Hearing and Vision Loss Together: Practical Support

How common and why it is missed

Studies suggest that a substantial minority of older adults, and a large share of those in care homes and over eighty, have both hearing and vision impairment. It often goes unnoticed because:

• Each loss is gradual, and the person adapts and hides it.
• Each can mask the other: poor sight is blamed for not following a conversation, poor hearing for missing signs.
• Families attribute difficulties to age, tiredness, stubbornness or memory loss.
• Health professionals may test one sense but not the other.
• The person may not recognise the cause of their difficulties, or may be embarrassed.
• Dementia and sensory loss often occur together; see hearing aids and dementia risk: what the evidence says.

A person with dual loss may be wrongly labelled as having dementia when part of the problem is that they cannot see or hear well enough to take part. Tests of memory should be done with glasses and hearing aids in place and with adapted methods.

Signs to look for

• Difficulty following conversation in groups and in the dark, or when the speaker is not facing them.
• Missing visual signals such as gestures or written information, as well as sounds such as doorbells and alarms.
• Poor orientation, getting lost, bumping into things or being startled.
• Reluctance to go out or join social events.
• Misunderstanding what is said, giving irrelevant answers or appearing confused.
• Falls and near-falls.
• Withdrawal, low mood, irritability, anxiety or suspicion.
• Difficulty reading medicine labels and using the phone.
• Difficulty with eating, since sight and sound cues are missing.

See signs of hearing loss in parents and how to raise it gently and low vision home safety: contrast, labels and layout.

Get both senses assessed and treated

• Eyes: a full examination by an ophthalmologist or optometrist, to treat cataract, check for glaucoma, macular degeneration and diabetic eye disease, and to make sure glasses are right; see a hearing and vision check-up schedule after 60, living with cataract: daily adjustments before and after surgery and diabetic eye care for older adults.
• Ears: a hearing test with an audiologist or ENT doctor, wax removal and hearing aids if appropriate; see a hearing test: what to expect and ear wax and hearing: safe care.
• Make sure aids and glasses are worn, kept clean, charged and working. A person who needs both may find it hard to manage two sets of devices, so help with routines.
• Check medicines and general health: diabetes, blood pressure, thyroid and other conditions can affect both senses; do not stop medicines without advice.
• Ask for a combined assessment where available, such as at a geriatric clinic, and tell professionals that both senses are affected so that they adapt.
• Review progress regularly.

Communication: key strategies

Because each sense helps compensate for the other, the aim is to make the most of whichever sense works better, and to add touch and clear structure.

Before communicating

• Make sure aids and glasses are in place.
• Approach gently and let the person know you are there: a light touch on the arm or shoulder (with consent and cultural sensitivity), a consistent personal sign or a familiar greeting before you speak.
• Introduce yourself every time, with your name.
• Position yourself at the person's best side, about one metre away, in good light on your face and out of glare; see lighting for older eyes: brightness, colour and glare.
• Reduce noise and distraction. See talking with someone who is hard of hearing.

While communicating

• Speak clearly, slowly and naturally, in short sentences, and pause. Do not shout.
• Use the person's name and say what you are about to do ("I am going to help you stand").
• Use simple, concrete language and avoid jargon.
• Use gestures and demonstration if vision allows, and large clear movements.
• Use touch cues: a hand-over-hand guide, a tap pattern for "come", or placing an object in the hand. Agree meanings with family and carers, and keep them consistent.
• Write in large print with bold black ink on white paper, if reading is possible, and speak the same words.
• Use object cues: show a cup to say "tea", a towel to say "bath".
• Give time for a reply, and check understanding gently by asking the person to repeat or show.
• Tell the person when you are leaving the room, or when someone else enters.
• Describe the environment and who is present, what is on the plate and where, using clock positions for the plate ("peas at six o'clock").
• Respect dignity and avoid talking about the person in front of them.

