Comprehensive Geriatric Assessment (CGA): Sensory impairment

Impairments of any of the senses increase as we age. Four out of ten of people aged 70-79 experience dysfunction of at least one sense, and more than a quarter experience it in multiple senses.¹

Sensory impairment refers to a dysfunction in any of the senses of:

• Sight
• Hearing
• Smell
• Touch
• Taste
• Spatial awareness

Hearing loss in older adults is especially prevalent, affecting an estimated 80% of people aged 80 years and over². It is known to be an under-recognised and under-treated problem, with impacts on quality of life, communication and cognition¹. People with hearing loss are at an increased risk of becoming socially isolated, and effects on mental health including depression and anxiety are often reported³.  Treatment of hearing loss is associated with improvements in physical, mental, emotional and social wellbeing.

Pure tone audiometry is the gold-standard method of assessing hearing loss, but there are also simple ways to include an assessment of hearing into the process of CGA. These include enquiring about hearing aid use, asking if the person is experiencing hearing loss, and the ‘whisper test’, where a short sequence of 3 letters or numbers is whispered by the assessor and repeated by the patient. When hearing loss is suspected, onward referral to local audiology services for a more detailed assessment should be considered and discussed with the person.

Visual impairment is also prevalent in older people. More than 2 million people in the UK are living with sight loss and nearly 80% are aged 65 years and over⁴. Sight loss can have a huge impact on functional ability, and early signs may include reported difficulties with reading small print, cooking, and taking medication. It can also have significant effects on mental health, with links to depression, anxiety and social isolation⁵. People with visual impairment are more likely to fall, with a subsequent increased risk of injuries including fractures. 

An assessment of vision is an essential element of CGA – this should include an enquiry about the use of glasses, any existing diagnosis of sight loss, and an objective assessment of visual acuity where appropriate.

While hearing and vision loss are the most commonly seen impairments, care must be taken to assess for any other sensory dysfunction that could affect function in older adults with frailty. For example, impairments in taste and smell may affect the ability to consume an appropriate nutritious diet.

See also:

CGA: Falls history CGA: Nutrition and weight