Journal of Gerontological Nursing

Guest Editorial Free

Imagine a World With Limited Sound and Light

Shaoqing Ge, PhD, MPH; Basia Belza, PhD, RN, FAAN, FGSA; Margaret Wallhagen, PhD, GNP-BC, FAAN

The prevalence of older adults reporting both hearing and vision loss increases dramatically with age. An estimated 30% of those aged >80 years have dual sensory loss (DSL) (Schneider et al., 2012). Older adults with DSL face unique, yet often underappreciated challenges in their daily lives due to functional limitations. Although limited research and clinical attention have been dedicated to older adults with DSL, nurses can play important roles in providing care and supporting those experiencing sensory functional limitations. The purposes of this editorial are to (1) highlight the physical, psychological, and financial challenges encountered by older adults with DSL; and (2) provide guidance and resources to nurses on strategies to address these challenges. We primarily focus on older adults with adult-onset hearing and vision loss, including but not limited to those who are deaf/blind.

Challenges Encountered by Older Adults with DSL

Older adults with single sensory deficit—either hearing or vision—can rely on the intact sensory function to compensate. Those with DSL lack this compensatory capability, which leads to daily challenges including (a) increased dependence and risk of social isolation; (b) limitations in conducting daily activities, such as doing housework, using the telephone, and preparing meals; and (c) heightened risk of encountering negative events, such as falls and vehicle accidents either when driving or walking. These limitations often lead to a need for constant companionship and assistance from family members or other caregivers.

Older adults with DSL may also encounter psychological difficulties, such as embarrassment when encountering difficulties communicating (Brennan et al., 2005). In addition, they may consider themselves as a burden to their families because of their need for assistance going to social events or activities. These thoughts, in turn, may cause them to voluntarily or passively withdraw from social activities. Older adults with DSL have reported a higher likelihood of being socially isolated and depressed (Mick et al., 2018). Unfortunately, stigma may cause older adults with DSL to refrain from wearing appropriate hearing or vision aids.

The procedures and devices for treatment and rehabilitation of DSL can place a considerable financial burden on older adults and their family members. Hearing aids are, on average, $4,700 (Willink et al., 2017). However, Medicare and many private insurance plans do not cover hearing aids (Wallhagen & Reed, 2018). Only five states require health benefit plans in their state to pay for hearing aids for adults (American Speech-Language-Hearing Association, 2020). Added to these costs are those of adaptive devices to facilitate vision (e.g., tablets or laptops with magnification and speech capabilities), which are also generally not covered by insurance plans (Radu, 2017). Moreover, older adults with DSL may need assistance from a service dog, whose cost is also not covered by Medicare.

Caring for Older Adults with DSL

Given the significant demands that sensory loss can bring to the patient, family, and society, nurses, physicians, and other health care providers must increase their awareness of sensory loss and equip themselves with current knowledge and skills to care for older adults and their families. During clinical encounters, nurses can support older adults with sensory functional limitations by assessing their hearing and vision capabilities and offering educational advice to older adults or their caregivers. Once probable sensory loss has been established, referrals should be made with informed consent from older adults or their caregivers. Providers can also support older adults with sensory loss by considering older adults' sensory functions when implementing assessments of other potential functional limitations. DSL can impact the performance of older adults in cognitive and physical function screening and assessments. Providers can deliver quality care to older adults with DSL by choosing and using the appropriate physical or cognitive functional screening tool according to the older adult's level of sensory function limitations.

Older adults with DSL may encounter communication challenges. To overcome these challenges, nurses and other providers might consider using these strategies: (a) speak to the older adult and not to the person who accompanies them; (b) try to provide a quiet environment when communicating; (c) speak clearly but do not shout, rephrase if asked to repeat, and make sure to face the older adult when talking; and (d) provide materials that are suitable for older adults who cannot hear or see well by using larger, sans serif font and more white space (Brabyn et al., 2007). Assistance from nurses and other providers can help older adults with DSL and their family members feel included and cared for.

