Sensory Deprivation Among Older Adults

The five senses allow us to interact with the world. Aging can contribute to such forms of sensory deprivation as hearing loss, vision loss, or diminished senses of taste, smell, and touch.

Sensory abnormalities can be minor annoyances, but they can also be major threats to a senior’s health and safety. While some find solutions, others must adapt to longer-term, permanent changes. There is a wealth of resources that allow us to identify, treat, and educate people about sensory loss. Since early detection affects the success of some treatments, medical advice should be sought at the first sign of any problems.

Every sensory system has its own unique problems, causes, and effects, but the decline of multiple senses is especially challenging. The most common multisensory decline is simultaneous loss of vision and hearing. Among older adults experiencing severe forms of sensory deprivation, social isolation, depression, and poor health are the most universal threats.

Vision

As people age, their eyes change: lenses can lose rigidity or form cataracts, their pupils may become slower to adjust, it can take longer to adjust to changes in lighting, and glare can be especially bothersome.

Abnormalities of the eye account for most instances of vision loss and blindness. In a 2013 Journal of Opthalmology review article, entitled “The Psychological Challenge of Late-Life Vision Impairment: Concepts, Findings, and Practical Implications,” a German researcher reports that age-related macular degeneration (AMD) is the leading cause of poor vision among seniors, affecting 20 percent of the population. The disease progressively destroys retinal light-sensing cells in the macula, resulting in the loss of central vision for all but a fraction of cases. Risk factors for AMD include having a history of hypertension, smoking, or cardiovascular disease, or a family history of AMD.

Cataracts are caused by an increasing opaqueness to the eye’s lenses that clouds vision, giving the world a brownish tint. The risk of cataracts is higher among older adults who have smoked or consumed alcohol, have diabetes or certain other diseases, and are excessively exposed to sunlight. Fortunately, the lens is usually replaceable.

Glaucoma causes fluids normally found in the eye to drain improperly, pressuring the optic nerve and resulting is the loss of peripheral vision. The biggest risk factor is a family history of glaucoma. Mexican Americans over 60 years old and African Americans over 40 years old are among those that have the most risk. Medications and surgeries can stop further progression, but won’t restore lost vision.

According to the National Eye Institute, diabetic retinopathy and macular edema are among the leading causes of blindness. Swollen or leaking blood vessels cause damage to the optic nerve that results in blurred vision. Abnormal blood vessel growth can do the same. With macular edema, these changes cause damage to central vision. Controlling blood sugars and early detection are the best preventive measures, while laser surgery can sometimes correct damage.

Compounding these abnormalities is the fact that many are associated with one another and other comorbidities, including:

  • Diabetes
  • Hypertension
  • Heart problems
  • Depression
  • Hearing impairment

For many, loss of eyesight is unexpected and can be unsettling. Basic tasks become complicated as seniors disconnect from their social and civic relationships. Fiercely independent seniors may suddenly find themselves relying on others. In addition, many seniors find that their vision problems negatively impact their overall health.

People experiencing vision loss adapt as best they can, often with remarkable success. How well a person copes depends on several factors:

  • The type and severity of visual loss
  • The psychosocial status prior to the onset of visual loss
  • The strength of an individual’s support systems
  • The impact of any comorbidities
  • An individual’s level of motivation

Technologies exist to support seniors’ independence. Computers help with communication and personal management needs while emergency call devices, such as Philips HomeSafe with AutoAlert System, bring peace of mind with the knowledge that help is a button’s press away. A number of assistive devices may include Braille materials, amplifiers, large-print books, audiobooks, tools to help with meal preparation, bathing, and other activities of daily living. Many organizations and resources exist to provide direct assistance and information.

Caregivers can help by providing empathetic emotional support while enhancing remaining functions. A few tips include:

  • Avoid unexpected touching of your patient.
  • Rearrange your patient’s furniture to improve safety.
  • Describe unfamiliar surroundings to your patient.
  • Be mindful of glare and sudden illumination changes.
  • Employ good lighting and contrasting backgrounds where possible.
  • Stay informed about resources, programs, and activities that can benefit your patient.

Hearing

According to the National Institute on Deafness and Other Communication Disorders, a third of people between the ages of 65 and 74, and half of those over 75, experience hearing loss. It occurs more commonly among men, primarily because of their exposure to excessive occupational noise. A complex problem, the risk of hearing loss is determined by several factors:

  • A person’s age
  • How much loud noise a person has been exposed to
  • The level of conversational speech affected
  • The degree and frequencies of hearing lost
  • If one or both ears are affected (hearing loss typically affects one ear more than the other)
  • Which part of the ear is affected
  • Brain involvement and other medical conditions

Hearing loss can have a profound effect on a senior’s life; in addition, it can signify the presence of other serious issues, and have long-term effects. According to a 2013 study published in the Journal of the American Medical Association, nearly a third of older adults experience cognitive decline as a result of hearing loss.

People who can’t hear may have trouble comprehending doctors and other professionals, communicating with family, and participating in many social events. A senior might be embarrassed about this problem, or feel misunderstood by others who peg him as stubborn, foolish, or otherwise having some unknown mental or medical issue. Depression and social isolation often come as a consequence of these reactions.

