Association between hearing and vision impairments in older adults

Visualizing Worldwide Prevalence of Age-Related Dual Sensory Loss

Objectives: This study aims to create a first visualization of global prevalence of age-related dual sensory loss (DSL), significantly affecting older people's quality of life. Methods: Data from World Health Organization (WHO) regions, particularly African, American, and European, were analyzed. The study focused on DSL onset and prevalence, using adjusted life expectancy for regional comparison. Results: There were notable regional variations in DSL onset and prevalence. The African region showed consistent data, thanks to standardized methods from the World Federation of the Deafblind. However, global patterns varied when adjusted for life expectancy, hinting at possible DSL prevalence stabilization at older ages. Discussion: The study identifies a lack of standardization in DSL prevalence research regarding definitions, methodologies, and reporting. It calls for more uniform and thorough research methods for accurate global DSL understanding. The research highlights the complexity and challenges in determining DSL prevalence worldwide.

Dynamics of the association between visual and auditory functional changes in glaucoma. Preliminary results

Glaucoma is a multifactorial degenerative optic neuropathy characterized by the irreversible loss of retinal ganglion cells. Vascular, genetic, anatomical and immune factors are present in etiopathogenic mechanisms. Being the second cause of blindness worldwide after cataract, and with an irreversible character, glaucoma has turned into a disease with a significant impact on public health. Patients with primary open-angle glaucoma (POAG) may have central neurodegenerative changes, such as sensorineural hearing loss and static changes. Aim: The aim of this study was to estimate the connections between visual and auditory functional changes in glaucoma. The subjects were grouped as follows: patients with glaucoma compared with patients without glaucoma, while trying to identify the functional defect of the optic nerve (visual field) and a hearing testing (audiogram). Materials and methods: The prospective, cross-sectional study included 32 eyes of 16 subjects with POAG in a group of study and 24 eyes of 12 healthy subjects in the other group, with a mean age of both groups between 61,64 ± 6,53 years old. Both groups were examined from ophthalmological, audiological and radioimaging perspectives with Pure-tone audiometry (PTA) and magnetic resonance imaging (MRI) for brain. All patients had ophthalmologic assessments according to a standardized protocol. Moreover, auditory functional parameters (audiometry) were recorded. Results: Female cases, over 65 years old, with residency in a city, predominated in the group of study. Compared to the control group, patients in the group of study had average levels of the PTA and modified visual field (VF) parameters. Multivariate analysis demonstrated that the correlation of PTA was indirect, reduced in intensity, both with MD (r = -0.108; p = 0.585), Cal HOV (r = -0.268; p = 0.168) and the slope profile of the right eye. Multivariate analysis demonstrated that there was a correlation of the right PTA, which was indirect, reduced in intensity, both with MD (r = -0.108; p = 0.585), Cal HOV (r = -0.268; p = 0.168) and the slope profile of the right eye. The left ear PTA correlation was indirect, moderate in intensity, statistically significant with both MD (r = -0.584; p = 0.001) and slope profile (r = -0.377; p = 0.048) and reduced as intensity with Cal HOV (r = -0.147; p = 0.456) of the left eye. Conclusions: Patients with POAG showed changes in audiometry in connection with ophthalmological parameters, a fact suggesting that the auditory system might have been affected in POAG. This study highlighted the interdisciplinarity of the medical field with the aim of ensuring the quality of life of glaucoma patients. A good collaboration between the ophthalmologist and the otolaryngologist was very important for our patients. Abbreviations: RE = Right eye, LE = Left Eye, POAG = Primitive Open Angle Glaucoma, PTA = Pure-tone audiometry, VF = visual field, MRI = magnetic resonance imaging, IOP = Intraocular pressure, BVAC = best visual acuity corrected, MD = mean defect, CNS = central nervous system, SAP = standard automated perimetry, CCT = central corneal thickness, ONH = Optic nerve head, CDR = Cup/ Disc ratio, RNFL = Retinal fiber layers.

