Hearing Impairment In Elderly Research Articles

Reviving the past－my stories with hearing-impaired elders

Reviving the past－my stories with hearing-impaired elders

Cochlear Implantation in Hearing-Impaired Elderly: Clinical Challenges and Opportunities to Optimize Outcome.

Cochlear implant (CI) overall provides a very good outcome, but speech comprehension outcome in the elderly is more variable. Several clinical factors play an important role. The management of residual hearing, the presence of comorbidities, and especially the progression of cognitive decline seem to be the clinical parameters that strongly determine the outcome of cochlear implantation and need to be discussed prospectively in the consultation process with the elderly hearing impaired. In the context of this review article, strategies for dealing with these will be discussed. Timely cochlear implantation should already be considered by hearing aid acousticians or practicing otolaryngologists and communicated or initiated with the patient. This requires intensive cooperation between hearing aid acousticians and experts in the clinic. In addition, residual hearing and comorbidities in the elderly need to be considered to make realistic predictions about speech comprehension with CI. Long-term aftercare and its different implementations should be discussed preoperatively, so that the elderly person with hearing impairments feels well taken care of together with his or her relatives. Elderly patients with hearing impairments benefit most from a CI in terms of speech comprehension if there is a large cochlear coverage (electrical or acoustic electrical) and the therapy is not hampered by comorbidities, especially cognitive decline.

Factors influencing making a choice and accessing a hearing aid among elders with hearing disability: mixed methods

PurposeHearing aid (HA) using is an option for enhancing the sound transmission. It effectively improves hearing ability during communication. In Thailand, two-third of hearing impaired persons were elders, while the utilization of an HA was low. This study aims to explore how the decision was made on the use of HA among the hearing impaired elderly.Design/methodology/approachMixed-methods sequential explanatory design was used by starting with a retrospective study to identify the prevalence of HA use and influencing factors including demographic and clinical data. Total, 199 elders with moderate to severe hearing impairment were enrolled. Qualitative data collection for thematic analysis was conducted by interviewing 28 participants to reveal elders’ subjective reasoning.FindingsIt was found that 25.63% of elders used an HA, whereas age, types of health insurance and disability registration were significant influencing factors. Six themes of subjective reasoning emerged including social activities, disability perspective, social support, medical and personnel, rights and accessibility and benefit of HA, which determined the elders’ decisions on HA use.Originality/valueThis study broadened insights of the elders’ decision process on HA use, which was mutually made by both health-care professional and care recipients. The elders themselves would make the final decision. Not only objective indications but also subjective reasoning of users played significant roles on HA acquisition. To enhance HA use among hearing impaired elders, patient engagement in decision-making was crucial while hearing counselling and elimination of reimbursement barriers became essential.

The Effect of the Use of Hearing Aids in Elders: Perspectives.

Older adults with hearing loss have difficulties during conversation with others because an elevated auditory threshold reduces speech intelligibility, especially in noisy environments. Listening and comprehension often become exhausting tasks for hearing-impaired elders, resulting in social isolation and depression. The aim of the present study was to investigate the advantages of hearing aid use in relation to relief from listening-related fatigue, which is still controversial. Participants included a sample of 49 hearing-impaired elders affected by presbycusis for whom hearing aids were prescribed. The Modified Fatigue Impact Scale was used to assess cognitive, physical and psychosocial fatigue. The vitality subscale of the Short Form Health Survey 36 and a single item of the multi-dimensional Speech, Spatial and Quality Hearing Scale (“Do you have to put a lot of effort to hear what is being said in conversation with others?”) were also used. The Cognitive Failures Questionnaire was used to investigate daily errors related to lack of memory and reduced mindedness. Hearing aids rehabilitation resulted in improved speech intelligibility in competing noise, and a significant reduction in cognitive and psychosocial fatigue and listening effort in conversation. Vitality was also improved and a significant reduction in the Cognitive Failures Questionnaire scores was observed. Findings from the study indicate that the use of hearing aids in older impaired-listeners provide them not only with an increased auditory function but also with a reduction in listening-related fatigue and mindedness.

