Hearing loss (or hearing impairment) is a non-life-threatening physiological change that can have a large impact on individuals – their family, friends and colleagues – and the community.
Hearing loss can have a profound social and emotional impact through an inability to hear and communicate effectively. It can be especially difficult for patients in aged care to engage in daily activities - especially to communicate with those caring for them. Staff have reported the difficulties in distinguishing the relative contributions of hearing loss and dementia to communication breakdowns.
Familiarity with patients can help care staff differentiate between sensory versus cognitive impairments in conversations with residents. Communication difficulties can complicate both the provision of care and support of quality of life for residents with dementia and hearing loss.
Misdiagnosed hearing loss
Hearing loss has too often been misdiagnosed as dementia as some of the symptoms may be similar, but incorrectly diagnosed. For example, confusion, isolation, depression and defensiveness may be misinterpreted as dementia - when in fact this may be because the person can't hear.
... Too often we see people with a hearing loss being unsupported in aged care and hospitals. Not enough staff know how to care for hearing aids or are able to communicate in a supportive way.
We know of some people being assessed for dementia when they simply don't have hearing aids in ..."
It can be devastating to being given a cursory diagnosis of dementia - so it is critical to rule out hearing loss before making a dementia diagnosis.
What can be done for patients?
Has it been more than a year since a patient's file has been updated? If so, it's time for an annual hearing examination. Evaluations by audiologists can reliably detect hearing loss and monitor known hearing impairment.
Consider these situations which may affect hearing loss in a patient:
- In the past year, a patient's medications may have changed
- A patient may have had noticeable weight gain or loss, and the shape of their ear may have changed which affects their hearing
- A patient may have cerumen impaction that should be removed
Cerumen impaction is a condition in which earwax has become tightly packed in the external ear canal to the point that the canal is blocked
- If a patient currently wears hearing aids, he/she may need a thorough cleaning to make sure the instruments are working properly
The importance of regular hearing examinations
Audiological evaluations can reliably detect hearing loss, and licensed audiologists are trained to recognise changes in hearing. There may be a misconception that this does not need to occur, when it most certainly does.
Annual hearing examinations do not mean that a patient will (automatically) require hearing aids. A third party should always be involved (such as a patient's attending physician or family members) regarding the results of a hearing evaluation to ensure that the patient is not being 'sold' something that may not improve the quality of their life.
Hearing loss in elderly people is the third most prevalent chronic condition in the older population. Help make a difference in the hearing health of your patients by referring them for annual hearing evaluations and hearing aid maintenance.
The danger of misdiagnosis
Negotiating the hospital system to get the best health outcomes whether for you or a loved one can often be challenging, as Paul Fox and Julie Stephens recently discovered when caring for his elderly mother Nancy, in the following case example:
Case example: Simple advice helped at a difficult time
Negotiating the hospital system to get the best health outcomes whether for you or a loved one can often be challenging, as Paul Fox and Julie Stephens recently discovered when caring for his elderly mother Nancy.
At age 93, Nancy had a bad fall, resulting in a broken neck and clavicle, and an extended hospital stay. While she retained movement in her legs, her frailty and overall health (worsened by advancing lung cancer), meant that she was severely incapacitated. On top of that, Nancy had a hearing impairment and relied on hearing aids along with the help of family to communicate on her behalf.
Nancy’s daughter-in-law Julie said: "Dealing with staff in the hospital system was very frustrating and an eye opener for us, particularly given the patient was an elderly person who was frail, unwell and had severe hearing loss, and who therefore found it extremely difficult to advocate for herself.
"Even for us, as her family, it was difficult to communicate with Nancy, to ensure she understood what was happening, how long she might need to stay in hospital and her treatment plan. When it was important that she understood, we would write things down for her.
... We found there was a lack of understanding and empathy in the hospital system towards those with hearing loss. It was a daily challenge, especially as nursing and medical staff changed regularly, almost on a daily basis, so the continuity of care was lacking ..."
Source: Nancy's daughter-in-law, Julie
"We constantly had to remind or inform staff that Nancy had a hearing impairment and that if they were speaking about her treatment, what was going to happen to her, the likely health outcomes, or even a timeframe for sending her home, they needed to be mindful of this."
"Both doctors and nursing staff didn’t seem to understand that they needed sensitivity in this process – to include Nancy in the discussions, but with a family member present to ensure she understood. Simply talking about her amongst themselves from the foot of her bed didn’t cut it. This often led to frustration and fear on her part and limited her ability to have a say in her own treatment."
Julie explained that after about two weeks in hospital, Nancy’s hearing aids didn’t seem to be working. "She just couldn’t hear at all and was becoming very agitated."
Fortunately, a telephone call to Better Hearing Australia (Vic) Inc resulted in a simple solution.
"It seemed such an obvious thing, but it was simply the batteries," Julie said.
"We hadn’t realised that Nancy would normally turn off her hearing aids at night. However, in hospital, she was unable to do so and the staff were not mindful of this need either."
"The Hearing Advisor at BHA explained the likely life of the batteries, so we realised there was nothing wrong with the aids, and we were then able to ensure they were turned off when not in use, and changed regularly as required."
"Thankfully BHA helped and we avoided the need to send the hearing aids off to be fixed, meaning Nancy would have been without them for some time."
"Importantly, Nancy was then better able to communicate and understand what was happening with her treatment and the course of action ahead."
Source: Better Hearing Australia: BetterHearingToday Newsletter (Issue 2, 2015)
We at BHA consider this to be a form of neglect. Under standard 2.16 all people with sensory loss need a daily care plan, not just an annual Audiometry appointment.
Do your staff know how to support someone with hearing loss? It's not difficult - just a short training session is required.
We can help and help you demonstrate to quality assessors that you have PCAs who can attend to daily needs.
More information can be found on our website: www.betterhearing.org.au
2.16 Sensory loss: This expected outcome requires that “residents’ sensory losses are identified and managed effectively”.
An example of meeting this standard would be:
The home has systems to identify and manage residents’ sensory losses. The sensory assessment includes vision, hearing, touch, taste and smell. The home has processes to refer residents to health specialists as appropriate. Residents and representatives are consulted on residents’ needs and preferences for prosthetics and assistive devices. The home has information to guide staff in the care of residents’ prosthetics and assistive devices.
Families leave their loved ones in care and rightly so, expect them to be supported in all aspects of care including personal hygiene, dental and eye care, including cleaning glasses. Too often, staff at Better Hearing Australia find residents being neglected in daily support, mainly due to lack of knowledge and training of front line staff. Supporting someone with hearing loss means more than an annual audiology appointment. Hearing support needs to be part of all daily care plans.
All personal care staff must be trained in this area, they should know how to change batteries, insert hearing aids, clean and store, know how to trouble shoot and when to bring in an audiologist for are assessment. These things are not complex and can be easily incorporated into daily routines. It's our view that the quality assessor should be looking for evidence like this. Visitors, family and career should also raise this issues.
Better Hearing Australia: www.betterhearing.org.au
I have asked staff about this and they have you Le me they are not trained to do this. Surely this is wrong given the amount of older folks with hearing loss.