In this education module, we review sensory changes (vision, hearing, taste, smell, and touch). While aging can affect all the senses, usually hearing and vision are most affected. A decline in senses can decrease quality of life by preventing us from enjoying activities and communicating with and staying involved with people, which ultimately can lead to isolation.
What you will learn in this education module:
- Know the signs and symptoms suggesting vision loss and identify assistive devices to assist someone with visual impairment.
- Identify signs and symptoms suggesting hearing loss and find assistive devices to compensate for hearing loss.
- Examine signs, symptoms and accommodations for loss of touch, taste and smell.
- Helpful links to respected websites for a deeper dive into specific sensory loss disorders.
Topic Quick Links – Click on a topic below to go to that area of the page.
- Vision Loss
- Hearing Loss
- Changes in Taste, Smell, and Touch
- Resources for Caregivers
More than 4.2 million Americans aged 40 years and older are either legally blind or have decreased/low vision. The leading causes of blindness and low vision in the United States are primarily age-related eye diseases such as age-related macular degeneration, cataract, diabetic retinopathy, and glaucoma. Other common eye disorders include amblyopia and strabismus.
Abnormal, Non-Emergency – Any changes in the appearance of your eyes or vision should be investigated further. Some examples include:
- Unusual trouble adjusting to dark rooms
- Difficulty focusing on near or distant objects
- Squinting or blinking due to unusual sensitivity to light or glare
- Change in color of iris
- Red-rimmed, encrusted or swollen lids
- Recurrent pain in or around eyes
- Double vision
- Dark spot at the center of viewing
- Lines and edges appear distorted or wavy
- Excess tearing or “watery eyes”
- Dry eyes with itching or burning
- Seeing spots, ghost-like images
Emergency – Indications of potentially serious problems that might require emergency medical attention
- Sudden loss of vision in one eye
- Sudden hazy or blurred vision
- Flashes of light or black spots
- Halos or rainbows around light
- Curtain-like blotting out of vision
- Loss of peripheral (side) vision
Common age-related eye disorders include:
- Glaucoma – visual field loss, blurred vision
- Age-related macular degeneration – blurred vision, image distortion, central scotoma (a partial loss of vision or blind spot in an otherwise normal visual field), difficulty reading
- Cataract – blurred vision, glare, monocular diplopia
- Diabetic retinopathy – blurred vision, floaters, visual field loss, poor night vision
- “Refractive” errors – the most frequent eye problems in the United States.
- Refractive errors include myopia (near-sightedness), hyperopia (farsightedness), astigmatism (distorted vision at all distances).
- Floaters are tiny spots or specks that float across the field of vision. Floaters often are normal, but can sometimes indicate eye problems such as retinal detachment, especially if they are accompanied by light flashes. Learn more about Eye Floaters.
- Dry eyes happen when tear glands can’t make enough tears or produce poor quality tears. Dry eyes can be uncomfortable, causing itching, burning or even some loss of vision. A health care provider may suggest using a humidifier or special eye drops that simulate real tears. Surgery may be needed in more serious cases of dry eyes. Learn more about dry eyes.
- Tearing, or having too many tears, can come from being sensitive to light, wind, or temperature changes. Protecting eyes by shielding them or wearing sunglasses can sometimes solve the problem. Tearing may also mean a more serious problem, such as an eye infection or a blocked tear duct. People with dry eyes may tear excessively because dry eyes are easily irritated. An eye doctor may be able to treat or correct both of these conditions. Learn more about Tearing.
- Eyelid disorders – problems can happen with many diseases or conditions. Pain, itching, tearing, and sensitivity to light are common symptoms of eyelid problems. Other problems may include drooping eyelids (ptosis), blinking spasms (blepharospasm) or inflamed eyelids near the eyelashes (blepharitis – See below after Diabetic Retinopathy). Eyelid problems often can be treated with medication or surgery.
Helpful Links and articles:
- List of eye disorders National Eye Institute
- Common Causes of Vision Loss in Elderly Patients, by David A Quillen, M.D.
- Centers for Disease Control and Prevention: Common Eye Disorders and Diseases
- American Optometric Association: Senior Vision: Over 60 Years of Age
Glaucoma is a group of eye diseases that can cause vision loss and blindness by damaging a nerve in the back of your eye called the optic nerve, the health of which is vital for good vision. The damage is often caused by an abnormally high pressure in your eye. Symptoms start so slowly that you may not notice them. The only way to find out if you have glaucoma is to get a comprehensive dilated eye exam. While there is no cure for glaucoma, early treatment can often stop the damage and protect your vision.