Os idosos e o uso de próteses auditivas: identificando os repertórios interpretativos que justificam essa decisão

O objetivo deste estudo foi descrever os repertórios interpretativos utilizados por idosos deficientes auditivos sobre a decisão de usar próteses auditivas. Foram entrevistados cinco idosos, de ambos os sexos, deficientes auditivos e usuários de próteses auditivas. Os dados foram analisados segundo as propostas de análise do discurso influenciadas pela perspectiva construcionista social. Como resultados, observamos que os usuários de prótese justificaram a sua decisão através da utilização de cinco repertórios: (1) o incômodo da repetição; (2) em busca da prevenção e autocuidado; (3) aproveitando um recurso tecnológico benéfico; (4) os benefícios superam as limitações e (5) a virtude da resignação. Buscando combater as fragilidades de cada um desses repertórios, os mesmos foram utilizados de maneira combinada. Concluímos, então, que, ao utilizar tais repertórios, os entrevistados procuraram legitimar sua decisão de usar a prótese auditiva, mostrando que a mesma foi tomada de maneira criteriosa e que, portanto, deve ser respeitada.

Cost-Effectiveness of Hearing Aids in the Hearing-Impaired Elderly

Hearing aids are the principal tool for rehabilitation of hearing loss, one of the most prevalent impairments among elderly adults, but cost-utility ratings for hearing aid use are limited. Cost-effectiveness analysis. A multistate Markov model was constructed to model 50- to 80-year-old patients moving between states, including normal hearing, mild, moderate, or severe hearing loss. Parameters assigned in the model are partly derived from the Medline source (1966-2005) and partly from data on hearing-impaired elders (n = 96) in a tertiary care center in Taiwan. To address uncertainty, most of the parameters were specified by distributions, rather than base-case values. A probabilistic approach with Monte Carlo simulations was performed to produce an acceptability curve, showing the probabilities of being cost-effective given threshold values of willingness to pay (WTP). Hearing-related quality-adjusted life-years and cost in US dollars and Euros. The incremental costs for gaining an additional hearing-related quality-adjusted life-years in women and men were US $13,615 (Euro 10,826) and 9,702 (Euro 7,715), respectively. The probability of being cost-effective increased to 53% in women and 65% in men given a WTP of US $12,000 (Euro 9,542). The probabilities of being cost-effective to reach plateau were 67% for women and 78% for men given a WTP of US $20,000 (Euro 15,904). By modeling different degrees of hearing loss with a multistate model, hearing aid use was demonstrated to be a cost-effective strategy to rehabilitate the hearing-impaired elderly. These results can assist policy makers in allocating health resources appropriately and effectively.

A home education program for older adults with hearing impairment and their significant others: A randomized trial evaluating short- and long-term effects

This paper addresses the development and effectiveness of a home education program. The program, designed for hearing-impaired elders and their significant others (SO), deals with communication strategies and speech reading. Participants were randomly assigned to a training group (hearing aid fitting + home education program) or a control group (hearing aid fitting). The training group included 24 hearing-impaired subjects and 24 SO's. Controls were 24 affected individuals and 22 SO's. Questionnaires addressing emotional response, communication strategies and the IOI-HA, IOI-AI and IOI-SO were used. A repeated measures analysis of variance was applied to test group differences between pre, post, and 6-months follow-up measures. Increased awareness of benefits of speech reading and improved interaction with the SO were observed in the training group only (p < 0.05). No group difference on ‘emotional response’ was found. IOI-AI and IOI-SO demonstrated favorable attitudes towards the program. Follow-up measures showed improved quality of life and satisfaction in the training group, while a decrease was observed among the controls (p < 0.05). Some effects differed between first-time and experienced hearing aid users. Addition of services to amplification and involvement of the SO are relevant in aural rehabilitation.

