Vision loss can be partial (involving one eye or parts of visual field) or complete (involving both eyes).  Vision loss can be considered a loss of sight that may occur either gradually or suddenly.  Age-related macular degeneration is Canada’s leading cause of vision loss. (4)

Why is it important?

  • 1 in 11 individuals over the age of 65 are living with vision loss (4)
  • Individuals with vision loss or impairment  experience 2 times the incidence of difficulties in daily living and social  dependence, falls, mortality rate; 3 times the incidence of depression; 4 times the incidence of hip fractures (8)

Common Causes

  • Tunnel vision (loss of visual acuity in peripheral fields) can be caused by damage to optic nerve, retina, or to visual input-processing brain areas (6)
  • Long-term double-vision may result in one eye becoming amblyopic (a lazy eye), leading to vision loss
  • Double-vision can occur from impairment of eye muscles, lens, cornea, brain, nerves or from diseases such as stroke, diabetes, myasthenia gravis, Grave’s disease(6)
  • Other common causes of vision loss include damage to the eye, cataracts, detached retina, floaters, glaucoma, and  diabetic retinopathy.(4) The increasing prevalence of diabetes and obesity are likely increase prevalence of vision loss.

Key Considerations

  • Symptoms of vision deterioration include: uncontrolled eye movement, squinting, difficulty driving at night, clumsy movement, falling due to misstep, seeing light flashes, and choosing bright colors (5)
  • Regular eye exams can detect age-related changes, referral to an optometrist may be required; vision can be maintained through corrective glasses, medication or surgery
  • Manage diabetes, hypertension, and hyperlipidemia; encourage smoking cessation; reduce ultraviolet light exposure; and appropriately respond to medication adverse effects (7)
  • 75% of vision loss can be prevented or treated by an early diagnosis and through lifestyle choices such as wearing UV-protective glasses, controlling diabetes, exercising, getting the right amount of vitamins, maintaining a smoke-free environment, and consuming a diet high in omega-3 fatty acids and dark, leafy greens (4)
  • Encourage communication through use of tools such as alternative large print formats, magnification devices,  tactile clues, adaptive computer equipment, individualized light settings
  • Refer to:
      • The Alliance for Equality of Blind Canadians runs a number of national programs and events, in addition to offering online discussion tools, chapters and affiliates, and direct support to those who are blind, deaf-blind and  partially sighted (1)
      • The Canadian Council of the Blind offers programs on education bursaries, legal advice, advocacy (2)
      • The Canadian Helen Keller Centre provides one-on-one support/training for deaf-blind seniors and family  members (3)
      • C.N.I.B. is a national non-profit rehabilitation agency that provides services for individual who are blind, visually impaired and deaf-blind

References

1.  A.E.B.C. (2014). Programs. Retrieved February 2014 from: 
     http://www.blindcanadians.ca/programs

2.  Canadian Council of the Blind. (2014). News/Information. Retrieved February 2014 from: 
     http://www.ccbnational.net/Wuzzy/index.php

3.  Canadian Helen Keller Centre. (2014). Home. Retrieved February 2014 from: 
     http://www.chkc.org

4.  CNIB. (2014). Fast Facts about Vision Loss. Retrieved February 2014 from:  
     http://www.cnib.ca/en/about/media/vision-loss/Pages/default.aspx

5.  Health Canada. (2006). Seniors and Aging- Vision Care. Retrieved February 2014 from:  
     http://www.hc-sc.gc.ca/hl-vs/iyh-vsv/life-vie/seniors-aines_vc-sv-eng.php

6.  MedicineNet. (2014). Vision Loss. Retrieved February 2014 from: 
     http://www.medicinenet.com/vision_loss/symptoms.html

7.  Pelletier, A. et al. (2009). Vision Loss in Older Persons. Am Fam Physician, 79(11), 963-970. 
     Retrieved February 2014 from:  
     http://www.aafp.org/afp/2009/0601/p963.html

8.  The National Coalition for Vision Health. (2011). Vision Loss in Canada. Retrieved February 2014 from:
     http://www.visionhealth.ca/news/Vision%20Loss%20in%20Canada%20-%20Final.pdf

