Linking sensory loss and mobility

Together the auditory and visual systems contribute to our spatial awareness of the environment and how we are moving within it, thereby allowing us to successfully perform everyday tasks such as walking and driving. For example, we use our auditory localization abilities and visual functions, such as the ability to perceive edges, depth, and motion, to gather information about our surroundings (e.g., approaching vehicles, obstacles, etc.). When you have good vision and hearing health, you can use this information to safely navigate your environment during complex, multisensory, and multitasking situations (1;2). Most of the activities we associate with independent functioning (e.g., meal preparation, driving, walking) involve the harmonization of sensory, motor, and cognitive functions, and very often, the coordination of more than one task at a time (i.e., multitasking) (3).

What the research tells us

When vision and/or hearing abilities are compromised, maintaining balance or walking safely becomes challenging, thereby increasing the risk of falls (4;5). Falls are 3 times more likely in individuals with hearing loss and 2 times more likely in those with vision loss (6;7).

Evidence suggests that cognitive capacity may be recruited to compensate for both age-related sensory and motor declines, thereby creating extra cognitive load during activities of daily living such as listening while walking or driving (8-10).

Similarly, poorer driving performance and crash risks are associated with impaired visual abilities, such as poor visual acuity, poor contrast sensitivity, small visual fields, small visual attentional fields, and high sensitivity to glare (11;12). There is some evidence that older drivers with both hearing and visual impairment have higher crash rates than drivers with no sensory impairments, or with visual/hearing loss alone (13). In Ontario, drivers must meet standard visual requirements for visual acuity and visual fields in order to hold a driver’s license. Older adults with declines in their sensory abilities often strategically manage their driving, such as avoiding driving in bad weather or at night.

Recommendations

What can one do to optimize mobility within and beyond the home? Recommendations to optimize safe mobility include taking preventive measures, such as protecting your sensory health (e.g., wearing ear protection and sunglasses), checking your hearing and vision regularly, and addressing any sensory problems with technologies (e.g., prescription lenses or hearing aids) or by learning new skills. At home, check that spaces are well-lit, quiet, and clutter-free to facilitate mobility-related safety. The World Health Organization acknowledges that addressing these building blocks (hearing and vision) can have far-reaching benefits in facilitating mobility and functional activities (e.g., social participation, exercise) that are associated with healthy aging (14). 

References

1. Andersen GJ. Aging and vision: Changes in function and performance from optics to perception. Wiley Interdisciplinary Reviews: Cognitive Science. 2012; 3(3):403-10. doi:10.1002/wcs.1167
2. Campos J, Ramkhalawansingh R, Pichora-Fuller MK. Hearing, self-motion perception, mobility, and aging. Hearing Research. 2018; 369:42-55. doi:10.1016/j.heares.2018.03.025
3. Campos JL, Marusic U, Mahoney JR. The intersection of cognitive, motor, and sensory processing in aging: Links to functional outcomes, Volume I. Frontiers in Aging Neuroscience. 2022; 14: 1-4. doi:10.3389/fnagi.2022.1009532
4. Foster JI, Williams KL, Timmer BH, et al. The association between hearing impairment and postural stability in older adults: A systematic review and meta-analysis. Trends in Hearing. 2022; 26. doi:10.1177/23312165221144155
5. Kahiel Z, Grant A, Aubin MJ, et al. Vision, eye disease, and the onset of balance problems: The Canadian longitudinal study on aging. American Journal of Ophthalmology. 2021; 231:170-178. doi:10.1016/j.ajo.2021.06.008
6. Lin FR, Ferrucci L. Hearing loss and falls among older adults in the United States. Archives of Internal Medicine. 2012; 172(4):369-71. doi:10.1001/archinternmed.2011.728
7. Dhital A, Pey T, Stanford MR. Visual loss and falls: A review. Eye. 2010; 24(9):1437-46. doi:10.1038/eye.2010.60
8. Humes LE, Young LA. Sensory–cognitive interactions in older adults. Ear and Hearing. 2016; 37:52S-61S. DOI: 10.1097/AUD.0000000000000303
9. Poirier G, Ohayon A, Juranville A, et al. Deterioration, compensation and motor control processes in healthy aging, mild cognitive impairment and Alzheimer’s disease. Geriatrics. 2021; 6(1):33. 10.3390/geriatrics6010033
10. Li KZ, Bherer L, Mirelman A, et al. Cognitive involvement in balance, gait and dual-tasking in aging: A focused review from a neuroscience of aging perspective. Frontiers in Neurology. 2018; 9:913. doi.org/10.3389/fneur.2018.00913
11. Freeman EE, Munoz B, Turano KA, et al. Measures of visual function and time to driving cessation in older adults. Optometry and Vision Science. 2005; 82(8):765-773. doi:10.1097/01.opx.0000175008.88427.05
12. Owsley C, Wood JM, McGwin Jr G. A roadmap for interpreting the literature on vision and driving. Survey of Ophthalmology. 2015; 60(3):250-262.doi:10.1016/j.survophthal.2015.01.005
13. Green KA, McGwin Jr G, Owsley C. Associations between visual, hearing, and dual sensory impairments and history of motor vehicle collision involvement of older drivers. Journal of the American Geriatrics Society. 2013; 61(2):252-257 .doi:10.1111/jgs.12091
14. World Health Organization. Integrated care for older people (‎ICOPE)‎: Guidance for person-centred assessment and pathways in primary care. [Internet] 2019. [cited November 2024]. Available from: https://iris.who.int/handle/10665/326843

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