Hearing and sight loss in older people

Code: OP02

Among older people, hearing loss is very common; over half of people over 60 have impaired hearing. Sight loss, though less common, affects one in 12 people in this age group. As more people survive into older age, the incidence of sight and hearing loss is growing.

The combined loss of these two key senses can give rise to immense challenges in everyday life. Nevertheless, much can be done to enable people with impaired sight and hearing to enjoy a better quality of life. This factsheet aims to help you to understand the combined effects of sight and hearing loss. It describes the major challenges and explains what families and carers can do to help, as well as sign-posting you to services which can help.

The loss of sight and hearing is often referred to as ‘deafblindness’, though this term can be very misleading as well as being a term few people would use to describe themselves or their loved ones. In this factsheet, we use the terms ‘hearing and sight loss’ or ‘impaired hearing and sight’ as they are closer to everyday language.

What do we mean by ‘hearing and sight loss’?

In this factsheet we are concerned with moderate to severe hearing and sight loss which make aspects of everyday living difficult. Each person with impaired sight and hearing has a unique combination of disabilities depending on what they can and cannot see or hear, and how their loss came about.

‘Partial sight’, for instance, can mean a variety of things. Some people have no central vision and cannot see faces or read, while others see as if through a tunnel. Some see everything through a dense ‘fog’ and others see a patchwork of blanks in their vision. A small minority of people have only limited light perception or are totally blind. Hearing loss can also be varied; some can hear certain frequencies, others register nothing. Hearing aids can help many people, but not everyone can benefit.

In general terms this factsheet covers:

• people who are hard of hearing and partially sighted;
• people who are deaf and partially sighted;
• people who are hard of hearing and blind;
• people who are deaf and blind. These people are a minority, as, fortunately, most people retain some useful vision or hearing or both.

In older age these disabilities may add to existing difficulties such as poor mobility. Life can be very trying indeed for older people with multiple difficulties, but tackling the problems caused by sensory loss can make a huge difference to their quality of life. On page 3 we describe what you can do to help make the most of any remaining senses.

What is it like to have impaired hearing and sight?

It is often difficult to understand the daily challenges for people who cannot hear and see properly. People with impaired hearing use their sight to compensate; for example they can follow a conversation by watching people’s lips and body language. Those with sight loss use their hearing to help them; for example they may use audio tapes to listen to books or other information and sound clues to help them find their way about. But people with impaired hearing and sight cannot rely on any sense to compensate their loss. For some people, touch is the only sense left, yet touch offers only limited opportunities. How would you hold a conversation with your family if you could not hear or see them properly? How would you cook a meal? How would you shop for food or clothes? How would you tell the time? How would you fill your time if you could not see television, listen to the radio, read a newspaper or magazine? How would you get out and about? There are answers to many of these difficulties but, alas, no ‘quick fix’ solutions for anyone.

The everyday challenges depend not only on the degrees of hearing and sight loss, but also on how people came to lose both major senses. People fall into one of four major groups:

• the majority of those with hearing and sight loss have had both sight and hearing throughout most of their lives. Some may have adapted if the losses came on gradually and are not severe but others will have had no opportunity to adjust to the loss of one sense before the loss of the other occurs. Sensory loss can shatter people’s confidence. Finding a means to communicate is usually the biggest difficulty and an immense frustration to the individuals themselves;
• some people who have been hard of hearing or deaf all or most of their lives go on to lose their sight in later life. These people are likely to have adapted to life with limited or no hearing. Some will use hearing aids successfully; others will have learned to lip-read, while a minority with profound deafness from an early age may have learned to use sign language. Many deaf people rely entirely on their sight to help them communicate, as well as find their way around, so sight loss cuts them off from their usual way of coping with the world;
• some people who have been blind or partially sighted all or most of their lives lose their hearing as they get older. Many visually impaired people can see enough to read large print, though this is tiring, but some rely on audio tapes for information and a few use braille. They will have relied on their hearing to hold a conversation, get information, and find their way around, so they too experience real difficulties if their hearing gets worse;
• a very small minority of people have been born with both impaired hearing and sight. Their needs as they get older are very complex and fall outside the scope of this factsheet.

