Problems in fitting hearing aids in the elderly

Abstract

The problems entailed in fitting hearing aids in elderly people and their subsequent use include the following aspects: whether the patient accept that he/she is hard of hearing and needs a hearing aid; distrust and anxiety with regard to any kind of technical devices, especially electronic ones, and an element of vanity in not wishing to be identified as a person who is hard of hearing. There are also problems in signal detection connected with the changed acoustic environment when a hearing aid is used. The validity and significance of these points are discussed on the basis of the answers of experienced hearing aid acousticians to a questionnaire. A representative survey by the Green Cross in West Germany, with supplementary audiometric investigations, has shown that about 27 % of the adult citizens of our country have a major hearing handicap which can be detected audiometrically. In 4% of the interviewes, improvements in hearing could be attained with medical treatment. In 23% of the interviewes, provision of a hearing aid is probably necessary to restore the ability to communicate. The distribution for the individual age groups is shown in Table I. These statistics confirm the well-known fact that hearing defects become more frequent with increasing age. About 40% of elderly people suffer from an impairment of hearing, but only 4% of persons aged between 60 and 69 years and only 9% of persons aged between 70 and 73 years have a hearing aid. It is known that the provision of a hearing aid becomes more problematical the older the people concerned. We have therefore carried out a survey amongst experienced hearing aid acousticians and asked them to specify the most frequent problems in provision of hearing aids to elderly people. In West Germany the establishment of the indication and the prescription of hearing aids is carried out by the otorhinolaryngologist in his office. The otorhinolaryngologist also checks the result of the fitting and confirms to the paying body (the health insurance fund) that the hearing aid fitted meets the requirements. The fitting of hearing aids (at least in adolescents and adults) is carried out by hearing aid acousticians. This is a paramedical craft profession. The results of this survey showed that the most important problems in fitting hearing aids in elderly people are ranked in the following order: 1. Fear of technology and the demands entailed in operating an electronic device, as well as lack of dexterity in manipulating the hearing aid. 2. Disappointment and dissatisfaction with the effect of the hearing aid. 3. Reluctance to wear a hearing aid. Many persons who are hard of hearing consider that they do not hear that badly. If people were to speak a bit more loudly, a hearing aid would then not be necessary at all. They are “not yet that old”. 4. Cosmetic criteria and worry about being identified as being hard of hearing and thus a fairly certainly not being in full command of their faculties on account of the hearing aid. These points are examined on the basis of audiological-medical experience. Distrust of technical devices