The impact of connectivity for the older patient

Abstract

The main responsibility of the hearing professional is to reduce the negative effects of hearing loss. Our primary focus has been to reduce the impact of hearing loss on face-to-face communication, but in some situations, often those without visual/speech reading cues, such as speaking on the phone or when watching television, hearing aids are not adequate or simply do not work well. Advances in wireless technology in wearable amplification provide greater opportunities to improve access to audio signals that arrive via electronic media such as television, radio, and telephones. Many audiologists have considered access to remote audio devices appropriate for the young tech savvy patient—the teenage patient who desires connectivity to an MP3 player or the on-the-go business person who needs to talk on a cell phone. However, the need for connectivity is perhaps the greatest for the older patient—those at greatest risk of isolation from the world around them. THE IMPACT OF AGING Aging carries with it a natural tendency for a person to become increasingly detached from the people, activities, and places that have defined their development over the years. Physical, economic, social, and occupational changes such as retirement, loss of a spouse, relocation of self, family, or friends all conspire to create a disconnection between the older person and the world that they knew. “Successful aging” describes the process by which an older person adapts successfully to the inevitable physical and social changes that accompany the aging process. Situational changes such as retirement or health-related issues—reduced mobility, vision loss, and hearing loss—cannot be avoided, so the key question is: How well does the person handle these challenges? People who age successfully deal actively with health problems as they arise by getting medical check-ups, taking necessary medications, and in the case of hearing loss, getting amplification. People who are less successful at aging endure life changes passively and this passive response can lead to poor physical and mental health. In 1998 Rowe and Kahn described the three markers of successful aging:1 Maintaining good physical health Maintaining good cognitive health Maintaining active engagement with other people and essential activities Physical health, cognitive health, and engagement are linked, but perhaps in a negative way. As the person's health begins to fail, they may have less opportunity to engage with others. The combination of health struggles and isolation can lead to depression, and as the depression deepens, the patient may now be less motivated to care for themselves. Health fails even more, isolation increases, and cognitive health continues to decline. A dramatic downward spiral becomes a great risk. THE IMPACT OF HEARING LOSS The importance of managing hearing loss in the older patient takes on added significance when viewed in light of the interrelated factors of successful aging, and hearing professionals can play a vital role in breaking the chain of events that can threaten the well-being of the older patient. As the older patient becomes more and more removed from other people and life activities, the role of electronic media increases in importance. The distance between the patient and family and friends can be bridged with the telephone, if the older person can hear on the phone. The role of television often changes as the user gets older. It is easy to be dismissive about the amount of time people spend watching television or talking on the phone, however that reaction does not consider the important role that these devices can play in elderly people's lives. For example, not only do the number of hours of spent viewing television increase as people age, but what the person watches also changes.2,3 Younger adults, those still in the workforce and those caring for young families, come home at the end of the day and use television as an escape. Television provides entertainment and a distraction from the demands of daily life. However, for the older person who is becoming more and more removed from direct contact with society, the television plays a vital role in keeping the person connected with the outside world.4 THE ROLE OF CONNECTIVITY When listening on the phone and to television, hearing aids often do not provide adequate assistance.5 Oticon's wireless-enabled hearing aids, Streamer gateway device, and ConnectLine products, including the TV Adapter and Phone Adapter, were developed specifically to improve the listening experience with external audio devices. These devices convert audio signals into dedicated Bluetooth signals that can be received by the Streamer. However, it is not just the technology that has made these devices successful, it is the additional design focus which sought to minimize barriers to use by making installation and operation as intuitive as possible. The Streamer has few buttons and the use of each button is obvious; the simplicity of the Streamer user interface allows the technology to be accessible to people who might otherwise be intimidated by a new high-tech device. Furthermore, ConnectLine is an integrated system, so switching between devices is easy. For example, if a person is watching TV using ConnectLine and a phone call comes in, the hearing aids ring to alert the listener of the phone call and the