Sensory impairment affects up to two-thirds of the geriatric population. Identification, evaluation, and treatment of these conditions (Table 45-1) may improve patients’ quality and quantity of life. The impact of sensory impairments is significant. The same objective level of sensory function can result in different levels of disability depending on the needs and expectations of patients. Poor hearing is associated with depression as well as decreased quality of life; poor mental health; and decreased physical, social, and cognitive functioning. Vision impairment increases the risk of death and is associated with an elevated risk of falling and hip fracture, depression, medication errors, and problems with driving.
Table 45–1.Differential diagnosis of geriatric hearing and vision impairment.a ||Download (.pdf) Table 45–1.Differential diagnosis of geriatric hearing and vision impairment.a
|Hearing Impairment ||Vision Impairment |
|Presbycusis ||Presbyopia |
|Cerumen impaction ||Age-related macular degeneration |
|Noise-induced hearing loss ||Glaucoma |
|Central auditory processing disorder ||Senile cataract |
|Otosclerosis ||Diabetic retinopathy |
|Chronic otitis media ||Central retinal artery or vein occlusion |
|Glomus tumor or vascular anomaly ||Posterior vitreous or retinal detachment |
|Cholesteatoma ||Vitreous hemorrhage |
|Autoimmune hearing loss ||Temporal arteritis |
|Perilymph fistula ||Optic neuritis |
|Ménière disease ||Corneal pathology |
|Acoustic neuroma ||Iritis |
Research has yet to demonstrate that community-based screening of asymptomatic older people results in improvements in vision or hearing. The US Preventive Services Task Force (USPSTF) and the American Academy of Family Physicians (AAFP) recommend screening for hearing difficulties by questioning elderly adults about hearing impairment and counseling them regarding the availability of treatment when appropriate. In a 2009 update, AAFP and USPSTF concluded that there is inadequate direct evidence that screening for impairment of visual acuity by primary care physicians improves functional outcomes in elderly; yet there is adequate evidence that early treatment of refractive error, cataracts, and age-related macular degeneration (AMD) improves or prevents loss of visual acuity.
COMMON CAUSES OF HEARING IMPAIRMENT IN THE ELDERLY
Presbycusis is the most common form of hearing loss in the elderly, although it often goes unrecognized. It occurs more frequently with advancing age and in patients with a positive family history. This multifactorial disorder is due to a combination of structural and neural degeneration and genetic predisposition. Risk factors for presbycusis include noise exposure, smoking, and medications such as aminoglycoside antibiotics, loop diuretics, and cardiovascular risk factors such as hypertension. Presbycusis is a diagnosis of exclusion.
Until the exact pathophysiology of presbycusis is understood, attempts at prevention will be limited. Limitation of noise exposure may reduce the hearing loss. Although several studies have evaluated the role of vitamins, antioxidants, smoking cessation, ...