Evaluation and Management of Vision Decline in an Older Adult Essay

Case Study Case A 79-year-old male remarks on his first visit that he has noticed a gradual decrease in vision in both his eyes since last year. His old medical record has not yet arrived at your office. He states that since he moved from Florida a year ago, he has not had an eye examination and does not yet know an ophthalmologist. He is having difficulty carrying on his activities of daily living that involve his sight. He states that he cannot recognize people at some distance until they come quite close, and he is often frightened by his perception of strangers speaking to him. Watching television and reading are becoming increasingly difficult for him. He states that glare is a problem and notes that a few times he almost tripped over something on the floor. He still drives his car in the local community. He asks if you think he may have a cataract. He says his wife had two cataracts in the past and he remembers her complaining of vision problems which have now been resolved. Vital Signs: BP 128/84; HR 82; RR 18; BMI 24. Evaluation and Management of Vision Decline in an Older Adult Essay

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Chief Complaint: Decrease in my vision; glare is very bothersome!

Questions

What additional subjective data are you seeking, including relevant family and social history?
For what additional objective data will you be assessing?
What national guidelines are appropriate to consider? Kennedy-Malone Advanced Practice Nursing in the Care of Older Adults, 2e
What diagnostic tests will you order?
What are the differential diagnoses that you are considering?
What is your plan of care? Discuss additional resources as well that you will consider with this patient?
What additional patient teaching may be needed?
Will you be seeking consultation and if so, what will you request?
What additional considerations are you thinking about due to the age of this patient? Would your plan of care or patient teaching be different if this patient was younger?

Introduction

This research is focused on a man, 79 years old, who has been diagnosed with progressive vision loss, difficulty in daily activities due to glare or poor visual recognition and anxiety related to cataract formation. He is also worried about the possibility of developing a cataract in future. In addition, all things required and other subjective and objective information are addressed in this comprehensive review, including relevant social and family background, national guidelines, diagnostic tests, possible variations in diagnosis, treatment plans, education and consultation needs, and age-related concerns. Evaluation and Management of Vision Decline in an Older Adult Essay

Additional Subjective Information

The whole concept of interpreting the patient’s medical condition from a subjective point of view should be carried out by considering numerous factors (Cai et al., 2021). All these can range from chronic illnesses and drugs used, any previous surgical procedures done on the eyes or those which have been performed on members of the family having ocular problems, for example. It is important to examine the wife’s experience with cataracts to know what they might be predisposed to genetically. Similarly, it is through examining his social history that we can understand how public elements around him are visually impairing him. This entails considering the lifestyle circumstances of a patient and 3his support system, as well as any recent changes, like deciding to move away from Florida.

Objective Data Assessment

Besides carrying out a full ocular examination with objective data evaluation your duty, you are supposed to perform a complete ocular examination so that you have a sightedness test: A slit lamp examination, measure intraocular pressure measurement or fundoscopic examination, among others. Fundoscopic examinations are also carried out at some point throughout this process. The evaluation process should focus on colour vision assessment, including glare sensitivity testing and contrast sensitivity. The other most important component during such evaluations is assessing if they can perform activities of daily living. In addition, there must be a thorough physical examination of any medical condition that contributes to loss of vision. Evaluation and Management of Vision Decline in an Older Adult Essay

National Guidelines

The American Academy of Ophthalmology (AAO) provides guidelines on diagnosing and treating age-related eye diseases such as cataracts in older adults. These recommendations are based on scientific evidence and aim to help choose the most appropriate action. These recommendations should guide the treatment of these diseases. Early diagnosis is important, and the need for a comprehensive evaluation and selection of suitable therapy alternatives that are designed to meet the specific needs of individual patients is highlighted throughout this guide. In addition, they stress the need for a full examination.

Diagnostic Tests

Several different tests can be done in diagnosing eye conditions. One of these is a comprehensive eye examination. This might include testing for visual field, OCT imaging and the option of referring to more specialized evaluations such as electroretinography (ERG) or fluorescein imaging. The first examination on the look of the patient assists in making sure whether this would be appropriate.

