Diabetic retinopathy Diabetic retinopathy is a complication of diabetes. With diabetic retinopathy, the blood vessels in the eye stop working properly. Blood leaking into the eye may also occur. This causes fluctuating and distorted vision and blind spots (scotomas), which may be filled in with hallucinations as the brain struggles to make sense of the visual field. The location and severity of the scotomas depend on the area of the eye affected. People may also have fluctuating symptoms dependent on their blood sugar control that day. They tend to lose peripheral vision and are very sensitive to glare. In terms of lighting, they are moderately sensitive to ambient lighting, and prefer moderate to bright task lighting (Newsham-Beckley, 2016). Macular degeneration Macular degeneration is the most common eye disease in older adults. It is often referred to as age-related macular degeneration. There are two types: dry and wet. It is caused by degeneration of the macula of the eye. Most people have dry macular degeneration where only degeneration is present. Their loss of vision is more obvious under dim lights or with small objects. Wet macular degeneration also involves the formation of abnormal leaking blood vessels; therefore, people may also experience a profound loss of central vision combined with a more progressive loss of overall vision in a shorter time frame. The visual field will contain distorted shapes as a result. Wet macular degeneration is managed with shots to dry up the blood vessels. Regardless of the type of macular degeneration, people lose their central vision first. They will also have difficulties with color vision and experience scotomas in other visual fields. It is progressive, though with proper monitoring and management, the progression can be slowed. They also experience visual hallucinations when the brain tries to fill in the scotomas. Discrimination of colors and facial expressions are also difficult. They prefer bright task lighting to increase the light and are very sensitive to ambient lighting (Newsham-Beckley, 2016). Field cuts and neglects Field cuts and neglects are more common with neurological conditions, such as cerebral vascular accidents and traumatic brain injuries. Field cuts, or homonymous hemianopia, may also develop after surgeries or infections. Field cuts can be in any visual field; people tend to be aware of the cut and learn to compensate for it. However, it is important to know of these cuts because they may dictate the placement of important objects. A field cut is not necessarily full blindness; it can present as increased blurriness in one specific visual field. Neglects, or hemispatial neglect, are caused by neurological injury and result in an inattention to one side. The person may ignore the entire left side of his or her body and environment. In severe cases, when tracking a finger, his or her eyes will follow toward the side of the neglect and bounce back to the other side once the finger hits midline. People typically are not aware of their neglect and require intervention. Clinicians typically place objects on that side to draw the attention in that direction. In terms of aging in place, if it is a chronic neglect that has not remediated, it should be noted so that important objects, such as the telephone, are not placed on the side that does not exist to the person. Neurological conditions Neurological conditions range from primary conditions to symptoms of other disorders. They are frequently associated with cerebral vascular accidents, diabetes, Parkinson’s disease, lumbar stenosis, multiple sclerosis, and carpal tunnel syndrome, to name a few. Neurological conditions impacting older adults can originate from either the central or peripheral nervous system. Neuropathy Neuropathies are either part of the aging process, due to demyelination or vitamin deficiencies, or as part of another condition. Peripheral neuropathy, or tingling and/or numbness in the hands and feet, commonly develops with people who
have diabetes, nerve impingements, carpal tunnel syndrome, multiple sclerosis, and rheumatoid arthritis. At times, it develops without an easily identifiable cause. Numbness, tingling, or pain in people’s hands can cause trouble with manipulation of objects and discrimination of temperature. Neuropathy in feet can place the person at a higher risk of balance deficits and falls. It can also cause the person to have more foot abrasions during functional mobility without their knowledge, which is problematic due to the slower wound healing time associated with diabetes. Pain Pain is considered one of the geriatric syndromes, and unfortunately, is a daily reality for many older adults. The causes of pain range from arthritis and neuropathies to structural changes, such as rotator cuff tears and spinal stenosis. All have a distinct impact on the daily functioning of the person experiencing it. Being mindful of proper body mechanics can prevent future pain development or avoid increasing pain. Pain due to arthritis and rotator cuff tears has already been discussed. Neuropathies and spinal stenosis cause significant pain due to the tingling sensation that can worsen with pressure. Other causes of neuropathies include nerve impingements and carpal tunnel syndrome. People with spinal stenosis will have sharp, electric pains at various points of their back, depending on the location of the narrowing spinal column. It is common in the lumbar region; older adults will experience significant pain that may radiate down their legs during extended standing periods, especially during meal preparation and bathing. Parkinson’s disease Parkinson’s disease is caused by the death of dopamine producing neurons in the substantia nigra portion of the brain. As the neurons die, motor functions become impacted. As many as one million Americans have Parkinson’s disease (Parkinson Association of the Carolinas, 2017). The disease is commonly diagnosed over the age of 50; to be diagnosed under 50 years old is to have early onset Parkinson’s disease. Every person experiences the symptoms differently; however, it is progressive. Special considerations must be made in the environment to support people as they age with this condition. Motor symptoms include a shuffling gait, a resting tremor, flat affect, bradykinesia, and decreased initiation of movement. Multitasking and combining motor functions with other functions, such as cognitive or sensory processing, also becomes more difficult. Righting reflexes lessen, making this group of people at a higher risk of falls. The brain interprets small movements as normal sized, even though the reality is the steps are small and voices are very soft. People with Parkinson’s disease often find it difficult to navigate around objects; turning requires more motor coordination than they may have available to them. They also tend to freeze when changing floorings, traversing thresholds, or when confronted with contrasting colors in floors and carpets. The ability to continue walking cannot occur while they are processing the change in the environment. Fine motor coordination is also impacted with Parkinson’s disease, and most people will develop Parkinson’s dementia. As time continues, the disease progresses to the point where people are no longer able to ambulate themselves and require assistance with all daily activities. Multiple sclerosis Multiple sclerosis is caused by demyelination of the neurons in the central nervous system; it is often diagnosed in young adulthood. Older adults will have had it for many years and will be dealing with the progression of the disease. Because most research has been aimed at the younger population, and multiple sclerosis can be harder to diagnose in older adults, the actual number of older adults living with multiple sclerosis is unknown. Multiple sclerosis symptoms will also vary from person to person; however, people typically will have some motor problems, ranging from decreased fine and gross motor coordination to paralysis of limbs. Along with these symptoms comes decreased balance and a higher risk of falls and injuries during functional mobility, transfers, and standing ADLs. They
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