For older adults hoping to remain independent, healthy aging may depend on paying attention to two things that are often dismissed as inevitable casualties of getting older: hearing and vision.
Alison Abraham, a University of Colorado epidemiologist and biostatistician who studies sensory loss and healthy aging, says declining eyesight and hearing can affect nearly every part of an older person’s life — from driving and avoiding falls to maintaining friendships, staying physically active, and protecting cognitive health.
“They’re sort of neglected stepchildren as risk factors for all the sort of bad outcomes of aging,” Abraham said in an interview with the Estes Valley Voice. Many older adults, she said, simply assume vision and hearing loss are unavoidable parts of getting older rather than health problems that can sometimes be treated.
That assumption can carry consequences.
Abraham is a professor and vice chair for education in the Department of Epidemiology at the Colorado School of Public Health and a professor in the Department of Ophthalmology at the University of Colorado School of Medicine on the Anschutz Medical Campus. She also co-directs graduate programs in epidemiology.
Her research focuses on aging and sensory loss, including studies of vision loss, retinal biomarkers, and cognition. She is principal investigator of the Eye Determinants of Cognition Study and the HIV Vision Study and has done extensive work involving adults aging with HIV.
Her work has increasingly focused on a straightforward idea: Seeing and hearing well aren’t simply about the eyes and ears. Sensory health can help determine whether people remain connected to their communities and continue doing the things that give their lives meaning.
That message is especially relevant in the Estes Valley, where adults 60 and older make up more than a third of the local population and access to specialized medical care can require traveling outside the community.
When hearing becomes hard work
Age-related hearing loss doesn’t necessarily mean everything simply becomes quieter.
People can lose the ability to hear certain frequencies, Abraham said. Because speech contains sounds across different frequencies, conversation can begin to sound incomplete or garbled.
“You’re editing out pieces of my words and then trying to understand what I’m saying,” she said.
The brain then has to fill in what is missing.
That creates what Abraham described as a “cognitive load problem.” Instead of devoting its resources to understanding and responding to a conversation, the brain must first work to decipher an incomplete auditory signal.
“When you have a garbled signal, and whether that’s vision or hearing, your brain has to work so much harder,” she said.
Yet hearing loss often goes untreated. Abraham said a commonly cited statistic is that 80 percent of people who could benefit from hearing aids do not wear them — a phenomenon researchers sometimes refer to as “hearing aids in the drawer.”
The effects can extend well beyond difficulty following a conversation.
Imagine, Abraham said, trying to meet friends in a busy restaurant when the background noise makes it nearly impossible to understand what anyone at the table is saying.
“How likely are you to go out into a crowded restaurant with your group of friends to socialize?” she said.
For some people, the easier solution eventually becomes staying home.
“You withdraw because you cannot hear them,” Abraham said. “Being able to hear is integral to maintaining our social networks as we age.”
Vision can change a person’s world
Vision loss can create similar barriers.
Some changes are readily treatable. Abraham points to cataracts and refractive errors — vision problems that can often be corrected with cataract surgery or glasses.
Other changes can be more subtle.
Contrast sensitivity, for example, can decline with age. That can make it harder to distinguish a stair from its surroundings in dim light, potentially increasing the risk of a fall.
Vision problems can also gradually shrink someone’s social world.
An older adult who no longer feels comfortable driving at night may stop attending evening meetings, concerts, dinners, or other activities unless someone else can provide transportation.
Abraham understands that personally. She has congenital cataracts and said glare makes nighttime driving difficult.
“Things that are occurring after dark are just — it’s a barrier for me to get out and do them,” she said.
The same pattern can affect physical activity, emotional well-being, and cognitive health.
“If we don’t maintain our sensory health, we’re sort of retracting from all of these other areas that contribute to healthy aging,” Abraham said.
Beyond memory loss
Abraham brought that message to a national audience this month as a panelist at the USAgainstAlzheimer’s 11th Annual National Alzheimer’s Virtual Summit, held Sept. 16 to 17.
Her presentation was part of the summit’s “Beyond Memory Loss: Recognizing and Taking Action Against Alzheimer’s” discussion. Abraham appeared with Sharon Cohen, a neurologist with the Toronto Memory Program in Canada, and Carole Roan Gresenz, dean of Georgetown University’s McCourt School of Public Policy.
The discussion reflected a central theme of Abraham’s research: Cognitive health cannot always be separated neatly from sensory health, and healthcare that treats vision, hearing, and cognition in silos can miss important connections.
Sensory loss and cognition
The connection between sensory loss and cognitive health is especially complicated.
Poor hearing or eyesight can affect how a person performs on a cognitive assessment because many commonly used tests depend on a person being able to hear spoken instructions or see visual material.
If someone cannot clearly hear the question or see the testing material, Abraham said, the test may not accurately measure what the person’s brain can actually do.
“Just imagine if either of those aren’t working well,” she said. “How well are you measuring their actual cognitive performance?”
There is another issue.
For someone already experiencing mild cognitive impairment, struggling to decipher unclear sounds or visual information places an additional burden on the brain. Hearing and vision loss can also contribute to social isolation, anxiety, and depression, all of which can intersect with cognitive health.
Abraham pointed to the 2024 Lancet Commission report on dementia, which included untreated vision loss and hearing loss among 14 potentially modifiable risk factors associated with dementia.
That doesn’t mean hearing aids or glasses guarantee that someone will avoid dementia. It does mean sensory health is increasingly part of the broader conversation about factors people and health systems may be able to address as they age.
There is another complication: What appears to be a problem with the eyes may not always originate in the eyes.
Changes in the brain can affect how visual information is processed and interpreted. That underscores Abraham’s concern about healthcare operating in silos and the need for clinicians caring for older adults to consider connections among vision, hearing, cognition, and other aspects of health.
Bringing care into the community
Abraham argues that healthcare needs to do a better job of looking at the whole person.
Her work includes efforts to develop integrated models that combine aging services with vision and hearing screening and other care. She works with the Colorado Health Network to integrate aging services and geriatric care models into traditional HIV services, including vision and hearing screening and access to glasses and hearing aids.
Abraham said she believes more care ultimately needs to move into communities rather than requiring patients to navigate a series of disconnected specialists and health systems.
Access is already difficult for many people, she said. Care can be expensive, and older adults can encounter ageism in medical settings.
“We have not done a good job as a country of thinking about aging adults and sort of their independence and their agency and how we’re going to best allow them to age happily,” she said.
Her research increasingly asks what future models of care should look like.
“I think that bringing care into communities is really where that should go,” Abraham said. “I work a lot with various organizations to think about integrated care that is provided in communities.”
For communities such as Estes Park, where many residents hope to age in place but specialty healthcare can mean a trip down the mountain, that approach could become increasingly important.
Abraham’s message about sensory health is relatively simple: Don’t automatically accept declining hearing or eyesight as something that must simply be endured with age.
Treating a cataract, getting the right pair of glasses, or addressing hearing loss may seem like a narrow medical intervention. But the real outcome may be much bigger — another dinner with friends, another evening event, another walk taken safely, another conversation fully understood, and another piece of independence preserved.
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