listener accepts the call by simply pressing the phone button on the Streamer. When the call is over, the TV program streaming will resume. TESTING CONNECTLINE Lab tests with ConnectLine, TV Adapter, and Streamer, have shown significant improvements in speech understanding over using hearing instruments alone.6 More recently, field tests using ConnectLine have shown fast acceptance of ConnectLine and self perceived benefit.7 In a field test with experienced hearing aid users, participants were fit with Oticon Agil hearing instruments and tested one or several ConnectLine devices, depending on their needs, for 2-4 weeks. After the field trial, participants rated their listening experience using Agil with ConnectLine and their own listening solution (hearing instrument alone or hearing instrument and T-coil.) Ratings showed that participants preferred listening to the television, mobile phone, and landline phone using ConnectLine with Agil. Preference ratings are shown in Figure 1.Figure: Participants compared their listening satisfaction with Agil and ConnectLine to the listening solution they previously used. Significantly more participants were satisfied with ConnectLine and Agil than their own listening solutions.TOWSON CONNECTIVITY STUDY At the American Academy of Audiology meeting in April 2010, Brian Kreisman, PhD, of Towson University, presented findings of a study focused on the quality of life impact of connectivity.8 Eighteen experienced hearing aid users (mean age 72 years), were fit with a set of Oticon Dual RITEs, Streamer, Phone Adapter, and TV Adapter. The average hearing loss sloped from 35-40 dB below 1 kHz sloping to 60–70 dB HL at 4 kHz and above. Participants were assessed at 1 month and 3 months post fitting using questionnaires focused on the performance and ease of use of the Streamer, Phone Adapter, and TV adapter; speech understanding and sound quality perception with the hearing aids; and overall impact of the hearing aids and connectivity aids on quality of life. Highlights of the findings included: Television Participants indicated that TV viewing was important to them and that they would watch more TV if it were easier to understand. The instructions for setting up the TV and Phone Adapter were considered to be clear and easy to follow and set-up was easy. TV was rated easier to understand with the TV Adapter than without. Without the TV adapter, only 8% of participants rated understanding television as “Easy” or “Very Easy.” In using the TV adapter, 85% of the participants rated understanding television “Easy” or “Very Easy.” Certain programs were identified as being hard to understand at the outset of the study. The shows identified as difficult were rated as easier to understand by 92% of the participants when the TV Adapter was used. Complaints from family members about the volume setting of the TV dropped from 75% to 17% after installation of the TV Adapter. Telephone At the outset of the study, landline phone use was rated as important and people reported that they would talk more on the phone if it were easier to understand. Participants rated listening on the phone significantly easier when using the Phone Adapter. Using cell phones was rated as important and participants indicated that if speech were easier to understand they would also increase their cell phone use. Use of Streamer and the cell phone significantly improved ease of use, as ratings of speech understanding difficulty dropped from 69% to 23%. BENEFITS OF CONNECTIVITY For many years the only connectivity for most adult hearing aid users was via use of the T-coil. Recently, there has been significant development in wireless transmission of audio signals to hearing aids and many professionals are in a position where they need to rethink the way they discuss connectivity options with patients. There is a tendency not to bring up the topic of connectivity when fitting advanced-technology hearing aids because the professional may be concerned that the patient assumes that the hearing aid will solve all communication issues. Of course, this is not the case, and the significant benefits of connectivity that many patients have experienced over the last few years should inspire professionals to broach the topic of connectivity with most patients being fit with hearing aids. A useful approach when talking to patients, particularly elderly patients, is to explain the technology in terms of benefits. When patients understand the potential benefit of a technology they are more likely to adopt it. Benefits of connectivity include: Higher-quality, more intelligible speech signal—When talking (listening) on the phone or when watching (listening to) the television, connectivity solutions improve speech understanding by providing a direct signal from the audio device of interest without any background interference. This allows listeners to understand more easily. Less trouble when using phones and televisions—In the past, connectivity solutions tended to require extensive installation and to only solve one problem, such as when looping a room for television watching. The availability of wireless connectivity, along with the smart design of the Streamer, has made connection to consumer electronics seamless. The integration with consumer electronics highlights the sophistication of modern advanced-technology hearing aids to the patient. This is something that many patients have