Vision and hearing impairment are highly prevalent, chronic conditions which disproportionately affect older adults . In the United States, vision impairment impacts approximately 14 million individuals 12 years and older, of which approximately 3 million would remain impaired even with refractive correction . Similarly, estimates suggest that hearing impairment, defined as a mild or greater hearing loss using World Health Organization criteria, impacts 38 million Americans and increases in prevalence with age such that two-thirds of Americans over age 70 years [3, 4]. A small and often overlooked subset is those with dual sensory impairment, concurrent hearing and vision impairment, which affects 1 in 9, or 11.3%, of Americans 80 years or older . As the United States population ages, these numbers are expected to increase [6, 7].
Once considered benign aspects of aging, recent literature has emphasized the public health importance of sensory impairment. Sensory impairment is independently associated with numerous negative health outcomes in older adults, including cognitive decline, dementia, falls, and functional decline and loneliness [8,9,10,11,12,13]. Despite consequences outlined above, adoption and pursuit of sensory care remains low: only 20–30% of persons with hearing impairment own and use hearing aids while less than 50% of Medicare beneficiaries with vision impairment have had an annual eye exam [14, 15].
Concurrent vision and hearing impairment may exacerbate negative health associations. Dual sensory impairment presents a unique challenge by removing sensory substitution compensatory strategies (i.e. reliance upon visual cues in the presence of hearing impairment and auditory cues in the presence of visual impairment) . There is a paucity of research on adults with dual sensory impairment. However, available evidence suggests those with dual sensory impairment experience compounded psychosocial, psychological and functional effects compared to those with either hearing or visual impairment only .
Sensory impairment in healthcare
Recent research has focused on how sensory impairment impacts healthcare specific outcomes. In a study of matched adults with and without vision loss who were hospitalized for common illnesses, Medicare beneficiaries with severe vision loss had, on average, 4% longer lengths of stay, 22% higher odds of 1-month readmission, and 12% higher mean costs of healthcare services during hospitalization and 90 days after discharge. Similar associations were seen among adults with commercial health insurance, where those with severe vision loss had a 4% longer length of stay, 32% higher odds of readmission, and 8% higher costs . Similarly, in a study of propensity-matched adults with and without hearing loss, adults with hearing loss accumulated, on average, $22,434 (95% CI, $18,219–$26,648) more in healthcare expenditures over a 10-year period. In addition, adults with hearing loss experienced a 47% higher rate of hospitalization, 44% higher risk of 30-day readmission, and spend, on average, 2.5 days longer during an inpatient stay over a 10-year period . Increased healthcare utilization may contribute to suggested poorer perceived satisfaction with care among those with sensory loss [20, 21].
Sensory impairment may negatively impact and limit communication, including patient-provider communication. When navigating health systems, individuals with vision or hearing impairment face barriers to effective communication which is a pillar of patient-centered care . For clinicians, communication limitations with patients could increase the time, effort and frustration associated with providing adequate care. For those with sensory impairment, inadequate communication with healthcare providers could increase the likelihood of misunderstanding medical information, reduce treatment adherence, lower patient satisfaction, and can result in poorer clinical outcomes or even accidental injury .
Accompaniment in healthcare
In the United States, 20–50% of older adult patients are accompanied by a companion to their medical visits . Importantly, in response to deficits in care quality and rising healthcare costs, there is a growing appreciation for patient-centered care and patient-provider communication and the concept of “patient-family-physician” partnerships. Previous studies on accompaniment in healthcare settings have demonstrated that the presence of companions may positively impact patient understanding, information recall and engagement in medical decision-making [25, 26]. However, there is limited research on the patterns of accompaniment for older adults with sensory impairment despite their unique communication and physical (i.e., transportation) barriers faced in accessing and interacting with the healthcare system. For older adult patients with sensory impairment, accompaniment may be particularly important to optimal patient care. To our knowledge, no previous studies have examined whether sensory impairment is associated accompaniment to physician visits in a nationally representative sample of older adults. This study investigated the patterns of and reasons for accompaniment to physician visits of Medicare beneficiaries with hearing impairment, vision impairment, and dual sensory impairment compared to those without sensory impairment.