Use of assistive devices to address hearing impairment by older persons with disabilities

Hearing impairment impacts on the lives of almost half of people over the age of 65. For many people, a hearing aid or other assistive device can enhance communication. However, there is a high rate of dissatisfaction with hearing aids among those who currently use, or have used them in the past. This study of 227 elders with hearing impairment sought to gain a description of their multiple needs relative to demographics, health status physical status, and psychosocial status. Furthermore, we compared along the same dimensions the 227 elders with hearing impairment with 495 frail elders who reported no hearing impairment. We found that hearing-impaired elders are older, have poorer eyesight and have a high level of co-morbidity, especially with arthritis and heart and circulatory conditions. We also found a higher rate of depression among those with hearing impairment. Although hearing aid use increased as the impact of impairment on activity increased, three-quarters of those who reported that hearing impairment had a large impact on daily life did not use a hearing aid. A factor relating to hearing aid use was race; being Caucasian, and living alone. Study participants listed their reasons for dissatisfaction or non-use of their hearing aids and provided suggestions for hearing aid design.

Cognitive adaptation and self-consistency in hearing-impaired older persons: testing Roy's adaptation model.

This study, based on constructs from Roy's adaptation model, examined the relationship between cognitive adaptation processes and self-consistency in hearing-impaired elders (N = 130). Data were collected through survey questionnaires. Major research hypotheses were formulated and tested. Results of this study supported Roy's theoretical proposition of cognitive adaptation processes and their role in the maintenance of self-consistency. Three cognitive processes (clear focus and methods, knowing awareness, and self-perception) significantly contributed to the maintenance of self-consistency. Understanding these cognitive processes helps nurses to promote effective adaptation in older persons.

Patients' task-orientation and perceived benefit of amplification in hearing-impaired elderly persons.

This study investigated the reported handicap of 50 elderly hearing-impaired patients who were classified as high or low in task-orientation. Measures of perceived handicap were taken when subjects were fitted with hearing aids and three months later. Analysis indicated that subjects classified as both high and low on task-orientation reported significant increases in their hearing impairment at 3 mo., but subjects classified as high on task-orientation reported significantly less handicap than subjects classified as low.

Stimulus variability and spoken word recognition: The effects of age and hearing impairment.

Three experiments were conducted to investigate the effects of age and hearing loss on the ability to maintain perceptual constancy in spoken word recognition. Specifically, the studies examined how variations in talker characteristics, speaking rate, and overall amplitude affected perceptual identification in normal-hearing young (NHY), normal-hearing elderly (NHE), and hearing-impaired elderly (HIE) listeners. The three dimensions were selected because variations in voice characteristics and speaking rate affect features of speech signals that are important for word recognition while overall amplitude changes do not have direct effects on phonetic identification. Thus, both phonetically-relevant and irrelevant sources of variability were investigated. Age differences, as indicated by greater effects of variability for the NHE compared with the NHY listeners, were observed for conditions with trial-to-trial variations in talker characteristics and overall amplitude. Effects of hearing impairment, as indicated by reduced scores for the HIE compared with the NHE group, were observed for conditions with variations in either speaking rate or talker characteristics. Considered together, the findings suggest that age-related changes in perceptual normalization, selective attention, and absolute sensitivity may all contribute to the reduced speech understanding often reported for older adults. Several possible mechanisms for the age- and hearing-related deficits are discussed.

Cooperation of hearing-impaired elderly subjects for participation in a hearing screening program.

Presbyacusis, the auditory disorder which accompanies the aging process, is well known. However, the practical assistance available to alleviate the breakdown in the communication ability of the older person is unsatisfactory, and provision for public awareness of a rehabilitation strategy has not yet been established in many countries. Four hundred and ninety-eight elderly subjects, aged 65-94 years, were hearing tested in different setups, a geriatric nursing home and in the community. It was found that the need for rehabilitation was high and the willingness to participate in a hearing screening program was low even though the rehabilitation treatment was provided without charge.

Speech Identification Difficulties of Hearing-Impaired Elderly Persons

This study examined the performance of four subject groups on several temporally based measures of auditory processing and several measures of speech identification. The four subjects groups were (a) young normal-hearing adults; (b)-hearing-impaired elderly subjects ranging in age from 65 to 75 years; (c) hearing-impaired elderly adults ranging in age from 76 to 86 years; and (d) young normal-hearing listeners with hearing loss simulated with a spectrally shaped masking noise adjusted to match the actual hearing loss of the two elderly groups. In addition to between-group analyses of performance on the auditory processing and speech identification tasks, correlational and regression analyses within the two groups of elderly hearing-impaired listeners were performed. The results revealed that the threshold elevation accompanying sensorineural hearing loss was the primary factor affecting the speech identification performance of the hearing-impaired elderly subjects both as groups and as individuals. However, significant increases in the proportion of speech identification score variance accounted for were obtained in the elderly subjects by including various measures of auditory processing.

