Hearing loss in the elderly : Consequences of hearing loss and considerations for audiological rehabilitation

Abstract

Presbyacusis is the most common cause of hearing loss and is considered to be among the three most commonly reported chronic health problems of the elderly. In future years, the problem is predicted to be aggravated as the expected life span of the population increases. The psychological and social consequences of hearing impairment have been the subject of several texts. Numerous articles have been published expressing concerns involving the considerable number of hearing aids that are not being put to use and are permanently ending up in drawers. However, several unresolved issues regarding the practical implications of hearing loss, including the expectations and motivational factors regarding hearing aid use, still remain. These issues concern the elderly population, who represent the primary hearing aid users in society, in particular. Declining health, varying conditions of life, increased age and the considerable number of individuals living alone may influence the experience of hearing loss. Such knowledge could be of substantial importance to treatment and potentially be beneficial to the development of rehabilitation programmes. <br><br>

Objective and aims.<br> The overall objective of this thesis was to obtain understanding and knowledge regarding hearing loss and hearing aid use among the elderly, in order to develop suitable audiological rehabilitation programmes. The specific aims:<br> - To assess daily life consequences of hearing loss in older adults and to explore the influence of hearing loss through a subjective assessment of health and general life satisfaction, gender, age and marital status.<br> - To describe preconceptions and expectations of older adults about getting hearing aids and to explore the influences of hearing loss, hearing aid experience, gender, age and marital status on these preconceptions and expectations. <br> - To describe hearing aid use among older adults and to identify motivational factors associated with their use. <br><br>

Subjective and methods. <br> This thesis is based on data from 174 men and women randomly selected from a waiting list for hearing aid fittings. The participants were all clients of the Department of Otolaryngology at the Lovisenberg Diakonale Hospital, a community hospital in Oslo. The inclusion criteria were that the participants were aged 65 years and above and that they expressed a need for hearing aids. Exclusion criteria were serious illness, senility and not being able to communicate in Norwegian. The study sample consisted of 174 individuals: 113 women (65%) and 61 men (35%) with an age range of 65–93 years. The mean age was 79.7 years. All participants were examined by an ear, nose and throat specialist and were given a hearing test at their initial appointment at the hospital. Hearing loss was measured using pure tone audiometry according to recommended procedures. The Hearing Disability and Handicap Scale (HDHS) was used to measure perceived activity limitation and perceived participation restriction. The hearing aid scale, a 35-item questionnaire in three sections, was constructed with specific focus on preconceptions and expectations regarding obtaining hearing aids and experiences regarding previous use. Demographic data were gathered to describe the study sample. <br><br>

Main findings. <br> Perceived activity limitation was significantly associated with increased hearing loss and decreased health, and participation restriction significantly was associated with decreased life satisfaction. Gender, age and marital status did not appear to be determinant factors for perceived activity limitation and participation restriction. (Article I). <br> Preconceptions and expectations of older adults regarding obtaining hearing aids revealed three factors: positive expectations, barriers and social pressure. Participants with moderate to severe hearing loss and hearing aid experience had significantly higher expectations towards hearing aids than participants with mild hearing loss and no hearing aid experience. The male gender was associated with fewer barriers toward hearing aids. Age and marital status had no influence on the three factors (Article II). <br> The use of hearing aids was positively and significantly associated with follow-up support and acceptance of need. Twenty-two per cent had used their previously fitted hearing aids less than one hour a day. The degree of hearing loss, gender, age and marital status demographics were all not significantly associated with hearing aid use (Article III). <br><br>

Conclusions and implications for practice.<br> The findings suggest that daily life consequences of hearing loss, health conditions and life satisfaction are closely related. The findings are also enlightening regarding the considerable impact on the individual experiencing hearing loss, whose life is affected and activities in daily life are limited. Health factors and psychosocial aspects should be considered as a part of the overall situation during the process of hearing aid fitting and rehabilitation. There are also indications of considerably varied preconceptions and expectations towards hearing aids among elderly hearing-impaired individuals. Less positive expectations and more problemoriented preconceptions among subjects with mild hearing loss may explain why hearing aids are scarcely used. The subjective acceptance of hearing loss, assessed need for hearing aids and experiences with follow-up support seem to be equally important to the benefits and use of hearing aids. Follow-up support, including individual rehabilitation programmes, may be of great importance to hearing aids being used, especially among individuals with a slight loss of hearing. <br> Hearing aid fitting must be considered a long-term process that includes sufficient time for information, education and training as well as easy access to professionals when problems arise. The individual should be well informed regarding what the hearing rehabilitation process involves and what is required as far as individual achievements and patience. Our findings indicate an unmet need for audiological rehabilitation and follow-up support among elderly hearing aid users, which, at least to some extent, is verified by the vast number of fitted hearing aids that are seldom or never used. Audiological rehabilitation, including psychosocial aspects and educational aspects of hearing aids and communication, may well constitute an important contribution to increased social activity and participation rates by the elderly population with hearing impairments.