An article by María Jara Lara,
Col No.: 3432 of the Professional College of Physiotherapists of the Community of Madrid ()
The visual and hearing deficit should be addressed as “geriatric syndromes” because have repercussions on all components of the bio-psycho-social sphere, in addition to limiting the functioning of the elderly, both for basic and instrumental tasks of daily life, putting them at risk of dependency, reducing mobility, increasing the risk of domestic accidents and falls. From a cognitive and social point of view, hinder communication and social relationshipsreducing activities outside the home, tending towards isolation and giving rise to greater situations of anxiety and depression.
hearing impairment
Risk factors and most frequent causes
The risk factor’s associated with loss of hearing acuity are:
- Advanced age
- Systemic arterial hypertension
- Mellitus diabetes
- Cerebrovascular disease
- smoking
- cognitive impairment
- Occupational noise exposure
- Previous ear surgery
Other identified factors that influence the onset and/or severity of hearing impairment in older adults are:
- Use or exposure to ototoxics (eg aminoglycosides, chemotherapeutic agents, heavy metals)
- ear infections
- immunological diseases
- Hormonal factors (estrogens – protective)
- Genetic factors
Hearing acuity impairment can be classified into 3 types:
- Neurosensory: affection of the inner ear, cochlea and vestibular cochlear nerve (VIII)
- Conductive: condition of the outer ear, middle ear, or both
- Mixed: Combines neurosensory and conductive affection.
The hearing loss in the geriatric population is closely associated with modifiable risk factorsTherefore, it is recommended to intentionally look for such factors and treat them in order to prevent hearing impairment. Presbycusis is defined as the sensorineural hearing deficit associated with aging. It is the leading cause of hearing impairment in older adults.
Consequences of hearing deficit in the elderly
The presbycusis it is generally characterized by a loss of hearing acuity in a symmetrical manner and begins with high frequencies. High frequencies are found in most spoken words, therefore the patient complains “that he does not understand the talk of other people” and not necessarily complain that “doesn’t listen well”.
He The main negative impact of hearing impairment occurs in communication. For example, this deficit interferes with the understanding of treatment recommendations; likewise, while the patient concentrates on understanding what is said to him, he loses the ability to express himself, therefore preferring isolation. Hearing impairment is often perceived as a social stigma or misinterpreted as a normal part of aging, which leads to failure to seek timely medical attention.
He hearing deficit generates disability and functional limitation in the socio-familiar, psychological and cognitive spheres, for example, it favors the appearance of depression, anxiety and limits social relationships leading to isolation. The hearing deficit causes cognitive alterations such as confusion, difficulty concentrating, inattention, low self-esteem and communication disorders. Hearing impairment affects some of the higher mental functions such as attention, working and long-term memory, some executive and processing functions, and is associated with reduced brain structure and white matter integrity.
It is also associated with a higher incidence of cognitive impairment and vice versa: Dementia and moderate cognitive impairment affect central hearing functions, causing greater hearing impairment. It has been confirmed that there is an association between hearing impairment and risk of morbidity and mortality, including dependence on activities of daily living or death.
Evaluation of hearing deficit in the elderly
There are several tests that are used in the office, but one essential initial test is otoscopyDue to the high prevalence of earwax plugging as a cause of hearing (conductive) deficit, it should be performed on all older adults with some degree of hearing deficit. The Whisper Test It consists of standing behind the patient and saying at a distance of approximately 60 cm in a low tone short sequences of numbers or words, so that the patient can repeat them later and the other ear is examined. One ear should be evaluated at a time, after occlusion of the ear canal of the unexplored ear. The test is positive for hearing loss if you do not repeat the sequence you were told.
