Our eyes and our ears are how we make sense of the world around us. While many people have been very successful despite visual or hearing impairments (and on occasion both), many of the compensatory abilities tend to decline with age. For example, as people age, more of their balance abilities depend on vision. Thus with increasing visual impairment, we get increased likelihood of falling. Even minor degrees of cognitive difficulty dramatically increase the impact of visual and hearing impairments. Simple tasks, such as injecting insulin, or taking the right pill at the proper time become very challenging with sensory impairment. Hearing-impaired older persons do not hear our instructions properly and often are too embarrassed to ask us to repeat, or do not even realize they have missed important information. Not surprisingly, both ophthalmologists and otorhinolaryngologists see large numbers of older patients. It is thus very important that at Geriatrics & Aging we provide a focus on aging eyes and ears.
Our continuing education article this month is “Age-Related Macular Degeneration: A Leading Cause of Blindness among Older Adults” by Dr. Robert Coffee and Dr. Tara Young. I am particularly interested in this article for two reasons. First, recent research has brought about a much greater understanding of the risk factors for the disorder, and second, one of the authors (Dr. Young) was a student of mine before starting a brilliant academic career in the United States.
When I started medical practice, cataract surgery was a crude affair, with patients using contact lenses (often difficult for an 80-year-old with tremor) or unsightly cataract glasses. Times have certainly changed as outlined in another of our focus articles, “The Evolution of Cataract Surgery: The Most Common Eye Procedure in the Older Adult” by Dr. Lorne Bellan. Our third eye-related article is also on a common theme, namely “A Clinical Perspective of Diabetic Retinopathy” by Dr. Chris Hudson. Our last focus article is on a problem that does not sound glamorous, but is extremely important to our patients, “Cerumen Impaction” by Dr. Mark A. Lutterbie and Dr. Daniel McCarter.
As expected, this issue also features articles on several important geriatric topics. Our cardiovascular disease column is on the “Approach to Dyspnea among Older Adults” by Dr. Siamak Moayedi and Dr. Mercedes Torres. Our gastrointestinal health column is entitled “Diagnosis and Management of Gastroesophageal Reflux Disease and Dyspepsia among Older Adults” and it is authored by Dr. Sander Veldhuyzen van Zanten. There is a tie-in with our focus article on diabetic retinopathy in the article by Dr. Medha Munshi and Dr. Alissa Segal entitled “Insulin Therapy for Older Adults with Diabetes.”
Finally, I recall a famous letter in the late 1970’s by David Marsden, a great neuroscientist and movement disorder specialist, calling for research to delineate the difference between Parkinson’s Disease Dementia and Alzheimer’s Disease (if in fact there was a difference). This challenge became even more complex when Dementia with Lewy Bodies was described as a discrete entity. Dr. Catherine Agbokou, Dr. Emmanuel Cognat, and Dr. Florian Ferreri address this last clinical dilemma in their article “Parkinson’s Disease Dementia versus Dementia with Lewy Bodies.”
Enjoy this month’s issue,
Barry Goldlist
