Hearing and visual impairments.

Abstract

Hearing impairments, with their resultant difficulties in communication function, represent a common chronic condition affecting one third of aged individuals. Loss of hearing ability pervades multiple domains of function in aged individuals, decreasing activity, increasing depressive symptoms, and confounding assessment of cognitive ability. Although they are not curable, hearing impairments are often remediable with appropriate audiologic evaluation and the prescription of amplification devices. The role of the geriatrician in managing hearing impairment is to recognize its presence, provide appropriate audiologic referral, and overcome its effects in the clinical setting by providing optimal listening environments and using ALDs appropriately. Visual loss, too, is a common age-associated disability that has effects in multiple domains of function. Visual loss especially increases the risk of falls and hip fractures and may limit the ability of an older individual to safely operate a car. The ability to remediate visual disability depends on the cause of the underlying impairments and the relative effectiveness of treatment for each. Sight restoration can be dramatic for selected patients with cataracts. Sight preservation is also excellent for persons with diabetic retinopathy. For those with macular degeneration, the data are hopeful but less compelling. Although persons with glaucoma should receive medications to lower their intraocular pressure, experimental evidence that this, in fact, preserves vision is currently lacking. The geriatrician's role in visual rehabilitation consists of the identification of the impairments, determination of the impact of visual loss on other functional domains, and appropriate referral to an ophthalmologist for full assessment and treatment. If severely limited by permanent visual losses, the patient should be referred for appropriate support services.