An impairment of one or more senses can occur in clients of any age, in addition to the aging process causing a decline in all sensory functioning. Sensory impairments, especially vision and hearing impairments, can impact the way a person navigates through the environment and thus increases their risk for falls. Refer to Chapter 11.8, “Neurological System” for additional information about sensory impairments. Information regarding communicating with individuals affected by sensory deficits can be found in the Chapter 1.3, “Strategies for Communicating With Patients With Impaired Hearing, Vision, and Speech” subsection. Interventions that can be performed by nursing assistants to reduce safety risks are described below.

Visual Impairment

The human eye changes around age 40 and decreases an individual’s ability to see close-up objects clearly and makes reading more difficult, although distance vision remains intact. Depth perception also becomes distorted, meaning the person cannot accurately determine the distance between themselves and another object.

Other eye conditions may occur with age that impair vision. Some people develop cataracts, a clouding of the clear lens of the eye. Cataracts can be observed in a person’s eye by the appearance of a cloudiness in their pupil. See Figure 9.13^[1] for a simulated image of a person with cataracts.

Glaucoma is a visual condition caused by elevated pressure on the optic nerve, resulting in loss of peripheral vision, blind spots, or even blindness across the entire visual field.

Macular degeneration is another visual condition that results in a blind spot in an individual’s center field of vision. It is the leading cause of vision loss in people over 50. See Figure 9.14^[2] for a simulated image of what a person with macular degeneration may experience.

The Snellen chart is a common tool for assessing distant vision.^[3] See Figure 9.15^[4] for a simulated image of how a person with 20/20 vision sees the Snellen chart compared to simulated visual experiences of those with levels of low vision and blindness.

The simplest interventions for maintaining safety for clients with visual impairment include ensuring they are wearing their prescribed eyeglasses, the glasses are clean, and their living areas are well-lit. There should be no clutter, area rugs, or other small objects on the floor or in a direct path to the bathroom, closet, or exit door of the room to prevent tripping. Keeping the room and personal belongings arranged in a consistent manner allows residents to remain aware of the room set-up, making it easier for them to navigate despite impaired vision. If their visual impairment is severe, tell them where personal items are located before leaving the room, especially the call light and frequently used things like facial tissue, beverages, television remotes, or phones. When ambulating a resident with poor vision, tell them when they are getting close to an object that could pose a fall risk.

Hearing Loss

The most common form of hearing loss occurs as a natural part of aging and is called presbycusis. This type of hearing loss is typically worse at higher frequency sounds, so it interferes with speech recognition and music appreciation. Men tend to experience greater hearing loss than females, perhaps because they have historically worked in louder environments, but it is unknown how much the differences in hearing between genders are caused by biological or social factors.^[8]

Hearing can impact an individual’s safety risks. For example, the sense of hearing allows a person to locate objects around them making noise without much conscious thought. For example, sounds like fire alarms or ambulance sirens warn people of emergencies. To understand how sound affects safety, try wearing noise-canceling headphones or earplugs while seated in a populated, busy area. Notice how the lack of hearing changes your perception of movement and the location of objects in your environment.

To assist individuals with hearing loss, use other senses, such as vision and touch, to aid in communication. Stand directly in front of the person when you are speaking, use appropriate gestures to guide actions, and use a light touch to gain their attention or assist in movement. People with hearing loss may become frustrated if they are unable to communicate effectively and may withdraw from interaction with others if hearing loss is profound. Be sure to utilize communication techniques described in the Chapter 1.3 subsection “Impaired Hearing” to prevent isolation.

Hearing aids make sounds louder but do not help in every environment. Even with hearing aids, it can be difficult for individuals to hear a conversation in a large open space or if there is other background noise such as music, television, or other conversations.

If a resident has hearing aids, be sure they are cleaned regularly, and change the batteries once a week. Wax can be removed with a monofilament tool provided with the hearing aids. Some hearing aids have rechargeable batteries that should be charged each night while the resident sleeps. See Figure 9.16^[9] for a hearing aid in a case with a battery and a cleaning tool.

Hearing aids are expensive for residents to purchase, so it is important to always handle them with care and store them in an appropriate place, so they are not lost. If you are unsure of how to fit a hearing aid into a resident’s ear, ask for assistance from the nurse. Hearing aids can fit completely inside the ear or over the top of the ear. See Figure 9.17^[10] for an example of a hearing aid that is placed over the top of the ear and Figure 9.18^[11] for a simulated hearing aid placed inside a mannequin ear.

Speech Impairment

Speech impairment is common for individuals who have had a stroke or who have experienced injuries to certain parts of their brain. These injuries can make forming words and understanding conversations difficult. The medical terms for these conditions are expressive aphasia and receptive aphasia.

People with aphasia can become very frustrated. Everyone has experienced a time when they were trying to think of a word but couldn’t remember it. Imagine how it would feel if this was your experience every time you were trying to communicate with someone. Just as can happen with people with hearing loss, clients with aphasia may isolate themselves, avoid interaction, or become agitated and even aggressive if not approached appropriately.

Interventions when working with a client with a speech impairment include allowing the person extra time to form words or to process what was spoken to them. The feeling of being rushed can make aphasia worse, so providing ample time to process and respond is key. Writing conversations on a whiteboard may also be helpful, depending upon the cognition of the person.

A speech therapist plays an integral role in assessing a resident with aphasia and creating a communication plan. A communication book may be created so the person can point to images of common phrases or requests instead of trying to remember or say the words. See Figure 9.19^[13] for an example of a communication board. Refer to the Chapter 1.2, “Overcoming Communication Barriers” subsection for additional information on overcoming barriers.