The onset of sensory impairments in late life can cause serious emotional distress for older persons. Elderly with vision impairments are two to five times as likely as non-impaired elderly to suffer from depression, and those with hearing impairments may be at a somewhat increased risk as well. The risk of depression does not seem to be related to the severity of the sensory loss. Instead, depression seems most likely to occur shortly after the initial onset of the impairment.

Examining the literature, author Amy Horowitz, D.S.W, finds that the following factors affect the association between sensory impairment and depression: loss of functionality, or ability to accomplish activities of daily living; fear of becoming dependent; and loss of valued activities. Evidence on the effect of hearing impairments on functional disability is unclear. However, deafness can severely impact social interactions, resulting in reduced social activity. Visual impairments, on the other hand, seem to be related to high levels of functional disability, evoke the most fear among older persons, and impact two activities crucial to senior independence and self-esteem: reading and driving. Considerable research links cessation of driving to higher levels of depression among older persons.

Depression among older adults with sensory impairment can worsen the impairment, as depression has a well-documented negative effect on rehabilitation outcomes. Depressed individuals are less likely be referred for, seek out, or successfully complete rehabilitation programs or to use adaptive devices. Rehabilitation interventions that help impaired older adults improve their functional skills and adapt to their disability can reduce levels of depression. On the other hand, directly treating the depression first can not only improve mental health, but also result in better outcomes from rehabilitation efforts.

Implications for Social Work
Although a significant minority of older persons develop depression as a reaction to the onset of vision or hearing problems, depression is neither a normal nor inevitable response to late-life sensory impairment. Social workers should make efforts to intervene at the initial onset of symptoms of sensory impairment, as they may be able to head off depression before it sets in by referring clients to appropriate resources that can help lessen functional impairment. Geriatric social workers should also be alert to signs of depression among older adults with vision and/or hearing impairments, and may want to recommend treating existing depression before rehabilitation of any impairments begins.

Social workers should also strive to involve family members with mental health interventions and rehabilitation efforts to make sure caregivers have appropriate attitudes toward older adults with vision or hearing impairments, and to help family members understand how to offer appropriate help. In addition, social workers should seek to work closely with mental health and sensory rehabilitation professionals to ensure that they can properly serve the growing number of older adults with vision and hearing impairments.

Posted on July 17, 2003