For most people — up to 94% of U.S. adults — our senses become at least somewhat dull as we age, leading us to stare at screens more intently, crave stronger flavors, and miss snippets of conversation more frequently. Researchers at the University of Chicago Medicine are investigating whether these changes go beyond mere inconveniences and could actually worsen older adults' overall mental health.
“When your senses decline, you experience the world less well,” says Jayanto Pinto, M.D., a physician at the University of Chicago Medicine and an expert on smell disorders. “You might not be able to hear your coworkers or friends at the dinner table, you might not be able to make sense of what's going on around you, you might have trouble reading or understanding things in your neighborhood. The cognitive burden becomes a little heavier, which probably becomes exhausting over time and leads to mental health issues.”
Pinto recently led a study with Alexander Wang, a medical student at the University of Chicago Pritzker School of Medicine, to explore the prevalence and impact of sensory impairment in older adults. They found that people with sensory impairment tend to have poorer mental health, and that mental health differs depending on the type of sensory impairment.
Clarifying the relationship between perception and emotion
Researchers at the University of Chicago analyzed data on sensory function (vision, hearing, smell) and self-reported mental health from nearly 4,000 older adults followed for more than 10 years as part of the National Social Life, Health, and Aging Project. The researchers found that people with impairments in multiple senses were more likely to feel lonely and have significantly worse self-reported mental health overall, and people with three sensory impairments were more likely to experience frequent depressive episodes. In analyses that differentiated between senses, visual impairment was most strongly associated with loneliness and poorer self-reported mental health.
Scientists are still learning how changes to the senses affect people, but researchers at the University of Chicago have already pointed to the many ways that diminished senses directly impact feelings of loneliness, sadness, and boredom.
Older adults with visual impairments may have difficulty leaving the home or seeing the faces of friends and family, while hearing problems can make conversations awkward and frustrating. Even loss of smell can affect an individual's ability to take pleasure in familiar scents, like a favorite home-cooked meal or a loved one's favorite perfume, and to detect pheromones that contribute to social dynamics (even if they're not consciously registered).
“We found that hearing and vision impairments tend to be associated with poorer self-rated mental health and loneliness, but the association was weaker for smell impairments,” Wang said. “This struck me because hearing and vision impairments are much more likely to be stigmatized than smell impairments. This led me to think that social stigma may be contributing to poor mental health.”
Caring for each other in an ageing society
The researchers say that in the face of this stigma, their findings highlight the importance of improving access to mental health services and raising awareness of the link between sensory loss and mental distress. In particular, understanding how different sensory impairments affect older adults' long-term mental health can help health professionals, particularly primary care providers, ear, nose and throat specialists, and ophthalmologists, screen for mental health conditions when they identify sensory loss in their patients, providing an opportunity for personalized and timely intervention.
In addition to proactively treating older adults' mental health, the researchers pointed to steps that can be taken to directly reduce the day-to-day impacts of sensory impairment and, in turn, its negative impact on mental health.
“Our society is aging. We all have relatives who are getting older and struggling to make ends meet. It's a burden we all share,” Pinto says. “Easing the burden on older relatives and friends can have a huge impact on people's lives, productivity and quality of life.”
At the individual level, family and friends can help by being patient and finding more effective ways to communicate, such as speaking clearly and taking notes. At the societal level, public policies and community programs can ensure accessibility in public spaces and provide resources that improve quality of life.
Pinto also emphasized that there are various technologies and medical interventions that can help compensate for sensory impairments. For hearing impairments, there are cochlear implants, hearing aids and other assistive hearing devices that, according to studies, can improve quality of life as well as slow cognitive decline. For vision impairments, there are aids such as glasses, contacts, cataract surgery, LASIK surgery and text-to-speech computer programs. For the sense of smell, health professionals can help by reducing sinusitis or conducting smell training.
“In many cases, alleviating sensory impairments could actually improve people's lives, their mental health, and loneliness – which is a huge epidemic,” Pinto said. “These are simple ways we can intervene to help people, and they could have a big impact on society.”
Awareness and destigmatization of sensory impairment
The researchers said they intentionally used the word “disability” throughout the paper to highlight the significant impact that sensory impairments have on individuals' lives. The terminology also aligns with efforts to destigmatize these conditions and promote a more holistic approach to medical care.
“To some extent, our society views sensory impairment as a disability – think of the blind or deaf community,” Wang says. “Like many marginalized communities, the disability community has historically had a very adversarial relationship with the medical field, which can cause distress and limit access to mental health services. By increasing understanding and compassion, we can strive to improve the care we provide to our elderly and disabled patients.”
He said he hopes that framing the data in this way will encourage more health care professionals to move away from a medical model of disability perspective and toward a social model of disability perspective.
“As I understand it, the medical model characterizes disability as something that is a 'deficiency' for a person and therefore requires some kind of 'fix' for that individual,” he explained. “The social model characterizes disability instead as an identity, with limitations regarding disability arising from society's lack of access and accommodation to disabled people.”
Recognizing sensory impairments as disabilities and their impact on mental health is an important step towards more holistic and compassionate care. By addressing the medical, social and environmental barriers that exacerbate these disabilities, clinicians, and society as a whole, can better support older people to maintain their independence.
sauce:
University of Chicago Medical Center