Hearing loss is a partial or complete inability to hear; the onset occurs either suddenly or as a gradual decline in how well a person can hear. (6) Hearing loss is one of the fastest growing and prevalent chronic conditions affecting Canadians over the age of 65; more than 30% of these individuals will experience some degree of hearing loss in their lifetime.(4)  The two most common types of hearing loss include age-related (presbycusis) and noise-induced hearing loss (NIHL).(5)   Untreated hearing loss can negatively impact one’s quality of life. Depression, decreased ability to do normal activities of life, and reduced participation in social activities are symptoms of a person’s inability to cope with hearing loss.(3)  Research has revealed that older adults with unmanaged hearing loss are at increased risk of cognitive decline, developing dementia, and falling.(2)  Hearing aids can improve the lives of even those with significant dementia.

Cost for many is a key consideration when considering buying a hearing aid. Hearing aids and special audio systemshowever they must be purchased from a vendor registered with the Assistive Devices Program (ADP).  ADP will reimburse eligible Ontarians 75% of the cost, including dispensing fee, ear molds and accessories, to a maximum of:

• $500 of the cost of one hearing aid
• $1,000 for two hearing aids
• $1,350 of the cost of a specialized system (1)

Discuss your needs with your doctor or health care professional.

References

1.  Canadian Hard of Hearing Association. (2010). Canadian Hearing Aid Subsidies.  Retrieved February 2014 from: 
     www.chha.ca/documents/Hearing_Aid_Subsidies_Across_Canada.pdf

2.  Canadian Hearing Society. (2013). Facts and Figures. Retrieved February 2014 from:
     http://www.chs.ca/facts-and-figures

3.  National Academy on an Aging Society. (1999). Hearing Loss. Retrieved February 2014 from:
     http://www.agingsociety.org/agingsociety/pdf/hearing.pdf

4.  Public Health Agency of Canada. (2006). Hearing Loss Info-Sheet for Seniors. Retrieved February 2014 from:
     http://seniorspolicylens.ca/Root/Materials/Adobe%20Acrobat%20Materials/Hearing_Loss_Info-Sheet.pdf

5.  The Hearing Foundation of Canada. (2010). Statistics. Retrieved February 2014 from:  
     http://www.thfc.ca/cms/en/KeyStatistics/KeyStatistics.aspx?menuid=87

6. National Institutes of Health. (2013). Hearing Loss and Older Adults. Retrieved February 2014 from: 
    http://www.nidcd.nih.gov/health/hearing/pages/older.aspx

Hearing loss is a partial or complete inability to hear; the onset occurs either suddenly or as a gradual decline in how well a person can hear. (5)

Why is it important?

  • Hearing loss is one of the fastest growing and prevalent chronic conditions affecting Canadians over the age of 65; more than 30% of these individuals experience some degree of hearing loss (6)
  • Untreated hearing loss can negatively impact one’s quality of life; decreased functional health, and reduced participation in social activities are symptoms of a person’s inability to cope with hearing loss (4)
  • Older adults with unmanaged hearing loss are at increased risk of cognitive decline, developing dementia, delirium and falling (3)
  • 90% of those with hearing loss can improve communication with proper assistive devices, environmental redesign, or counseling (3)

Common Causes

  • The two most common types of hearing loss include age-related (presbycusis) and noise-induced hearing loss (NIHL) (9)
  • Other causes include: infection, heart conditions, stroke, head injuries, tumours and certain medications (7)

Key Considerations

  • Conduct the Whisper Test to screen for hearing loss.  (whisper test & how to)
  • Health professionals: consider referring patients to an audiologist and hearing centres for consideration of hearing aides, cochlear implants, assistive listening devices or to learn lip reading
  • Patients may benefit from other assistive devices such as volume control telephones, computers to communicate,closed-captioned TV or decoder, amplifiers, and visual or vibrating alarms (1)
  • Cost for many is a key consideration when considering buying a hearing aid. Hearing aids and a specialized systems must be purchased from a vendor registered with the Assistive Devices Program (ADP). ADP will reimburse eligible Ontarians 75% of the cost, including dispensing fee, ear molds and accessories, to a maximum of:
      • $500 of the cost of one hearing aid
      • $1,000 for two hearing aids
      • $1,350 of the cost of a aspecialized system (2)
  • When communicating with a patient: maintain eye contact, speak clearly and naturally,  move hands away from face, remove audio distractions, write things down if needed, use facial expressions and gestures when appropriate
  • Prevent further decline: prolonged exposure to sounds greater than 85dB cause hearing threshold shifts leading to permanent hearing loss (8)

