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Background

Constipation is the most common bowel problem in older adults. The definition varies by patients and health care providers, but generally it means less frequent bowel movements than usual, and those which are hard, dry, and difficult to pass. Constipation is a preventable and treatable problem. Changes that occur with normal aging, such as peristalsis in the gut slowing down or decreased physical activity, predispose older persons to constipation.

Risk Factors/Warning Signs

Constipation is often due to a combination of causes. Some of the risk factors include decreased activity, medications (such as certain pain pills, iron supplements, and calcium supplements), depression, neurological conditions (dementia, Parkinson’s disease, stroke, diabetes mellitus, and spinal cord injury), dehydration, low dietary fiber, metabolic disturbances (such as hypothyroidism), undergoing dialysis, obstruction, and decreased access to the toilet (Halter et al., 2009). The range of “normal” for bowel movements is three times per day to three times per week. A decrease in number of stools that is “normal” for the person and the occurrence of hard, dry stools that are difficult to expel are typical signs of constipation.

Diagnosis

If constipation is severe enough for the person to seek medical care, the patient may complain of abdominal pain and even have symptoms similar to other problems such as an appendicitis or diverticulitis. These more serious ailments can be ruled out through x-rays, CT scan or MRI. The diagnosis is based on clinical presentation, history, and physical examination. It is important to determine the onset and duration of the constipation, along with functional and nutritional status.

Treatments

Before starting a bowel program to prevent constipation, the existing problem should be dealt with. A physician may prescribe laxatives, suppositories, and/or enemas to get the stool moving and eliminated. Many such products can be obtained over the counter as home remedies, but severe and recurrent problems should be referred to the primary care provider for further examination of the cause. After starting with a clean bowel, interventions should focus on lifestyle and dietary modifications. All natural means should be tried first before adding medication to the regimen. This includes regular exercise, establishment of a regular routine for toileting (assure privacy), and encouragement of a high-fiber diet with adequate fluid intake (unless contraindicated)(Joanna Briggs Institute, 2008). Medications may be considered for those who do not respond to lifestyle changes. Residents of nursing homes appear to respond to stimulant laxatives (e.g., senna, bisacodyl) or Miralax. Enemas should not be used on a regular basis because they promote lazy bowel function. Most older persons can avoid constipation if they remain active, have proper nutrition high in fiber, and drink plenty of fluids.
Adapted from Mauk, K. L., Hanson, P., & Hain, D. (2014). Review of the management of common illnesses, diseases, or health conditions. In K. L. Mauk’s (Ed.) Gerontological Nursing: Competencies for Care. Sudbury, MA: Jones and Bartlett Publishers. Used with permission.

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Hearing loss can have a profound effect on a person and their quality of life. Hearing loss can lead to a withdrawal from social situations, signs of depression and other effects on the health of an individual. Therefore, it is imperative that any loss in hearing be treated as soon as possible. In order for hearing loss to be treated, an individual must recognize that a loss of hearing has occurred. Some hearing loss can have a gradual onset, so the person with the hearing loss may not be fully aware that treatment is needed.

According to the National Academy on an Aging Society, millions of Americans suffer from hearing loss. Those suffering from hearing loss range in symptoms from very mild to severe or near total hearing loss. Of these, 43 percent are those individuals aged 65 and older. However, hearing loss can affect all ages with some 5 percent of children having some form of hearing loss. The causes of specific hearing loss are varied, with some created due to occupational stress, or life choices, or those brought about because of aging.

Audiologists and hearing aid specialists at Hearinglife.com lists the types of hearing loss as:

• Conductive Hearing Loss
• Sensorineural Hearing Loss
• Mixed Hearing Loss

Conductive hearing loss is a result of some form of obstruction in the ear. This type can be temporary and usually corrected via medical procedure and occasionally the application of a mechanical aid.

Sensorineural hearing loss is damage or some other issue affecting the auditory nerve or inner ear. This category encompasses hearing loss due to aging or disease. Correction usually involves the application of assisted hearing devices as this loss is usually permanent.

Mixed hearing loss is attributed to directed sound at excessive volume, such as that found in headphones and in occupational settings. Corrective measures also require the use of a mechanical or assisted hearing device. Based on statistics performed by the Centers for Disease Control and Prevention, mixed hearing loss is a widespread concern affecting over 22 million Americans each year. As suggested by the professionals for Kaiser Permanente Health System, they symptoms of hearing loss appear as:

• Muffled Hearing
• Requiring Higher Than Normal Volumes
• Frequently Misunderstanding Spoken Words
• Ringing or Pain in the Ear or Fluid Leakage
• Off Balance or Feeling of Spinning

Any of these, and potentially other symptoms, can occur with hearing loss. Even before hearing loss is suspected, it is generally accepted that hearing should be tested regularly in order to quickly diagnose and treat any hearing loss before it becomes significant to the detriment of the individual and their quality of life.

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