Whichever group people fall into, hearing and sight loss together can be very frustrating and stressful. It is not uncommon for people to react with anger, depression or withdrawal and on page 7 we give some tips on dealing with these.

What causes hearing and sight loss? Can further loss be prevented?

Many different illnesses, age-related conditions and even accidents can result in hearing and sight loss. The commonest causes of sight loss in later life are cataract, macular degeneration and glaucoma. Cataracts can usually be treated successfully by a simple operation; there is no need to wait until the condition is advanced before starting treatment. Glaucoma can be prevented or treated if it is caught in the early stages, but until recently little could be done for people with macular degeneration. There have been recent developments in the treatment of macular degeneration - although this is still in the early stages and is not widely available yet. RNIB has some useful, free booklets on these and other eye conditions (see page 8).

It is very important for all older people to have regular eye health checks at a reputable optometrist (optician) or visit the GP if sight suddenly deteriorates. Never put a sight problem down to ‘old age’ and ignore it! Patients will be referred to a hospital eye clinic for further tests if the optometrist or GP suspects a condition that cannot be put right by spectacles. It is also possible to have more than one eye condition, which is why regular eye tests are so important. After diagnosis at the hospital, ask the eye consultant (ophthalmologist) to refer the visually impaired person to a ‘low vision clinic’. These clinics assess vision, provide suitable aids such as magnifiers, and offer guidance on making the best use of the sight that is left. If you have no such service in your area, ask the Partially Sighted Society for advice (see page 8).

Hearing loss cannot usually be prevented or reversed. There are many causes of deafness but in later life the commonest is presbyacusis. This condition affects the inner ear and makes it difficult to hear certain frequencies. This particularly interferes with people’s ability to hear speech. Fortunately many people with this condition can be helped by hearing aids, and nowadays these are not just very powerful, they are also tiny and very discreet. Recent advances such as cochlear implants may help a few people who cannot benefit from conventional hearing aids.

People with hearing loss should have their hearing assessed at a hospital - ask the GP for a referral. The hospital tests will show the cause of the problem and will determine what kind of hearing aids and other support will best help. After the initial diagnosis it is important to have regular check ups.

Making the most of remaining hearing

Many people with hearing loss can be helped in some easy, common sense ways:

• make sure that hearing aids are working properly and that batteries are replaced as soon as needed;
• hearing aids unfortunately amplify all sounds and not just the sound someone wants to focus on. So when you speak to a hearing aid user, cut out background noises such as the radio;
• speak to a deaf person where they can see your face as clearly as possible. We can all 'hear' better when we can see the speaker's lips. Some people may benefit from training in lip-reading and many local colleges offer suitable courses;
• speak clearly and a little slowly; don’t shout. Give the person time to absorb what you have said and check that the person is following the conversation.

Making the most of remaining sight

Many people can be helped to make better use of the sight that is left. Here are some things to be aware of:

• most people with poor sight function better in strong, even light, so improving the lighting can help a great deal. A minority of people with sight loss prefer dim lighting however, so always ask what works best;
• when you are speaking to someone with poor sight and hearing, sit where they can best see you and with your face well lit. It also helps to avoid strongly patterned clothing as this causes visual confusion. Wear plain clothing which contrasts with your skin colour; it is easier to see black people in pale colours and white people in dark colours;
• many people can see to read print if the type size and weight are adequate. Use a thick marker pen on paper or a white board to write messages;
• some people with residual sight may be able to learn sign language. There are two main sign languages and an adaptation of both, called ‘visual frame signing’, which is specifically for people with limited vision. Sign language does take time to master however. For more information contact Sense.

Finding a way to communicate

Hearing and sight loss can be so severe in some people that they do not have an obvious means of communication. If this is the case, then you need to communicate by touch. There are a number of techniques you can try, but for all of them you will need perseverance, bags of patience and a good sense of humour. The options are:

Block

This is a method of spelling out words on the palm of the hand. Trace each letter with your finger, in block capitals, on the palm, placing each letter on top of the previous one. The advantage of this method is that you don’t need any equipment, and it can be used in any language. But not everyone finds it easy to follow.