not experienced before and many do not even know it is possible. Easier shared use—It is very common for family members of hearing impaired persons to complain that the television has to be played at excessively high volume when the hearing-impaired loved one is in the room. Wireless connectivity to hearing aids allows the hearing aid user to have independent control over the sound level of the television signal, allowing the rest of the family to listen at a comfortable level. Decreased mobility concerns—Some patients have physical limitations when moving around their living space. When the phone rings, for some people it is not a trivial matter to get up and answer the phone in time. The phone connectivity solution makes answering the telephone much easier. All the hearing impaired person using the Streamer has to do is push a button on the device and it will alert the person through the hearing aids, so they can hear it even when watching television. Volume control adjustment—Another benefit of the Streamer is that it works as a binaural volume and program control for the hearing aids. Additionally, the telephone and television volume can be changed by adjusting the hearing aid volume, so instead of turning up the television and bothering others, the patient can turn up only his/her television volume. For patients with dexterity problems, this provides an easy-to-use volume and program control, and because it is integrated in the Streamer, patients only need to keep track of one device. WIRELESS PLATFORM OPTIONS The new era of connectivity in modern hearing aids was driven by the widespread use of Bluetooth in cell phones; however, the hearing aid industry needed to find a way to convert the wireless Bluetooth signal coming from cell phones, and other consumer electronics, into a signal that could be used by the hearing aid without sacrificing reasonable size and battery life. Two major technologies were available for manufactures to consider: Near Field Magnetic Induction (NFMI) and Radio Frequency (RF). NFMI was newer and was beginning to show up in other industries that required short distance data transmission at low power. RF was better known, as many devices such as cordless phones and satellite communication systems transmit using various RF frequencies. Oticon, along with three other manufacturers (Siemens, Widex, and Phonak) decided to use NFMI for three reasons. First, the size of the component is small. Second, the power requirements are low. In Oticon wireless products, battery life is reduced only by 10-15% when full wireless capabilities are engaged. Finally, by being able to incorporate both an NFMI receiver and transmitter into each hearing aid, not only can wireless signals be received from outside the hearing aid, but also two hearing aids in a binaural set can communicate with each other, allowing for various levels of binaural signal processing. Since the Bluetooth wireless signal cannot be received by the hearing aid directly, proponents of both the NFMI and RF approaches must use an intermediate device (gateway) to transform the Bluetooth signal into either the NFMI or RF format. The lower power usage of the NFMI format results in a transmission distance of 1 meter or less. This means that to use the Streamer, it must be within 1 meter of the hearing aids. That is not considered a problem since in order to pick up the user's voice there needs to be a microphone near the user's mouth. The professional considering which wireless format to use has various factors to consider: (1) the RF format can eliminate the need for a body worn gateway when listening to wireless signals other than those received from a cell phone, but at the cost of significant reduction in the life of the battery, (2) loss of a remote control to coordinate the wireless reception of signals from multiple devices, and (3) the potential loss of binaural connectivity between devices. Our use of NFMI and our Streamer allows, we believe, the greatest possibility that these patients will get the most from their residual auditory abilities. OUR IMPORTANT ROLE The professional's job is to decrease the impact of hearing loss in all aspects of a patient's life. Wireless technologies have opened up new possibilities for us to address long-standing concerns that our patients present to us. Oticon has paid particular attention to designing connectivity technology that is intuitive and effective for our patients and the hearing healthcare professional plays a vital role in learning how these technologies can be incorporated into a patient's life, particularly older patients at risk for becoming detached from society. We all play an important role in keeping our patients as active and involved in the modern world as possible. BHI PUBLISHES LIST OF HEARING AID COMPATIBLE CELL PHONES ON ITS SITE As a service to hearing aid owners, the Better Hearing Institute (BHI) has provided a list of US cell phones that are most compatible with hearing aids meaning they carry the highest rating of M4/T4—on its website. M4 indicates that there is the least likelihood of microphone interference and T4 means there is the greatest likelihood of telecoil coupling compatibility with the cell phone. Along with the list of over 65 compatible cell phones, links are also included to a BHI guide on how to buy a cell phone and tutorials on wireless access. To access the list, visit www.betterhearing.org.