiner & Yeager, 2019). The retina will suffer gradual damage as a result, with little to no symptoms. Vascular wall hyperplasia and permanent artery constriction are among the abnormalities found. These senses are crucial for human functioning and affect the quality of life of our patients.

References

Cheslock, M., & De Jesus, O. (2022). StatPearls: Presbycusis. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK559220/

Meiner, S. E., & Yeager, J. J. (2019). Gerontologic nursing (6th ed.). Elsevier.

Say, M. A., Sevik Elicora, S., Erdem, D., Bilgin, E., & Baklaci, D. (2021). Evaluation of the vestibular system in individuals with presbycusis using video head impulse test and videonystagmography. Acta Oto-Laryngologica, 141(6), 545–550. https://doi.org/10.1080/00016489.2021.1905177

# 2

Hearing and Eye Aged-Related Diseases

“Presbycusis is a gradual age-related loss of hearing in both ears (Panza et al., 2015)”. The term’s precise definition is "elder hearing," which is supposed to afflict anyone over 70. Hearing other people's speech slurred or mumbled is a standard indicator and symptom. Patients have difficulty distinguishing high-pitched sounds like "the" and "s." They also have difficulty understanding talks, especially when there is background noise. Men's voices are more accessible for patients to hear than women’s. Certain sounds may be irritating or too loud for them at times. The causes of presbycusis are multifaceted. The most common cause of presbycusis is age-related alterations in the ears and nerve pathways leading to the brain.

In certain circumstances, the condition is inherited. It can also happen as a side effect of some medications or as a result of prolonged exposure to loud noises. Exclusion is used to make a diagnosis of presbycusis. Infection, noise exposure, trauma, generally inherited hearing loss, tumor, autoimmune illness, metabolic dysfunction, and otosclerosis are among the differential diagnoses for sensorineural hearing loss. Its etiology is caused by environmental and inherited factors like tobacco use, lifetime exposure to noise, ear infections, trauma, ototoxic drugs, and autosomal recessive and dominant, among others.

Adequate care is delivered when there is an excellent grasp of surgical therapy, amplification, and medical management indications. A comprehensive physical examination and history are essential for treating and diagnosing presbycusis. The first step of physical examination is palpation of the auricle and visualization, followed by the Weber and Rinne tests and speech testing using standard word lists.

Three intervention-education methods suitable for a presbycusis patient can be developed. The first is to educate patients, coworkers, and caregivers on the prevalence of age-related hearing loss. They will also be educated on the significance of early detection. The use of hearing aids is the second type of intervention. These will be delivered following a consultation with an audiologist who will do a hearing aid evaluation. The third intervention measure is surgical treatment. This is primarily appropriate when hearing loss is caused by osteosclerosis. “A stapedectomy is surgery to treat hearing loss caused by otosclerosis (Alzhrani et al., 2017).”

Eye Aged-Related Diseases

Glaucoma is one form of age-related retinal and macular disease. Glaucoma occurs when an increase in intraocular pressure can destroy optic nerves and cause blindness. This may cause damage to the optic nerve and lead to loss of vision and even blindness. There are usually no obvious signs at first, but with time, sufferers may realize the gradual failure of their peripheral or side vision. When left untreated, they may experience progressive tunnel vision. It has no evident symptoms, but as it worsens, one may notice a progressive loss of peripheral vision. Various drugs can be used, but in certain situations, surgery is required (trabeculoplasty, the use of a laser to improve fluid flow out of the eye, thereby relieving pressure, trabeculectomy, the creation of a new drainage path in sight under the eyelid). One of the factors is the use of steroid medicine and aging. (Ahmed and colleagues, 2020)

 The second disease is cataracts. It appears as a cloudy eye lens, an otherwise transparent part of the eye. This cloudiness occurs when the protein and water of the eye lens clump. This then obscures the transmission of light. As the condition progresses, vision may be significantly affected, and the patient may undergo a surgical procedure to remove the cataract or the clouded lens and replace it with a clear one. The third disease is macular degeneration. This condition is characterized by losing sight of one’s central vision. It is not common for people with macular degeneration to go blind completely. However, it becomes difficult for them to perform daily activities such as reading and driving.

“Diabetic retinopathy is the primary cause of new blindness in Americans in their forties and fifties. It is also a leading cause of vision morbidity in the elderly (Quillen, 1999).” The prevalence of diabetic retinopathy increases with diabetes duration. Significant diabetic retinopathy, on the other hand, may be detected in the elderly at the time of diagnosis or in the first few years of diabetes. Diabetic retinopathy is classified as either non-proliferative or proliferative. Non-proliferative diabetic retinopathy is distinguished by retinal circulation abnormalities such as microaneurysms, intraretinal hemorrhages, cotton-wool spots, retinal edema and exudates, and intraretinal microvascular abnormalities. Macular edema is the most prevalent cause of vision loss in non-proliferative diabetic retinopathy. Macular edema patients may be asymptomatic or complain of impaired or distorted central vision. Ophthalmoscopic examination reveals retinal thickness, frequently accompanied by lipid exudate, microaneurysms, and intraretinal hemorrhages.

References

Ahmed, T., Zulfiqar, A., & Ishaq, S. (2020). Age-Related Diseases. Nutrients and Nutraceuticals for Active & Healthy Ageing, 27–51. https://doi.org/10.1007/978-981-15-3552-9_3

Alzhrani, F., Mokhatrish, M. M., Al-Momani, M. O., Alshehri, H., Hagr, A., & Garadat, S. N. (2017). Effectiveness of stapedotomy in improving hearing sensitivity for 53 otosclerotic patients: retrospective review. Annals of Saudi Medicine, 37(1), 49-55. https://doi.org/10.5144/0256-4947.2017.49

Panza, F., Solfrizzi, V., & Logroscino, G. (2015). Age-related hearing impairment—a risk factor and frailty marker for dementia and AD. Nature Reviews Neurology, 11(3), 166–175. https://doi.org/10.1038/nrneurol.2015.12

Quillen, D. A. (1999, July 1). Common Causes of Vision Loss in Elderly Patients. AAFP. https://www.aafp.org/pubs/afp/issues/1999/0701/p99.html

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