Hearing loss can be sensorineural, where the auditory nerves are damaged, especially in the inner ear. This type of hearing loss is usually permanent. Conductive hearing loss, on the other hand, is usually treatable and results from the blockage of sound transmission. Some of the causes of hearing loss are:

  • Noise exposure
  • Infectious diseases
  • Ear wax blockage
  • Punctured eardrum
  • Head trauma
  • Ototoxic medications, including aspirin, quinine and non-steroidal anti-inflammatory drugs (NSAIDS), certain antibiotics and chemotherapy drugs
  • Chronic diseases such as hypertension, heart disease and diabetes
  • Heredity factors

Two problems are common among adults over 50: presbycusis (a gradual loss of hearing over time) and ringing sounds in the ears caused by tinnitus. Because of its insidious onset, presbycusis may go undetected by the individual for several years. Tinnitus is more apparent than presbycusis, but neither condition should be ignored. Sudden hearing loss is a medical emergency. A person who complains of having trouble hearing telephone conversations, can’t hear well over background noise or when more than one person is speaking, often asks people to repeat themselves, or plays music or television at louder volumes, should have his hearing evaluated.

The place to begin is to see a general practitioner. If she believes it necessary, she may refer a patient to an otolaryngologist, otherwise known as an ear, nose, and throat specialist (ENT). The ENT will gather more information and assess the need for an audiology test, which determines the level of loss and at which frequencies it exists. From there, this specialist may recommend such treatments as surgery, implants, hearing aids, assistive devices, and counseling to learn coping methods.

By sharing their diagnosis with friends and family, much of the frustration and embarrassment associated with hearing loss can be reduced. Among the things that can help is speaking to a person while facing him, speaking slowly, clearly, and slightly louder, and eliminating background noise when possible.

Taste and Smell

Taste and smell are discrete sensory systems. While smell disorders are more common, most taste-related issues are not disorders at all. Both are usually short-term, decrease with age, result from many of the same causes, create similar hazards, and share solutions. Either condition could signal a serious health issue, so a medical examination is imperative.

According to the National Institutes of Health, around 25 percent of men experience smell disorders while only 11 percent of women do. Problems with taste are much less common and usually are associated with smell problems. Someone might believe, for example, that he has a taste disorder, when age-related smell loss makes food taste blander.

The main types of smell and taste loss are:

  • Hyposmia, which is a loss of smell, and hypogeusia, which is loss of taste
  • Dysosmia and dysgeusia, wherein smells and/or tastes, respectively, are distorted
  • Anosmia and ageusia, which occur with the absence of smell or taste, respectively
  • Phantosmia, which is the perception of smells that don’t exist, and phantom taste perception, which is the false perception of taste.

Loss of these senses is usually related to short-term factors, and both can be lost altogether. Problems unique to the sense of smell include nasal polyps and hormonal issues, while taste can be affected by middle ear infections. The loss of smell and taste are often caused for the same reasons, including:

  • Medications
  • Sinus and upper respiratory infections
  • Smoking
  • Head injury
  • Certain kinds of radiation to the head and neck
  • Chemical exposures
  • Oral hygiene and dental issues
  • Nervous system diseases
  • Certain surgeries

According to the National Institutes of Health, the three leading dangers resulting from smelling disorders are cooking accidents, eating spoiled food, and a failure to detect gas leaks and/or fires. The loss of taste may indicate such underlying problems as Parkinson’s or Alzheimer’s disease, but the most common problems associated with taste issues are depression, weight loss, malnutrition, and weakening of the immune system. In addition to seeking professional help if loss of these sensations are detected, ensuring that foods are fresh, helping with meal preparations, and installing smoke and gas alarms thwart many associated risks.

Touch

Speech, walking, use of the hands, and reception of pain all rely on a connection between the brain and tactile nerves. The most common problems relating to the sense of touch is peripheral neuropathy. The Hartford Institute of Geriatric Nursing reports that nearly 60 percent of women evidence neuropathy by the age of 65.

Up to one third of neuropathies are unknown in origin, while another third are caused by diabetes. The remainder result from such causes as spine diseases, infections, autoimmune disorders, and heredity. The end result of each is a reduced ability to use the hands for any number of finer sensorimotor tasks like opening pill bottles or writing. The greatest danger from neuropathy, however, is the increased risk of falls. The CDC reports that falls are the leading cause of injury among older adults. There are several measures caregivers can take to reduce the risk of falling. These include:

  • Removing tripping hazards
  • Improving lighting
  • Using assistive devices like canes and walkers
  • Installing rails and grab-bars, especially in the bathroom
  • Making commonly used household items more easily accessible
  • Avoiding the use of stairs when possible
  • Having all medications regularly reviewed for fall risk
  • Keeping up with eye exams

The older a person becomes, the more likely it is that he will experience sensory deprivation. Healthcare providers and caregivers have access to technology and resources that can help people live normal lives in spite of multiple sensory losses. It’s imperative that older adults and those who care for them learn about the various forms of sensory deprivation, understand their threat to a senior’s health, and take measures that prevent or help their loved ones learn to cope with them.

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