Prevalence and impact of combined vision and hearing (dual sensory) impairment: A scoping review

Hearing and vision impairments are common globally. They are often considered separately in research, and in planning and delivering services. However, they can occur concurrently, termed dual sensory impairment (DSI). The prevalence and impact of hearing and vision impairment have been well-examined, but there has been much less consideration of DSI. The aim of this scoping review was to determine the nature and extent of the evidence on prevalence and impact of DSI. Three databases were searched: MEDLINE, Embase and Global Health (April 2022). We included primary studies and systematic reviews reporting the prevalence or impact of DSI. No limits were placed on age, publication dates, or country. Only studies where the full text was available in English were included. Two reviewers independently screened titles, abstract, full texts. Data were charted by two reviewers independently using a pre-piloted form. The review identified 183 reports of 153 unique primary studies and 14 review articles. Most evidence came from high-income countries (86% of reports). Prevalence varied across reports, as did age groups of participants and definitions used. The prevalence of DSI increased with age. Impact was examined across three broad groups of outcomes-psychosocial, participation, and physical health. There was a strong trend towards poorer outcomes for people with DSI across all categories compared to people with one or neither impairment, including activities of daily living (worse for people with DSI in 78% of reports) and depression (68%). This scoping review highlights that DSI is a relatively common condition with substantial impact, particularly among older adults. There is a gap in evidence from low and middle-income countries. There is a pressing need for a consensus position on the definition(s) of DSI and standardisation of reporting age groups to enable reliable estimates to be ascertained and compared and responsive services developed.

Self-Reported Sensory Decline in Older Adults Is Longitudinally Associated With Both Modality-General and Modality-Specific Factors

Background and Objectives

Self-reported sensory data provide important insight into an individual's perception of sensory ability. It remains unclear what factors predict longitudinal change in self-reported sensory ability across multiple modalities during healthy aging. This study examined these associations in a cohort of older adults for vision, hearing, taste, and smell.

Research Design and Methods

Data on self-report sensory ability were drawn from 5,065 participants of The Irish Longitudinal Study on Ageing (mean age at baseline = 61.6, SD = 9.5, range 32-93 years; 59% female; resident in the Republic of Ireland) across 6 waves of data collection (2009-2021). Covariates included demographics, lifestyle factors, and measures of sensory, physical, mental, and cognitive health. Independent discrete survival analyses were performed for each sensory modality.

Results

A transition to self-reported fair/poor hearing was most prevalent (21% of the sample), followed by fair/poor vision (19%), smell (11%), and taste (6%). Participants who self-reported fair/poor function in one sensory modality were likely to report fair/poor ability in another sensory modality, although not for all pairings. Only self-rated fair/poor health was associated with increased odds of self-reported fair/poor ability across all sensory modalities. Age was associated with increased odds of self-reported fair/poor hearing, smell, and taste, as was current smoker status (vision, smell, and taste). Several other sensory (e.g., eye disease, hearing aid use) and nonsensory covariates (e.g., education, depression) were associated with the odds of self-reported fair/poor ability in one or two sensory modalities only.

Discussion and Implications

Over time, older adults perceive associations in fair/poor ability for multiple sensory modalities, albeit somewhat inconsistently. Both modality-general and modality-specific factors are associated with a transition from normal to fair/poor sensory ability. These results suggest the need for more routine testing of multiple senses with increasing age.

Prevalence of Individuals with Deafblindness and Age-Related Dual-Sensory Loss

Introduction

The authors of this paper have compiled a report on the prevalence of deafblindness and dual-sensory loss based on the review of existing estimates. The purpose is to inform readers of the importance of using consistent, well-researched definitions and survey questions in future prevalence studies.

Methods

Articles were extracted through ProQuest and EBSCOhost, online library databases of Cambrian College and Laurentian University. Keywords search included “deafblindness,” “dual-sensory impairment,” “dual-sensory loss,” “age-related,” “congenital,” “acquired,” and “prevalence.” Additionally, the authors conducted a search with Google for research reports and Google Scholar for other relevant peer-reviewed articles.

Results

This review provides a current overview of prevalence estimates of deafblindness and age-related dual-sensory loss around the world, examining 19 articles or reports published over the last 20 years (2000–2020) in 18 countries, including the European Union (consisting of 8 countries). In line with the prevalence estimates by the World Federation for the Deafblind global report 2018, the review indicates an estimated 0.2–2% prevalence of dual-sensory impairment and underscores varying ranges of prevalence among populations, studies or countries, age groups, and types of deafblindness. The review highlights that the prevalence of deafblindness or dual-sensory loss was often not comparable across studies, but it is clear that the prevalence of dual-sensory impairment increases with age. The studies varied in methods (e.g., population surveys, cross-sectional, and longitudinal studies).

Implication for practitioners

The review provides evidence of varying ranges of prevalence rates. Future prevalence studies may benefit from consistent definitions, standard data-collection tools to do better comparisons across countries, and identify factors that predict higher or lower prevalence rates among populations and age groups.

Effects of cigarette smoking on sensorineural hearing impairment and age related macular degeneration

INTRODUCTION

Cigarette smoking has been causally associated with various diseases, and among the numerous harmful effects of smoking is included its impact on the senses of vision and hearing. The purpose of this study is to evaluate the impact of cigarette smoking on the visual and auditory functions.

