Sensory Loss in Healthcare
By Daniel Dutton (11th August 2019)
In the UK, there are eleven million people with hearing loss (Action on Hearing Loss, 2019) and over two million people with sight loss (RNIB, 2019), so it is important that health and social care workers have a good understanding of sensory loss.
In this essay, I will examine the causes and indicators of sensory loss, the factors that impact on individuals with sensory loss and their service provision and the methods and importance of effective communication with these individuals. Although sensory loss can include Anosmia (loss of smell), Agusia (loss of taste), Somatosensory loss (loss of tactile sense) and even an impairment of spatial awareness, in this essay I will focus primarily on the three most prevalent types of sensory loss; blindness, deafness and deafblindness.
Causes of sensory loss can be either congenital or acquired. Congenital sensory loss is present at birth (or very soon after), whereas acquired sensory loss is an impairment that develops later in life.
According to the World Health Organisation (2019), the leading causes of vision impairment are; uncorrected refractive errors (e.g. farsightedness and nearsightedness that has not been diagnosed and treated with corrective glasses or lenses); age-related macular degeneration, which is a deterioration of the retina in people over 60 years of age; glaucoma, which is a deterioration of the optic nerve that tends to be inherited; cataracts, which are a clouding of the eye’s lens that usually occurs in older people; diabetic retinopathy, which is damage to the back of the eye caused by high blood sugar levels and complications in diabetes; corneal opacity, which is when the cornea becomes damaged through infection or injury, and; trachoma, which is a bacterial infection of the eye.
And the leading causes of hearing impairment (World Health Organisation, 2019) are; complications during pregnancy and childbirth, such as low birth weight or birth asphyxia; infectious diseases, such as rubella, measles and mumps; chronic ear infections; otitis media, which is an infection and subsequent inflammation of the middle ear; the use of certain medications (ototoxic drugs) in large doses; head and ear injuries; aging; foreign bodies (including wax) in the ear canal and; exposure to excessive or loud volume noises.
Deafblindness can be the result of a combination of the causes above as well as genetic conditions such as Usher Syndrome, Cerebral Palsy, Foetal Alcohol Syndrome and damage to the brain caused by injury, stroke or meningitis for example (National Health Service, 2019).
Looking at these lists, it is noticeable that age is an important demographic factor in the prevalence of sensory loss in the population. As well as the direct causes such as age-related hearing loss and macular degeneration, it is also important to note that conditions such as cataracts and glaucoma are more likely to occur in an aging population. And older people are also more likely to have been exposed to loud or excessive noise for longer periods of time either through their work (e.g. use of loud machinery) or recreation (e.g. rock concerts) Therefore, it should be of no surprise to learn that “one in five people aged 75 and over are living with sight loss” (RNIB, 2019) and “more than 40% of people over 50 years old have hearing loss” (Action on Hearing Loss, 2019).
The RNIB (2019) also state that sight loss is more prevalent in females, people from black and minority ethnic communities and adults with learning disabilities.
With sensory loss being so prevalent, especially in the older generations, it is important that care workers have an awareness of the indicators that may suggest that an individual’s hearing or vision is deteriorating.
Individuals may report that they have issues with their vision such as seeing flashes of light or black spots, haziness, blurriness, halos around sources of light or even total loss of peripheral or full vision. Similarly, they may report issues with their hearing such as conversations sounding muffled, ringing in the ears or difficulty hearing the doorbell or telephone. If an individual reports these kind of issues then they should be treated seriously and they should be encouraged to meet with a health professional.
However, care workers come into contact with individuals who may not realise that their sensory input has diminished or feel uncomfortable about speaking up so it is useful to be mindful of some of the more subtle early warning signs.
For vision loss, indicators could include moving around cautiously and an increased frequency of bumps or trips. Individuals may have difficulty recognising people they know, have trouble making eye contact or may squint or tilt their head more often. There may be noticeable changes to their personal appearance or recreational activities that they choose to participate in. In addition, they may hold texts, such as books or their phone closer to their face and rely on touch more than they did previously.
Signs that an individual may be losing their hearing could be that they have their television or radio on louder than is usual or their telephone usage has reduced. They may have reduced interaction with others, have difficulty following conversations or regularly ask others to speak up, speak slowly, speak clearly or repeat themselves. They may also oblivious to anyone speaking to them from behind.