References

1.  Canadian Academy of Audiology. (2014). Retrieved February 2014 from: 
     https://canadianaudiology.ca/for-the-public/hearing-aids-and-implants

2.  Canadian Hard of Hearing Association. (2010). Canadian Hearing Aid Subsidies.
     Retrieved February 2014 from:
     www.chha.ca/documents/Hearing_Aid_Subsidies_Across_Canada.pdf

3.  Canadian Hearing Society. (2013). Facts and Figures. Retrieved February 2014 from:
     http://www.chs.ca/facts-and-figures

4.  National Academy on an Aging Society. (1999). Hearing Loss. Retrieved February 2014 from:
     http://www.agingsociety.org/agingsociety/pdf/hearing.pdf

5.  National Institutes of Health. (2013). Hearing Loss and Older Adults. Retrieved February 2014 from:  
     http://www.nidcd.nih.gov/health/hearing/pages/older.aspx

6.  Public Health Agency of Canada. (2006). Hearing Loss Info-Sheet for Seniors. Retrieved February 2014 from:
     http://seniorspolicylens.ca/Root/Materials/Adobe%20Acrobat%20Materials/Hearing_Loss_Info-Sheet.pdf

7. The Hearing Foundation of Canada. (2010). Causes of Hearing Loss.
    http://www.hearingfoundation.ca/causes-of-hearing-loss/

8. The Hearing Foundation of Canada. (2010). Noise-Induced Hearing Loss and Prevention
    http://www.hearingfoundation.ca/noise-induced-hearing-loss/

9.  The Hearing Foundation of Canada. (2010). Statistics. Retrieved February 2014 from: 
    http://www.hearingfoundation.ca/statistics/

Social isolation, Alzheimer’s disease and other dementias, and falls are all linked to hearing loss and are three of the top four reasons for admission to long term care facilities” - Canadian Hearing Society, 2014

Hearing loss is a partial or complete inability to hear; the onset occurs either suddenly or as a gradual decline in how well a person can hear. (5)

Why is it important?

  • Hearing loss is one of the fastest growing and prevalent chronic conditions affecting Canadians over the age of 65;more than 30% of these individuals experience some degree of hearing loss (6)
  • Untreated hearing loss can negatively impact one’s quality of life; decreased functional health, and reduced participation in social activities are symptoms of a person’s inability to cope with hearing loss (4)
  • Older adults with unmanaged hearing loss are at increased risk of cognitive decline, developing dementia, delirium and falling (3)
  • 90% of those with hearing loss can improve communication with proper assistive devices, environmental redesign, or counseling (3)

Common Causes

  • The two most common types of hearing loss include age-related (presbycusis) and noise-induced hearing loss (NIHL) (9)
  • Infection, heart conditions, stroke, head injuries, tumours and certain medications (7)

Key Considerations

  • Conduct the Whisper Test to screen for hearing loss.  (whisper test & how to)
  • Health professionals should consider referring patients to an audiologist and hearing centres for consideration of hearing aides, cochlear implants, assistive listening devices or to learn lip reading
  • Patients may benefit from other assistive devices such as volume control telephones, computers to communicate, closed-captioned TV or decoder, amplifiers, and visual or vibrating alarms (1)
  • Cost for many is a key consideration when considering buying a hearing aid. Hearing aids and special audio systems must be purchased from a vendor registered with the Assistive Devices Program (ADP). ADP will reimburse eligible Ontarians 75% of the cost, including dispensing fee, ear molds and accessories, to a maximum of:
      • $500 of the cost of one hearing aid
      • $1,000 for two hearing aids
      • $1,350 of the cost of a specialized audio system (2)
  • When communicating with a patient: maintain eye contact, speak clearly and naturally,  move hands away from face, remove audio distractions, write things down if needed, use facial expressions and gestures when appropriate
  • To prevent further decline, avoid prolonged exposure to sounds greater than 85dB which can lead to permanent hearing loss (8)