To date, research and public policies have mainly targeted either hearing or vision loss, but not DSL. This situation creates an opportunity for nurses and nurse researchers to develop and test hearing- and vision-friendly environments, develop community-based interventions to reduce social isolation, and advocate for the creation of public policies for people with DSL (e.g., enlarging the Medicare coverage of sensory aids). Nurses can help draw public and policymakers' attention by being vocal about their clinical experience in caring for older adults with DSL (e.g., observed challenges experienced by older adults and their caregivers, rehabilitation strategies for DSL and related financial burdens, effective training approach and materials). Stakeholders and organizations, such as hospital leadership, health service and quality improvement committees, and nursing and geriatric societies should consider sensory function as an important component of health and carefully listen to stories and suggestions from health care providers for improved care.

Resources

The Library of Congress provides information for older adults with DSL and their care providers through its National Library Service for The Blind and Print Disabled. A comprehensive list of resources, including bibliographies and links to external organizations for DSL, is provided on their website (access https://www.loc.gov/nls/resources/deaf-blindness). This website serves as an “information supermarket” for older adults with DSL and their caregivers to easily access. These resources were chosen from academic journals and private or public organizations that specialize in the field of sensory loss.

The National Academies of Sciences, Engineering, and Medicine has a Forum on Aging, Disability, and Independence. The forum has recently published several resources, including a webinar on the best practices for patient–clinician communication for people with disabilities (e.g., hearing loss) in the era of COVID-19, and a summary report of a workshop on hearing loss and healthy aging. Although these resources do not directly address DSL, they may provide timely references for older adults with a single modality or both types of sensory loss, their caregivers, clinicians, and researchers.

Shaoqing Ge, PhD, MPH
Doris Carnevali Engaging with Aging
Postdoctoral Scholar Fellow

Basia Belza, PhD, RN, FAAN, FGSA
Aljoya Endowed Professor of Aging
University of Washington
School of Nursing
Seattle, Washington

Margaret Wallhagen, PhD, GNP-BC, FAAN
Professor, Department of Physiological
Nursing
Senior Nurse Scholar, VA Quality Scholars
Program
University of California San Francisco
School of Nursing
San Francisco, California

References

  • American Speech-Language-Hearing Association. (2020). State insurance mandates for hearing aids. https://www.asha.org/advocacy/state/issues/ha_reimbursement
  • Brabyn, J. A., Schneck, M. E., Haegerstrom-Portnoy, G. & Lott, L. A. (2007). Dual sensory loss: Overview of problems, visual assessment, and rehabilitation. Trends in Amplification, 11(4), 219–226 doi:10.1177/1084713807307410 [CrossRef] PMID:18003865
  • Brennan, M., Horowitz, A. & Su, Y. P. (2005). Dual sensory loss and its impact on everyday competence. The Gerontologist, 45(3), 337–346 doi:10.1093/geront/45.3.337 [CrossRef] PMID:15933274
  • Mick, P., Parfyonov, M., Wittich, W., Phillips, N., Guthrie, D. & Pichora-Fuller, M. K. (2018). Associations between sensory loss and social networks, participation, support, and loneliness: Analysis of the Canadian Longitudinal Study on Aging. Canadian Family Physician, 64(1), e33–e41 PMID:29358266
  • Radu, S. (2017). Who's paying for assistive technology?https://www.usnews.com/news/best-countries/articles/2017-12-01/assistive-technology-keeps-growing-but-paying-for-it-is-next-challenge
  • Schneider, J., Gopinath, B., McMahon, C., Teber, E., Leeder, S. R., Wang, J. J. & Mitchell, P. (2012). Prevalence and 5-year incidence of dual sensory impairment in an older Australian population. Annals of Epidemiology, 22(4), 295–301 doi:10.1016/j.annepidem.2012.02.004 [CrossRef] PMID:22382082
  • Wallhagen, M. I. & Reed, N. S. (2018). Implications of hearing care policy for nurses. Journal of Gerontological Nursing, 44(9), 9–14 doi:10.3928/00989134-20180808-04 [CrossRef] PMID:30148527
  • Willink, A., Schoen, C. & Davis, K. (2017). Consideration of dental, vision, and hearing services to be covered under Medicare. Journal of the American Medical Association, 318(7), 605–606 doi:10.1001/jama.2017.8647 [CrossRef] PMID:28662240
Authors

The authors have disclosed no potential conflicts of interest, financial or otherwise. This work was supported by the University of Washington School of Nursing Doris Carnevali Engaging with Aging Post-Doctoral Fellowship.

10.3928/00989134-20201208-01

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