Signs of deafblindness can include any combination of the indicators of vision or hearing loss.
If a care worker has concerns about an individual’s sight and/or hearing, they should record their concerns and, if applicable, report it to their manager. In most cases, they should also open a dialogue with the individual about their concerns and encourage them to make an appointment with their General Practitioner (GP) to have their eyes and/or ears checked. However, the approach used will depend on the individual and their specific circumstances. Some individuals may not be able to book a doctors appointment themselves and require support, so consent would be required. Other individuals may not be able to go to their doctor’s surgery and require a home visit.
It is important that concerns about sensory loss are dealt with swiftly because “treatment for some underlying causes of deafblindness can be more effective if started early” and “early diagnosis will also ensure the person is able to access local support services sooner” (NHS, 2018).
Support services that may be accessed by individuals experiencing an onset of sensory loss can include health professionals such as their GP or hearing/vision specialists and their local authority. The local authority has a responsibility to identify, make contact with and assess the needs of all individuals with sensory loss and provide a suitable package of services to assist them. In addition, there are several charities that provide information and support to individuals experiencing sensory loss including the Royal National Institute of Blind People (RNIB), Action on Hearing Loss and Sense.
These support services are often essential for the health and wellbeing for individuals with sensory loss because the loss of one or more sensory inputs can have a life-changing impact on their lives.
First and foremost, communication can be severely reduced. Visual impairments lead to difficulties in reading and writing, as well as the observation of body language and gestures. Auditory impairments lead to difficulties in verbal communication. Both face-to-face and electronic communication can be affected; individuals with hearing loss will have difficulty making voice calls and individuals with sight loss will have difficulty texting and emailing.
Accessing information will also be a greater ordeal for individuals with sensory loss because some information is only available in certain formats. This results in a loss of both their independence and privacy due to their reliance on others to access and translate the information for them. It can also lead to reduced learning, vocational and employment opportunities.
As well as making the practical aspects of day-to-day life more complicated, sensory loss can also result in individuals reducing their contact with family, friends and the local community and becoming socially isolated. They may also experience emotions such as anger, frustration and sadness which can lead to mental health conditions such as anxiety and depression, consequently having a negative impact on their wellbeing.
An individual that lives with family and/or friends will have a network around them that can provide practical and emotional support as and when it is needed and so they will often be able to manage the onset of sensory loss more successfully. Similarly, individuals that already have care provision, such as elderly people in a residential home will also be able to access support more easily.
Sensory loss will have a greater impact on individuals that have other existing disabilities. Individuals that are visually impaired will often rely on their other senses (especially their hearing) more – for example they may use audiobooks rather than printed books. Similarly, individuals that have impaired hearing will rely on their sight more – for example, to lip read. However, if an individual loses both their vision and hearing everyday life and communication can become exponentially more difficult. This is why there are support services and charities that have a focus on deafblind individuals.
Existing disabilities that affect mobility can also be compounded by sensory loss. For example an individual with cerebral palsy may already be unsteady on their feet but if they also lose their sight they may not be able to move around safely at all and have to rely on others to help them to access the community.
Individuals with cognitive difficulties, such as learning disabilities may have already found it challenging to communicate with others as well as understand and process information given to them, but this will become an even greater challenge with the onset of sensory loss. For example, some individuals with learning disabilities are not literate and rely on verbal communication, however if they also lose their hearing their communication options will be severely restricted.
Loss of one or more senses can also lead to restricted mobility. This can include the loss of a driving licence, difficulty accessing public transport or the financial implications of using taxi services.
The onset of sensory loss can also disrupt an individual’s routines. Activities that involve the use of the senses such as watching television, listening to the radio, coffee mornings with friends or playing sports may need to be adapted to cater for their requirements or cancelled altogether.
For those with vision loss, visiting places that are unfamiliar can be very daunting as the sensory information for personal orientation comes primarily from sight. Therefore, these individuals may become disoriented, confused and frustrated.
An individual with sensory loss will also be more vulnerable to health and safety risks. This could include not being able to recognise visitors, not hearing smoke alarms, difficulty using household appliances and difficulty with personal care.
The attitudes and beliefs of society can also impact on the lives of individuals with sensory loss. Although the Equality Act 2010 makes it unlawful for people with disabilities to be discriminated against, individuals with sensory loss may still find themselves treated differently. This can range from a member of the public inadvertently raising their voice at a blind person to an employer not employing a deaf person because they might not hear the fire alarm.