References

1.  Canadian Academy of Audiology. (2014). Retrieved February 201 from
     https://canadianaudiology.ca/for-the-public/hearing-aids-and-implants/#what-other-devices-could-help-me

2.  Canadian Hard of Hearing Association. (2010). Canadian Hearing Aid Subsidies
     Retrieved February 2014 from:
     www.chha.ca/documents/Hearing_Aid_Subsidies_Across_Canada.pdf

3.  Canadian Hearing Society. (2013). Facts and Figures. Retrieved February 2014 from:  
     http://www.chs.ca/facts-and-figures

4.  National Academy on an Aging Society. (1999). Hearing Loss.
     Retrieved February 2014 from: 
     http://www.agingsociety.org/agingsociety/pdf/hearing.pdf

5. 
National Institutes of Health. (2013). Hearing Loss and Older Adults.
     Retrieved February 2014 from:
     http://www.nidcd.nih.gov/health/hearing/pages/older.aspx

6.  Public Health Agency of Canada. (2006). Hearing Loss Info-Sheet for Seniors.
     Retrieved February 2014 from:
     http://seniorspolicylens.ca/Root/Materials/Adobe%20Acrobat%20Materials/Hearing_Loss_
     Info-Sheet.pdf


7.  The Hearing Foundation of Canada. (2010). Causes of Hearing Loss. Retrieved February 2014 from:
     http://www.hearingfoundation.ca/causes-of-hearing-loss/

8.  The Hearing Foundation of Canada. (2010). Noise-Induced Hearing Loss and Prevention. 
     Retrieved February 2014 from:
     http://www.hearingfoundation.ca/noise-induced-hearing-loss/

9.  The Hearing Foundation of Canada. (2010). Statistics. Retrieved February 2014 from:
     http://www.hearingfoundation.ca/statistics/

“Falls are one of the leading causes of injury among seniors, and often result in avoidable Emergency Department visits, hospitalizations and admission to long-term care homes. Ontario’s annual costs for falls by seniors have been estimated at $962 million. Unmanaged hearing loss is a risk factor for falling.” - Canadian Hearing Society, 2014

Hearing loss is a partial or complete inability to hear; the onset occurs either suddenly or as a gradual decline in how well a person can hear. (4)

Why is it important?

  • Hearing loss is one of the fastest growing and prevalent chronic conditions affecting Canadians over the age of 65; more than 30% of these individuals experience some degree of hearing loss (5)
  • Untreated hearing loss can negatively impact one’s quality of life; decreased functional health, and reduced participation in social activities are symptoms of a person’s inability to cope with hearing loss (3)
  • Older adults with unmanaged hearing loss are at increased risk of cognitive decline, developing dementia, delirium and falling (2)
  • 90% of those with hearing loss can improve communication with proper assistive devices, environmental redesign,or counseling (2)

Common Causes

  • The two most common types of hearing loss include age-related (presbycusis) and noise-induced hearing loss (NIHL) (7)
  • Other causes include: infection, heart conditions, stroke, head injuries, tumours and certain medications (6)

Key Considerations

  • Conduct the Whisper Test to screen for hearing loss.  (whisper test & how to)
  • Health professionals: should consider referring patients to an audiologist and hearing centres for consideration of hearing aides, cochlear implants, assistive listening devices or to learn lip reading
  • Patients may benefit from other assistive devices such as volume control telephones, computers to communicate, closed-captioned TV or decoder, amplifiers, and visual or vibrating alarms (1)
  • If the patient has a hearing aid ensure it is in working order and ask patient to use their appliance

References

1.  Canadian Academy of Audiology. (2014). Retrieved February 2014 from:
     https://canadianaudiology.ca/for-the-public/hearing-aids-and-implants

2.  Canadian Hearing Society. (2013). Facts and Figures. Retrieved February 2014 from:
     http://www.chs.ca/facts-and-figures

3.  National Academy on an Aging Society. (1999). Hearing Loss. Retrieved February 2014 from:
     http://www.agingsociety.org/agingsociety/pdf/hearing.pdf

