Index/Content of This Module

In this module you will learn more about the signs that someone is having vision and hearing problems or losing  his/her ability  to taste, touch, and smell. You will learn about vision disease and treatment. You will also learn ways to deal with these changes that most older adults experience to one degree or another.

Click on a topic below to go to that area of the page:

1 Vision Loss

2 Cataracts

3  Glaucoma

4  Age Related Macular Degeneration (ARMD)

5 Diabetic Retinopathy

6 Blepharitis (Granulated Eyelids)

7 Hearing

8 Touch, Taste, and Smell

Vision Loss

Decreased vision; diminished eyesight; impaired vision; or blindness if totallyimpaired
As people age, most people lose a certain amount of the ability to see as well as they did when they were younger. Blurred vision is the loss of visual acuity or sharpness resulting in unclear visual details. The difference between vision impairment and blindness is whether or not corrective lenses can provide at least 20/200 vision..Any change in vision needs to be evaluated.Medications and other health problems can create temporary or permanent vision loss.This section will help raise the awareness of caregivers about what to look for.

Common Causes of Vision Loss:

  • Aging (the most common cause of decreased vision)
  • Cataracts (common in older adults)
  • Glaucoma
  • Complications of diabetes (the most common cause of blindness in the United States) including double vision, retinal hemorrhages and diabetic retinopathy
  • Eye infection, inflammation, or injury including infection of the cornea or retina
  • Floaters (tiny particles) drifting across the eye which are usually harmless and require no treatment
  • Fatigue
  • Medications

Signs and Symptoms Suggesting Vision Loss

  • Inability to see well in dim light.
  • More easily blinded by glare.
  • Difficulty in refocusing quickly from near to far.
  • Difficulty adjusting from bright areas to dimmer areas.
  • Difficulty seeing differences in color. A person may see blues, lilac and other colors as gray.
  • Difficulty seeing contrast or in three dimensional surfaces such as stairs.
  • Difficulty in seeing moving objects such as cars on the highway.

Listed below are common causes of vision loss in older adults with symptoms and ways to compensate for vision loss.
Call your health care provider if these symptoms occur:

  • Any sudden visual changes
  • Partial or complete blindness in one or both eyes
  • Trouble seeing objects to either side (decreased peripheral vision) or if halos are seen around lights.
  • Blind spots suddenly appear

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Cataracts
Source: National Eye Institute
Cataracts result in the lens becoming clouded, which means that lens becomes cloudy and light cannot pass to the retina properly. Signs include:

  • Cloudy or blurry vision
  • Headlights seem too bright at night
  • Experience too much glare from lamps or very bright sunlight
  • Halo around lights.
  • Colors seem faded.
  • Poor night vision.
  • May cause double or multiple vision (this symptom often goes away as the cataract grows).
  • Frequent changes in eyeglasses or contact lenses.
  • More than half the people over age 65 have some degree of cataract development.
    Treatment for Cataracts: Surgery to remove the diseased lens is the only effective treatment for cataract. In the majority of cases, diseased tissue is replaced with an artificial device known as an intraocular lens implant.

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Glaucoma

Source: Glaucoma Foundation
Elevated intraocular pressure, is the most important risk factor for the development of glaucoma. Signs of glaucoma include:

  • Intense pain, which may result in nausea and vomiting.
  • Red eye(s).
  • Swollen or cloudy cornea(s).
  • Halos around lights (rainbow-colored rings around lights).
  • Recurrent blurry vision.
  • Morning headaches.
  • Pain around eyes after watching TV or leaving a dark theater.

The person with glaucoma is usually unaware of it until serious loss of vision has occurred. Damage from glaucoma cannot be reversed. Risk factors for glaucoma include:

  • Over age 45.
  • Family history of glaucoma.
  • Abnormally high intraocular pressure.
  • African descent.
  • Diabetes.
  • Myopia (nearsightedness).
  • Regular, long-term steroid/cortisone use.
  • Previous eye injury.

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Age Related Macular Degeneration (ARMD)

Source: Macular Degeneration Foundation
Age Related Macular Degeneration is a leading cause of visual impairment for older adults. This is a commonly used name given to a group of diseases in which the sight-sensing cells in the macular zone of the retina malfunction or lose function. This loss results in debilitating loss of central or detail vision. It usually affects individuals over the age of 55 years and may have a major genetic component. Sometimes only one eye loses vision while the other eye continues to see well for many years.

The condition may be hardly noticeable in its early stages. When both eyes are affected, reading and close up work can become difficult.

Risk Factors
The risk of macular degeneration is affected by the following factors.

