it is appropriate to question the patient regarding any sensory deficits or diminishment he or she may be experiencing.

  1. Special attention should be given to medications and conditions that might contribute to sensory impairment.

  2. Patients with perceived decreased hearing should be referred for screening by an audiologist.

  3. Diabetic patients should be referred to an ophthalmologist annually.

  4. Biannual screening should be recommended to all patients at high risk for glaucoma. Tonometry alone is not adequate screening for glaucoma.

  5. Because many older patients are poorly informed about sensory loss, clinicians should develop a library of patient information on sensory impairment, its screening, disabilities, and treatments.

  6. Patients should be taught the signs and symptoms of sensory impairment—particularly those related to hearing and visual impairment.

  7. Patients should be taught how to minimize the safety risks associated with sensory impairment.

  8. Clinicians should discuss the importance of adequate glare-free lighting with their visually impaired patients.

  9. Magnifying glasses should be prescribed for patients with macular degeneration that is still at an early stage.

  10. Clinicians should provide information on large-print books and newspapers to visually impaired patients.

  11. All patients should be questioned routinely to uncover hearing impairment.

  12. Elderly patients should be taught how to position themselves in a room to minimize visual and hearing deficits.

REFERENCES

1. Applegate, W. B., Miller, S. T., and Elam, J. T. Impact of cataract surgery with lens implantation on vision and physical function in elderly patients. Journal of the American Medical Association 1987; 257:1064-1066.

2. Bartoshuk, L. M., Rifkin, B., and Marks, L. E. Taste and aging. Journal of Gerontology 1986; 41:51-57.

3. Bingea, R. L., Raffin, M. J. M., Aune, K. J., et al. Incidence of hearing loss among geriatric nursing home residents. Journal of Auditory Research 1982; 22:275-283.

4. Branch, L. G., Horowitz, A., and Can, C. The implications for everyday life of incident self-reported visual decline among people over age 65 living in the community. The Gerontologist 1989; 29(3):359-365.

5. Butler, R. N., and Gastel, B. Hearing and Age: Research challenges and the National Institute on Aging. Annals of Otology 1979; 88:676-683.



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