The “Click Test” It consists of standing next to the patient and rubbing the fingers at 15cm (one ear at a time, after occlusion of the ear canal of the unexplored ear). The test is repeated 6 times and is positive for hearing loss when it fails 2 or more times. It has a positive predictive value of 10. The “Clock Ticking Test” It consists of standing next to the patient at 15 cm with a hand clock (one ear at a time, after occlusion of the ear canal of the unexplored ear). The test is repeated 6 times and is positive for hearing loss when it fails 2 or more times out of 6 trials. It has a positive predictive value of 70.
exist office clinical trials They are not suitable for screening, but they allow differentiating conductive hearing loss from sensorineural hearing loss, so it is recommended to perform them. These are the Weber and Rinne tests. The Weber’s test It is done by placing the tuning fork on the vertex of the skull, on the nose or teeth and asking the patient to tell us if he hears louder with one ear or the other. The test is normal when there is no difference between the two ears, that is, the sound is not lateralized. The Rinne’s test allows us to compare bone and air conduction. The test initially consists of placing the tuning fork on the mastoid process to assess bone conduction and then placing it next to the ear to assess air conduction. The test is positive (normal) when air conduction is greater than bone conduction. When any of the screening tests is positive, it is pertinent to refer to the next level of care for an evaluation by the ear specialist or referral to audiometric tests.
Interventions in the elderly with hearing impairment
An essential part in the management of the elderly with hearing impairment is facilitate the communication process Therefore, some techniques must be used such as:
- The speaker must be close and face to face with the listener who has hearing impairment, speak clearly and without haste, with accentuated facial and lip expression, without sources of noise such as television or radio, and make sure that the message has been understood.
- The listener with hearing impairment should be focused on communication, read lips to promote understanding and preferably repeat the message heard
- Signs or images can be used to contextualize the topic being discussed.
Certain conditions such as smoking, diabetes mellitus, arterial hypertension, cardiovascular diseases and/or dyslipidemia favor the progression of hearing impairment in the elderly, which is why the smoking cessation and control of chronic pathologies, all this is essential in the management of hearing deficit in the first level of care. It has been confirmed that the use of hearing aids improves the perception of quality of lifedecreases the degree of anxiety and depression assessed with the Geriatric Depression Scale (GDS).
visual deficit
Risk factors and most frequent causes
He visual deficit associated with diseases related to aging is one of the most common conditions among the elderly and a public health problem. Visual deficit can be defined as: uncorrectable blindness, correcting blindness, or decreased visual acuity. He The most important risk factor for visual impairment is age..
Consequences of Visual Deficit:
Visual deficit negatively impacts:
- The functionality of the patient
- Create or increase disability
- Starts or perpetuates psychosocial deterioration
- Hinders or hinders rehabilitation
- It increases the costs of health services, among others.
There is a correlation between the decrease in visual acuity and basic activities of daily living, as well as instrumental activities. This correlation is more evident in patients with short-distance visual deficit than in those with distant visual deficit. He Visual deficit in the elderly increases depressive symptoms and is correlated with an increase in the prevalence of depression. Older adults with visual impairment and depressive symptoms are more likely to present:
- Smoking 14.9%
- Difficulty for self-care 27.9%
- Obesity 28.2%
- Difficulty participating in social activities 52.1%
- Poor self-perceived health 76%
- Physical inactivity 80.5%.
Visual deficit is a independent risk factor for presenting a fall and/or falls recurring (fall syndrome) in the elderly. Impaired near vision is considered an independent risk factor for presenting a fracture event after a fall. The relationship between visual deficit with impaired distance vision and a fracture is minor, however it is also present.
Visual deprivation is related to a high risk of adverse health outcomes (functional dependence on basic activities of daily living and death). Therefore, older adults with visual sensory deprivation syndrome should be monitored and managed interdisciplinary since they have a higher risk of dependence and death. The useful and applicable tests at the first level of care are screening surveys, the Snellen visual chart, the Amsler chart, and the physical examination.
Interventions in the elderly with visual deficit:
- Maintain adequate lighting mainly in bedroom and bathroom
- Use color contrast
- Guardrails for fall prevention
- Large-scale font text printing
- Promote adaptation and acceptance of the patient’s conditions.
Bibliography:
Detection and Management of Sensory Deprivation Syndrome in the Elderly. Mexico: Ministry of Health, 2013.