Family physicians are keenly aware of the joy that comes from interacting with the world around them. Many elderly patients are deprived of parts of this world because of hearing and vision impairment. Sensory impairment affects up to two-thirds of the geriatric population. Identification, evaluation, and treatment of these conditions (Table 44-1) may improve patients' quality and quantity of life.
Table 44-1. Differential Diagnosis of Geriatric Hearing and Vision Impairment.a |Favorite Table|Download (.pdf)
Table 44-1. Differential Diagnosis of Geriatric Hearing and Vision Impairment.a
|Hearing Impairment||Vision Impairment|
|Cerumen impaction||Age-related macular degeneration|
|Noise-induced hearing loss||Glaucoma|
|Central auditory processing disorder||Senile cataract|
|Chronic otitis media||Central retinal artery or vein occlusion|
|Glomus tumor or vascular anomaly||Posterior vitreous or retinal detachment|
|Autoimmune hearing loss||Temporal arteritis|
|Perilymph fistula||Optic neuritis|
|Ménière disease||Corneal pathology|
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. Vision and hearing impairments have been linked with the wish to die in elderly patients. Poor hearing is associated with depression as well as decreased quality of life, mental health, and 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.
Given the functional impact of undetected and untreated sensory impairments, many arguments have been made for population-based screening. 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. Although, in 2009 update, AAFP and USPSTF concluded that there is inadequate direct evidence that screening for impairment of visual acuity by primary care physicians improve functional outcomes in elderly, they found adequate evidence that early treatment of refractive error, cataracts, and AMD improves or prevents loss of visual acuity.
- Age-related high-frequency sensorineural hearing loss.
- Difficulty with speech discrimination.
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 multifactor disorder is due to a combination of structural and neural degeneration and genetic predisposition. Risk factors for presbycusis include noise exposure, smoking, medications like amino glycoside antibiotics, loop diuretics, and cardiovascular risk factors like hypertension. Presbycusis is a diagnosis ...