4.  National Institutes of Health. (2013). Hearing Loss and Older Adults. Retrieved February 2014 from:  
     http://www.nidcd.nih.gov/health/hearing/pages/older.aspx

5.  Public Health Agency of Canada. (2006). Hearing Loss Info-Sheet for Seniors. Retrieved February 2014 from:
     http://seniorspolicylens.ca/Root/Materials/Adobe%20Acrobat%20Materials/Hearing_Loss_Info-Sheet.pdf

6. The Hearing Foundation of Canada. (2010). Causes of Hearing Loss.
    http://www.hearingfoundation.ca/causes-of-hearing-loss/

7.  The Hearing Foundation of Canada. (2010). Statistics. Retrieved February 2014 from:
    http://www.hearingfoundation.ca/statistics/ 

Hearing loss is a partial or complete inability to hear; the onset occurs either suddenly or as a gradual decline in how well a person can hear. (5)

Why is it important?

  • Hearing loss is one of the fastest growing and prevalent chronic conditions affecting Canadians over the age of 65;
    more than 30% of these individuals experience some degree of hearing loss (6)
  • Untreated hearing loss can negatively impact one’s quality of life; decreased functional health, and reduced participation
    in social activities are symptoms of a person’s inability to cope with hearing loss (4)
  • Older adults with unmanaged hearing loss are at increased risk of cognitive decline, developing dementia, delirium and
    falling (3)
  • 90% of those with hearing loss can improve communication with proper assistive devices, environmental redesign, or
    counseling (3)

Common Causes

  • The two most common types of hearing loss include age-related (presbycusis) and noise-induced hearing loss (NIHL) (9)
  • Other causes include: infection, heart conditions, stroke, head injuries, tumours and certain medications (7)

Key Considerations

  • Conduct the Whisper Test to screen for hearing loss.  (whisper test & how to)
  • Health professionals should consider referring patients to an audiologist and hearing centres for consideration of hearing
    aides, cochlear implants, assistive listening devices or to learn lip reading
  • Patients may benefit from other assistive devices such as volume control telephones, computers to communicate,
    closed-captioned TV or decoder, amplifiers, and visual or vibrating alarms (1)
  • Cost for many is a key consideration when considering buying a hearing aid. Hearing aids and specialized audio systems must be
    purchased from a vendor registered with the Assistive Devices Program (ADP). ADP will reimburse eligible Ontarians
    75% of the cost, including dispensing fee, ear molds and accessories, to a maximum of:
    • $500 of the cost of one hearing aid
    • $1,000 for two hearing aids
    • $1,350 of the cost of a specialized audio system (2)
  • When communicating with a patient: maintain eye contact, speak clearly and naturally,  move hands away from face,
    remove audio distractions, write things down if needed, use facial expressions and gestures when appropriate
  • To prevent further decline, avoid prolonged exposure to sounds greater than 85dB which can lead to permanent hearing
    loss (8)

References

1.  Canadian Academy of Audiology. (2014). Retrieved February 2014 from:  
     https://canadianaudiology.ca/for-the-public/hearing-aids-and-implants/

2.  Canadian Hard of Hearing Association. (2010). Canadian Hearing Aid Subsidies
     Retrieved February 2014 from:
     www.chha.ca/documents/Hearing_Aid_Subsidies_Across_Canada.pdf

3.  Canadian Hearing Society. (2013). Facts and Figures. Retrieved February 2014 from:  
     http://www.chs.ca/facts-and-figures

4.  National Academy on an Aging Society. (1999). Hearing Loss. Retrieved February 2014 from:
     http://www.agingsociety.org/agingsociety/pdf/hearing.pdf

5.  National Institutes of Health. (2013). Hearing Loss and Older Adults. Retrieved February 2014 from:  
     http://www.nidcd.nih.gov/health/hearing/pages/older.aspx

6.  Public Health Agency of Canada. (2006). Hearing Loss Info-Sheet for Seniors. Retrieved February 2014 from:
     http://seniorspolicylens.ca/Root/Materials/Adobe%20Acrobat%20Materials/Hearing_Loss_Info-Sheet.pdf

