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INTRODUCTION

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, dependency, and problems with driving.

Table 45–1.Differential diagnosis of geriatric hearing and vision impairment.a

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) (2012) concluded that there is insufficient evidence to assess the balance of benefits and harms of screening for hearing loss in asymptomatic adults aged 50 years or older (I recommendation). The American Academy of Family Physicians (AAFP) recommends screening persons older than 60 years for hearing loss during periodic health examinations (Strength of Recommendation Taxonomy [SORT] C). 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 the 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

ESSENTIALS OF DIAGNOSIS

  • Age-related high-frequency sensorineural hearing loss.

  • Difficulty with speech discrimination.

General Considerations

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.

Prevention

Until the exact pathophysiology of presbycusis is understood, attempts at ...

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