The Role of Public Health in Addressing Aging and Sensory Loss
The Role of Public Health in Addressing Aging and Sensory Loss
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公共卫生在解决衰老和感觉丧失方面的作用
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发表时间：
2003
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通讯作者：
J. Crews
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作者：
J. Crews
老年人的感觉丧失相对常见，往往会产生严重的后果。失明或失聪的社会和功能影响，或两者兼而有之，在小规模和基于人群的研究以及经历过这些经历的人的个人描述中都有很好的记录(Crews和Campbell，在新闻中)。然而，令人惊讶的是，患有视力和听力损失的老年人的整体健康状况通常比普通人群更差。有感觉障碍的人比没有感觉障碍的人有更高的高血压、心脏病、中风和髋关节骨折的发生率。健康方面的这些差异有多种后果，包括开展有价值的活动和参与社会角色的能力下降。从历史上看，康复计划、医学和老龄化网络都以这样或那样的方式满足了患有视力或听力丧失的老年人的需求。这些学科中的每一个都代表着不同的观点，都是有价值的。康复可能寻求恢复功能，通常是通过技术或补偿策略。例如，视力康复聘请康复教师、低视力专家以及定向和行动指导员来解决一系列促进独立的技能。医学是为了治愈疾病。老龄化网络试图确保所有老年人都得到广泛的社会支持，使他们能够通过住房、交通、营养和对家庭的支持参与社会。这些都是值得努力的。但是，公共卫生可能会给这个选区带来什么呢？公共卫生观点公共卫生观点很可能是一种手段，可以用来阐明了解患有感觉障碍的老年人的情况的策略，并确定一些社会、健康和康复干预的途径。更多的独立性可能是通过多种努力的汇合--例如，实施技术、培训、同行支持和修改环境--而不是单一的干预。公共卫生领域提供的观点可能是这一努力的一个重要方面。公共卫生提供了一门科学来更好地理解衰老和感觉丧失的程度，为这些人类经历的多维性质提供了一个概念框架，公共卫生指出了一些具体的机会来改变行为和环境，有可能实现更好的健康结果。定义、量化和解决残疾Pope和Tarlov(1991)断言：“残疾被列为国家最大的公共卫生问题，不仅影响残疾患者及其直系亲属，而且影响整个社会。”那些关心为经历感觉丧失的老年人提供政策和服务的人面临着几个挑战，这些挑战可能会由公共卫生来解决。在宏观层面上，关于被归类为视力障碍或听力损失的人数仍然存在很大的不确定性。例如，即使在这本散文集中，估计也有相当大的差异。这种不确定性至少有两个原因。其中一个问题与视力损害或听力损失的定义有关。无法以最佳矫正方式阅读报纸印刷品，近乎视觉损伤的“黄金标准”定义。对比度敏感度和照明问题会影响视觉性能，导致进一步的不精确度。其次，由于定义不同，各国对视障人数的估计也不同。关于视力受损人数的估计已经争论了几十年(Kirchner，1988；灯塔研究所，1995；Crews，1991；预防失明美国，1994)，总的来说，潜在的假设是，数字越大，公共政策就越有可能照顾到视障老年人的需求。…
Sensory loss among older people is relatively common and often has serious consequences. The social and functional implications of loss of vision or hearing, or both, are well documented in small-scale and population-based studies as well as personal accounts of people who have lived these experiences (Crews and Campbell, in press). It is striking to note, however, that the overall health of older people with vision and hearing loss is generally poorer than that of the general population. People with sensory loss have higher rates of hypertension, heart disease, stroke, and broken hips than people without sensory impairments. These disparities in health have multiple consequences including decreased ability to perform valued activities and participate in social roles. Historically, rehabilitation programs, medicine, and the aging network have in one way or another addressed the needs of older people who experience either vision or hearing loss. Each of these disciplines, representing differing points of view, is valuable. Rehabilitation may seek to restore function, usually by technology or compensatory strategies. For example, vision rehabilitation employs rehabilitation teachers, low-vision specialists, and orientation and mobility instructors to address an array of skills promoting independence. Medicine seeks to cure. And the aging network seeks to assure that all older people have the broad social supports that allow them to participate in society-through housing, transportation, nutrition, and support to families. These are all worthy efforts. But what might public health bring to this constituency? A PUBLIC HEALTH PERSPECTIVE A public health perspective may well be the means to illuminate strategies for understanding the circumstances of older people with sensory impairments and to define some avenues for social, health, and rehabilitation interventions. Increased independence is likely to be gained through the confluence of multiple efforts-for example, implementation of technology, training, peer support, and modifications to the environment-not a single intervention. The perspective provided by the field of public health could be an important aspect of such an endeavor. Public health provides a science to better understand the magnitude of aging and sensory loss,a conceptual framework for the multidimensional qualities of these very human experiences, and public health points to a number of concrete opportunities to change behaviors and environments with the potential to achieve better health outcomes. DEFINING, QUANTIFYING, AND ADDRESSING IMPAIRMENT Pope and Tarlov (1991) assert that "disability ranks as the nation's largest public health problem affecting not only individuals with disabling conditions and their immediate families, but also society at large." Those concerned with policy and services for elders experiencing sensory loss have faced several challenges that might likely be addressed by public health. At the macro level, great uncertainty remains regarding the number of people classified as experiencing visual impairment or hearing loss. The estimates, for example, vary considerably, even among this collection of essays. There are at least two reasons for this uncertainty. One problem has to do with the definition of vision impairment or hearing loss. The inability to read newspaper print with best correction comes close to a "gold standard" definition of visual impairment. Issues of contrast sensitivity and illumination influence visual performance, leading to further imprecision. Second, because definitions vary, national estimates of the number of people who are visually impaired differ as well. Estimates regarding the number of people experiencing vision impairment have been debated for decades (Kirchner, 1988; Lighthouse Research Institute, 1995; Crews, 1991; Prevent Blindness America, 1994), by and large with the underlying assumption that the larger the number the more likely it is that public policy will attend to the needs of older people who are visually impaired. …