7.  The Hearing Foundation of Canada. (2010). Causes of Hearing Loss. Retrieved February 2014 from:    
     http://www.hearingfoundation.ca/causes-of-hearing-loss/

8.  The Hearing Foundation of Canada. (2010). Noise-Induced Hearing Loss and Prevention. 
     Retrieved February 2014 from:
     http://www.hearingfoundation.ca/noise-induced-hearing-loss/

9.  The Hearing Foundation of Canada. (2010). Statistics. Retrieved February 2014 from:  
     http://www.hearingfoundation.ca/statistics/

Polypharmacy, defined as the use of five or more prescription medications is common among seniors and can lead to reduced adherence with medication regimens and problems with drug interactions.(4) Medication-related problems are common, costly, are preventable in older adults and can lead to poor outcomes. 

Why is this Important?

  • 27% of seniors report taking five or more medications on a regular basis (4)
  • 12% of seniors taking five or more medications experienced a side effect that required medical attention compared with 5% of seniors taking only one or two medications (4)
  • The number of prescription medications was associated with the rate of emergency department use (4)
  • Less than 50% of all seniors reported receiving a prescription medication review from their physician identifying potential side effects.(4)
  • 27% of adverse drug events (ADEs) in primary care were preventable, with most problems occurring at the ordering and monitoring stages of care (1)

Key Considerations

  • When conducting a medication review ask for all prescribed medications, OTC and herbal preparations
  • Monitor medication adherence, ask about common side effects and adverse occurrences especially when new medications have been ordered
  • As patients become more frail, the possible harm from preventative medications must be weighed against the benefits (1)
  • Follow BEERS criteria when prescribing and evaluating:
      • medications to avoid in older adults regardless of disease or conditions
      • medications considered inappropriate when used in older adults with certain conditions or syndromes
      • medications to consider for use in certain individuals recognizing the potential for misuse and harm is substantial (5)

References

1.     Campanelli, C. (2012).  American Geriatrics Society Updated Beers Criteria for Potentially Inappropriate
        Medication Use in Older Adult. 
Published online Feb 29, 2012.  Retrieved Feb.27, 2014 from: 
        http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3571677/

2.     Frank, C.  (2010) Multiple medications in geriatric care.  OSMT Volume 17/Issue 2, Summer 2010. 
        Retrieved Feb. 2014 from:
        http://www.osmt.org/uploads/Multiple%20medications%20in%20geriatric%20care.pdf

3.     Institute for Safe Medication Practices Canada.  (2014). Safe Medication Use in Older Persons Information
        Page
.  Retrieved Feb. 2014 from: 
        https://www.ismp-canada.org/beers_list/

4.     Reason, B.  et al.  (2011) The impact of polypharmacy on the health of Canadian seniors. Oxford Journals. 
        Medicine, Family Practice.  Volume 29, Issue 4Pp. 427-432.  Retrieved Feb. 27, 2014 from: 
        http://fampra.oxfordjournals.org/content/29/4/427.long  

5.     The American Geriatrics Society. (2012).American Geriatrics Society Updated Beers Criteria for
        Potentially Inappropriate Medication Use in Older Adults, Beers Criteria Update Expert panel, 
       
Journal of American Geriatrics Society (2012), 1-16, Retrieved May 2014 from:
        
http://www.americangeriatrics.org/health_care_professionals/clinical_practice/clinical_guidelines

Older individuals tend to have medical conditions that require them to take multiple drugs (polypharmacy). Polypharmacy is a major problem among older people especially those with many complex diagnosis and health problems.  With each additional medication taken, older individuals are at an increased risk of adverse reactions from side effects and from interactions between drugs. Taking multiple drugs, herbal remedies, dietary supplements and over-the-counter medications can make routines complicated and difficult to follow. Each of these drugs and products can cause side effects or can react with each other.(1) Remember to take a current list of your medications and all your medications in the original containers to all physician appointments.

References

  1. Hogan, D. & Kwan, M.  (2006)  Patient sheet: Tips for avoiding problems with polypharmacy.
    CMAJ, October 10, 2006 vol. 175 no. 8,  876.  Retrieved Feb. 27, 2014 from:
    www.cmaj.ca/content/175/8/876/F1.expansion.html

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