As we age, it is common to experience vision and hearing loss. However, older adults should know the difference between changes that are normal and those that are not.
Vision changes common with the natural aging of the eye include difficulty seeing objects clearly, even close up; a decline in colour sensitivity, such as being able to distinguish colours such as blue from black; and the need for more light when reading. Often these can be corrected with a new prescription for glasses or improved lighting. These changes should be distinguished from the common eye diseases and conditions that affect older adults which include age-related macular degeneration (AMD), cataract, diabetic retinopathy, glaucoma, and dry eye.
Hearing loss includes difficulty understanding speech, especially if the speech is distorted or embedded in noise; problems related to localizing sound; being able to hear with both ears; and increased sensitivity to loudness. Presbycusis, or normal age-related hearing loss, worsens slowly, affects both ears, but usually only results in difficulty hearing high-pitched sounds. Hearing loss is due to three causes:
• Degeneration of the cochlea or inner ear, called peripheral hearing loss.
• Central hearing loss due to brain disease, occurring much less frequently.
• Conductive hearing loss in the middle and outer ear, which is the most common type of hearing loss. This can occur due to extreme wax build-up.
In addition, vision and hearing loss may result from changes to a vulnerable brain, for example a brain not fully operational because of blood vessel disease.
Good vision and hearing are connected to brain health. Three possible causal processes have been identified:
• Cognitive load, when you can see or hear well. The brain is receiving clear signals and is not forced to work harder to derive meaning from the message.
• Individuals who are socially engaged prevent diminished cognitive stimulation and cognitive loss. People with vision and hearing problems are more likely to become isolated.
• Hearing and seeing well helps avoid brain shrinkage, mostly of the hearing portion of the brain, which also is involved in functions like memory, learning and thinking.
What you can do to
protect your vision
According to the CNIB Foundation, the following strategies can help maintain good vision and avoid eye diseases:
• Quitting smoking. Through adopting this strategy, you will reduce the risk of developing age-related macular degeneration, diabetic retinopathy and cataracts.
• Improving your diet and maintaining a healthy weight. This reduces the risk of developing age-related macular degeneration.
• Reducing sunlight exposure. This protects the eye’s retina and reduces chances of developing age-related macular degeneration and cataracts. When out in the sun, wear sunglasses with 100 per cent UV protection, even in winter.
• Preventing diabetes, for example through physical activity, reduces your risk of many kinds of vision loss, including diabetic retinopathy.
• Managing diabetes (if you already have it), significantly lowers your risk of developing diabetic retinopathy. It’s particularly crucial if you have type 1 diabetes to control your blood pressure, sugar, and lipid (fat) levels.
• Drinking in moderation reduces the risk of developing cataracts.
• Taking steps to avoid eye injuries. Injuries including a hard blow, puncture, cut, intense heat, or a chemical burn may lead to cataracts. Wear eye protection when doing sports, home repairs, or other activities that could put your eyes at risk. You should also work in a well-ventilated area if you are using chemicals.
• Getting regular eye exams. These increase the likelihood of catching age-related eye diseases in the early stages, where they often have no noticeable symptoms.
Lifetime investing in good hearing can be achieved by lowering the volume and turning off music when not actively listening. Wearing hearing protection when using power tools or travelling on subways and trains is also helpful. Playing a musical instrument throughout adulthood can help maintain listening skills, including understanding what a person is saying in noisy environments.
If your hearing quality has already decreased, you can work on becoming a more effective communicator by taking charge of your communication assertively. Ways to achieve this involve asking people to get your attention before speaking to you, suggesting that they face you, and asking them not to shout. Other techniques include learning to use strategies for handling communication breakdowns, such as knowing when to ask for a ‘rephrase’ instead of a ‘repeat,’ and how to apply a clarification strategy. Put simply, learn how to ask questions.
Is visual loss an issue for me?
You can assess the quality of your vision if you have difficulty seeing objects clearly, a decline in sensitivity, such as not being able to distinguish colours, or needing more light in order to see.
Is hearing loss an issue for me?
If any of the following statements apply to you, then you may have difficulty hearing and should be seeking help from a health practitioner:
• You sometimes feel embarrassed when you meet new people because you struggle to hear.
• You feel frustrated when talking to members of your family because you have difficulty hearing them.
• You have difficulty hearing when someone speaks in a whisper.
• You feel restricted or limited by a hearing problem.
• You have difficulty hearing when visiting.
• A hearing problem causes you to attend faith organization services less often than you desire.
• Hearing problems cause you to argue with family members.
• You have trouble hearing the TV or radio at levels that are loud enough for others.
• You feel that any difficulty with your hearing limits your personal or social life.
• You have trouble hearing family or friends when you are together in a restaurant.
Who can support me?
You and your family can work together to make vision and hearing easier. Telling your family and friends that you are experiencing vision or hearing loss will allow these people to support you better. If you have poor vision, ask your friends and family to ensure good lighting in the places where you meet. If you have poor hearing, ask your friends and family to face you when they talk to you so you can see their faces. You can also ask people to speak more clearly and loudly, but not shout. Eliminating other background noises around you can also make it easier to hear people speaking to you. Working together to see or hear better may be tough on everyone for a while, but is worth the effort.
In the community
In addition to health charities who provide services to those with hearing and vision impairments, you might also consider help from your peers. Seeking out others in the community who share in visual and hearing difficulties will enable them to relate and empathize with you better than others might.
In the health service
If your poor vision or hearing persists despite seeking help from your family, friends and community, it might be time to consult a professional. For hearing problems an audiologist is the first person to consult. If wax buildup is not causing the problem, they will start the process of assessing the benefit that a hearing aid and support service could offer.
It is important not to see the hearing aid as simply a piece of technology. It takes time to adjust to the hearing aid and to learn how to use it. The audiologist can also advise on the need for specialist advice or referral to an ear, nose, and throat department. Audiologists can also educate you on ways to improve communication in difficult listening situations.
For visual problems, see an optometrist. For sudden loss of vision in one or both eyes, go straight to a hospital emergency department. People aged over 50 should be seeing an optometrist regularly, and the common age-related problems will be detected at these visits.
If you have diabetes type 1 or 2, you will be receiving separate invitations for screening to detect retinopathy. If the optometrist thinks specialist advice and assessment is required, they will make the necessary arrangements.
Larry W. Chambers has authored 175 articles and books concerning disease prevention (e.g. dementia), quality improvement in long-term care homes and innovative approaches for continuing professional development. He is research director of the Niagara Regional Campus, School of Medicine, McMaster University. Madeleine Smith is a medical student at the Niagara Regional Campus, Michael G. Degroote School of Medicine, McMaster University.