can support them with resolving any issues resulting from the visual impairments. Counselors can also encourage or make referrals for optical devices (e.g., eye glasses, larger numbers on their phones). Counselors can provide strategies to live independently with redesigning their environment, and they can also monitor their compliance with any treatment regimes. Loss of independence will be a concern for many older adults who are visually impaired, and counselors are positioned to facilitate the relocation to another environment (if necessary) and to offer resources as alternatives for loss of ability to drive. Counselors will provide support, encouragement, coping strategies, referrals, and resources to make the transition easier for older adults, while maintaining a focus on strengths and capabilities versus disabilities with older clients.
Vision is affected in various ways due to aging. Changes occur in the components of the eye itself and in central processing in the brain. These changes affect reading, balance, and driving, but compensatory glasses and behavior can maintain safety. As the eyes age, it is normal for older adults to have a reduced visual field. Pure aging makes clear that no disease, environmental, lifestyle, or behavioral risk factor plays a role in the change. It includes a decline in accommodation, which is the increase in optical power by the eye in order to maintain a clear image (focus) as objects are moved closer (e.g., presbyopia or farsightedness). Low-contrast acuity refers to the sharpness or keenness of vision. Glare tolerance declines, as does adaptation (adjustment to environmental conditions) and color discrimination. Also, there is a decreased attentional visual field that describes a person’s ability to divide attention and extract visual information from the visual field within a glance. The common eye diseases in old age (e.g., glaucoma, macular degeneration, cataracts, diabetic retinopathy) are superimposed upon these pure aging changes (Besdine & Wu, 2008).
Older individuals may begin to have difficulties with contrast sensitivity, in which the difference between an object and its background is reduced. This reduction in sensitivity is gradual because of progressive eye problems that can lead to scarring or clouding of the cornea, which decreases vision. Decreased contrast sensitivity also diminishes an elderly person’s ability to perceive depth. Reduced depth perception makes steps or street curves difficult to manage. Additionally, seeing at night can become difficult. A person with early nuclear sclerosis (cloudiness of the eye lens) may complain of glare especially during night driving, due to light scattering, which is light directed in many different directions. At the same time, older people need more lighting in their surroundings than a younger person. Beginning in the early mid-40s, most adults start to experience problems with their ability to see clearly at close distances, especially for reading and computer tasks.
A reduction in number of cones at the fovea causes generalized reduction in color vision. Fovea is the central focal point on the retina (lines the back of the eye) around which cones cluster. Cones are photoreceptors located near the center of the retina that are responsible for your ability to see during the day, in color, and in detail. For people of all ages, it is harder to distinguish blues and greens than it is to differentiate reds and yellows. This becomes even more pronounced with age. Using more warm contrasting colors (e.g., yellow, orange, and red) in the home can improve the ability to determine where things are and make it easier to perform activities of daily living. Many older people find that keeping a red light on in darkened rooms (such as the hallway or bathroom) makes it easier to see than a regular night light (white/yellow in color) (Salvi, Currie, &Akhtar, 2005). Another common visual change in older adults is the increase of floaters or tiny black specks moving across their field of vision. These specks are bits of normal fluid in the eye that have solidified. Floaters do not significantly interfere with vision and are not a cause for concern unless they suddenly increase in number. Additionally, the eyes tend to become dry. This change occurs due to a decrease in the number of cells that produce fluids to lubricate and a decrease in tear production (Porter, 2009). Vision loss has profound effects on the quality of life of older adults, as does the loss of hearing.
Hearing
Conductive and sensory hearing losses occur with age. Individuals with hearing loss may be unable to hear higher tones, making consonants in speech difficult to differentiate. Other consequences of hearing loss include difficulty in localizing sound and understanding speech, usually accompanied by hypersensitivity to loudness. Common conditions in old age (ruptured eardrum, wax buildup, infection) are superimposed upon these changes, often resulting in worsening hearing impairment (Besdine & Wu, 2008).
Hearing loss can create a psychological solitary confinement, yet many older adults with hearing loss deny the disability or the impact it exerts on their quality of life. A practitioner working with older adults experiencing hearing loss may need to ascertain the individual’s stage of acceptance. Family members who attribute hearing loss as mild or moderate inadvertently bolster the individual’s denial (Dewane, 2010).
Older adults who are hard of hearing often report that when their hearing loss causes communication problems, it can result in difficulty thinking or concentrating. This results in inattentiveness, distraction, and boredom. The most serious consequence is withdrawal or abandoning participation in conversations. Older adults with hearing loss face many of the same fears that anyone with a disability encounters: They worry about loss of significant relationships or jobs or about being perceived as incompetent. Communication breakdown problems may show up in physical symptoms such as tension, exhaustion, and psychological symptoms (Dewane, 2010).
Sometimes hearing loss exerts a direct impact on mental health. Depression and adjustment disorder can occur as a natural response to hearing loss and its subsequent impact on the quality of life. On the other hand, some people have premorbid mental health issues and hearing loss simply compounds the problem. Inability to hear and discern messages and their meaning can result in feelings of shame, humiliation, and inadequacy. It can be highly embarrassing to be unable to behave according to applicable social rules. The feeling of shame linked to hearing loss stems from older adults inadvertently reacting in inappropriate and socially unacceptable ways, such as responding to a misunderstood question in an inaccurate fashion (Dewane, 2010).
Most changes in hearing are likely due as much to noise exposure as to aging. Exposure to loud noise over time damages the ear’s ability to hear. Nonetheless, some changes in hearing occur as people age, regardless of their exposure to loud noise. As people age, hearing high-pitched sounds becomes more difficult. This change is considered age-associated hearing loss (presbycusis). For example, violin music may sound less bright. The most frustrating consequence of presbycusis is that words become harder to understand. As a result, older people may think that other people are mumbling. Individuals need to articulate consonants more clearly, rather than speak louder. Many older people have more trouble hearing in loud places or in groups because of the background noise. Also, earwax, which interferes with hearing, tends to accumulate more (Porter, 2009; Talbot & Hogstel, 2001). Changes in the ability to hear impacts older adults in many ways, and the change in taste also interferes with personal well-being.
Taste
Taste helps all of us recognize when food is good or bad. When an elderly person loses taste, it can cause a loss of appetite, weight loss, poor nutrition, weakened immunity, and even death (Sollitto, 2015). When older persons lose the ability to taste certain foods, they may also lose interest in eating them, which could affect the amount of nutrients they consume, and they could accidentally consume food that has gone bad or contains harmful ingredients (Orenstein & Marcellin, 2015). Mental health professionals can refer older adults to a nutritionist. They can also provide ways to make meals more enjoyable by eating with others, teaching the use of herbs and spices, experimenting with new foods. Mental health professionals are able to develop programs with older persons to educate and monitor progress toward healthier dietary habits.
Older adults will experience a reduction in their taste sensation. Taste buds diminish; perception of salty and sweet tastes decrease first, followed by bitter and sour tastes. The volume and quality of saliva diminish. Such