Differential Diagnoses

Besides cataracts, AMD, retinopathy for diabetes, disorders for corneal or glaucoma may also be considered. Differential diagnosis stands for cataracts. Based on the symptoms of this patient and his family history, it is most likely that cataracts caused his condition. The existence of a cataract is thus crucial in this particular case. It is vital to perform examinations for correct diagnosis and treatment approaches.

Plan Of Care

The treatment plan’s major goal should be to manage the present issues facing the patient; however, it should consider the patient’s vision from a long-term perspective and possible outcomes they may have throughout their life. After assessing all the details of this situation, sending him to an ophthalmologist for further investigation may be necessary. If there is a need to do so, cataract surgery could be an alternative route. Moreover, other comorbidities like diabetes and hypertension must be under control; otherwise, optimum healthy eyes can not be guaranteed. Evaluation and Management of Vision Decline in an Older Adult Essay

Additional Resources and Patient Teaching

To promote patients’ involvement in their healthcare provision, they could benefit from being provided with information about their eyesight. This is called one way: nothing but informing them about eye healthcare services available. Some of these include knowledge of cataracts, ageing-related changes in vision, and ways to minimize glare and vision impairment. Furthermore, the patient can adjust to the changing vision through the connections established between him and local resources like the low-vision rehabilitation programs that will improve his independence level.

Consultation Needs

In dealing with age-related vision loss and potential side effects, it is recommended that a multidisciplinary team, including an optometrist, ophthalmologist and probably a low-vision specialist, be involved. Hence, it is highly suggested to consult this group. If several healthcare providers work together it can be possible to give comprehensive care coordination and meet all needs of a patient. Some of these could include primary care physicians or geriatricians.

Considerations Due to Age

Adults over 65 may have cataracts resulting from ageing and can cause severe visual impairments. Thus, treatment plan must be adjusted to accommodate altered physiological functions due to aging process, decreased cognitive abilities and potential limitations in functional capacities. Every patient’s instruction should be written in very simple language and available to everybody (Thomas et al., 2020)Evaluation and Management of Vision Decline in an Older Adult Essay . Furthermore, addressing any cognitive or hearing problems the patient might have been necessary.

Conclusion

Treatment and examination of vision loss among older people requires a comprehensive interdisciplinary approach (Meisner et al., 2020). The above data should be obtained through extensive quantitative and qualitative measures using established standards, testing out the right diagnostic tests and comparing possible divergences, and implementing an individualized care program so that health practitioners can respond adequately to changes in the peripheral view of seniors. A patient has to be informed properly about their condition; moreover, collaboration with other healthcare specialists is needed when treating patients with impaired sight; plus, there is the need to consider age-related factors.

References

Cai, T., Verze, P., & Bjerklund Johansen, T. E. (2021). The quality of life definition: where are we going?. Uro, 1(1), 14-22. https://www.mdpi.com/2673-4397/1/1/3

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Meisner, B. A., Boscart, V., Gaudreau, P., Stolee, P., Ebert, P., Heyer, M., … & Wilson, K. (2020). Interdisciplinary and collaborative approaches needed to determine impact of COVID-19 on older adults and aging: CAG/ACG and CJA/RCV joint statement. Canadian Journal on Aging/La revue canadienne du vieillissement, 39(3), 333-343. https://www.cambridge.org/core/journals/canadian-journal-on-aging-la-revue-canadienne-du-vieillissement/article/interdisciplinary-and-collaborative-approaches-needed-to-determine-impact-of-covid19-on-older-adults-and-aging-cagacg-and-cjarcv-joint-statement/03B29D0C79593F913A6F9DA46F637008

Thomas, W., Varley, J., Johnston, A., Symington, E., Robinson, M., Sheares, K., … & Besser, M. (2020). Thrombotic complications of patients admitted to intensive care with COVID-19 at a teaching hospital in the United Kingdom. Thrombosis research, 191, 76-77. https://www.thrombosisresearch.com/article/S0049-3848(20)30144-4/abstract Evaluation and Management of Vision Decline in an Older Adult Essay