and smell deteriorate.

Hearing and vision losses are the most upsetting, because they directly affect the ability to perform activities of daily living. These problems threaten bodily safety, and distort communication.

The major forms of hearing loss are classified as conductive loss. Because hearing loss in older people can interfere significantly with individual pursuits and social interaction, the caregiver must periodically assess each older patient thoroughly to rule out conditions that can be treated by surgery and medication.

One frequently overlooked cause of hearing loss in older people is cerumen impaction. It is easily treatable, however, most older adults who have this condition don't realise that their hearing is reduced and don't seek treatment.

Cerumen is produced by the ceruminous glands that line the outer two thirds of the ear canal. Ask your doctor, as cerumen impaction is a blockage of the ear canal and gentle removal of this blockage is usually all that is required by your doctor.

Caregivers should encourage their patients not to insert any objects into the ear, thereby avoiding the risk of perforating the ear drum and causing infection. Encourage regular ear examinations, and tell the patient to report any changes in hearing accuracy.

Finally, when these situations arise, prompt treatment is required, as persons experiencing this type of impairment could be inappropriately labelled as confused. You must explain that although loss of hearing often occurs with advanced age, it is often treatable and not something to be ashamed of.

Paulette Godfrey is a qualified geriatric caregiver and the matron of Herb Garden Seniors Residence in Southampton.