An Overview of Dual Sensory Impairment in Older Adults: Perspectives for Rehabilitation

Abstract

and visual impairment. Herein, we focus on the difficulties experienced by those who have acquired hearing and vision loss associated with age-related changes and pathologic conditions. Most individuals with age-related DSI experience gradual onset of mild to moderate sensorineural hearing loss and vision loss. Awareness of late-onset DSI among older individuals is increasing, presumably because the size of this population is growing rapidly. However, there is almost no research on rehabilitation for this population; therefore, there is a tremendous imperative to develop and test rehabilitation strategies.Although there are clear definitions of degrees of vision impairment and hearing impairment, definitions of DSI are lacking, and determination of a standardized definition is complex. Proposed definitions are functional in nature and tend to be nonspecific, with few implications for clinical practice. For instance, Davenport 5 suggests that DSI is "any combination of hearing and vision loss that interferes with access to communication and the environment and requires interventions beyond those necessary for hearing or vision loss alone." This generality is in part due to the fact that there is an unknown, and presumably variable, interaction between the two impairments. As D ual sensory impairment (DSI) refers to the presence of both hearing loss and vision loss. According to the Centers for Disease Control and Prevention, 1 at least 1.7 million people report DSI. Studies show that between 9% and 21% of adults older than 70 years have some degree of DSI [2][3][4] and that the prevalence increases with age. As pointed out by Desai et al, 1 as the population ages, so will the number of individuals with DSI.Individuals with DSI can be classified into the following 4 groups: congenital deafblindness, congenital visual impairment with acquired hearing impairment, congenital hearing impairment with acquired visual impairment, and acquired hearing Dual sensory impairment (DSI) refers to the presence of both hearing loss and vision loss. The occurrence of DSI is particularly prevalent among the aging population, with studies showing between 9% and 21% of adults older than 70 years having some degree of DSI. Despite this, there is little direction regarding recommended clinical practice and rehabilitation of individuals with DSI. It is assumed that the problems encountered by individuals with DSI are considerably greater than the effects of vision impairment or hearing impairment alone, because when these two sensory impairments are combined, the individual is seriously deprived of compensatory strategies that make use of the nonimpaired sense. In this article, the literature available regarding DSI is summarized, and research needs regarding rehabilitation strategies are outlined and discussed. Simple suggestions for addressing DSI are provided that use available tools and technology.

Blast exposure and dual sensory impairment: An evidence review and integrated rehabilitation approach

“…These studies illustrate that the effects of DSI generally exceed the effects of single sensory impairment, presumably because the individual with DSI cannot compensate for the single sensory impairment with the second sense [2]. For example, it has been long established that supplementing a degraded auditory signal with visual information results in considerable benefit for speech understanding [51][52], resulting in improvements in speech understanding of 50 percent over auditoryalone conditions [53].…”

“…The value of such is that it provides a basic understanding of the activity limitations and participation restrictions an individual will encounter as a result of his or her impairment, it can help clinicians select appropriate interventions for the impairment, and it provides a metric from which to track change-either disease progression or improvement following intervention [62]. HI and VI are unfortunately, and problematically, diagnosed and treated in isolation [2]. HI is classified based on unaided ability to hear, while VI is classified using best-corrected vision.…”

“…In a meta-analytic evaluation of the methodological quality of research on cognitive rehabilitation after TBI, Cicerone et al reported that of 32 randomized clinical trials, only 4 measured treatment effects on participation and only 1 on quality of life [102]. Given the prevalence of DSI in blast-exposed Veterans, evidence for impaired community integration following TBI [103], and the challenges that vision and hearing difficulties pose in everyday life [2], assessment of reintegration and quality of life in returning OIF/OEF servicemembers should be considered critical metrics when VA is evaluating the success of its rehabilitation programs. This is because while performance-based assessments, such as reading and speech discrimination, are clearly important to everyday function, they do not necessarily capture patient-centered outcomes, such as return to job, activity, and independent living and life satisfaction overall.…”

“…Rehabilitation research on dual sensory impairment (DSI) is fairly sparse and has primarily focused on deafblind individuals [1] or aging individuals with gradual onset peripheral hearing loss and vision loss (see Saunders and Echt [2]). Little or no research has been conducted to examine the effect of, and rehabilitation for, DSI associated with military operations.…”

The Evaluation of Employment Policies for Older Adults in the Czech Republic, Poland, and Slovakia

“…These conditions may affect older adults' physical and mental health (Anderson, Freedland, Clouse, & Lustman, 2001;Miller et al, 2008) and may cause worse physical functioning (Boult, Kane, Louis, Boult, & McCaffrey, 1994). In addition, sensory impairments such as vision and hearing loss are associated with ageing (Saunders & Echt, 2007). It is, therefore, likely that both vision and hearing loss and other chronic health conditions negatively influence individuals' ability to perform job responsibilities.…”