- Intense pain, which may result in nausea and vomiting
- Red eye(s)
- Swollen or cloudy cornea(s)
- Halos around lights (rainbow-colored rings around lights)
- Recurrent blurry vision
- Morning headaches
- Pain around eyes after watching TV or leaving a dark theater
Glaucoma Risk Factors
Because chronic forms of glaucoma can destroy vision before any signs or symptoms are apparent, be aware of these risk factors:
- Having high internal eye pressure (intraocular pressure) how diagnosed; not the disease itself
- Being over age 60
- Being black, Asian or Hispanic
- Having a family history of glaucoma
- Having certain medical conditions, such as diabetes, heart disease, high blood pressure and sickle cell anemia
- Having corneas that are thin in the center
- Being extremely nearsighted or farsighted
- Having had an eye injury or certain types of eye surgery
- Taking corticosteroid medications, especially eyedrops, for a long time
Prevention and management
Self-care steps can help you detect glaucoma in its early stages, which is important in preventing vision loss or slowing its progress.
- Regular dilated eye examinations.
- Regular comprehensive eye exams can help detect glaucoma in its early stages, before significant damage occurs. As a general rule, the American Academy of Ophthalmology recommends having a comprehensive eye exam every one to three years if you’re 55 to 64 years old; and every one to two years if you’re older than 65.
- Be aware of family’s eye health history.
- Glaucoma tends to run in families. Those people at risk of glaucoma may need more frequent screening. Ask the primary care physician or ophthalmologist.
- Exercise safely.
- Regular, moderate exercise may help prevent glaucoma by reducing eye pressure. Talk with a doctor about an appropriate exercise program.
- Take prescribed eyedrops regularly.
- Glaucoma eyedrops can significantly reduce the risk that high eye pressure will progress to glaucoma. To be effective, eyedrops prescribed by the doctor need to be used regularly even without symptoms.
- Wear eye protection.
- Eye protection can reduce serious eye injuries which can lead to glaucoma.
- Learn more about the Types of Glaucoma from National Eye Institute
- Learn about Diagnosis and Treatment Options for Glaucoma
There is currently no known cure for Macular Degeneration. Risk can be reduced and possibly slow the progression once diagnosed. For example, one can pursue lifestyle changes like Food and Recipes Good for Macular Degeneration, exercise, avoiding smoking, and protecting your eyes from ultraviolet light, which aggravates Macular Degeneration.
Symptoms of Macular Degeneration
Sometimes only one eye loses vision while the other eye continues to see well for many years. Condition may be hardly noticeable in its early stage. When both eyes are affected, reading and close up work can become difficult
- Worse or less clear vision. Vision might be blurry, and it may be hard to read fine print or drive.
- Dark, blurry areas in the center of vision.
- Rarely, worse or different color perception.
- Results in debilitating loss of central or detail vision.
The biggest risk factor for Macular Degeneration is age; the disease is most likely to occur in those 55 and older. Other risk factors include:
- Genetics – People with a family history of Age-related Macular Degeneration (AMD) are at a higher risk.
- Race – Caucasians are more likely to develop the disease than African-Americans or Hispanics/Latinos.
- Smoking – Smoking doubles the risk of AMD.
- Learn more at the Macular Degeneration Foundation at: eyesight.org
- Visit: American Macular Degeneration Foundation
Diabetic retinopathy (DR) is a common complication of diabetes. It is the leading cause of blindness in American adults and a significant cause of vision problems in the older adult population. The prevalence of diabetic retinopathy rises with increasing duration of diabetes. However, significant diabetic retinopathy may be observed in the elderly at the time of diagnosis or during the first few years of diabetes.
It is characterized by progressive damage to the blood vessels of the retina, the light-sensitive tissue at the back of the eye that is necessary for good vision.
The longer a person has diabetes the greater his/her chances of developing retinopathy. Regular eye examinations are necessary. The risks of DR are reduced through disease management that includes good control of blood sugar, blood pressure, and lipid abnormalities.
- Learn about Diagnosis and Treatment options for Diabetic Retinopathy
- Common Causes of Vision Loss in Elderly Patients, by David A. Quillen, M.D.