The latter is an example of the medical model of disability, whereby an individual’s disability is considered to be a problem that needs to be resolved (usually by a medical cure or remedy). This is in contrast to the social model of disability which considers societal attitudes to be the problem and identifies ways to overcome these barriers. In the example above, the employer could have used the social model to think of ways that a deaf individual could be alerted to a fire alarm. There are technological solutions that could be used such as a vibrating cushion or visual alarm systems but the most straight-forward option would be to simply ensure that one or more other employees in the same office alert the deaf individual if the fire alarm sounds.
Factors such as the social model of disability, person-centred values and direct payments also impact the provision of care services for individuals with disabilities because they give the care receiver a lot more choice and control over how services are delivered. This contributes to the individual’s independence, which can have a positive effect on their wellbeing.
As stated earlier, individuals with sensory loss can find communication particularly difficult, however there are solutions that involve adapting existing materials or learning new skills.
Individuals that are visually impaired but still have some vision may need large print texts using clear fonts or a high contrast between the text and paper to aid them in reading. Magnifiers can also be used to enlarge the font size – these can be physical magnifying glasses or computer software. For individuals with little to no sight, a form of tactile written language such as braille or moon can be used. These comprise of patterns of raised dots, lines or curves that signify letters of the alphabet, which can be “read” using the sense of touch. Specialist synthesizers may also be used for reading the text on a computer by converting the written words into auditory speech.
Individuals with hearing loss may learn to lip read or communicate using British Sign Language (BSL), which uses gestures or signs to convey words. Technology can also help with the use of hearing aids and hearing loop systems which amplify sound as well as subtitles and closed-captions. Text messaging, social media and email are also useful forms of communication.
For deafblind individuals, a form of tactile sign language can be used. The deafblind manual alphabet is based on the BSL alphabet and involves spelling out words on an individual’s hand that they can interpret using their sense of touch. A simpler version of this is the block alphabet that involves using a finger to trace block capital letters on an individual’s palm.
To communicate effectively with sensory-impaired individuals, it is essential to ensure that the environment is suitable.
As well as making sure that the environment is comfortable, care should be taken to reduce background noise, have adequate lighting (natural light is best) and have any specialist equipment that may be required to hand. Specialist equipment can include laptops, tablets, tactile phones, tactile flooring and braille signage. Simple adjustments can also help, such as contrasting wall paint so that visually-impaired individuals can identify where one wall ends and the other begins or arranging the seating so that you can sit face-to-face with an individual that can lip read.
Adequate staff training is also vitally important for communication with individuals with sensory. Staff should have an awareness of the barriers to communication and ways to overcome them and, where necessary, specialist training in relevant communication methods such as BSL and the deafblind manual alphabet.
Being able to communicate effectively with others can have an immense positive impact on the lives of individuals with sensory loss. Not only will they feel valued and able to make a positive contribution, they will also have more opportunities and a greater sense of worth. This will affect their health and emotional wellbeing, improve their quality of life and help to keep them free from discrimination.
ACTION ON HEARING LOSS (2019). Facts and figures. [Online] Available at: https://www.actiononhearingloss.org.uk/about-us/our-research-and-evidence/facts-and-figures/ [Accessed 12 Aug. 2019].
NHS (2018). Deafblindness – Causes . [Online] Available at: https://www.nhs.uk/conditions/deafblindness/causes/ [Accessed 3 Sep. 2019].
NHS (2018). Deafblindness – Symptoms. [Online] Available at: https://www.nhs.uk/conditions/deafblindness/symptoms/ [Accessed 5 Sep. 2019].
RNIB (2019). Key information and statistics on sight loss in the UK. [Online] Available at: https://www.rnib.org.uk/professionals/knowledge-and-research-hub/key-information-and-statistics [Accessed 12 Aug. 2019].
WHO (2019). Vision impairment and blindness. [Online] Available at: https://www.who.int/news-room/fact-sheets/detail/blindness-and-visual-impairment [Accessed 3 Sep. 2019].
WHO (2019). Deafness and hearing loss. [Online] Available at: https://www.who.int/news-room/fact-sheets/detail/deafness-and-hearing-loss [Accessed 3 Sep. 2019].