Hearing, vision, and lighting conditions among older recipients of home care

Abstract

Background Hearing and vision impairments and poor indoor lighting conditions in the homes of older persons are risk factors for functional decline, reduced social participation, and accidents. A literature search revealed that few studies have focused on hearing and vision abilities in home-care patients older than 80 years, and on the indoor lighting in their homes. Aims The main aims of this study were to obtain knowledge about the characteristics of hearing and vision impairments in elderly recipients of home care, and to determine whether there is consistency between self-assessments and standardized tests of hearing and vision in the elderly. Furthermore, the aim was to measure the effects of an intervention designed to improve their functional hearing and vision and the lighting conditions in their homes. Design and method The study consists of two substudies. Substudy 1 (Papers I and II) had a cross-sectional design in which 93 elderly recipients of home care with a mean age of 89 years were screened for hearing and vision impairments. Paper I was a baseline description of the data on hearing and vision impairments, and Paper II was a Receiver Operating Characteristic Curve analysis used to compare self-assessments of hearing and vision abilities with a gold standard test. Substudy 2 (Paper III) was an exploratory, randomized, controlled trial involving an intervention group (n =46) and a control group (n =47) that tested whether improved indoor lighting, removal of earwax, and referrals to specialists can improve the functional hearing and vision in the elderly (Paper III). Results Substudy 1 found that 41% of the 93 recipients of home care had slight and 47% had moderate hearing impairments according to the World Health Organization (WHO) measurement scale (1). The mean pure-tone average (PTAV) was 40.4 dB for the better ear in each subject. According to the WHO, the PTAV is < 25 dB for normal hearing. The measurements of visual acuity (VA) found that 40% of the subjects had slightly impaired and 56% had impaired vision according to the WHO measurement scale (2). The mean VA was 0,45 for the better eye in each subject. According to the WHO, the VA is > 0.8 for normal vision in the elderly. When the patients were asked to self-assess their hearing and vision function with a single global question (“Do you consider your hearing/vision to be good, not so good, poor or very poor/deaf/blind?”), the results were only weakly correlated with the PTAV and VA measurements. When they were asked about their communication and reading abilities more in detail, however, 72 % admitted it was difficult to understand speech. Nearly 30 % found it tiring to read and 41% could not read very small print (Paper I). Seventeen percent reported having difficulties in performing activities of daily living/instrumental activities of daily living because of hearing and vision impairments. To explore consistency between standardized tests and global self-assessments, we used the cutoff points on the global self-assessment scale of hearing and vision with the corresponding results on the goldstandard tests, which were PTAV < 35dB and VA > 0.7. Comparison of findings yielded 18 false negatives for hearing, and 40 false negatives for vision. This indicated that a significant proportion of the older people in this study reported their functional hearing and vision as good on the global question when standardized tests indicated that they were not (Paper II). Substudy 2 revealed that the elderly in this study lived in poorly lit environments with lux values far below what is recommended for older people (3). However, the maximum and minimum lighting values were significantly improved in the intervention group after the intervention (P = 0.02 and P = 0.039, respectively). All participants in the intervention group who were asked to remove their earwax had seen their general practioner and had their earwax removed during the intervention (Paper III). Conclusion Many elderly recipients of home care live with hearing and vision impairments which have not been sufficiently attended to. Asking elderly people aged 80+ years about their functional hearing and vision with a single global question will not provide accurate information about their hearing and vision problems. It is necessary to use standardized tests in addition. When asking more detailed questions about their communication and reading abilities, the elderly reported having difficulties. Indoor lighting levels in their homes showed that the lighting levels were far below recommended values, but were significantly improved in the intervention group after the intervention. Many elderly could not be expected to do all the self-care activities necessary to improve their functional sensory impairments and/or the indoor lighting conditions in their homes. Close monitoring and assistance is recommended.