Kathleen Jaques Bennett, BSc, BSc, MSc

In Ontario, 71% of the individuals with poor vision are over 65 years of age. To make matters worse, these seniors often suffer from additional sensory deprivation in the form of hearing loss.¹ Sensory deprivation can be defined as the partial or complete loss of any of the five senses. It can lead to embarrassment, social isolation, depression, or the labelling of the patient as demented or infantile by family and caregivers. Vision and hearing loss are strongly correlated to an increased risk of mortality over a five-year period,² probably because the psychosocial effects take an enormous toll on the afflicted individual. The partial or complete loss of the senses can lead to diminished quality of life, and may predispose an elderly person toward other conditions.

Types of Sensory Deprivation
Sensory deprivation can involve the loss of only one sense, or the combined loss of several senses. The loss of visual acuity associated with age often begins with the development of presbyopia. Presbycusis, the loss of hearing, is more prevalent among men than women.7 As well, touch, taste and smell become less acute with time. All of these forms of sensory deprivation undermine an elderly person's ability to live independently, increasing dependence on caregivers, and can result in the infantilization of the elderly individual. When sensory loss is coupled with another condition such as diabetes, the handicap becomes even more severe.

Health care professionals are often ignorant of the issues that are of the greatest importance to the elderly. One commonly shared misconception is that the most important cause of deterioration in health-related quality of life is either cancer or heart disease. In fact, numerous surveys reveal that it is arthritis which is by far the most significant cause of poor health-related quality of life.

Similarly, I feel we underestimate the impact of sensory deprivation on our elderly patients. It is much more difficult to interact positively with the rest of the world when one is blind and/or deaf. Many people withdraw from social interaction under these circumstances. Sensory deprivation is an obvious cause of a decreased quality of life, but there is also persuasive evidence to suggest that lack of social contact can, in itself, raise mortality. Numerous studies have documented that patients, and also their families, are frequently unaware of their impairments in vision or hearing. In a standard geriatric assessment, there should be formal testing of both vision and hearing.

Sensory deprivation can have numerous medical consequences. Impaired hearing has long been associated with paranoid ideation; for example, if you didn't hear it, obviously people are trying to keep it from you! Visual impairment can, particularly among the elderly, result in falls, often with tragic results. Even young people can develop a delirium-like state when they are subjected to sensory deprivation for long periods. It is therefore not a surprise to learn that blind or deaf elderly patients are more likely to become delirious with an acute illness than are their contemporaries who hear and see well.

Perhaps the greatest problem for health care practitioners is how sensory impairment, particularly deafness, can impair communication. We all know how frustrating it can be to get a history from someone who is hard of hearing, yet few offices or medical wards have access to devices which can assist in communication and can ease this problem. It is frightening how often elderly people remain impaired in hospitals because no one thinks to ask whether they are missing their glasses or hearing aids. Every geriatrician has seen at least one person who was initially assessed as having dementia but who was in fact just deaf.

Some patients and doctors maintain a pessimistic attitude with regard to existing therapy for visual and hearing loss. One bad experience with a hearing aid a decade earlier often convinces an elderly patient not to try again. Newer equipment and technology renders such thinking misguided. I have actually seen doctors advise their patients not to have cataract extractions because they are too old! Age alone is rarely a contraindication, particularly when it comes to treating cataracts with lens implantation.

This month's edition focuses on ear and eye diseases. Mark Mandelcorn, one of Canada's most prominent retinal surgeons, discusses macular degeneration, and Catherine Birt outlines the medical management of glaucoma. Dr. Robert Schertzer reviews the surgical options available for glaucoma, and there is an introduction to an article by Dr. Marvin Kwitko who reviews cataract surgery (full article on our web site). Cindy Hutnik provides a general review of the aging eye that puts the other articles into the appropriate context.

There is an excellent overview on hearing loss in the elderly by an audiologist, Nadia Sandor, which puts the problem in perspective. There is also an article on hearing aids by Cory Sole. Kathleen Jacques Bennet outlines the psychosocial costs of sensory impairment, and Nadège Chery gives an overview on the aging ear.

We also have articles on retinal stem cells, and the presentation of tuberculosis in seniors, as well as a law column which outlines the implications of mental health legislative amendments for geriatric practitioners. Finally, we have articles on new developments in the field of telomeres and cancer and major discovery in AD.

This is a great issue, so 'keep your eyes and ears open' for all the useful information.