The Second Fifty Years Promoting Health and Preventing Disability (1992) / Chapter Skim
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Preventing Disability Related to Sensory Loss in the Older Adult
Preventing Disability Related to Sensory Loss in the Older Adult
Pages 101-118
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From page 101... ...
From a practical point of view, impairments in these two areas are potentially preventable as are the associated disabilities and handicaps.633 Limiting this chapter to sight and hearing also allows for development of an agenda for preventing sensory impairment and associated disability or handicap that reflects current knowledge. It is not intended to suggest that other sensory Tosses do not deserve careful attention.
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From page 102... ...
According to this measure, preliminary data indicate that approximately 13 percent of noninstitutionalized Americans aged 65 and older have some form of visual impairment.23 Of this group, 8 percent suffer with a severe impairment, which is defined as the inability to read newsprint even with glasses.39 The severely impaired therefore also include those who are blind in both eyes.39 The survey reports that 3.2 percent of respondents reported blindness in one eye, and 1 percent reported blindness in both eyes.23 Legal blindness, on the other hand, is defined as 20/200 vision or worse. (An eye with 20/ 200 vision sees at 20 feet that which an eye with 20/20 vision can see at 200 feet.)
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From page 103... ...
ETIOLOGIC BREAKDOWN Visual impairments The leading causes of visual impairment among the elclerly are cataracts, glaucoma, macular degeneration, and diabetic retino
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From page 104... ...
Overall, people with significantly increased ocular pressure are seven times more likely to develop glaucoma than those with normal intraocular pressure.43 Accurate figures for the prevalence of macular degeneration floss of central vision in both eyes, frequently characterized by spots of pigmentation and other abnormalities as a cause of blindness are not available; however, data pooled from the National Health and Nutrition Examination Survey and the Framingham Eye Study indicate that it is a leading cause of blindness among older adults. The incidence of macular degeneration increases with age especially after the age of 50.~6 Prevalence estimates in the 65- to 75-year-old age group are 6.9 percent in white females, 11.4 percent in black females, 9.6 percent in white males, and 9.3 percent in black mates.
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From page 105... ...
in case-control studies.~5 Generally, visual loss is caused by an ingrowth of choroidal neovascularization and the formation of round or oval macular scars. Unlike visual impairment that results from cataracts and glaucoma, visual impairment that results from macular degeneration usually occurs suddenly.
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From page 106... ...
O 59 65 3440 4349 51-57 :: MEN ~C\~o ! I I I O l // / 1 1 1.5K 2K 3K 4K 6K OK 250 500 1 K : ~ _ Age groups O 1 ~24 · 26 32 ~ 3440 · 43 49 · 51-57 0 59 65 WOMEN ~0 Jfi~ GO 1 K 1 .5K 2K 3K 4K OK OK 250 500 FIGURE 7-2 Mean threshold values for hearing pure tones as a function of frequency for men and women in six different age groups.
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From page 107... ...
Thus, as with visual loss, the specific etiology of hearing loss is important in structuring preventive strategies. DISABILITIES ASSOCIATED WITH SENSORY LOSS The burden imposed on the elderly by the two specific sensory impairments discussed in this chapter has been inadequately studied.
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From page 108... ...
Two studies that consider social isolation among elderly individuals with either visual or hearing impairments conclude that these sensory deficits play a role in such isolation.24 58 The finding is strengthened by the observation that more severe hearing impairment is associated with greater degrees of social isolation.58 (In this study social isolation was measured with the Subjective Isolation Scale and the Objective Isolation Scale of the Comprehensive Assessment and Referral Evaluation.2i The measurement criteria for social isolation of the other study24 are available in the text.) Neither study, however, measures social isolation in a control group, although both use multiple regression to control for potentially confounding variables such as age and type of activity.
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From page 109... ...
These issues are further obfuscated by a contradictory cohort study among elderly hospitalized psychiatric patients in England that did not show the expected association between paranoid and affective disorders and sensory deficits.34 This study has methodological limitations, however, similar to those aIreacly mentioned. Thus, the relationship between sensory impairments and serious psychiatric illness is only suggestive at best.
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From page 110... ...
and Instrumental Activities of Daily Living fIADLs) are short lists of basic activities considered useful in measuring the progress of recovery or diminution of basic human function.
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From page 111... ...
The lack of standards for determining which age groups to study and the lack of criteria to define sensory impairments and the nature and severity of the resulting disabilities make comparison across studies difficult. Therefore, although the relationship between sensory impairment and physical, emotional, or cognitive disabilities is intuitively obvious, it is impossible to make definitive statements regarding that relationship at this time.
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From page 112... ...
i,25~55 Studies correlating perceived handicaps with pure tone audiometry indicate that the perception of a handicap correlates best with pure tone Tosses above 40 dB among the elderly. Perceived disability may be related to educational level, as well as economic status and participation in activities.56 Preventing disability or handicap from sensory impairment in vision or hearing therefore cannot rely solely on screening strategies.6 43 Theoretically, disability can be prevented by restoring the lost sense, which is the guiding principle of the strategy in senile cataracts and presbycusis.
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From page 113... ...
3. The development of uniform criteria for the definition of individual sensory impairments (e.g., hearing impairment, visual impairment)
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From page 114... ...
2. Uniform measurements of disability as well as handicap related to individual and multiple sensory impairments should be developed.
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From page 115... ...
7. Patients should be taught the signs and symptoms of sensory impairment particularly those related to hearing and visual impairment.
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From page 116... ...
L., Reed, M., et al. Acquired hearing loss and psychiatric illness: An estimate of prevalence and co-morbidity in a geriatric setting.
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From page 117... ...
M., et al. Hearing loss in the elderly: An epidemiologic study of the Framingham Heart Study Cohort.
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From page 118... ...
E., and Amsel, L Hearing loss and senile dementia in the institutionalized elderly.
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