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Abnormalities of the middle or external ear and sensorineural damage due to noise exposure or infections, for example, are also causes of hearing loss.  Central auditory processing disorders are uncommon but can be found in some cases of Alzheimer’s Disease and Parkinson’s.  In these instances, hearing is intact but the ability to process sound is impaired.  According to the 2017 AANC course on geriatric sensory changes, normal aging can result in ear drum thickening and a decrease in sound moving across the ear canal.  High frequency sounds are harder to detect, and more time is needed to process and respond to sounds (AACN, 2017).  Certain consonant sounds and blends are harder to distinguish, including /p/, /w/, /f/, and /sh/.   In addition, perhaps due to the higher pitch of their voices, children and women’s voices are more difficult to hear.    Background noise may also interfere with accurate hearing (Wallhagen et al, 2006).  What happens when we, as caregivers, get agitated or raise our voices to communicate to a hard of hearing client?  As our volume increases, so typically does our pitch.  This response compounds the issues with comprehension.  Higher pitched voices are less likely to be in the auditory range of a hearing-impaired adult. 

 

Hearing aids can reduce loss in some cases but individuals who could benefit most wait to purchase them.  Stigma, cost, and delay are all factors detrimental to hearing aid success.  The impaired individual may find it difficult adjusting to ambient noise after becoming accustomed to silence.  According to the ANCC (2017), the best time to obtain hearing aids is when background noise interferes with understanding conversation.  University settings are usually more cost-effective places to obtain hearing aids as most insurance, including Medicare, does not cover them.  In contrast, cochlear implants are covered by both insurance and Medicare.  These implants bypass the damaged parts of the ear but are only prescribed for severe hearing impairment and are usually unilateral (done on one-side only) due to the cost and limited benefit of two implants (Bond et al, 2009).  Small hearing amplifiers might be a less expensive option to pursue but these typically cannot be adjusted for frequency and individual hearing needs.

 

Did you know that older adults with hearing loss may be more at risk for dementia and have higher mortality rates? (Karpa et al., 2010; Lin et al., 2013 in ANCC Geriatric Special Topics: Sensory Changes, September 21, 2017).    Multiple studies have linked hearing loss to dementia and cognitive decline. In fact, hearing loss and associated brain shrinkage can more than double the risk for dementia (Paturel, 2017).  Why might this be? One theory states that a hearing impairment requires additional concentration to process sounds.  This increased energy to compensate takes focus away from other cognitive processes such as thinking and memory.  Others postulate that not using the auditory centers contributes to loss of other parts of the brain.  Another explanation involves the loss of word recognition due to hearing loss which in turn decreases conversation with others.  Speech paucity, defined as decreased attempts for others to have meaningful conversations with the hearing impaired, often leads to social isolation (Wallhagen et al., 2004).  Lack of conversational interaction contributes to depression and low self-esteem in the auditorily impaired and their partner due to only necessary information being conveyed while social information is not (ANCC, 2017).

 

Decreased ability to hear and communicate may coincide with lower quality of life.  Safety issues are also impacted—not hearing traffic noise, missing physician or medication instructions, etc.  According to Frank Lin, associate professor of otolaryngology at John Hopkins University in Baltimore, those with hearing impairment are also more likely to have balance issues and falls (Paturel, 2017).

 

My parents have a plaque in their kitchen that never fails to make me smile.  It says, “My wife says I never listen to her.  At least that’s what I think she said.”  This might not be a listening issue at all!! Decreased ability to hear and discriminate sounds impacts comprehension exponentially.  A person without dementia can readily use context clues to extrapolate words missed during communication.  A client with dementia might not be as readily able to follow this multi-step process.  Speak simply, stand directly in front of the person, and use as few words (and sentences) as possible.  Do not resort to baby-talk unless it is comforting to the client.  Some words and questions can be communicated with simple gestures. 

 

As in all cases, listen to the message behind the words.  Words spoken by dementia patients might not be the word they are trying to retrieve or use.  This is addressed more completely in Theodor Reik’s book Listening with the Third Ear (1949).  The underlying and unspoken meaning may require intuitive listening on our part. 

 

Sources: 

American Association of Colleges of Nursing. (2017, September 21).  Geriatric special topics:  Sensory changes.  Retrieved from https://www.elitecme.com.

 

Bond M, Mealing S, Anderson R, Elston J, Weiner G, Taylor RS, Hoyle M, Liu Z, Price A, Stein K. (2009).  The effectiveness and cost-effectiveness of cochlear implants for severe to profound deafness in children and adults:  a systematic review and economic model.  Health Tech Assessment, 2019;13(44)1-213.

 

Chao T, Chen T.  Predictive model for progression of hearing loss:  meta-analysis of multi-state outcome.  Journal of Evaluation in Clinical Practice, 2009;15(1).

 

Karpa MJ, Gopinath B, Beath K, Rochtchina E, Cumming RG, Wang JJ, Mitchell P.  Associations between hearing impairment and mortality risk in older persons:  the Blue Mountains hearing study.  Annals of Epidemiology.  2010 June; 20(6):452-59.

 

Lewis-Cullinan C, and Janken JK. (1990).  Effect of cerumen removal on the hearing ability of geriatric patients.  Journal of Advanced Nursing, 15:594-600.

 

Lin FR, Yaffe K, Xia J, et al.  Hearing loss and cognitive decline in older adults.  JAMA Intern Med. 2013;173(4):293-299.

 

Paturel A. “Save Our Senses”.  AARP Bulletin July-August 2017:8-10. Print.

 

Reik, Theodor (1949). Listening with the Third Ear. New York, NY: Farrar, Straus and Company.

 

Wallhagen M, Pettengill E, Whiteside M.  Sensory impairment in older adults: Part 1: Hearing loss.  American Journal of Nursing; 2006:106(10)40-48.