METHODS

In this analytic study, hearing and smoking status of 40 patients with agerelated macular degeneration (AMD) were analyzed with 40 age-matched control subjects without AMD. In all subjects (n=80), retinal status was investigated by optical coherence tomography (OCT), with analyses of thickness central subfield (TCS) and thickness average cube (TAC) of the macula. All participants were examined with pure tone audiometry. Audiometric trials comprised pure tone bone and air conduction. The smoking history of all the subjects was recorded in detail.

RESULTS

A significant correlation was found between smoking status and visual (p<0.001) and hearing impairment (p<0.05). Cigarette smoking was found to be highly correlated with sensorineural hearing impairment and exudative macular degeneration.

CONCLUSIONS

Cigarette smoking damage anti-oxidative systems and tissue metabolism. We have underlined a clear correlation between the risk of sensorineural hearing impairment, exudative macular degeneration and cigarette smoking. Our findings may result in future screening of smokers to identify any hearing and vision impairment and for improving smoking cessation interventions.

The Impact of COVID-19 on Individuals Across the Spectrum of Visual Impairment

Purpose

TO assess perceptions and implications of COVID-19 infection across the spectrum of individuals with visually impairment (VI) and those with normal sight.

Design

Prospective cross-sectional comparative study.

Methods

Setting: institutional. Patients: 232 patients and their caregivers. Four groups were created based on better eye characteristics: blind (best-corrected distance visual acuity [BCDVA] <3/60 or visual field <10 central degrees); severe VI (BCDVA ≤3/60 to <6/60; vertical cup-to-disc ratio ≥0.85 or neuroretinal rim width ≤0.1); moderate VI (BCDVA ≤6/60 to <6/18); or no or mild VI (controls: BCDVA ≥6/18) based on International Classification of Diseases-10 criteria and Foster and Quigley's consensus definition of glaucoma. Procedure: telephone questionnaires. Main outcome measures: differences in perceptions and implications of COVID-19 infection across various levels of VI. Caregiver perceptions were a secondary outcome measure.

Results

Surveys were completed by 232 participants, with 58 participants in each VI group. Mean age was 58.9 ± 13.2 years old. Greater degrees of VI were associated with older age (P = .008) and lower education level (P = .046). Blind participants more commonly perceived vision as a risk factor for contracting COVID-19 (P = .045), were concerned about access to health care (P <.001), obtained news through word of mouth (P <.001), and less commonly wore masks (P = .003). Controls more commonly performed frequent handwashing (P = .001), were aware of telemedicine (P = .029), and had fewer concerns about social interactions (P = .020) than groups with substantial VI. All caregivers reported more frequent patient care since the COVID-19 pandemic began.

Conclusions

The pandemic might have had a disproportionate impact on the visually impaired, and evidence-based assessments of COVID-19 health outcomes in this population are warranted.

Prevalence, diagnoses and rehabilitation services related to severe dual sensory loss (DSL) in older persons: a cross-sectional study based on medical records

OBJECTIVE

To estimate the prevalence of severe dual sensory loss (DSL) among older persons (aged ≥65 years) in the Swedish population, to identify the diagnoses that cause severe DSL, and to identify rehabilitation services in which the participants have been involved.

DESIGN

A cross-sectional design was applied. Medical records from Audiological, Low Vision, and Vision clinics from two Swedish counties were used.

STUDY SAMPLE

1257 adults, aged ≥65 years with severe hearing loss (HL) (≥70 dB HL) were included, whereof 101 had decimal visual acuity ≤0.3.

RESULTS

Based on the population size in the two counties (≥65 years, n = 127,638), the prevalence of severe DSL was approximately 0.08% in the population. Within the group having DSL (n = 101), 61% were women and 71% were aged ≥85 years. Common diagnoses were cataract and/or age-related macular degeneration (AMD) in combination with HL. The rehabilitation services offered were mainly hearing aids and various magnifiers.

CONCLUSIONS

The study confirmed previous results, indicating that the prevalence of severe DSL increases with age and that sensorineural HL and cataract, AMD or glaucoma coexist. The identified rehabilitation services mainly focussed on either vision loss or HL but not on severe DSL as a complex health condition.

Social Determinants of Association among Diabetes Mellitus, Visual Impairment and Hearing Loss in a Middle-Aged or Old Population: Artificial-Neural-Network Analysis of the Korean Longitudinal Study of Aging (2014⁻2016)

BACKGROUND

This study introduces a new framework based on an artificial neural network (ANN) for testing whether social determinants are major determinants of association among diabetes mellitus, visual impairment and hearing loss in a middle-aged or old population.