Blepharitis is an inflammation of the eyelids in which they become red, irritated and itchy with dandruff-like scales that form on the eyelashes. It is a common eye disorder caused by either bacteria or a skin condition, such as dandruff of the scalp or rosacea. Symptoms include:
- Redness, itching, burning, and generalized irritation
- Discharge (especially in the mornings)
- Scratchy sensation
- Temporary blurred vision
- Can lead to stye formation
- People with the skin condition known as “rosacea” tend to have blepharitis and dysfunction of these oil glands
- Learn more about the types of Blepharitis, Diagnosis, and Treatment: American Optometric Association/Blepharitis
- Learn What other health problems can blepharitis cause from the National Institutes for Health
Simple tasks around the house can become dangerous for those experiencing vision loss. Here are some suggested home modifications
- Brighten the home
- Decrease glare (I.e., sheer draperies to let in light but cut glare)
- Evenly distribute light using two lights when possible
- Use diffused light
- Use sunglasses with 100% UV protection
- Use night lights in the bedroom, hallways and bathroom
- Place reflective or colored tape on the edges of steps
Assistive Devices for Vision Loss
- Magnifying glasses
- Large number calculator, Clocks, telephones
- Dialing aids for the phone
- Large print books, catalogues, bills and newsletters
- Voice activated computers
- Must be printed clearly
- At least a 12-point font size
- Bright colors: red, yellow, orange
- Increase the lighting if necessary
Age-related vision changes and eye diseases can negatively affect driving abilities in older adults, even before you are aware of symptoms. Some age-related vision changes that commonly affect seniors’ driving are:
- Not being able to see road signs as clearly.
- Difficulty seeing objects up close, like the car instrument panel or road maps.
- Difficulty judging distances and speed.
- Changes in color perception.
- Problems seeing in low light or at night.
- Difficulty adapting to bright sunlight or glare from headlights.
- Experiencing a loss of side vision.
These tips can help you stay safe when driving, especially at night:
- Use extra caution at intersections.
- Many collisions involving older drivers occur at intersections due to a failure to yield, especially when taking a left turn.
- Look carefully in both directions before proceeding into an intersection.
- Turn your head frequently when driving to compensate for any decreased peripheral vision.
- Reduce your speed and limit yourself to daytime driving.
- If you are having trouble seeing at night or your eyes have difficulty recovering from the glare of oncoming headlights, slow down and avoid driving at night.
- Avoid wearing eyeglasses and sunglasses with wide frames or temples. Glasses with wide temples (side arms) may restrict your side vision.
- Take a driving course for seniors.
- Participate in a program for older drivers in your community, such as those offered by the American Association of Retired Persons (AARP). This can help you learn how to compensate for the physical changes that may affect your driving ability, and may even lower your insurance premium.
- Have an annual eye examination.
- Yearly eye exams can ensure your eyeglass or contact lens prescription is up to date. It can also ensure early detection and treatment of any developing eye health problem.
Hearing loss can occur in one or both ears and range from mild to profound. Some lose clarity more than volume. For some, high-pitched sounds (including women’s voices) become fuzzy or it becomes difficult to distinguish one consonant from another.
Hearing loss that occurs gradually as you age (presbycusis) is common. About one-third of people in the United States between the ages of 65 and 75 have some degree of hearing loss. For those older than 75, that number is approximately 1 in 2.
Hearing loss is defined as one of three types:
- Conductive (involves outer or middle ear)
- Sensorineural (involves inner ear)
- Mixed (combination of the two)
Signs and Symptoms Suggesting Hearing Loss
- Turns up the volume on the TV or radio
- Often asks to have information in a conversation repeated
- Misunderstands what others say
- Conversation becomes difficult
Impact of Hearing Loss
- Psychological/behavioral: may neglect to do something important because they did not hear it
- Social: may withdraw
- Emotional: may become irritable or depressed
- Take a free online hearing test
- Learn more from the NIH: https://www.nia.nih.gov/health/hearing-loss-common-problem-older-adults
Hearing aids can’t restore normal hearing. They can improve your hearing by amplifying sounds that you’ve had trouble hearing. Unfortunately few people who need hearing aids wear them due to perceived stigma, cost, or impatience.
