Vision and hearing in old age

Effects of age simulation suits on psychological and physical outcomes: a systematic review

Age simulation suits (ASS) are widely used to simulate sensory and physical restrictions that typically occur as people age. This review has two objectives: first, we synthesize the current research on ASS in terms of the observed psychological and physical effects associated with ASS. Second, we analyze indicators able to estimate the validity of ASS in simulating "true" ageing processes. Following the PRISMA guidelines, eight electronic databases were searched (BASE, Cinhal, Cochrane, Google Scholar, ProQuest, PsychINFO, Pubmed, and Web of Science). Qualitative and quantitative studies addressing effects of ASS interventions regarding psychological outcomes (i.e., empathy, attitudes) or physical parameters (i.e., gait, balance) were included. The Mixed Methods Appraisal Tool was applied for quality assessment. Of 1890 identified citations, we included 94 for full-text screening and finally 26 studies were examined. Publication years ranged from 2001 to 2021. Study populations were predominantly based on students in health-related disciplines. Results suggest that ASS can initiate positive effects on attitudes toward (d_weighted = 0.33) and empathy for older adults (d_weighted = 0.54). Physical performance was significantly reduced; however, there is only little evidence of a realistic simulation of typical ageing processes. Although positive effects of ASS are supported to some extent, more diverse study populations and high-quality controlled designs are needed. Further, validation studies examining whether the simulation indeed reflects "real" ageing are needed and should build on reference data generated by standardized geriatric assessments or adequate comparison groups of older adults.Prospero registration: 232686.

Lipreading and audiovisual speech recognition across the adult lifespan: Implications for audiovisual integration

In this study of visual (V-only) and audiovisual (AV) speech recognition in adults aged 22-92 years, the rate of age-related decrease in V-only performance was more than twice that in AV performance. Both auditory-only (A-only) and V-only performance were significant predictors of AV speech recognition, but age did not account for additional (unique) variance. Blurring the visual speech signal decreased speech recognition, and in AV conditions involving stimuli associated with equivalent unimodal performance for each participant, speech recognition remained constant from 22 to 92 years of age. Finally, principal components analysis revealed separate visual and auditory factors, but no evidence of an AV integration factor. Taken together, these results suggest that the benefit that comes from being able to see as well as hear a talker remains constant throughout adulthood and that changes in this AV advantage are entirely driven by age-related changes in unimodal visual and auditory speech recognition. (PsycINFO Database Record

An intervention designed to improve sensory impairments in the elderly and indoor lighting in their homes: an exploratory randomized controlled trial

Background

Vision and hearing impairments in the elderly (aged over 80 years) and poor indoor lighting conditions in a home-care setting are risk factors for functional decline, reduced social participation, withdrawal, and accidents.

Objective

We aimed to evaluate the changes in vision, hearing, and lighting conditions in the homes of participants aged over 80 years after implementation of a clinical intervention.

Methods

We undertook an exploratory randomized, controlled experimental study of sensory impairments and lighting conditions in the homes of elderly aged over 80 years who received home care. The intervention group (IG) received advice and encouragement to improve their vision, hearing, and indoor lighting conditions in the home, with a 10-week follow-up period. The control group (CG) received their usual care and underwent the same vision and hearing tests but were provided no intervention.

Results

Vision and hearing (self-assessed) and tested by Wilcoxon rank-sum test were significantly better (P=0.025 and P=0.008, respectively) in the IG after the intervention and follow-up. The test between the groups showed a significance of P=0.026 for visual acuity and P=0.098 for pure-tone average. The maximum and minimum lighting levels were significantly improved in the IG after the intervention (P=0.002 and P=0.039, respectively) but were unchanged in the CG.

Conclusion

Several of the IG participants did not follow all of the advice; however, among those who did, vision, hearing, and lighting conditions were all significantly improved. It appears that modest interventions have great potential for improving vision and hearing. Older patients in the home-care setting cannot be expected to take the necessary action to improve their sensory impairments by themselves. They require close monitoring, help from a specialist, and help to improve the indoor lighting conditions in their homes.