  • Age: Macular degeneration can occur at any age; however, the chance of its occurrence increases nearly five-fold after the age of sixty-five.
  • Heredity: Macular degeneration tend to “run in families.” This means that there is a genetic factor that predisposes a person toward developing the condition. Anytime a “bloodline” relative has macular degeneration, there is an increased chance of developing the condition.
  • Gender: Women have a slightly higher incidence of developing macular degeneration than men.
  • Ethnic Background: Fair-skinned people of northern European ancestry (Scandinavian, English, or German descent) have a higher chance of developing macular degeneration.
  • Eye Color: Blue-eyed individuals are more prone to develop the condition than brown-eyed persons.
  • Cardiovascular History: A history of heart disease or stroke is associated with a higher incidence of macular degeneration.
  • High Cholesterol Levels: High levels of blood serum cholesterol are associated with an increased tendency to develop macular degeneration.
  • Smoking: Macular degeneration tends to occur more frequently in persons who smoke. Even after treatment, smokers are reported to have a greater chance of having macular problems recur.

Symptoms differ for individuals but may include:

  • Blurring and dim colors in central vision
  • Vision that is noticeably distorted.
    • Straight lines appear wavy.
    • Objects may appear as the wrong shape or size.
  • Dark or empty area in the center of vision

There are two forms of macular degeneration.

  • The Dry Type: The dry type of macular degeneration is the most common form. In this type of macular degeneration, the delicate tissues of the macula become thin and cease to function properly.
  • The Wet Type: The wet type of macular degeneration is less common, but is typically more damaging. The wet type of macular degeneration is caused by the growth of abnormal blood vessels behind the macula. The abnormal blood vessels tend to hemorrhage or leak, with the result being the formation of scar tissue if left untreated. In some instances, the dry type of macular degeneration can turn into the wet type.

Eat a low-fat, low cholesterol diet.

  • Maintain a program of regular, cardiovascular exercise
  • Wear sunglasses with ultraviolet (UV) protection.
  • Stop smoking.
  • Try to consume at least two servings of leafy dark green vegetables per day, especially spinach.
  • Do not smoke, and avoid exposure to secondhand smoke.
  • Eat food and or supplements rich in vitamins E and C and lutein. Lutein is a plant antioxidant found in high quantities in spinach, kale and other dark green, leafy vegetables.

Consult with a physician concerning estrogen replacement therapy. This may have an impact upon cholesterol lipid levels that play a role in worsening the disease.

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Diabetic Retinopathy

Source: Diabetic Retinopathy FoundationDiabetic retinopathy is the leading cause of blindness in the United States. It is a progressive disease that destroys capillaries by depositing an abnormal material along the walls of the retina. Blurred vision and blindness may result. The longer a person has diabetes the greater his/her chances of developing retinopathy. After the onset of diabetes, careful eye examinations may reveals mild retinal abnormalities about seven years after the onset of diabetes. The damage occurs later, however.

Some people develop a condition called macular edema. It occurs when the damaged blood vessels leak fluid and lipids onto the macula, the part of the retina that lets us see detail. The fluid makes the macula swell, blurring vision.

Diabetic retinopathy often has no early warning signs. At some point, though, you may have macular edema. It blurs vision, making it hard to do things like read and drive. In some cases, your vision will get better or worse during the day. As new blood vessels form at the back of the eye, they can bleed (hemorrhage) and blur vision.

Treatment
Laser surgery. This is the most typical procedure to treat macular edema. During this office procedure a laser beams into the vicinity of the macula to seal leaking blood vessels.Other procedures are available for advanced cases.It is important to note that although these treatments are very successful, they do not cure diabetic retinopathy.
Lifestyle
People with diabetes need to have an eye examination including dilated pupils, at least once a year. Research indicates that better control of blood sugar levels slows the onset and progression of retinopathy and lessens the need for laser surgery for severe retinopathy.

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Blepharitis (Granulated Eyelids)

Blepharitis is a common inflammatory condition that affects the eyelids. It usually causes burning, itching and irritation of the lids. In severe cases, it may also cause styes, irritation and inflammation of the cornea (keratitis) and conjunctiva (conjunctivitis) Some patients have no symptoms at all.Blepharitis is detected during a routine examination of the eyelids and lashes
Signs and Symptoms

  • Sandy, itchy eyes
  • Red and/or swollen eyelids
  • Crusty, flaky skin on the eyelids
  • Dandruff

Treatment
Blepharitis is usually a chronic problem that can be controlled with extra attention to lid hygiene. However, it is sometimes caused by an infection and may require medication. The key to controlling blepharitis is to keep the eyelids and eyelashes clean. In some cases, anti-inflammatory and antibiotic drops or ointments are necessary for flare-ups or more severe cases.

