find an area of better focus. The person may also put their hand over one eye if they cannot see out of it clearly. You may also see frequent frowning as an attempt to strain to see better. Frequent blinking may also be noted. Problems such as a cataract may cause someone to avoid bright lights or to blink heavily at bright lights.

You may also see a change in the person's activities where they avoid close-up work, because they can no longer see it well. When it comes to drawing, they may draw tiny pictures or very large pictures. They may also seem to see bright colors better than dark ones. You might also note visual changes expressed as someone who appears to have a short attention span. Someone beginning to exhibit poor selfcare skills may also be experiencing visual loss, because they can no longer see themselves clearly. You might also see dramatic changes in a person's behavior. They may become upset or anxious for no apparent reason, or startled by noises because their vision is affected, and they can't see what's happening around them.

Other indications of visual loss include not recognizing people unless spoken to, because they cannot visually recognize the person. They also may not make eye contact, or they may stare for long periods at someone, as they are trying to figure out who they are. They might also become startled when approached without being warned. You may also see them favoring areas of bright lights or moving objects to areas with better lighting. They may have trouble making out items that are similar in color, such as a white plate on a white tablecloth.

They may be anxious or unwilling to walk alone, they may fall or crash into objects, or they may seem clumsy or uncoordinated. These changes may be particularly noted in areas that are poorly lit. They may also mistake dark areas in flooring, such as a dark rug on a light-colored floor, as a hole or a step and may be afraid to walk in that area.

HEARING

Hearing loss can come from different causes. One more common and easily treatable cause is cerumen impaction, also known as excessive ear wax. This can usually easily be removed by a clinician. Other problems include ear infections, sensoryneural hearing loss, damage to the hair cells that sense sound waves, or a combination

RISK AND REWARD: Recognizing hearing loss earlier rather than later can not only help people remain more engaged in life, but can help reduce the risk of dementia.

of different causes. Presbycusis is age-related hearing loss due to the loss of the tiny hair cells in the interior of the ear that pick up sound waves.

In one study of hearing loss in people with and without disabilities, people with intellectual disabilities showed anywhere from three to nine times greater loss, compared with other people the same age who did not have a disability. Recognizing hearing loss earlier rather than later can not only help people remain more engaged in life, but can help reduce the risk of dementia. People who experience hearing loss are significantly more likely to experience cognitive decline and dementia, than people who do not experience hearing loss. And correcting that hearing loss early can have a significant, positive impact on the outcome.

People who experience hearing loss as they get older may seem distracted, particularly in noisy areas. They may turn up the volume on the television or radio louder than usual. They may not seem to understand conversations and ask people to repeat themselves. They may become disengaged from others and appear less interested in activities they used to enjoy. They might be startled when someone "suddenly" appears in from of them, because they did not hear them come into the room. They may also not seem to follow requests, such as "let's go eat," because they cannot hear it.

WHAT TO DO

Be aware of any changes you see in people around you who may have difficulty communicating using words. An appropriate healthcare professional should evaluate a person who exhibits visual or hearing loss signs, to determine if these causes are treatable or if assistive devices, such as glasses or hearing aids, could be helpful. Early treatment can help people remain active and engaged in life, contributing to a better overall quality of life. •

ABOUT THE AUTHOR:

Dr. Craig Escudé is a boardcertified Fellow of the American Academy of Family Physicians and the American Academy of Developmental Medicine and is the President of IntellectAbility (replacingrisk.com). He has more than 20 years of clinical experience providing medical care for people with IDD and complex medical and mental health conditions serving as medical director of Hudspeth Regional Center in Mississippi for most of that time. While there, he founded DETECT, the Developmental Evaluation, Training, and Educational Consultative Team of Mississippi. He is the author of Clinical Pearls in IDD Healthcare and developer of the "Curriculum in IDD Healthcare," an eLearning course used to train clinicians on the fundamentals of healthcare for people with IDD