Red Book

Preventive activities in older age

Visual and hearing impairment

Age range chart

0-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-79 >80

Visual acuity should be assessed from 65 years of age using the Snellen chart (B) in those with symptoms or who request it. There is no evidence that screening of asymptomatic older people results in improved vision.50,51

Hearing loss is a common problem among older individuals and is associated with significant physical, functional and mental health consequences. Annual questioning about hearing impairment is recommended with people aged >65 years (B).

In some states and territories, there are legal requirements for annual assessment (eg driving aged >70 years).52

Eye disease and visual impairment increase three-fold with each decade of life after 40 years of age. They are often accompanied by isolation, depression and poorer social relationships, and are strongly associated with falls and hip fractures.53 It should be determined whether the patient is wearing up-to-date prescription spectacles, and whether there is a possibility of falls because the patient is no longer capable of managing a bifocal, trifocal or multifocal prescription. People at greater risk of visual loss are older people and those with diabetes and a family history of vision impairment; such history should be sought. Smoking (current or previous) increases the risk of age-related macular degeneration.54 Cataracts are the most common eye disease in Australians aged ≥65 years (42% of cases of visual impairment), followed by age-related macular degeneration (AMD; 30%), diabetic retinopathy and glaucoma. The leading causes of blindness in those aged ≥65 years are AMD (55%), glaucoma (16%) and diabetic retinopathy (16%).55,56

Visual and hearing impairment: Identifying risks

Table 5.4.1

Visual and hearing impairment: Identifying risks

Visual and hearing impairment: Preventive interventions

Table 5.4.2

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