Assistive Devices for VisionThe use of glasses and other assistive devices and a few changes in the environment can create not only a safe environment but one that helps a person with vision loss maintain independence.

Changes in the Home To Help Those With Low Or Decreased Vision:

  • Brighten home.
  • Decrease glare.
  • Evenly distribute light using two lights when possible.
  • Use diffused light.
  • Use sunglasses with 100% UV protection.
  • Use night lights in the bedroom, hallways and bathroom.
  • Place reflective or colored tape on the edges of steps to show more contrast.
  • Use assistive devices in addition to prescription spectacles or contact lenses
    • Magnifying glasses.
    • Large number calculator.
    • Large number telephones.
    • Dialing aids for the phone.
    • Large print books, catalogues, bills and newsletters.
    • Voice activated computers.

    For other tips and devices go to the link below
    Click here for our assistive devices links

    Written Materials

    • Written materials must be printed clearly.
    • Use at least a 12 point font size.
    • Use bright colors: red, yellow, orange.
    • Encourage the reader to increase the lighting if necessary.

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HearingAbout one third of people over 60 or up to seven million people experience significant hearing loss. Half of those older than 85 have hearing loss.

Healthy Hearing 2010

With hearing loss in older adults they often lose clarity more than volume. High pitched sounds may become fuzzy. Many people with hearing loss often have difficulty hearing some women`s voices due to their higher pitch. Someone with hearing loss may also have difficulty distinguishing one consonant from another (c, k, l).
The impact of hearing loss can dramatically affect someone`s life.

The person may withdraw socially because conversation becomes difficulty. Someone may neglect to do something important because he/she did not hear the instructions.

Emotionally, a person may become irritable, depressed, defensive, or argumentative. Signs and Symptoms Suggesting Hearing Loss

  • Turns up the volume on the TV or radio
  • Often asks to have information in a conversation repeated
  • Misunderstands what others say
  • Conversation becomes difficult
  • Complains that others “mumble”

The person needs to be thoroughly examined by a physician. Medication and other medical treatment may solve some hearing problems that are caused by infections. Treatment will depend on the hearing problem, and some treatments will work better than others. If a medical condition is ruled out, the physician may refer someone to a specialist: An Otolaryngologist (oh-toe-lair-in-GAH-luh-jist) is a doctor who specializes in the ear, nose, and throat. The doctor will try to discover the cause of the hearing loss and offer treatment options and may refer to another hearing professional, an audiologist (aw-dee-AH-luh-jist). An audiologist measures hearing. Sometimes otolaryngologists and audiologists work together to find the best treatment. If a hearing aid is required, an audiologist can help find the right one. Assistive Devices: Assistive devices may help a person to regain much of their hearing loss.

  • Vibrating alarm clocks.
  • Doorbells and telephones that flash instead of ring.
  • Hearing aids, tiny instruments worn in or behind the ear, make sounds louder. These devices are getting smaller as the technology improves. Things sound different when wearing a hearing aid, but an audiologist can make adjustments and help someone get used to it.
    The older adult may have to try more than one. Ask the audiologist whether trial periods are available with a few different hearing aids. Work with the audiologist until the hearing aids are comfortable.
    Click here for our assistive devices links

Few people who need hearing aids wear them. There is still a perceived stigma. There are various levels of quality and fit for each person.

Only 20% of those people who need a hearing aid have one. Consumer Reports has shown that over 40% of hearing aid consumers are dissatisfied with their hearing aids. Research indicates that nearly 20% of workable hearing aids lie in bureau drawers, factoring to 100,000`s of unused aids. Small adjustment knobs on smaller ones difficult for people with stiff fingers.

There is a period of adjustment for hearing aids. Sounds can be overwhelming, distorted and chaotic and not sound `natural.` The person might not be able to identify once familiar sounds. It takes time to get used to them.

If a person will continue to wear hearing aids for three to six months to allow time to adjust to them the success rate significantly increases.

