Imagine living in a world of darkness, or of total silence. For most of us it’s hard to comprehend, but seniors with blindness and deafness live in that world every day, facing huge challenges in communicating. Occupational therapists working with this population have an opportunity to help guide these individuals toward more complete and fulfilling lives.

Visual and auditory impairments are not small problems in the U.S., and are only exacerbated by the aging process. According to the National Institutes of Health, 30% of adults ages 65 to 74 have some hearing impairment, and that figure rises to 47% of adults 75 or older. Unfortunately, just one out of five people who need hearing aids actually wears them.

The American Foundation for the Blind reports that there are about 10 million blind and visually impaired people in the U.S., and more than half of them are over 65. Given those numbers, it’s a virtual certainly that most OTs will encounter patients with visual and auditory impairments.

The Basis for Need

Teddy Kern, MS, OTR/L, has been working in the visual rehabilitation field for nearly 30 years, helping patients with a range of eye problems. “People with blindness make up a good portion of our patients, but the larger population is made up of those with low vision,” she notes. “That’s defined as a visual impairment severe enough to interfere with the successful performance of activities of daily living, but allowing some usable vision.”

Kern, an OT at VISIONS/Services for the Blind and Visually Impaired in New York, says that although many people think that cataracts are the most common cause of visual impairment, it’s actually age-related macular degeneration. “Cataracts used to be the most common cause, but with the advent of cataract surgery and its high success rate [about 90% according to the Mayo Clinic], it’s no longer considered a major cause of vision loss,” she says. “Glaucoma and diabetic retinopathy rank second and third.”

Communicating with someone who can’t see presents obvious challenges, but technology is now removing many of those barriers. Text-to-speech software allows the visually impaired to listen to printed material such as discharge instructions and other important missives on a computer, and text size can be easily enlarged as well. Personal digital assistants allow quick access to information, as do the newer electronic books such as the Amazon Kindle and Sony Reader. Optical character recognition readers can scan text from a piece of paper and read it out loud, and Braille embossers can turn text into hard-copy Braille.

Making an Impact

How much help an individual needs is based on the level of impairment, says Jerry Davidoff, OD, an optometrist in Delaware County, Pa. who often works with occupational therapists. “People who are impaired all the way down to the level of basic light perception are going to need much more comprehensive care than someone who’s 20/40,” he notes.

Because of their unique access to the home environment, he notes, OTs can often catch problems that an office visit can’t: “An occupational therapist visiting a patient’s home might notice that, say, too much glare is coming through a window and recommend a sun filter or special blinds or curtains. That’s where the two disciplines can meld very nicely.”

Because they usually work as part of an interdisciplinary team, therapists who notice a problem with a patient’s vision can quickly refer the person to an optometrist or other vision professional. OTs who work with the deaf and hearing impaired have the same access, but are presented with an entirely different set of challenges.

Barb O’Donnell, OTR/L, works with many clients with auditory impairment at Columbus Colony Eldercare, which provides both skilled nursing and independent housing at its facility in Westerville, Ohio. As with the visually impaired, her patients’ hearing loss covers a complete spectrum from mild impairment to total deafness.

The first thing any therapist wishing to work with the hearing impaired should do is learn sign language, according to O’Donnell. “I didn’t know it when I first got here two years ago, but I learned it pretty quickly,” she says.

Just as with visual disabilities, technology has greatly aided those with hearing impairments in overcoming many of the limitations once encountered. People can now use video phones and cameras to communicate with loved ones, and handheld readers aid in the exchange of information as well.

Sign language, however, is still the dominant method of communication, so O’Donnell does her best to keep patients’ hands in good shape. “I do a lot of hand therapy because we want to keep their hands limber. We give them hand exercises, massages, and heat treatment, especially if they have arthritis or have had a stroke,” she says.

Kern notes that vision problems can cause people — especially the elderly — to retreat from life, and the same can happen with the hearing-impaired. For OTs, the goal is to keep people engaged, independent, and productive for as long as possible.