Читать книгу Pathy's Principles and Practice of Geriatric Medicine - Группа авторов - Страница 116

Sensory impairments are common in older adulthood. At least one‐third of older adults have some form of vision impairment, and up to two‐thirds report hearing loss. The causes and treatment of sensory impairment are addressed elsewhere in this book, but it is important to understand how sensory impairments affect older adults' relationships with their surroundings.

Impaired vision can have significant impacts on older adults' quality of life. They have reduced in‐home mobility, reduced ability to drive or navigate public transportation, and increased risk of isolation. Impaired vision particularly affects the ability to engage in leisure activities, and adults with impaired vision report a decline in quality of life related to their leisure time.³⁹ Limitations in self‐care may lead to a loss of independence. For instance, in an Australian study, researchers found that with each line of reduction in presenting visual acuity, there was a 7% increase in the risk of institutionalization.⁴⁰ Vision loss can exacerbate chronic conditions, possibly due to impediments in medication administration and increased risk of falls and fractures. Where available, low‐vision rehabilitation can address the functional deficits accompanying vision loss and should be utilized in addition to standard ophthalmologic care.

Table 4.1 Strategies to combat ageism.

Source: Based on Frameworks Institute, ‘Reframing Ageing’ (www.frameworksinstitute.org).

Eliminate the ‘othering’ of ageing. Use phrases like ‘When we age …’ or ‘wAs we grow older …’ when discussing processes of ageing.

Reframe ageing. Avoid language like ‘fighting’ or ‘battling’ ageing. Emphasize positive aspects of ageing, including accumulated experience/wisdom and improved life satisfaction. Avoid unrealistic idealism.

Increase awareness of ageism. Use public policy and media to introduce the concept of ageism. Call out examples of ageism when encountered.

Emphasize that social policies influence ageing. Contradict the belief that one's financial and health conditions are solely a result of individual choices. Emphasize how social structures and policies (transportation, housing availability, Social Security) influence ageing.

Appeal to values of justice. Emphasize concrete, systemic examples of ageism such as discrimination and abuse to appeal to societal values of inclusion and equity.

Hearing loss can also have numerous impacts on older adults. Many older adults are not forthcoming about their hearing loss and may have significantly impaired communication that goes unnoticed by providers or even loved ones. They may find treatments, such as hearing aids and cochlear implants, to be prohibitively expensive. Hearing loss is associated with social isolation and increased risk of depression and correlates with risk of cognitive impairment, although the causative relationship between hearing loss and cognition is not yet understood. All providers who care for older adults should understand communication strategies for communicating with adults who are hard of hearing, summarized in Table 4.2. Personalized sound amplifiers can be inexpensive alternatives to hearing aids for adults with mild to moderate hearing loss.