SENSORY IMPAIRMENT

Although sensory impairments are not imminently life threatening, their impact on health can be substantial. Hearing impairment is associated with decreased quality of life, depression, isolation, and dementia. Visual impairment is related to increased risk for falls, hip fractures, physical disability, and depression. Nursing home residents with visual impairment are more likely to require assistance with ADLs and can be at risk for falls and hip fractures. Visual impairment also appears to increase mortality.^27,51,52

Sensory impairment results not only from deficits in peripheral sensory structures but also from the central pro­cessing of sensory information. The older person's diffi­culty in processing multisensory information is seen most strikingly when there is a rapid fluctuation in the nature of the information that is received from the environment.²⁷

It has been reported that a lack of sensory information can predispose to psychological symptoms. Charles Bonnet syndrome is an organic disorder occurring in the elderly that is characterized by complex visual hallucinations. It is associated with ocular disease and, strictly speaking, is seen in older adults with preserved intellectual functions.⁵³ In one study, 10% of persons (mean age, 75 years) with severe visual disability experienced visual hallucinations.⁵⁴ These persons retained insight into the problem and needed only reassurance that their hallucinations did not represent mental illness. Both auditory and visual impairment can have important psychological effects in association with dementia. Delusions have been associated with hearing impairment. In one study that used a case-control method, elderly persons with late-life psychosis with paranoid symp­tomatology were four times more likely to have hearing impairments compared with control subjects.⁵⁵