Manual alphabet

This is another method of spelling out words. Each letter of the alphabet is represented by a place on the hand; for instance, if you touch the tip of the forefinger, this denotes the letter ‘e’. As with block, you need no equipment to use this method and it works for all languages using our alphabet. It does take a bit of time to learn but is worth mastering for those able to do so.

Braille and Moon

These are tactile means of producing text. Braille uses a series of raised dots to represent letters, while Moon uses something closer to raised letter shapes. Braille can be hard to master in later life because it requires a lot of sensitivity in the fingertips. Moon is much easier, though less material is published in Moon. Both need special equipment however, so neither is useful for conversation. But both methods give access to books and magazines and other information.

Objects of reference

This is a very simple method of communication using objects to signify actions. For example you could place a towel in someone’s hands to signify that it’s time for a wash, or a fork to indicate dinner time. Obviously this method is very limited in its scope, but used with consistency it can be a real help to those who cannot use any other technique.

Hands on signing

For people who have mastered sign language, ‘hands on signing’ is an adaptation which allows people to feel rather than see the signs. This method is often used by people who have been deaf most of their lives and who are accustomed to signing, but may also be learned by people who have become dual-sensory impaired more recently.

Obviously, any method you choose must be right for the individual. There is little point in introducing the manual alphabet to someone with little sensation in their hands. But it is also easy to under-estimate people. Some people who have not been communicated with for a long time may seem less capable than they actually are. If in doubt, give something a try. Above all, be patient - results are certain to come slowly.

Maintaining independence at home

People with hearing and sight loss can be helped to maintain their independence by the careful use of equipment, adaptations, support and, preferably, skilled rehabilitation training from specialists. Try the following:

• Improve the level of lighting to suit the person. Most people prefer high levels of light and good task lighting, but for others you will need to dim the lighting and eliminate glare, by putting in sun blinds for instance. Lighting needs to be specially well thought out on steps and stairs;
• Use colour contrast to highlight features and make them easier to find. For example put contrasting tape on the edge of stairs and round plug sockets. Paint door frames and skirting boards a different colour from the doors, walls and carpets. Choose crockery that contrasts with worktops and tables;
• Move obvious hazards such as coffee tables in the middle of a floor, things that jut out at head height, or things that can be tripped over such as rugs and waste bins;
• Use tactile clues to help people distinguish things. For instance, put one rubber band round the tinned tomatoes and two round the peaches; bubble wrap on some door handles and string on others;
• There is a wide range of high-tech solutions on offer such as text-phones for people with some sight to simple gadgets such as tactile watches or alarm clocks that vibrate under your pillow. There are literally hundreds of items to choose from to suit most people’s basic needs. The Access Catalogue details these and is available from Sense.
• Scented clues can help too. Put lemon-scented soap in the sock drawer and lavender bags with the jumpers for instance.

Getting out and about

Few older people with impaired sight and hearing will be able to get about totally independently but they have as much need of a change of scene as anyone else. They will probably need your help; here’s how:

• Learn to guide someone correctly Allow the person with poor sight to hold your arm just above the elbow and walk half a pace ahead of them so that they can tell from your movement when to turn. When you reach any steps, indicate whether they go up or down and place the person’s hand on the rail if there is one;
• Most people will get around their own homes well enough but will need help to learn basic routes if they are in a new and unfamiliar place such as a relative’s home or a day centre. Walk them through the route pointing out features on the way which will help them locate themselves, for instance the textured wallpaper in the corridor with the bathroom. A useful technique for walking around safely is to hold one hand ahead while trailing the back of the other hand against a wall;
• Find out about any local transport schemes for people with disabilities, such as ‘dial-a ride’. Your local council will tell you about these. Some train operators offer special help to disabled passengers and concessions to the person accompanying them;
• If someone could make a simple journey unaided, to the local shop for instance, teach him or her the route. Walk the route with them, pointing out key features to help orientate them such as changes of surface or the number of gates they need to count. The correct use of a white cane (or red and white for people with impaired sight and hearing) is a great help on such trips.

A few don’ts

Some things are unhelpful or distressing to people with hearing and sight loss.