Speech-Recognition Difficulties of the Hearing-Impaired Elderly

The role that sensorineural hearing loss plays in the speech-recognition difficulties of the hearing-impaired elderly is examined. One approach to this issue was to make between-group comparisons of performance for three groups of subjects: (a) young normal-hearing adults; (b) elderly hearing-impaired adults; and (c) young normal-hearing adults with simulated sensorineural hearing loss equivalent to that of the elderly subjects produced by a spectrally shaped masking noise. Another approach to this issue employed correlational analyses to examine the relation between audibility and speech recognition within the group of elderly hearing-impaired subjects. An additional approach was pursued in which an acoustical index incorporating adjustments for threshold elevation was used to examine the role audibility played in the speech-recognition performance of the hearing-impaired elderly. A wide range of listening conditions was sampled in this experiment. The conclusion was that the primary determiner of speech-recognition performance in the elderly hearing-impaired subjects was their threshold elevation.

Validation of Screening Tools for Identifying Hearing-Impaired Elderly in Primary Care

Two instruments for the detection of hearing impairment, the Welch-Allyn audioscope (Welch-Allyn Inc, Skaneateles Falls, NY) and the Hearing Handicap Inventory for the Elderly--Screening Version (HHIE-S), were validated against pure tone audiometry in 178 patients over 65 years old screened in primary care practice. The prevalence of hearing impairment in this sample was 30%. The audioscope yielded reproducible results in the physicians' offices and a hearing center. The sensitivity of the audioscope was 94% in both locations, while its specificity was 90% in the hearing center and 72% in the physicians' offices. The HHIE-S yielded reproducible results between the two test locations. An HHIE-S score from 0 to 8 resulted in a likelihood ratio of 0.36 (95% confidence interval, 0.19 to 0.68), and a score of 26 or more yielded a likelihood ratio of 12.00 (95% confidence interval, 2.62 to 55.00) for predicting the presence of hearing impairment. Used together, the two instruments had a test accuracy of 83%. The audioscope and HHIE-S are valid, reliable, inexpensive tools for detecting hearing impairment in the elderly.

THE INTERSECTING OF AGING AND DISABILITIES

The estimated number of elders with certain lifelong and later‐life disabilities is already quite substantial. These numbers are on the increase (e.g., increasing to 11 million hearing impaired elders by the year 2000), and many elders have multiple impairments. Gerontologi‐cal educators and researchers are relatively inexperienced regarding elders with impairments, and need to learn more about these elders, the disabilities services systems, concurrent changes in American lifestyles that affect caregiving, and basic strategies for action appropriate to meeting the needs of elders with lifelong and later‐life disabilities.

Developing Residential Design Statements for the Hearing-Impaired Elderly

Hearing impairments are the third most prevalent chronic condition facing individuals 65 years and older. Sociodemographic trends suggest a further growth in magnitude and incidence of this handicap. Current residential design principles for the hearing-impaired elderly are limited and do not adequately reflect the complex nature of the problem. Researchers have noted that rules or statements that can compensate are not well specified. This article presents a systematic procedure for developing design statements appropriate to the needs of the hearing-impaired elderly. In contrast to traditional approaches, the procedure emphasizes a systematic review of the medical literature on the auditory capabilities of the older individual. Intermediate environmental concepts are developed from this review and provide a basis for a set of performance-based design statements for the hearing-impaired elderly. These statements are compared with standards currently being promulgated by the American National Standards Institute.

Some characteristics of the hearing-impaired elderly who do not present themselves for rehabilitation.

Social and audiometric characteristics of the hearing-impaired elderly without aids have been analysed and some understanding developed of the factors which lead people to seek rehabilitation. The two major single determinants of seeking help were found to be severity of impairment and onset of deafness before reaching retirement age. There were strong indications that negative attitudes of both the elderly themselves and their general practitioners towards deafness and ageing played a crucial part in perpetuating the neglect of the disorder.