Sensory impairments in community health care: a descriptive study of hearing and vision among elderly Norwegians living at home

Background

Hearing and vision impairments increase with age and are common risk factors for functional decline reduced social participation and withdrawal.

Objective

Describe the hearing and vision of home care patients older than 80 years.

Methods

Ninety-three older adults (80+ years) receiving home care were screened for hearing and vision in their homes. Data were collected using a HEINE Mini 3000^® Otoscope to examine the eardrum and presence of earwax, an Entomed SA201-IV portable pure-tone audiometer to measure the pure-tone average (PTAV), a logarithm of the minimum angle of resolution chart to measure visual acuity (VA), and the Combined Serious Sensory Impairment interview guide.

Results

Slight and moderate hearing impairments were found in 41% and 47% of the population, respectively (mean PTAV =40.4 dB for the better ear), and 40% and 56% had impaired and slightly impaired vision, respectively (mean VA =0.45 for the better eye). The participants’ self-assessments of hearing and vision were only weakly correlated with PTAV and VA values. The visual function was significantly worse in men than in women (P=0.033). Difficulty in performing instrumental activities of daily living because of hearing and vision impairments was experienced by 17% of the participants, whereas 76% experienced no difficulties. When many people were present, 72% of the participants found it difficult to understand speech. Nearly 30% found it tiring to read, and 41% could not read very small print.

Conclusion

The patients’ self-assessments of their hearing and vision did not correlate strongly with their VA and PTAV scores. Asking the elderly about their overall hearing and vision ability is not sufficient for detecting sensory impairment, and asking more specific questions about what they could not hear and see was not an adequate indicator of the patients’ hearing and vision problems. To detect hearing and vision impairments among elderly home care patients, standardized measurements of their hearing and vision are necessary.

Dual sensory loss: development of a dual sensory loss protocol and design of a randomized controlled trial

Background

Dual sensory loss (DSL) has a negative impact on health and wellbeing and its prevalence is expected to increase due to demographic aging. However, specialized care or rehabilitation programs for DSL are scarce. Until now, low vision rehabilitation does not sufficiently target concurrent impairments in vision and hearing. This study aims to 1) develop a DSL protocol (for occupational therapists working in low vision rehabilitation) which focuses on optimal use of the senses and teaches DSL patients and their communication partners to use effective communication strategies, and 2) describe the multicenter parallel randomized controlled trial (RCT) designed to test the effectiveness and cost-effectiveness of the DSL protocol.

Methods/design

To develop a DSL protocol, literature was reviewed and content was discussed with professionals in eye/ear care (interviews/focus groups) and DSL patients (interviews). A pilot study was conducted to test and confirm the DSL protocol. In addition, a two-armed international multi-center RCT will evaluate the effectiveness and cost-effectiveness of the DSL protocol compared to waiting list controls, in 124 patients in low vision rehabilitation centers in the Netherlands and Belgium.

Discussion

This study provides a treatment protocol for rehabilitation of DSL within low vision rehabilitation, which aims to be a valuable addition to the general low vision rehabilitation care.

Trial registration

Netherlands Trial Register (NTR) identifier: NTR2843

Association between hearing and vision impairments in older adults

PURPOSE

To determine which, if any, vision variables are associated with moderate bilateral hearing loss in an elderly population.

METHODS

Four hundred and forty-six subjects completed a hearing screening in conjunction with measurements on a variety of vision tests including high contrast acuity, low contrast acuity measured under a variety of lighting conditions, contrast sensitivity, stereopsis, and colour vision. Logistic regression analyses were used to assess the relationship between various vision variables and hearing impairment while controlling for demographic and other co-morbid conditions.

RESULTS

In this sample of older adults with a mean age of 79.9 years, 5.4% of individuals were moderately visually impaired (binocular high contrast VA worse than 0.54 logMAR, Snellen equivalent 6/21 or 20/70) and 12.8% were moderately bilaterally hearing impaired (hearing none of the 40 dB tones at 500, 2000 or 4000 Hz in either ear). Three measures of low contrast acuity, but not high contrast acuity or other vision measures, were significantly associated with hearing loss when controlling for age, cataract surgery history, glaucoma history and self reported stroke, all of which were significantly associated with hearing loss, although the association of glaucoma with hearing loss was negative.

