Sensory Loss in Older Adults

As a carer it’s important to know what sensory loss is, how to recognise and differentiate it from expected age-related changes, and how to make adjustments for older people living with, or developing, sensory loss.

This article provides advice on how you can support an older adult with sensory loss (specifically, loss of hearing, vision, taste, smell and touch) to improve their safety, enjoyment, and quality of life. Keep in mind sensory loss can relate to a range of age-related physiological and psychological changes.

Sensory loss is linked to the Aged Care Quality Standards: Standard 1 - Consumer Dignity and Choice; Standard 3 - Personal Care and Clinical Care and Standard 4 - Services and Supports for Daily Living.

The Significance of Sensory Loss

Changes to hearing, vision, taste, smell and touch impact the way a person experiences the world.

Sensory loss can impact:

• Communication;
• Quality of life;
• Daily living;
• Enjoyment;
• Socialisation, engagement and interaction;
• Personal safety;
• Independence; and
• Wellbeing.

Sensory loss in older adults is common. A recent American study found that sensory loss affected 94% of older adults. The study found that 94% of older adults had one type of sensory loss; 38% have two; 28% have three to five. These numbers were influenced by age, gender and race (University of Chicago Medical Center 2016).

Underlying factors of sensory loss in older adults include nerve degeneration, environmental insults, genetic susceptibility, or a combination of these (University of Chicago Medical Center 2016).

Types of Sensory Loss

• Hearing loss:
• • The term ‘deafness’ encompasses the scope of hearing loss between partial loss of hearing and complete inability to hear.
  • Causes include: aged-related hearing loss (presbycusis), exposure to noise, trauma, and hereditary or genetic disorders.

(Healthy WA n.d.; Better Health Channel 2017)

• Vision loss:
• • A person is legally blind if their field of vision is less than 20 degrees in diameter.
  • Causes include: aged-related macular degeneration, glaucoma, cataracts, diabetic retinopathy.

(Achieve Australia 2019; Vision Australia n.d.)

• Oral loss ‘Anosmia’ (smell/taste)
• • As a person ages their smell sensitivity reduces. A loss of smell implicates the ability to taste.
  • Causes include: side effects of smoking, nasal mucus, adaptation (olfactory cells become flooded).

(Better Health Channel 2014)

• Loss of touch
• • As a person ages, reduced or changed sensations result.
  • This may be an effect of decreased blood flow to the nerve endings or to the spinal cord or brain. It can be affected by brain surgery or nerve damage from chronic disease such as diabetes.

(Medline Plus 2019)

• Dual sensory loss
• • This is defined as the progressively worsening sensory loss of more than one sense.
  • In older people, the combination of both hearing and sight loss is common, this is called ‘deafblindness’.

(Vision Aware n.d.)

How to Care for and Communicate with Someone who has Hearing Loss

If a person in your care is over the age of 65, they should have their hearing tested every year (My Aged Care n.d.)

• Stand in front of them when you’re speaking to them, always avoid speaking from another room.
• Say the person’s name before you start talking to them, giving them a chance to focus before you begin.
• Speak to the person with hearing difficulties rather than their interpreter (if they have one).
• Speak slowly and carefully without over-emphasising or distorting your lip movements.
• Raise your voice if necessary but avoid shouting.
• Utilise body language and facial expression when you speak, providing context.
• Consider writing messages if reading is less of a challenge.
• Certain phrases may be harder to hear, try to come up with a different way of saying something if a person is having trouble understanding you.
• Keep in mind that facial hair, eating or chewing, and having your hands in front of your face will make it more difficult for the person to understand.
• Reduce additional environmental noise.
• Ensure that hearing aids are functional and checked regularly.
• Reduce other distractions that may be present in the room.

(My Aged Care n.d.; Health Hearing 2014; University of California San Francisco Health n.d.)

As a Facility

• Install (and regularly check) visual smoke detectors.
• Investigate whether visual alerts such as alarm clocks and front door alerts may benefit the resident.
• Install assistive-listening devices to enable a resident to contact people in an emergency.

(My Aged Care n.d.)

How to Care for and Communicate with Someone who has Vision Loss

A person’s chance of developing a visual impairment rises as they reach the age of 40. (My Aged Care n.d.)

• State your name clearly as you arrive.
• Use a neutral voice when speaking.
• Use everyday language, don’t avoid words such as ‘look’ and ‘see’.
• Continue to use body language as it can affect your tone of voice.
• If you are moving around a room or about to leave it, make sure to let the person know.
• Help or instruct a resident when eating, for example, let them know where food is placed on their plate.
• If you move something in a resident’s room, make sure to let them know.
• Be mindful of tripping hazards such as cords, wet floors, mops and buckets.
• Be aware that a half-open door is a hazard, keep doors either open or shut.
• If a person requests your assistance in walking, let them take your arm and guide them by walking slowly, remove or describe obstacles in their path.

(My Aged Care n.d.; Vision Australia n.d.)

How to Care for and Communicate with Someone who has Oral Sense Loss

As a person ages, maintaining an optimal standard of oral health becomes increasingly difficult (My Aged Care n.d.).

• Encourage regular visits to the dentist as required by their dental condition. Check for dental or mouth diseases.
• Let their dentist know if they have any general health problems and medications that may complicate dental health and treatment.
• Make sure a resident brushes their teeth twice a day, particularly after meals - make flossing part of this routine.
• Encourage the use of fluoride or other sensitive toothpaste on a soft brush.
• Advise them to avoid sweet foods and drinks.
• Make sure they clean their mouth and/or dentures well each day and have both checked regularly.

(My Aged Care n.d.; SA Health 2012)

How to Care for and Communicate with Someone with Loss of Touch

The cause of a loss of touch as a person ages is likely the combination of a general loss of sensory acuity and comorbid conditions such as arthritis and cerebrovascular disease (Wickremaratchi and Llewelyn 2006).

• A reduced sense of touch or feeling makes it difficult for older people to detect temperature, pain, vibration, pressure and/or texture. Talk to them about how you can make them more comfortable in the event of this sensory loss.

(Wickremaratchi and Llewelyn 2006; Medline Plus 2019)

How to Care for and Communicate with Someone who has Deafblindness

Communication preferences for people who are deafblind depend upon the extent to which the person’s vision and/or hearing is affected (Senses Australia 2019).

Consider the following modes of communication:

• Lip reading.
• Auslan.
• Co-active signing: respectfully moulding a person’s hands to make signs.
• Tactile signing: placing your hand over the hand of the signer to feel or read the signs.
• Visual field signing: signing within the confined area of their vision.
• Braille.
• Printing on their palm.
• The use of communication devices.

(Deafblind Australia n.d.; Senses Australia 2019)

Guiding:

• Always respect their guiding preferences.
• When guiding, stand beside the person who is deafblind on their preferred side. Stay half- to a whole step ahead of them as you guide and indicate obstacles.

(Carers in Derbyshire 2019)

Additional Resources

• Aged Care Quality Standards: https://agedcare.health.gov.au/quality/aged-care-quality-standards#Standard%205
• Deafblind Australia: https://www.deafblind.org.au/
• Hearing Australia: https://www.hearing.com.au/
• Vision Australia: https://www.visionaustralia.org/