Screening for Hearing and Vision Problems: An Evaluation Study

Screening to detect hearing and vision problems among the elderly has been implemented for over a decade at more than 20 sites around Israel by ESHEL in cooperation with the health plans, municipalities and local authorities. These tests aim to identify people with hearing or vision problems that impair their functioning and to refer them to their health plan for continued diagnosis and treatment. This is very important, as many elderly do not themselves seek treatment of such problems, even though these may adversely affect their physical functioning, independence, and quality of life.

This study was designed to examine why some of those who are invited do not come to be screened, to examine the outcomes of screening, and also to learn why some of those who are identified as having problems do not seek further diagnosis and care. The results of this study are intended to help ESHEL and other organizations that develop and implement screening programs to improve their efficiency. The study involved a four-month follow-up of some 400 people who had been found by screening to have some degree of impaired hearing and/or vision. In addition, about 100 people who were invited and did not come to be screened were also interviewed.

The study revealed the following:

  • Of all those found to have some impairment of either their vision or hearing, about half needed further examination by a physician. Indeed, within four months of screening, 70% of those who were found to have impaired hearing and 73% of those who were found to have impaired vision saw their family physician or a specialist for continued treatment.
  • About half of those who saw a physician received treatment; they represented about one-third of those who were identified as having a sensory problem that impairs their functioning.
  • Four months after the screening, 19% of those screened and found to have impaired hearing and 25% of those screened and found to have impaired vision, reported an improvement in their hearing or vision. All of them were among those who had sought and received treatment from a physician.
  • The main reasons for not seeing a physician following screening (and consequently not receiving treatment), or not responding to a screening invitation, were mistrust of the treatment’s ability to improve or solve their problem, or unsuccessful past attempts to treat the problem. About 25% reported having another illness or disability in functioning or mobility, which made it difficult for them to reach their health plan clinic. In addition, about 25% of those who did not come to be screened reported never having received an invitation.

These findings indicate that screening significantly contributes to detecting sensory problems in the elderly, and is a catalyst for diagnosis and treatment. It therefore appears that existing screening programs are of value and should be continued and developed. At the same time, there appears to be a need to take additional steps to structure and improve the system of follow-up at all stages of the program.

There also appears to be a need to design a more comprehensive system, from initial invitation to screening through continuous follow-up of those examined, which will include structured channels of communication between the screening programs and health plans by which the elderly are insured. Lastly, there is a need to address the barriers to accessibility that confront some of the elderly at various stages of the program, which limit their ability to be examined and receive treatment.

The preliminary findings of this study were brought to the attention of the program developers, and have served as the basis for improving follow-up of both those who had and those who had not been screened. The final results have been disseminated to program coordinators and implementers throughout the country, with the aim of improving the programs’ efficiency and outcomes. The study was conducted in cooperation with ESHEL – The Association for the Planning and Development of Services for the Elderly.