Hearing changes - external auditory canal atrophies, resulting in thinner walls and increased cerumen buildup; degenerative changes in ossicular joints leading to slower/stiffer movements; loss of hair cells and cochlear neurons in inner ear.

Presbycusis - bilateral loss of high-pitched tones; slightly less severe in women than in men.
Impaired pitch discrimination - after 55 years, makes localizing and understanding sounds difficult; impaired ability to understand consonants.
Decline in speech discrimination - after 60 years, speech intelligibility declines; slowing of memory and slowing of mental processes with advancing age may also affect speech, hearing, and understanding.
Diminished vestibular function - deficits in equilibrium and greater fall risk.

Nursing goal/implementation: improve communication for hearing-impaired person.

Compensate with other senses - face listener; make eye contact if culturally acceptable; get person’s attention before talking; use touch if culturally appropriate; help with hearing aid; avoid walking around room while talking; write down key words if person can read.
Alter stimulus and behavior - speak in normal volume of voice or slightly lower, avoid shouting; use short sentences; separate important words with pauses; allow more time for communication; have person repeat to show understanding; repeat; teach person to be more assertive about impairment.
Modify environment - eliminate or reduce background noise (turn off running water, close doors, lower TV or radio); select areas with sound-absorbing abilities for conversations (carpets, drapes); amplify telephone; allow for adequate light on speaker’s face.

Age-related macular degeneration - leading cause of irreversible and legal blindness for those over 65 yr; blurred far and near vision; loss of central vision; difficulty going up and down steps and stairs; parts of words and letters disappear when reading; straight lines appear to be wavy. Acuity: 20/200 or less

Risk factors: increased age, women, Caucasian, smoking, UV light exposure, diabetes, diet (low in leafy green vegetables and antioxidants).
Prevention: UV light filters, aspirin, vitamins A and B, beta carotene, zinc.
Prognosis: no treatment or cure; laser may prevent spread of AMD in some patients.
Nursing goal: assist patient to maintain independent functioning.

for other causes of visual problems in the older adult, such as stroke, glaucoma, cataracts, and diabetes.

Loss of urinary control - neurological mechanism controlling bladder emptying does not work effectively and results in incontinence; a symptom, not a diagnosis.

Immobility.
Cognitive and functional impairments - Parkinson’s disease, Alzheimer’s disease, multiple sclerosis, alcoholism, stroke, vitamin B deficiency, inability to walk and transfer to toilet.
Medications.
Institutionalization.
Pathological conditions - men: hyperplasia leading to infection, incomplete emptying, urgency, and frequency; women: weakening of pelvic floor postmenopause,
leading to residual urine and infection; atrophy of vaginal and trigonal tissue, leading to frequency, urgency, and incontinence.
Childbirth.

Incontinence - possible symptom of urinary tract infection, impaction, chronic constipation, dementia, inability to walk and transfer by self to toilet, dehydration.
Nursing goal/implementation: minimize incontinence episodes and reduce urinary tract infections.

Regular toileting schedule - every 2 hr, with some exceptions at night; or personalize regimen based on assessment.
Modify environment - location of toilet, good lighting, prompt response to calls for assistance, use of Velcro closures on clothing, raised toilet seats with safety bars.
Monitor fluid intake; adequate hydration - 1-2 L during day; avoid alcohol and caffeine and restrict fluids at bedtime.
Avoid medications contributing to incontinence.
Avoid use of indwelling catheters if possible.
Use usual undergarments; be positive about continence; use absorbent pads to improve perineal hygiene if other measures fail.
Treat constipation.