The proportion of the Australian population aged 65+ years will increase from 13% in 2006 to 26% by 2050.(1) The age-related loss of both vision and hearing are becoming increasingly frequent disabilities. Individuals with combined hearing and vision loss (known as dual sensory impairment, DSI) can experience problems greater than those associated with each impairment separately.(2,3) DSI in older people has been associated with depression, (4,5) limitations in activities, (6,7) cognitive decline (8,9) and reduced quality of life. (2) Currently, imperfect systems of care inhibit the effective delivery of services and rehabilitation to older adults with DSI. There has been no active screening or case-finding strategy to detect older persons affected by DSI. Separate vision and hearing rehabilitation systems currently operate in Australia, and often fail to service and support older people with DSI in a coherent and collaborative manner.

The Vision–Hearing project pilots an integrated service model and gathers data on the effectiveness of this model to inform health policy decisions. The Vision-Hearing project is a practical extension of information gained from the Blue Mountains Eye Study (BMES).

The Blue Mountains Eye Study (BMES) was the first large population-based assessment of visual impairment and common eye diseases of a representative older Australian community sample. The project was conducted in the Blue Mountains area west of Sydney. Those aged over 49 years were identified via door to door census and invited to participate. Baseline data collection took place in 1992-1994 with 3654 residents. Follow-up assessments have been conducted at 5 year (BMES2); 10 year (BMES3) and 15 year intervals (BMES4). From BMES2, the design of the study was extended to include a detailed hearing assessment conducted by audiologists (Blue Mountains Hearing Study, BMHS) giving a more comprehensive picture of sensory functioning in older Australians.

BMES & BMHS data suggest that many clients accessing vision rehabilitation services could have dual loss, and may not have previously had their hearing needs adequately addressed. The studies revealed:

• Both vision and hearing impairment are strongly age-related.
• Hearing loss was associated with two major causes of vision loss, cataract and ARMD.
• 65% of those aged 55+ years with presenting vision loss also had hearing loss.
• The frequency of hearing loss increased as level of vision worsened.
• Health Related Quality of Life (assessed using the SF-36) was lower in those with dual sensory impairment (DSI) than those with single hearing or vision impairments. (2)
• Those with DSI were at greater risk for possible cognitive impairment (measured using the Mini Mental State Examination) than those with single sensory impairment. (9)
• Those with DSI had greater risk of depressive symptoms (measured using Mental Health Index of SF-36) (unpublished).
• Only 33% of people with a hearing loss owned hearing aids and only 25% wore them habitually. (10)

References

1. Australian Bureau of Statistics. 2008 Year Book Australia. Pink B, editor. [ABS Cat. No. 1301.0]. 2008. Canberra, Australian Bureau of Statistics.
2. Chia EM, Mitchell P, Rochtchina E, Foran S, Golding M, Wang JJ. Association between vision and hearing impairments and their combined effects on quality of life. Arch Ophthalmol. 2006;124(10):1465-1470.
3. Saunders GH, Echt KV. An overview of dual sensory impairment in older adults: perspectives for rehabilitation. Trends Amplif. 2007;11(4):243-258.
4. Capella-McDonnall ME. The effects of single and dual sensory loss on symptoms of depression in the elderly. Int J Geriatr Psychiatry. 2005;20(9):855-861.
5. Lupsakko T, Mantyjarvi M, Kautiainen H, Sulkava R. Combined hearing and visual impairment and depression in a population aged 75 years and older. Int J Geriatr Psychiatry. 2002;17(9):808-813.
6. Crews JE, Campbell VA. Vision impairment and hearing loss among community-dwelling older Americans: implications for health and functioning. Am J Public Health. 2004;94(5):823-829.
7. Brennan M, Horowitz A, Su YP. Dual sensory loss and its impact on everyday competence. Gerontologist. 2005;45(3):337-346.
8. Lin MY, Gutierrez PR, Stone KL et al. Vision impairment and combined vision and hearing impairment predict cognitive and functional decline in older women. J Am Geriatr Soc. 2004;52(12):1996-2002.
9. Tay T, Wang JJ, Kifley A, Lindley R, Newall P, Mitchell P. Sensory and cognitive association in older persons: findings from an older Australian population. Gerontology. 2006;52(6):386-394.
10. Chia EM, Wang JJ, Rochtchina E, Cumming RR, Newall P, Mitchell P. Hearing impairment and health-related quality of life: the Blue Mountains Hearing Study. Ear Hear. 2007;28(2):187-195.

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