Summary: The Senses After 60
When the World Gets Quieter and Less Clear
Two out of three adults over 60 have hearing loss. Nearly 20 million Americans over 40 live with some form of age-related macular degeneration. Each accommodation is small: the television louder, the font size up, the evening drive abandoned. The cumulative effect is not. The person who can no longer follow group conversation declines invitations. The person whose vision dims stops reading, then driving, then going out. These look like personality changes. They are often sensory losses masquerading as something else.
The Lancet Commission identified hearing loss as the single largest modifiable risk factor for dementia. When the cochlea sends degraded signals, the auditory cortex works harder to decode them, drawing cognitive resources away from memory and attention. A meta-analysis of 1.5 million participants found hearing loss increased dementia risk by 35%. The ACHIEVE trial found that hearing aids reduced cognitive decline by 48% in a higher-risk subgroup, and a secondary analysis showed 27% fewer falls over three years.
Only about 30% of Americans over 70 who could benefit from hearing aids have ever used one. Over-the-counter devices ($200 to $800) have increased adoption modestly, but they serve only mild to moderate loss. Cochlear implants remain dramatically underused in older adults despite strong evidence.
Harold is 74 with moderate hearing loss and early macular degeneration. His primary care doctor knows about neither finding. Harold thinks he is slowing down. What is actually happening is that two treatable conditions are converging to shrink his world, and nobody has connected them.
For vision, the first FDA-approved treatment for dry macular degeneration arrived in 2023: pegcetacoplan and avacincaptad pegol, complement inhibitors administered by injection into the eye. They slow geographic atrophy by 17 to 22% over two years. Real but modest. Wet AMD treatment with anti-VEGF injections is well established but requires visits every four to eight weeks for years.
AI-enabled retinal screening, already approved for diabetic eye disease, may eventually detect macular degeneration and even Alzheimer’s-related changes through routine eye exams. The screening infrastructure exists. What does not yet exist is the routine integration of sensory assessment into primary care for older adults.