Sensory Changes and Frailty

As we age, our sensory systems gradually start to decline. For more information about the ways in which our senses are affected by age the following article from MedlinePlus Medical Encyclopaedia, called Ageing Changes in the Senses is a useful summary which you can access HERE

To understand the scale of the problem consider firstly the number of older people who wear glasses or contacts who are over 55. It’s also worth noting that it is estimated that 945,000 people in Scotland are deaf or have hearing loss and that more than 500,000 people in Scotland have a form of tinnitus.

Sensory impairment has been shown to have psychological, psychosocial,
and functional effects that may lead to social isolation, anxiety, depression, paranoia, and decreased self-esteem.

Dual sensory loss (DSL), the presence of both hearing loss and vision loss is particularly prevalent among ageing populations across the world with studies showing that more than 20% of adults older than 70 years are affected with that percentage increasing with advancing age. The interaction between the variety of visual losses and the variation in types of hearing loss means that there is a wide variation in each individuals needs. This makes it difficult for community staff who have very little cross disciplinary training to meet every need they encounter even though they are meeting older people with multiple sensory impairments every day.

However DSL also affects the ability of older people to perform Instrumental Activities of Daily Living (IADL’s). So although problems with dressing and bathing may occur using a ‘phone or grocery shopping, preparing meals, managing housework and money are far more likely problems and will limit the ability of frail older people to remain at home. The likelihood of identifying and intervening when such problems exist is not helped by older adults themselves, who tend to overestimate their capabilities. Not only are AIDL’s affected, frail older people with sensory impairments also experience poorer overall mobility and the more severe the loss the more likely functional and cognitive decline will occur.

What Can You Do?

The Importance of Hearing Aids. One of the most important things you can do is encourage the use of hearing aids. Kochkin and Rogin (2000) in a study conducted for the US National Council on Aging showed that individuals with hearing impairment who did not use hearing aids participated in statistically significantly fewer social activities and reported statistically significantly more anxiety, depression, emotional instability, and paranoia than individuals who used hearing aids.

However there is a huge stigma surrounding hearing impairment that generally manifests as a reluctance to acquire hearing aids or to participate in any other types of aural rehabilitation.

Consider the Persons Manual Dexterity? With advancing age comes diminished manual dexterity. This has direct effects on several aspects of
hearing aid use and aural rehabilitation, with the most obvious being hearing aid insertion, manipulation of the hearing aid controls, and handling of the battery. There is a strong association between poor manual dexterity and poorer hearing aid outcomes, like less daily use, and lower satisfaction with hearing aids. A study by Parving and Philip (1991) reported that 40% of hearing aid users by the time they were 90 could not use the
volume control wheel, 36% could not change the hearing aid battery, and 34% could not clean the hearing aid ear mould.

Consider the Person’s Health Literacy. DSL is also known to limit a person’s ability to understand and recall the information provided and to successfully integrate self-care into their daily life. It has
been shown that generally older people have the lowest health literacy and
related adverse health outcomes than younger people. Therefore, communication needs to be optimized to accommodate the sensory needs of older individuals to the extent possible.

  • To ensure this the environment needs to be optimized.
  • You need to speak clearly and make efforts to clearly enunciate and to increase the time between spoken words, decreasing your rate of speech.
  • Provide clear written materials. Remember literacy level and pitch to a reading age around 12. Written material should be 14 points and have wide spaces between the lines. A sans serif font should be used and multiple columns on a page should be avoided.

A more extensive guide with videos on how to communicate with someone with hearing loss can be found HERE

Provide/Use Assistive Devices. Like hearing loops, magnifiers with lights, video magnifiers, tactile devices (like vibrating alarm clocks, door bells etc). Whatever you think might help the person. See: https://www.hearinglink.org/living/loops-equipment/ and https://shop.rnib.org.uk/

Provide Redundancy. When delivering information use multiple perceptual channels (visual, auditory, and tactile). This increases the person’s opportunity to all information provided. Supplement anything you say with written materials which can be verbally repeated by carers, relatives etc. If you use low or high technology always buy/use technology with built in redundancy. The reason for doing this is that the circumstances of the person the assistive technology/device will change. As a result, you never know when you might need more functions/capabilities to be switched on.

Use Patient Teach-back. A useful method for verifying that the information you want the person to understand is understood to get the person to repeat back in his or her own words what was said or demonstrate the procedure you are trying to get them to learn/understand indicated by the provider. This way you can check the communication is understood and correct any misunderstandings. See http://scottishhealthcouncil.org/patient__public_participation/participation_toolkit/teach-back.aspx#.Xhu9_sj7TIU

Further Information

See: Royal National Institute for the Blind Services page https://www.rnib.org.uk/services-we-offer-advice-professionals-health-professionals/services-patients

and Action on Hearing Loss’s Guidance for Nurses. https://www.actiononhearingloss.org.uk/how-we-help/health-and-social-care-professionals/guidance-for-nurses/

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