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Neurological and Sensory Changes
The brain size and weight decrease with age. Cognition is not impaired, but reaction time is slower, and elders may take longer to process information. There may be a modest decline in short-term memory, called “age-associated memory impairment” or “benign senescent forgetfulness” (Miller, 2004). All sensory organs show some change by the age of 70. There is a higher sensory threshold and a decrease in sensory acuity. Vision changes include diminished acuity and accommodation, decreased depth perception, delayed dark to light adaptation, and increased sensitivity to glare (Cacchione, 2004). Hearing loss starts with high-frequency loss and progresses to difficulty in understanding verbal communications. Sensory changes often affect older patients’ communication abilities, and they can result in misunderstanding and frustration (Wallhagen, 2002). Provide large print or audio directions, or invite family to assist with communication. The ability to taste and smell also gradually diminishes. Even the sensation of pain is altered, and the usual signs and symptoms of pain may not be present. The sense of balance may also be altered Woollacott, 2000). Clinical Alert. Vision and hearing loss may interfere with learning or following instructions. Describe the environment and ask whether the patient can see objects. Be patient, speak clearly, and establish eye contact. Focus on the “better side;” avoid shouting; lower the pitch of the voice; and use gestures, pictures, and diagrams. Assess that patients understood the directions by asking them to repeat what was said. Explain that they may have difficulty hearing instructions because they may not be facing the technologist. Be aware of environmental factors such as lighting, temperature, and noise levels. Be especially careful when asking older patients to step on and off equipment because they may misjudge the distance to the floor. Be alert to signs of pain or discomfort, especially in situations when pain would be expected.
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