When Vision and Hearing Fail: Dual Sensory Impairment Among Older Adults
By Mark Brennan, PhD
The special circumstances of dual sensory impairment in later life, or concurrent impairment of vision and hearing, have largely been ignored. With funding from the AARP Andrus Foundation, researchers at Lighthouse International completed a study on the consequences of the loss of both vision and hearing in older adults.
Vision and hearing impairment are among the most prevalent chronic health conditions affecting older adults, with over one-third reporting vision loss and two-fifths reporting hearing impairments. Not surprisingly, dual sensory impairment is not uncommon, and affects approximately one in five US adults age 70 and older. Members of racial or ethnic minority groups are at greater risk for both single and dual sensory impairments.
What We Learned
Study results showed that vision impairment alone or in combination with hearing loss was linked with greater physical and social difficulties and increased medical care, even after adjusting for the effects of age and other physical and mental health problems. For example, vision impairment generally increases difficulty performing everyday activities of living, (e.g., dressing, using the telephone, preparing meals). But higher degrees of dual impairment over vision impairment alone were found to increase the risk of having problems preparing meals, shopping, using a telephone, getting dressed, and getting in and out of bed. Both dual sensory loss and vision impairment alone predicted diminished functional ability over time.
Both vision and hearing impairment alone were associated with a greater risk of falls and poorer physical functioning. However, dual sensory impairment contributed to a greater risk of falls over and beyond that accounted for by single sensory losses. In addition, dual sensory impairment was the only consistent predictor of changes in physical functioning over time compared to a single impairment in hearing or vision. Thus, a more pronounced risk of falls and poorer physical functioning was found among older adults experiencing dual sensory loss, especially among those with higher levels of impairment.
Older adults with dual sensory loss are, not surprisingly, more likely to receive help from family and friends with tasks of daily living compared to those without impairments or hearing loss alone. And those with dual sensory loss were more likely to have increased levels of such help over time. This effect was more pronounced for instrumental activities (e.g., housekeeping, preparing meals) as compared with personal activities (e.g., bathing, dressing).
However, there was little increased likelihood of receiving this type of help among older adults with dual impairments compared to those with single impairments in vision. In general, older adults with dual sensory loss did not exhibit many significant differences in social activities or participation in their informal social networks of family and friends as compared to those with a single impairment or those with none. But both older adults with dual impairment and those with vision impairment only were more likely to retire and live with others due to health reasons compared to their peers.
Dual sensory impairment had little effect on the use of community-based services, but was related to health care utilization. However, the relationship between sensory impairment status and health care use was complex, and depended on whether the older adult had survived over the six-year course of the study.
In general, among respondents who had survived, dual sensory impairment was related to a greater number of short-term hospital episodes relative to no impairment or single impairments. In addition, among survivors, dual sensory impairment was related to a greater number of doctor visits and an increase in the number of doctor visits over time, but was not related to nursing home use.
In contrast, among decedents (i.e., those who died over the course of the study), dual sensory impairment did not increase the likelihood of hospital episodes or physician visits over single sensory loss, but was related to a greater likelihood of nursing home use before death.
In Conclusion
These findings illustrate the far-reaching impact of sensory impairment status on the quality of life of older adults. The effects of vision loss and dual sensory impairment were especially noteworthy in areas related to independent living, such as functional ability, physical functioning and falls. The negative effects of sensory impairment highlight the need to address sensory functioning as part of the regular clinical assessment process for older adults. Such findings also underscore the need for expanded educational, rehabilitation and outreach programs for elders with concurrent vision and hearing impairments to support them in efforts to remain independent and living in their communities.
Mark Brennan, PhD, is a Senior Research Associate, Arlene R. Gordon Research Institute, Lighthouse International, New York, NY.
Reference:
"Dual Sensory Impairment Among the Elderly," funded
by the AARP Andrus Foundation. Amy Horowitz, DSW, Principal
Investigator; Mark Brennan, PhD, Co-Investigator, Ya-ping Su, PhD, Data
Analyst.
Source: Lighthouse International's Aging & Vision newsletter (Fall 2002 issue)
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