Loss In Older Adults Research Articles

Diagnosis of sensory impairment in people with intellectual disability in general practice.

The present authors have participated in the development of a Dutch consensus on the early detection, diagnosis and treatment of hearing and visual impairment in children and adults with intellectual disability. They argue that the early detection of sensory impairment in babies and children with intellectual disability should primarily be a responsibility of paediatricians and youth health physicians. General practitioners should be aware of the necessity of screening and should check whether this has been done when children visit the surgery. It is stressed that the general practitioner should play a more active role in the detection of age-related sensory loss in older adults with intellectual disability, and the assessment of younger adults whose sensory functions have never or incompletely been evaluated. Annual sensory screening is certainly not necessary, but annual otoscopy to detect impacted earwax or unidentified middle ear infection, as well as checks of the proper use of glasses and hearing aids, are suggested. Most adults with mild or moderate intellectual disability can be assessed with methods that are normally used by general practitioners. Uncooperative people should be referred for screening with specialized methods. A low-threshold referral system (e.g. via district expert teams) has been outlined.

Hearing Impairment in Older Adults: New Concepts

To review present information about the epidemiology, etiologies, pathogenesis, evaluation, and quality of life aspects of hearing loss and to present an approach to rehabilitation for hearing loss in older adults. A survey of recent findings on the problem of hearing loss in older adults, efficacy of intervention with amplification, and new developments in intervention strategies. The complex nature of hearing problems in older adults involves changes in the auditory periphery as well as in the central mechanisms for processing sound input. These changes affect the social and emotional impact of the hearing disorder. The importance of understanding the many implications of hearing loss on quality of life is emphasized. Both older adults and immediate family members need information and advice about the consequences of age-related hearing loss. The physician has a key role in helping them to overcome negative attitudes toward a hearing handicap. For most older persons, hearing aids alleviate many of the handicaps of hearing impairment. For some older persons who do not benefit adequately from conventional hearing aids, assistive listening devices may be helpful. Many old persons and their relatives are reluctant to confront the reality of hearing handicap and try to hide the fact that they need sound amplification. One important future direction is to foster acceptance of hearing loss and to support the more open use of amplification systems.

An audioscope was more accurate than a questionnaire for screening for hearing loss in older adults

Source Citation McBride WS, Mulrow CD, Aguilar C, Tuley MR. Methods for screening for hearing loss in older adults. Am J Med Sci. 1994 Jan;307:40-2.

Methods for Screening for Hearing Loss in Older Adults

Two common screening tools for detecting hearing loss, the Hearing Handicap Inventory for the Elderly-Screening Version (HHIE-S) and Audioscope, are compared. One hundred eighty-five consecutive patients over age 60 at a primary care clinic received both screening tests followed by pure tone audiometry. Three criteria for hearing loss was considered: Speech Frequency Pure Tone Average > or = 25 dB; High Frequency Pure Tone Average > or = 25 dB; and Ventry and Weinstein's criteria of a 40 dB loss at 1.0 or 2.0 kHz. Ranges of respective operating characteristics for the Audioscope versus the HHIE-S were: sensitivities 0.64 to 0.96 versus 0.29 to 0.63; specificities 0.80 to 0.91 versus 0.75 to 0.93; and positive likelihood ratios 4.86 to 7.52 versus 2.42 to 4.27. Most patients preferred screening with the Audioscope (60%) over the HHIE-S (13%). The Audioscope is preferred by patients, and outperforms the HHIE-S using a variety of reference standard definitions.

Low-Vision Rehabilitation with Older Adults

Vision loss increases dramatically with age but relatively little attention has been paid to blind and low-vision rehabilitation with older adults in the health care literature. The present article describes the nature and etiology of vision loss in older adults and provides an overview of the techniques and technologies available to help older adults overcome the disabilities associated with loss of vision.

Aging and luminance-adaptation effects on spatial contrast sensitivity.

Contrast sensitivity as a function of target luminance for four spatial frequencies (0.5, 2, 4, and 8 cycles/deg) was measured in younger (n = 12; age range, 19-35 years) and older (n = 11; age range, 68-79 years) adults in order to examine the feasibility of optical and neural explanations for the impairment of contrast sensitivity in older adults. All subjects were free from identifiable ocular disease and had good acuity. Sensitivity for each spatial frequency was measured at eight luminance levels spanning 3.5 log units in the photopic-mesopic range. When gratings were flickered at 0.5 Hz, functions for older adults were displaced downward on the sensitivity axis across all luminance levels, and the slopes of these functions were steeper than those for younger adults, suggesting that optical mechanisms alone cannot account for the vision loss in older adults. Further measurements, in which spatial targets were flickered at 7.5 Hz, indicated that this faster temporal modulation affected sensitivity as a function of luminance differentially in younger and older adults. These data imply that the neural mechanisms subserving human spatial vision undergo significant changes during adulthood.

Evaluating Involuntary Weight Loss in Older Adults

Involuntary weight loss is a common complaint among patients over 40 years of age. Few studies concerning the etiologies of weight loss, however, have been published. This article reviews two recent studies that address common causes of unintentional weight loss. In these investigations, almost half of the patients claiming significant weight loss had no decrease in weight at all. In 35 percent of patients with true weight loss, no physical source was found after six months of follow-up. Of those in whom a cause of weight loss was discovered, the etiology was usually apparent after a brief history, physical exam and screening laboratory evaluation. Common causes of involuntary weight loss are discussed. Guidelines for evaluation of the patient who complains of weight loss are offered.