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Losing hearing or vision dramatically changes a person’s life in obvious ways. The most mundane tasks, such as walking, talking or taking medicine, are no longer routine, and place the sufferer at greater risk for other health problems.

Most physicians do an adequate job of addressing the physical needs of patients who have decreased sensory acuity, but they sometimes do not fully appreciate the effect it can have on one’s mental health.

Becoming disconnected from their environment can trigger severe mood swings, lower self-esteem, fracture previously strong relationships and bring about social isolation. In many cases, this change in lifestyle leads to depression, stress and anxiety disorders, and even paranoia.

Not surprisingly, the loss of vision and hearing occurs mostly in older people. According to the U.S. Centers for Disease Control and Prevention, more than 3.5 million Americans age 70 or older have some degree of visual impairment. That number almost doubles, to 6.7 million, for diagnoses of impaired hearing.

Because the prevalence of those sensory losses is found primarily in the older population, it also makes it more difficult to diagnose changes in mental health.

Early changes can be subtle, and often are not easily recognized by the patient or even family members. That could be because they believe diminished hearing and sight are unavoidable consequences of aging.

Dr. Zeena Marshall, a board-certified psychiatrist at Orlando Regional Medical Center, said people who lose their hearing “are frequently ignored’’ by those around them, “which causes them to become sad and depressed.’’

“They start losing their hearing and people around them start ignoring them because it’s difficult for both parties to communicate,’’ Marshall said. Older people, in particular, “become more isolated and withdrawn, and go into their own world,’’ she said. “It becomes even more difficult for them to connect to the outside world, even through TV or radio.’’

That makes it more difficult to “deal with life in general,’’ Marshall said, “because they feel they have nothing to look forward to. That’s when the symptoms of depression set it.’’

According to the National Institute of Mental Health, those symptoms include sadness, loss of interest or pleasure in activities, weight change, loss of energy and appetite, difficulty sleeping or sleeping too much, feelings of worthlessness and thoughts of death or committing suicide. If the symptoms persist or interfere with the patient’s ability to navigate daily life, depression is a likely diagnosis.

Marshall formerly practiced at the National Deaf Academy in Mount Dora, where she treated mostly youngsters and frequently “agitation was a symptom of depression.’’ In older people, however, Marshall said, depression is more likely to manifest with feelings of helplessness or worthlessness, loss of appetite and weight loss.

Left untreated, Marshall said, depression can have serious consequences on a patient’s physical health and aggravate co-morbidities.

“Depression can suppress your immune system, which can lead to more infections,’’ Marshall said. “Lowered immune systems open them up to more bacterial and viral infections.’’ In addition, “if you’re stressed, it can lead to hypertension or certain endocrinological problems like hypothyroidism, which can then (contribute) to depression,’’ she said.

Marshall said there are “lots of antidepressants for the chemical imbalances that are associated with depression,’’ but the goal always should be to avoid getting to that stage of treatment. Toward that end, she said “families should make efforts early on to keep (their sensory-impaired loved ones) from drowning in their own world.’’

She continued: “If they’re not treated … and hearing or vision gets worse, the more depressed they will be and (have) less incentive to live.’’

“Families have to take an active part in getting them the help they need,’’ Marshall said, which includes getting them to physicians to obtain the sensory aids that can augment or restore their visual or hearing acuities.

“Get them hearing aids, or proper glasses, or surgeries,’’ Marshall said. “They help tremendously and can stave off depression,’’ she said.

And for the deaf, family members should not only “help the impaired person learn sign language,’’ but they should “learn it themselves,’’ Marshall said. “They can restore the communication in the family and overcome the isolation and depression.’’

Dr. Jason Salagubang, assistant director at Florida Hospital’s Family Medicine Residency Program in Orlando, values the family’s observations.

“Many times, (sensory) impairment is brought up by the family,” he said. “They say ‘I can’t sleep at night because dad has the TV up so loud,’ or ‘I told dad to read these directions and he didn’t follow through.’’’

The sensory-impaired individual who is slipping into depression, “generally speaking, doesn’t recognize it,’’ Salagubang said. “And that’s especially true if they don’t have any family members. Sometimes they come too late.’’

Salagubang, a family medicine physician with added qualifications in geriatrics. said he often sees elderly patients “with some sort of underlying depressions associated with hearing and vision loss.’’ He does his best to help them by trying to focus on early detection and prevention, but admitted that he sometimes must “realize (my) limitations. When there is something above my expertise, there are certified geriatric psychiatrists to whom I refer them.’’

Support groups remain another option for primary care physicians to help their sensory-impaired patients stave off depression, Salagubang noted. Some “welcome the group interaction … with people who are going through the same thing. There is that sense of empowerment and ‘I am not alone’’’ he said. “It’s a great way to get things out in the open in a safe environment.’’

That preventive approach is why “primary care physicians can play a very important role’’ in identifying depression before it progress too far, Marshall said.

“When we take our children to pediatricians, they’re regularly checked for vision and hearing,” she said. “If the same process occurred for elderly people when they get to a certain age, it would prevent a lot of problems. I don’t think (enough primary care doctors) are routinely checking (seniors’) eyes. Once people stop driving and working, and they’re retired at home, when they go to the doctor for whatever illnesses, nobody is paying that much attention to their vision and hearing,’’ she pointed out.

It is paramount that those who are experiencing sensory loss remain engaged with what is happening around them to avoid mental illness, Marshall said.

When they lose their connection with the familiar aspects of their lives, and people shut them out or ignore them, “they will have difficulty keeping in touch,’’ Marshall said. That is when “they lose the love of life.’’



December 2007

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