METHODS

The data came from the Korean Longitudinal Study of Aging (2014⁻2016), with 6120 participants aged 45 years or more. The association was divided into eight categories: one category for having no disease, three categories for having one, three categories for having two and one category for having three. Variable importance, the effect of a variable on model performance, was used to evaluate the hypothesis based on whether family support, socioeconomic status and social activity in Y2014 are among the top 10 determinants of the association in the year 2016 (Y2016).

RESULTS

Based on variable importance from the ANN, brothers/sisters cohabiting (0.0167), voluntary activity (0.0148), income (0.0125), family activity (0.0125), parents alive (0.0121), leisure activity (0.0095) and meeting with friends (0.0092) in Y2014 are the top-10 determinants of comorbidity in Y2016.

CONCLUSION

The findings of this study support the hypothesis, highlighting the importance of social determinants for the effective management of the comorbidities of the three diseases.

Association of Age Related Macular Degeneration and Age Related Hearing Impairment

Purpose:

To evaluate the association between age-related macular degeneration (ARMD) and sensory neural hearing impairment (SHI).

Methods:

In this case-control study, hearing status of 46 consecutive patients with ARMD were compared with 46 age-matched cases without clinical ARMD as a control group. In all patients, retinal involvements were confirmed by clinical examination, fluorescein angiography (FA) and optical coherence tomography (OCT). All participants were examined with an otoscope and underwent audiological tests including pure tone audiometry (PTA), speech reception threshold (SRT), speech discrimination score (SDS), tympanometry, reflex tests and auditory brainstem response (ABR).

Results:

A significant (P = 0.009) association was present between ARMD, especially with exudative and choroidal neovascularization (CNV) components, and age-related hearing impairment primarily involving high frequencies. Patients had higher SRT and lower SDS against anticipated presbycusis than control subjects. Similar results were detected in exudative, CNV and scar patterns supporting an association between late ARMD with SRT and SDS abnormalities. ABR showed significantly prolonged wave I and IV latency times in ARMD (P = 0.034 and 0.022, respectively). Average latency periods for wave I in geographic atrophy (GA) and CNV, and that for wave IV in drusen patterns of ARMD were significantly higher than controls (P = 0.030, 0.007 and 0.050, respectively).

Conclusion:

The association between ARMD and age-related SHI may be attributed to common anatomical components such as melanin in these two sensory organs.

Effects of a Dual Sensory Loss Protocol on Hearing Aid Outcomes: A Randomized Controlled Trial

OBJECTIVES

Dual sensory loss (DSL; concurrent vision and hearing loss) negatively affects quality of life. As speechreading is hampered, use of hearing aids (HAs) is important for older adults with DSL. However, due to vision loss, use of small and complex HAs is assumed to be difficult. An integrative DSL protocol that addresses rehabilitative care for older adults with DSL, including proper HA use, was implemented in low vision rehabilitation centers. The present study aims to evaluate the effectiveness of the DSL protocol among HA owners on HA outcomes (i.e., HA use, benefit, satisfaction with HAs, and hearing with HAs).

DESIGN

In a randomized controlled trial, the DSL protocol was compared to a waiting list control group among clients (aged ≥50 years) of low vision rehabilitation centers with DSL. The International Outcome Inventory for Hearing Aids (IOI-HA) and the HA Fitting Questionnaire (HAFQ) were administered at baseline and 3 months follow-up. Participants (n = 128) were randomly allocated to either the intervention (n = 63) or control group (n = 65).

RESULTS

Intention-to-treat analyses showed a near significant effect on IOI-HA Residual problems (effect size, 0.35; p = 0.063). Per-protocol analyses showed similar (nonsignificant) results on the main outcomes, and a ceiling effect was found on the HAFQ. Significant effects were found in subgroups of patients: among patients with low HAFQ scores (HAFQ-Use: effect size = 0.56, p = 0.046; HAFQ-Hearing with HAs: effect size = 0.64, p = 0.019), male participants (effect size = 0.80; p = 0.003), and those with moderate hearing loss (effect size = 0.72; p = 0.028), significantly better IOI-HA scores were found in the intervention group at 3 months follow-up.

CONCLUSIONS

Although the per-protocol and subgroup analyses need to be interpreted with caution, DSL patients who experience HA difficulties could benefit from the DSL protocol by making better use of their HAs. The increasing prevalence and impact of DSL on a person's independence and social participation call for more awareness of concurrent sensory impairments in both low vision and audiology rehabilitation. Interdisciplinary training for rehabilitation professionals could be an important step, followed by integration of vision and hearing services using the DSL protocol.

