Vision and Hearing: Managing Age-Related Losses

Currently, I’m at that stage in editing my book about ageing where I’m reviewing what I wrote about managing the increased likelihood of problems with vision and hearing as we get into old age.

Blindness was something that preoccupied me for some time as an eight-year-old, when it was finally worked out that the reason I kept walking up to the blackboard in class to see what was written on it was because I was myopic. For some time after that I was frightened to go to sleep in case I woke up blind. Happily, I didn’t, and that fear disappeared, at a personal level.

But research by Glaucoma Australia in 2012 revealed the unsurprising fact that my childhood fear was a pretty common one, since “86 per cent ranked blindness as their greatest fear, while 87 per cent said sight was their most valued sense.” And, it turns out, as we get older losing that sense does actually become a more realistic fear, with age-related macular degeneration (AMD) being identified as the leading cause of blindness for Australians aged over 55, followed closely by glaucoma over the same age.

So, it is surprising that it has been reported that the majority of at-risk older people don’t take the simple step that could keep them from losing their eyesight. The good news highlighted by the Lancet is that “75% of blindness from all causes is preventable, treatable or curable.” And that first step towards those options is an annual eye exam. If caught early enough, for example, glaucoma is treatable, as is the “wet” type of AMD.

Encouragingly, also, the British College of Optometrists has advised that “while AMD is a condition associated with old age, there are steps you can take earlier in life to minimise your risk. Research suggests that a diet rich in leafy green vegetables, brightly coloured fruits and vegetables and oily fish may help prevent AMD. Smoking also doubles your chances of developing the condition so quitting can also reduce your risk.”

Nonetheless, it has to be accepted that serious vision loss or blindness is a reality that some older people will be confronted by. And if that happens, it is important to access a variety of appropriate aids and stratagems to help us cope with our loss. For those in that situation, The New York Times had reported as far back as 2010 that “the range of visual aids now available is extraordinary. There are large-picture closed-circuit televisions, devices like the Kindle that can read books aloud, computers and readers that scan documents and read them out loud, Braille and large-print music, as well as the more familiar long canes and guide dogs.”

The challenge for the ageing visually impaired is to find out about such resources as their need for them arises. The benefits of doing so are not only practical but emotional, according to a 2014 study. It found that those with age-related vision loss, and who developed a coping plan to help them “engage with favourite activities” – and adhered to it – reported feeling happier, and had a lower risk of depression, than those who did not.

And then there is hearing. Interestingly, the opinion of someone who would definitely know from her own toughest of situations – Helen Keller – was that deafness was “a much worse misfortune than blindness because it means the loss of the most vital stimulus – the sound of the voice that brings language, sets thoughts astir and keeps us in the intellectual company of man.”

And again, that is a sense that is vulnerable to time. In a 2016 article in the Canadian Globe and Mail it was noted that age-related loss “typically begins in our mid-40s and 50s. We may not admit it, even to ourselves, but perceiving others as mumbling – especially in noisy situations – is a dead giveaway.” And what happens here is somewhat different to vision. After Katherine Bouton experienced adult deafness and researched this condition she found that while someone having problems with their vision would “probably head to a doctor pretty quickly,” that is far less likely to be the case with hearing loss. Instead, deafness and denial are closely linked, leading in many cases to years of inaction. Writing in the NZ Marlborough Express in 2016, for example, hearing therapist Tania Shearer pointed out that while “one in six people have hearing loss, many do not take action – or wait a very long time to finally get help.”

And for those who would benefit from a hearing aid, according to Bouton, in the USA “only one in seven over the age of 50 years uses a hearing aid. Like [herself] they don’t want to look old – ‘a hearing aid is a visible sign of an impairment that has long been associated with aging and mental retardation’ – and they’re put off by the price.”

What she also found, through her own experiences and through interviews with others who had experienced hearing loss was “how much depends on the resiliency and personality of the newly hearing-impaired person.” And, in similar terms to those linked with best management of vision loss, what she and Shearer have recommended are a range of coping strategies. In the words of Shearer, “it is important to identify the conditions that make hearing a challenge for you…. Hearing aids could well be a solution, but there are other things people don’t always think about that can help, like developing good communication strategies and tactics to help cope with your listening environment,….[and which] will improve everyday situations that are challenging for those who have hearing loss.”

Audiologist Kathy Pichora-Fuller advises that “people who develop hearing problems should get help early on….[since if] left unchecked hearing loss may lead to withdrawal from socializing and other activities that keep people active, mentally and physically – and help us age well. The good news is that older adults can learn to cope with hearing problems using certain cognitive skills – such as their greater vocabulary, knowledge of the world and familiarity with the context of conversational topics – that tend to improve rather than decrease with age.” And both Bouton and Shearer have also stressed the importance of “educating others about the best ways of communicating with you.” In such ways, “older adults can continue to be successful in conversations and social interactions by learning to compensate for hearing decline.”

All of what I’ve written so far is information that I digested and accepted and have acted upon myself, since the time of writing the original draft, which was a while ago. So you’d think that I wouldn’t have been taken aback when suddenly, in my updating searches, a very uncomfortable article about a rarely discussed topic popped up: one which should have been no surprise, but – nonetheless – it was. What I found was quite an old (2000) BBC news item entitled “Deaf-blindness in elderly ‘untreated’”.

And it wasn’t the “untreated” that gave me pause, but the question of why on earth hadn’t I done the math before? For the obvious equation that where there is both vision loss + hearing loss, that can = some degree of deaf-blindness in the elderly.

A consequence of that condition is that “many thousands of elderly people are suffering by themselves or ending up in costly nursing homes.” And once again, one solution to this serious problem is a focus on assistance with coping strategies. All that is needed, according to the British deafblind organisation Sense, “is fast, correct identification of their disability plus extra help and support” to enable them to live successfully in their own homes.

Another, longer term approach to consider, of course – after the initial panic over such an appalling possibility recedes – is for older people to be taking those steps identified above for each condition separately, and to both monitor their vision with regards to preventable or treatable conditions that might be starting to affect it, and their hearing if incipient losses are starting to occur, so that both conditions can be adjusted to as necessary, and worked on progressively.

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