Lichtenstein M J
Department of Medicine, University of Texas Health Science Center, San Antonio.
Clin Geriatr Med. 1992 Feb;8(1):173-82.
Hearing impairments, with their resultant difficulties in communication function, represent a common chronic condition affecting one third of aged individuals. Loss of hearing ability pervades multiple domains of function in aged individuals, decreasing activity, increasing depressive symptoms, and confounding assessment of cognitive ability. Although they are not curable, hearing impairments are often remediable with appropriate audiologic evaluation and the prescription of amplification devices. The role of the geriatrician in managing hearing impairment is to recognize its presence, provide appropriate audiologic referral, and overcome its effects in the clinical setting by providing optimal listening environments and using ALDs appropriately. Visual loss, too, is a common age-associated disability that has effects in multiple domains of function. Visual loss especially increases the risk of falls and hip fractures and may limit the ability of an older individual to safely operate a car. The ability to remediate visual disability depends on the cause of the underlying impairments and the relative effectiveness of treatment for each. Sight restoration can be dramatic for selected patients with cataracts. Sight preservation is also excellent for persons with diabetic retinopathy. For those with macular degeneration, the data are hopeful but less compelling. Although persons with glaucoma should receive medications to lower their intraocular pressure, experimental evidence that this, in fact, preserves vision is currently lacking. The geriatrician's role in visual rehabilitation consists of the identification of the impairments, determination of the impact of visual loss on other functional domains, and appropriate referral to an ophthalmologist for full assessment and treatment. If severely limited by permanent visual losses, the patient should be referred for appropriate support services.
听力障碍及其导致的沟通功能困难，是一种常见的慢性疾病，影响着三分之一的老年人。听力丧失会影响老年人多个功能领域，降低活动能力，增加抑郁症状，并混淆认知能力评估。虽然听力障碍无法治愈，但通过适当的听力评估和佩戴放大装置往往可以得到改善。老年科医生在管理听力障碍方面的作用是识别其存在，提供适当的听力转诊，并通过提供最佳的听力环境和适当地使用助听设备来克服其在临床环境中的影响。视力丧失也是一种常见的与年龄相关的残疾，会影响多个功能领域。视力丧失尤其会增加跌倒和髋部骨折的风险，并可能限制老年人安全驾驶汽车的能力。改善视力残疾的能力取决于潜在损伤的原因以及每种治疗方法的相对有效性。对于某些白内障患者，视力恢复可能非常显著。对于糖尿病性视网膜病变患者，视力保留情况也很好。对于黄斑变性患者，数据虽有希望但说服力较弱。虽然青光眼患者应接受降低眼压的药物治疗，但目前缺乏实验证据表明这实际上能保留视力。老年科医生在视力康复中的作用包括识别损伤，确定视力丧失对其他功能领域的影响，并适当地转诊给眼科医生进行全面评估和治疗。如果患者因永久性视力丧失而受到严重限制，应转诊接受适当的支持服务。