Vision impairment and dual sensory problems in middle age

PURPOSE

Vision and hearing impairments are known to increase in middle age. In this study we describe the prevalence of vision impairment and dual sensory impairment in UK adults aged 40-69 years in a very large and recently ascertained data set. The associations between vision impairment, age, sex, socioeconomic status, and ethnicity are reported.

METHODS

This research was conducted using the UK Biobank Resource, with subsets of UK Biobank data analysed with respect to self-report of eye problems and glasses use. Better-eye visual acuity with habitually worn refractive correction was assessed with a logMAR chart (n = 116,682). Better-ear speech reception threshold was measured with an adaptive speech in noise test, the Digit Triplet Test (n = 164,770). Prevalence estimates were weighted with respect to UK 2001 Census data.

RESULTS

Prevalence of mild visual impairment (VA >0.1 logMAR (6/7.5, 20/25) and ≥0.48 (6/18, 20/60)) and low vision (VA >0.48 (6/18, 20/60) and ≥1.3 (6/120, 20/400)) was estimated at 13.1% (95% CI 12.9-13.4) and 0.8% (95% CI 0.7-0.9), respectively. Use of glasses was 88.0% (95% CI 87.9-88.1). The prevalence of dual sensory impairment was 3.1% (95% CI 3.0-3.2) and there was a nine-fold increase in the prevalence of dual sensory problems between the youngest and oldest age groups. Older adults, those from low socioeconomic and ethnic minority backgrounds were most at risk for vision problems.

CONCLUSIONS

Mild vision impairment is common in middle aged UK adults, despite widespread use of spectacles. Increased likelihood of vision impairment with older age and with ethnic minorities is of concern given ageing and more ethnically diverse populations. Possible barriers to optometric care for those from low socioeconomic and ethnic minority backgrounds may require attention. A higher than expected prevalence of dual impairment suggests that hearing and vision problems share common causes. Optometrists should consider screening for hearing problems, particularly among older adults.

Dual sensory loss and social participation in older Europeans

The purpose of the study was to describe the prevalence of hearing difficulties, vision difficulties and dual sensory difficulties in 11 European countries, and to study whether sensory difficulties are associated with social inactivity in older Europeans. This cross-sectional study is based on the 2004 data collection of the Survey of Health, Ageing and Retirement in Europe comprising 27,536 men and women aged 50 years and older. Hearing and vision difficulties, as well as participation in seven different social activities were assessed using a structured computer-assisted personal interview. Logistic regression models were used for analyses. Altogether, 5.9 % of the participants reported both hearing and vision difficulties (dual sensory loss), 10.2 % vision difficulties only, and 13.5 % hearing difficulties only. More than two-thirds (68.6 %) of the participants with dual sensory loss were socially inactive compared to half of those who reported no sensory difficulties. The participants who reported dual sensory loss had 2.18 (95 % CI 1.83-2.59) times higher odds for social inactivity compared to persons without hearing or vision difficulties. In a model adjusted for age, gender, mobility, depressive symptoms, cognition, education and wealth the corresponding odds ratio was 1.21 (95 % CI 1.00-1.47). According to our results, sensory difficulties were associated with social inactivity, but the higher likelihood for social inactivity among persons with sensory difficulties was attenuated by other health and socio-economic indicators. Our results suggest that various preventive and rehabilitative actions targeting older persons' sensory functions may enhance their social activity.

Dual sensory loss: A major age-related increase of comorbid hearing loss and hearing aid ownership in visually impaired adults

AIM

Despite increasing interest in visual and hearing impairment in the older population, little attention has been paid to concurrent hearing and vision loss, also known as dual sensory loss. The aim of the present study was to investigate the prevalence of comorbid hearing disability and hearing aid ownership in visually impaired older adults.

METHODS

In a cross-sectional survey, a self-report hearing disability screener was administered to 1396 visually impaired patients (aged ≥ 50 years) of outpatient low vision rehabilitation centers in the Netherlands and Belgium.

RESULTS

Of all participants, 44.8% (95% CI 42.2-47.5) had insufficient or poor hearing; the prevalence increased quadratically with age. Of all dual sensory impaired participants, 31.2% in the Netherlands and 55.7% in Belgium did not own hearing aids.

CONCLUSIONS

The high prevalence of dual sensory loss calls for more awareness of related problems in these patients. Differences between the Netherlands and Belgium regarding hearing aid ownership might be due to different criteria used for hearing aid referral and insurance policies. For patients with dual sensory loss, specialized care implemented in low vision rehabilitation seems warranted.

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