• Don’t grab hold of someone and take charge. If you need to get their attention, tap them lightly on the arm and explain what you need to do; guide them using the correct techniques;
• Don’t leave people out of the conversation. Explain what is going on, even if they cannot follow everything;
• Don’t offer a plate at mealtimes without saying what is on it;
• Don’t leave someone without explaining that you are going, or they could end up addressing an empty space;
• Don’t move furniture or objects in someone’s home without discussing it first. The tea caddy you moved is as good as lost!
• Don’t leave things, like your bag, where they could be a hazard. Doors should be left fully closed or fully open, never half open.

Enjoying life

One of the greatest challenges for older people with hearing and sight loss is to fill the time when reading, television and other activities may be difficult or impossible. However, it is possible to adapt some activities; gardening, for instance, is enjoyed by older people with impaired sight and even totally blind people. Cooking can be fun again for people who enjoy it, and people with some sight may be able to use large print, knitting patterns for example. For those with some hearing, audio-taped books may be a boon.

For people with very severe sensory loss, the solutions have to be tactile. RNIB sells a number of tactile games, such as dominoes and playing cards which can be played with sighted and hearing people too. Some museums, galleries and cathedrals offer ‘touch tours’ for people who cannot see exhibits. Some organisations run holiday hotels offering special services to people with sensory problems.

Dealing with depression and other problems

Few disabilities can be as frustrating as hearing and sight loss and many people become depressed, angry or withdrawn. Often these difficulties arise because the disabled person has no means to communicate his or her feelings and anxieties. Establishing a workable means to communicate is thus very important. It is also very time consuming and requires endless patience, but it will reap dividends. If people can off-load to a sympathetic listener they can often move on in their lives and adapt successfully to their new situation. Severe depression may require medical help. Contact Sense if you need advice.

Benefits and services

There are many benefits and services that can help people with hearing and sight loss. This is a brief run-down of the main ones.

Extra money

Older people with impaired sight and hearing will almost certainly qualify for Disability Allowance (for people up to 65) or Attendance Allowance (for people over 66). Other benefits such as council tax concessions and housing benefit may also be available. The benefits system is not easy to understand so we urge everyone to get specialist advice; RNIB’s Benefit Rights and Information Team can help. These benefits are there to help with the extra costs of disability, so do use them.

Help at home

Social services departments, run by local councils, have a duty to provide services for disabled people. These may include home care assistance, equipment, day care, advice on benefits, rehabilitation, communicator guides and residential care for those who need it. Services are however patchy, so what is available in one area may not be offered in another. But everyone has the right to an assessment and can complain if the service offered is inadequate. Contact your social services department’s sensory impairment team (if there is one), or ask for the team responsible for elderly people.

At home or in a home?

Some people cannot remain independent in their own homes even with the very best home care services. Sheltered housing may be the answer for some. This type of housing offers small flats to rent with some communal facilities and a resident warden to keep an eye on tenants and summon help in an emergency. But residents are expected to be able to care for themselves. For people who cannot, a residential care home or nursing home may be the only answer. It is however a big decision to give up one’s own home, and choosing the right residential care home is no easy task. We suggest you take professional advice from Counsel and Care (0845 300 7585) who provide a free confidential advisory service for older people, carers and relevant professionals.

Support from Sense

Sense can offer a wide range of services:

• Information, advice and support from Regional Advisers
• Training for families and carers
• In some areas, communicator-guides are available. Communicator-guides provide one-to-one assistance to deafblind people in their homes. This may include, for example, reading mail, sorting clothes and interpreting phone calls. The communicator guides also act as an escort and communication link when people go shopping, visit the doctor and take part in leisure and other activities.

Help for carers

Looking after someone who can’t hear or see properly is a demanding and stressful role and carers too may need support, extra money or a break from the task. Sense can help, as can the National Association of Carers (address at the end of this factsheet). Don’t feel guilty about asking for the support you need to do a difficult, important and worthwhile job.

Where can I go for help?

If you would like to find out more about deafblindness, or the services for deafblind people in your area, you should contact the Sense Regional Adviser for your area.

If you require information in alternative formats including braille, large print, audio or disk then please contact the Communications department:

tel: 020 7272 7774
fax: 020 7272 6012
textphone: 020 7272 9648

This factsheet was produced by:

Sense
11-13 Clifton Terrace
Finsbury Park
London N4 3SR

Copyright Sense November 2003