Period of Adjustment for Hearing Aids
- Sounds can be overwhelming, distorted and chaotic
- Might not be able to identify once familiar sounds
Assistive devices for Hearing
- Devices on the phone to amplify sounds
- Headphones for the television or radio
- Vibrating alarm clocks
- Doorbells and telephones that flash instead of ring
- Cell phone ear pieces
When you know about a hearing impairment:
- Use simple, direct sentences
- Speak clearly at a steady, normal pace
- Speak slightly louder than normal
- Reduce confusion by turning down the TV or reducing other background noise
- Make eye contact or get the person’s attention in some other way
- Stand near the person when talking
- Face the individual if possible
- Use gestures and facial expressions
- Speak at a normal volume if the person wears a hearing aid
- Speak clearly, but don’t exaggerate lip movements
- Rephrase comments if asked to repeat something
- Introduce the topic before talking about it in detail (“Mom, about your doctor’s appointment on Tuesday…”)
On the Telephone
- Cup your hand around the mouthpiece, especially when there is background noise
- Keep sentences simple and short
- Keep the topic of the conversation clear
- Avoid chewing, eating or covering your mouth
- Verify that you and the person are understanding one another
- Try saying the same thing in different words
- Check for understanding
- Give instructions slowly and ask him/her to repeat, when necessary
Smell, taste, and sensitivity to touch all change as we age. Loss of taste and smell can have a significant impact on quality of life, often leading to decreased appetite and poor nutrition. Sometimes loss of taste and smell contributes to depression. Loss of taste and smell also might tempt the use excess salt or sugar on food to enhance the taste — which could be a problem with high blood pressure or diabetes.
Some loss of taste and smell is natural with aging, especially after age 60.
- Most people over 60 have lost 50% of their taste buds
- Most people in their 70s have 1/6 of the taste buds of a 20-year-old
Signs of loss of taste include complaints about food not tasting right and using excessive seasoning, especially salt. Loss of the sense of smell may interfere with the sense of taste which can cause reduced or increased appetite.
Factors that can contribute to loss of taste and smell:
- Nasal and sinus problems, such as allergies, sinusitis or nasal polyps
- Certain medications, including beta blockers and angiotensin-converting enzyme (ACE) inhibitors
- Dental problems
- Cigarette smoking
- Head or facial injury or mass
- Alzheimer’s disease
- Parkinson’s disease
If necessary, a doctor might recommend consulting an allergist, an ear, nose and throat specialist (otolaryngologist), a neurologist, or other specialist.
- If the person overly salts, suggest use low salt spices, herbs, and seasonings
- Help identify foods that the person can enjoy
- Purchase bath oils and soaps as gifts to encourage bathing
- Recommend the use of gloves to protect the person who has lost the sense of touch to protect the hands and footwear to protect the feet
As you get older, your sense of smell may fade. Your sense of smell is closely related to your sense of taste. When you can’t smell, food may taste bland. You may even lose interest in eating.
Smell is an important sense. Certain smells help us recall memories. Other smells, like smoke from a fire, alert us to danger. When your care receiver can no longer smell things they enjoy, like morning coffee or spring flowers, life may seem dull.
If someone is experiencing a loss of taste and smell, consult a doctor. Although age-related taste and smell cannot be reversed, some causes of impaired taste and smell are treatable. Quitting smoking can help restore the sense of smell. A doctor might adjust medications if they’re contributing to the problem. Many nasal and sinus conditions and dental problems can be treated as well.
If your care receiver avoids touching or being touched, is unable to sense pain or overly sensitive to touch or pressure, or has no response to being touched they may be experiencing a loss of this sense.
Compensating and Accommodating for Sensory Loss
- Ensure home and environment safety
- Recognize changes in daily routines and habits and take action to help the person compensate for the loss
- Call 2-1-1 throughout Texas for information and access to health and human service information for all ages.
- Call 800-252-9240 to find local Texas Area Agency on Aging.
- Call 800-677-1116 – Elder Care Locator service to find help throughout the U.S.
Use resources such as Area Agency on Aging (AAA). Types of assistance provided by AAAs:
- Information and referral
- Caregiver education and training
- Caregiver respite
- Caregiver support coordination
- Case management
- Transportation assistance
Assistance available through AAAs for persons age 60 and older may include:
- Benefits counseling
- Ombudsman – advocacy for those who live in nursing homes and assisted living facilities
- Home-delivered meals
- Congregate meals
- Light housekeeping
Be sure to check out our Resource Directory, FAQ, and Educational Events Calendar for more great information! Permission is granted to duplicate any and all parts of this page to use in education programs supporting family members caring for elders.
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We hope this information is helpful to you in the important work you do as a family caregiver.
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