  • Personal listening systems eliminate or lower other noises around the person. Some, called auditory training systems and loop systems, make it easier to hear someone in a crowded room or group setting. Others, such as FM systems and personal amplifiers, are better for one-on-one conversations.
  • TV listening systems allow an individual to listen to the television or the radio without being bothered by other noises or bothering others with a volume that is uncomfortable for them. These systems can be used with or without hearing aids and do not require a very high volume.
  • Direct audio input hearing aids are hearing aids that can be plugged into TVs, stereos, microphones, auditory trainers, and personal FM systems.
  • Telephone amplifying devices. Some telephones are made to work with certain hearing aids. With a hearing with a “T” switch, ask the telephone company about getting a phone with an amplifying coil (T-coil). When the hearing aid is in the “T” position, this coil is activated when the phone is picked up. It provides a comfortable volume and helps lessen background noise. Special types of telephone receivers and other devices make sounds louder on the phone.
  • Mobile phone amplifying devices. To help people who use a T-coil hear better on mobile phones, an amplifying device called a loopset is available. The wire loop goes around the neck and connects to the mobile phone. The loop transmits speech from the phone to the hearing aid in the ear. It also helps get rid of background noise to make it easier to talk in a noisy environment.
  • Auditorium-type assistive listening systems. Many auditoriums, movie theaters, churches, synagogues, and other public places are equipped with special sound systems for people with hearing loss. These systems send sounds directly to the ear. Some can be used with a hearing aid and others without. Ask for this device in these public buildings.
  • Cochlear (COKE-lee-ur) implants have three parts: a headpiece, a speech processor, and a receiver. The headpiece includes a microphone and a transmitter. It is worn just behind the ear where it picks up sound and sends it to the speech processor, a beeper-sized device that can fit in a pocket or on a belt. The speech processor converts the sound into a special signal that is sent to the receiver. The receiver, a small round disc about the size of a quarter that a surgeon places under the skin behind one ear, sends a sound signal to the brain. Cochlear implants are most often used with young children born with hearing loss. However, older adults with profound or severe hearing loss are beginning to receive these implants more often.
  • Lip reading or speech reading is another option. People who do this pay close attention to others when they talk. They watch how the mouth and the body move when someone is talking. Special trainers can help someone learn how to lip read or speech read.

Making Conversations Easier
when you know about a hearing impairment Person to Person

  • Use simple, direct sentences.
  • Speak at a steady, normal pace.
  • Speak slowly and clearly.
  • Speak slightly louder than normal.
  • Reduce confusion by turning down the TV or reducing other background noise.
  • Make eye contact or get the person`s attention in some other way.
  • Stand near the person when talking.
  • Face the individual if possible.
  • Use gestures and facial expressions.
  • Speak at a normal volume if the client wears a hearing aid.
  • Speak clearly, but don`t exaggerate lip movements.
  • Rephrase comments if asked to repeat something.
  • Introduce the topic before talking about it in detail (Mrs. Price, about your doctor`s appointment on Tuesday….).

Telephone Conversations

  • Cup your hand around the mouthpiece, especially when there is background noise.
  • Keep sentences simple and short.
  • Keep the topic of the conversation clear.
  • Avoid chewing, eating or covering your mouth.
  • Verify that you and the person are understanding one another.
  • Try saying the same thing in different words.
  • Check for understanding.
  • Give instructions slowly and ask the person to repeat if you are not understanding one another.

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Touch, Taste, and Smell

Most people over age 60 experience some degree of loss in the ability to taste, touch and smell. Most people over 60 have lost 50% of their taste buds. Most people in their 70s have one sixth of the taste buds of a 20-year-old.

Loss of the sense of smell may interfere with the sense of taste. Loss of smell affects the ability to smell body or household odors and to appreciate fragrances.
Some people may experience a loss of sensitivity to the skin or in some cases, become highly sensitive to touch.

It is important for caregivers to observe and notice the behaviors and signs that indicate that someone is trying to make up for a loss in these senses.
Remember, that the person is maybe unaware of this loss or not realize how much it is affecting his life.

Signs and Symptoms Suggesting Loss of Taste

  • Reduced or increased appetite.
  • Complaints about food not tasting right.
  • Use of excessive seasoning, especially salt.

Signs and Symptoms Suggesting Loss of Smell

  • Wears a lot of perfume, scented powder, oils, etc.
  • Wears clothes that have odor indicating that they may not be clean.

Signs and Symptoms Suggesting Loss of Touch

  • Avoids touching or being touched.
  • Unable to sense pain or overly-sensitive to touch or pressure.
  • No response to being touched.

Compensating for Sensory Loss

  • Ensure home and environment safety.
  • Recognize changes in daily routines and habits and take action to help the person compensate for the loss.
  • Suggest options
    • If the person overly salts food, suggest or purchase low salt spices, herbs, and seasonings.
    • Help identify foods that the person can enjoy.
    • Purchase bath oils and soaps as gifts to encourage bathing.
    • Recommend the use or provide gifts of gloves to protect the person who has lost the sense of touch to protect the hands and footwear to protect the feet.

Click here for a home safety checklist.

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