CONCLUSIONS

Poorer vision for low contrast targets was associated with an increased risk of hearing impairment in older adults. Audiologists and optometrists should enquire about the other sense in cases in which a deficit is measured as individuals with dual sensory loss are at a marked disadvantage in daily life.

Prevalence of age-related hearing loss in Europe: a review

Populations are becoming progressively older thus presenting symptoms of diminished organ function due to degenerative processes. These may be physiological or caused by additional factors damaging the organ. Presbyacusis refers to the physiological age-related changes of the peripheral and central auditory system leading to hearing impairment and difficulty understanding spoken language. In contrast to epidemiological data of other continents, the prevalence of age-related hearing loss (ARHL) in Europe is not well defined, due in part to the use of different classification systems. We performed a systematic literature review with the aim of gaining a picture of the prevalence of ARHL in Europe. The review included only population and epidemiological studies in English since 1970 with samples in European countries with subjects aged 60 years and above. Nineteen studies met our selection criteria and additional five studies reported self-reported hearing impairment. When these data were crudely averaged and interpolated, roughly 30% of men and 20% of women in Europe were found to have a hearing loss of 30 dB HL or more by age 70 years, and 55% of men and 45% of women by age 80 years. Apparent problems in comparing the available data were the heterogeneity of measures and cut-offs for grades of hearing impairment. Our systematic review of epidemiological data revealed more information gaps than information that would allow gaining a meaningful picture of prevalence of ARHL. The need for standardized procedures when collecting and reporting epidemiological data on hearing loss has become evident. Development of hearing loss over time in conjunction with the increase in life expectancy is a major factor determining strategies of detection and correction of ARHL. Thus, we recommend using the WHO classification of hearing loss strictly and including standard audiometric measures in population-based health surveys.

Cognitive, Visual, Auditory, and Emotional Factors That Affect Participation in Older Adults

OBJECTIVE. To determine whether changes in hearing, cognition, depression, and vision affect daily life participation and whether screening tests that identify problems could be used in the home.

METHOD. Interviewers assessed presence of medical conditions, social class, distance acuity, cognition, hearing, depression, and participation using valid screening tools. Participation scores were subgrouped according to negative or positive results. Multiple regression analysis determined association of screening tests with participation.

RESULTS. Eighty-eight older adults, ages 62–90, participated. Positive screening tests were found in 43% of participants for distance acuity, 9% for cognitive problems, 8% for depression, and 15% for hearing loss. Relationships were found among age, cognition, depression, and vision and participation.

CONCLUSION. Mild levels of decreased vision, depression, and decreased cognition are associated with lower participation. These conditions can be screened by occupational therapists and managed to help older adults remain active and maintain their health.

Auditory-visual discourse comprehension by older and young adults in favorable and unfavorable conditions

This investigation examined how age and test condition affect one's ability to comprehend discourse passages, and determined whether age and test condition affect discourse comprehension and closed-set sentence recognition in a similar way. Young and older adults were tested with closed-set sentences from the newly-created build-a-sentence test (BAS) and a series of discourse passages in two audiovisual conditions: favorable, where the talker's head was clearly visible and the signal-to-babble ratio (SBR) was more optimal; and unfavorable, where the contrast sensitivity of the visual signal was reduced and the SBR was less optimal. The older participants recognized fewer words in the BAS than the young participants in both test conditions. Degrading the viewing and listening conditions led to a greater decline in their performance than in the young participants' performance. The older participants also did not perform as well at comprehending spoken discourse in the two test conditions. However, unlike the results from the BAS, the age difference for discourse comprehension was not exacerbated by unfavorable conditions. When attempting to comprehend discourse, older adults may draw upon verbal and cognitive abilities that are relatively insensitive to age.