Group settings

• Introduce each speaker, one at a time, and describe the scene.
• Seat the person with the better ear and eye toward the group.
• Provide written notes or a summary afterwards.

In emergencies

• Keep calm, approach safely and use a touch signal and clear words.
• Make sure emergency information is on a card; see emergency contact card and medical summary.

Devices and technology

• Hearing aids with good fitting and follow-up; see hearing aids: types, costs and how to choose.
• TV and phone aids such as headphones, streamers and amplified phones; see TV headphones and streamers for hearing loss and amplified phones and phone settings for hearing loss.
• Large-print, high-contrast and tactile labels and talking devices; see talking clock guide.
• Magnifiers and good lighting; see magnifier lamps: reading and hobbies with low vision.
• Vibrating alarms and flashing alerts for the doorbell, smoke alarm and clock, which suit both: a loud alarm may not be heard, and a flashing light may not be seen, so combine loud sound, bright flashing light and strong vibration (such as a pillow or bed shaker). See smoke and gas safety for older adults.
• Phone accessibility features such as vibration, large text, magnification, voice, captions and text-to-speech; see phone accessibility features for hearing and vision loss.
• Emergency alert devices with large, tactile buttons and vibration feedback; see panic pendant buying guide.

Devices should be simple. Too many gadgets can overwhelm. Introduce them one at a time and keep what helps.

Safety and the home

• Clear, consistent layout: furniture in fixed places, clear paths, no clutter, doors fully open or closed; see decluttering for safety and calm.
• Lighting and contrast: strong, even light, contrast on steps and edges, tactile marks; see low vision home safety: contrast, labels and layout.
• Falls prevention: vision and hearing both help balance, so the risk of falls is higher; see falls risk assessment at home.
• Stairs, bathroom and kitchen: handrails, grab bars, non-slip surfaces and safe appliances; see bathroom safety checklist for seniors and kitchen setup for seniors.
• Outdoor safety: a companion, a cane that signals poor sight, and care around traffic, which the person cannot hear or see easily.
• Alarms: multiple modes (sound, light, vibration).
• Visitors and callers: a door viewer and chain, intercom with video and text, and a plan for doorstep callers; see preventing scams and doorstep fraud.
• Wandering: if dementia is also present; see wandering and dementia safety.
• Medicines: large-print labels, a weekly organiser and supervision; see pill organiser guide and giving medicines safely at home.

Daily routine and independence

Keep a predictable routine with consistent places for objects and the same sequence for daily tasks. Let the person do what they can, offer help respectfully, and plan activities that use the remaining senses: music, touch, smell, taste, cooking together and company. See chair exercises for seniors.

Mood, isolation and thinking

Dual sensory loss is strongly linked with loneliness, depression, anxiety and reduced participation. Some people experience hallucinations related to sight loss (Charles Bonnet syndrome) or hear musical sounds with hearing loss; tell the doctor. Support:

• Daily contact, touch and company, and regular visits.
• Group activities adapted to both losses, in small, quiet, well-lit settings.
• Peer support and rehabilitation services.
• Treatment of depression and anxiety; see hearing loss and isolation in later life, loneliness and isolation in older adults: practical ways to help and depression in older adults.
• Memory assessment done with sensory aids and adapted tests; see mild cognitive impairment: what it is and what families can do and caring for a parent with dementia at home.

For carers

Caring for someone with dual sensory loss is demanding. Learn the strategies, share the work and take breaks; see caregiver burnout: signs and prevention. In hospital, tell staff about both losses in writing and keep aids and glasses with the patient.

When to ask a professional

Ask the family doctor to arrange both an eye and a hearing assessment. Ask an audiologist, ophthalmologist, optometrist, occupational therapist and, if available, a rehabilitation worker with experience in combined sensory loss. Seek urgent help for sudden loss of vision or hearing, flashes, a curtain, eye pain, dizziness or ear pain or discharge. Call 112 for signs of stroke, such as facial droop, weakness, speech difficulty or confusion.