Most people who are registered as “deafblind” have extensive needs. Many are congenitally deafblind and were identified at birth or early childhood, while others may have acquired this form of dual sensory loss during adulthood. However, a large percentage of those who have dual sensory loss develop it after the age of 60. Dual sensory loss in this age group is often not labelled as “deafblindness” or recognised as a disability, in fact it is often assumed to be an inevitable and inescapable element of growing older.
The proportion of older people who experience sight and hearing loss is increasing. In particular, there has been a significant increase in the number of people living beyond 85, when deafblindness is most likely to be problematic. While the statutory guidance issued in 2001 clearly sets out that local authorities are obliged to record those people they have identified as deafblind, this does not include all of those who have difficulties created by dual sensory impairment.
One of the problems is that there is no common understanding of how the Department of Health definition should be applied and consequently many older people affected by a combined sight and hearing impairment are not officially recorded. Over a decade ago the estimated total number of recognised deafblind people in the UK was 24,000: a figure which rose to nearly 250,000 when estimated numbers of those aged 60 and over with a combined sight and hearing impairment were included. These figures are likely to rise dramatically as the proportion of the population, those aged over 85, is projected to treble by 2050.
Vulnerability and isolation
Many studies show that the combined loss of vision and hearing has a greater impact than that of either impairment alone, since the person affected cannot use one or other sense to compensate for the loss. People who have adjusted to hearing impairment, for example, may lose the ability to lip-read as their sight fails, and individuals with visual impairment may lose the ability to hear clearly. In both cases, there is likely to be increased isolation arising from the loss of not only essential information and interactive routes like conversation, but also more solitary leisure activities such as reading, listening to the radio or watching TV.
The influence of a combined dual sensory impairment on sight and hearing may also make the person more physically vulnerable. In some cases the domestic environment may present physical obstacles or difficulties and require changes to make it safer or easier. While it is important to obtain diagnosis and treatment for conditions giving rise to sensory loss, the social aspects are often masked by a focus on the medical aspects of impairment and are separated from associated outcomes, such as falls.
For people with dual sensory impairment the potential for isolation increases as their impairment becomes more severe. Visits outside the home or from family and friends may become increasingly difficult when ease of travel and communication are lost, for example. As a result, such visits may diminish in frequency, leading to a loss of social interaction and potentially a loss of information about the world outside the home. Older people, their families and carers may also display unwitting ageism and assume that such isolation is an inescapable consequence of ageing, with the result that its effect on mood and motivation are rarely questioned. But studies have shown that while visual impairment and, to a lesser extent, hearing loss, clearly increases the risk of depression, combined dual sensory loss has an even greater effect. Depression, when identified, is considered a medical problem and therefore capable of treatment.
However, the combination of assumptions about the natural course of ageing and dual sensory loss means that the depression which can result is often ignored until it becomes severe. Disability in any form, but particularly the combination of vision and hearing loss, results in an increased risk of developing depressive symptoms and disorders which, in turn, can lead to illness, further physical impairments and other restrictions on activities of daily living.
Support and awareness
Raising awareness among those who come into contact with older people is important, especially with “non-specialists” such as social care and health workers, carers and family members. Non-specialists have the opportunity to identify problems at a much earlier stage and have a key role to play in raising awareness of how the potentially adverse effects of deafblindness on older people’s quality of life can be mitigated. Their early identification of disabling dual sensory loss has the potential to involve specialists at a stage when interventions may be less intrusive while still providing a robust basis for enhancing and maintaining older people’s independence and autonomy.
There are simple, non-technical and non-specialist forms of assistance. For example, one study indicates how minor alterations to individual behaviour can have a substantial impact in terms of minimising social isolation. By providing examples it shows how an awareness of the basic needs of those with combined sight and hearing loss can lead to an enhanced level of communication. It indicates how conversations can be physically arranged to allow light to fall on the face of the speaker to facilitate lip reading and how sound interference from the environment can be minimised. It therefore demonstrates how, if suitable hearing aids and spectacles have been provided and are used, simple interventions can allow older people who are deafblind to interact more easily with those around them.
● Sense: charity working with those with dual, deafblind, sensory impairment www.sense.org.uk. It produces reports, factsheets and information sources including a toolkit, “Fill the Gaps” for use by those working with or in contact with older people.
● Deafblind UK: charity offering services to support people with sight and hearing impairment and training to staff and others
● Deafblind International, Bagely, M (1998), Communication and people who have lost vision and hearing in later life, from expert meeting on older people with vision and hearing loss, 18-24 March 1998, Copenhagen, Denmark.
Research abstracts: Findings on dual sensory loss