Report: Managing hearing impairment for people living with dementia in residential aged care.
A new Australian research investigation has found that people with dementia and hearing impairment living in residential aged care facilities are not receiving optimal hearing management.
The report recommends that changes in practices of both care staff and audiologists are required to improve hearing impairment management for this population.
Analysis revealed an overarching theme of different priorities for managing hearing impairment that emerged from the data. Audiologists and care staff prioritised different practices for managing hearing impairment: audiologists emphasised hearing aids and care staff emphasised communication strategies. Care staff also identified that current management of hearing impairment was sub-optimal as they do not prioritise managing it.
The co-occurrence of hearing impairment and dementia among people living in Residential Aged Care Facilities (RACFs) is high. About 55% of adults aged over 60 years and 80% of adults aged over 80 years have a bilateral hearing impairment; and 10% of adults aged over 65 years and 43% of adults aged over 85 years have a dementia diagnosis. Hearing impairment is associated with increased risk of dementia.
Hearing impairment likely exacerbates the negative consequences of dementia on communication and quality of life.
Audiologists emphasised device management
For the management of hearing impairment, audiologists prioritised hearing devices, specifically hearing aids. For example, an audiologist said “Well, obviously, if the client can’t hear or is really struggling to hear, I would consider hearing aids first.” Audiologists identified that hearing aid use and level of technology is influenced by the presence of dementia, highlighting that many people living with dementia were unable to manage their hearing aids.
Care staff emphasised using communication strategies
In contrast to audiologists, care staff emphasised using communication strategies to manage hearing impairment in residents with dementia. Care staff discussed strategies such as: moving closer to the individual; maintaining eye contact; and slowing down their speech to improve resident-caregiver communication. Care staff members also discussed using visual aids to facilitate communication, however identified that these were not always an available resource in the RACF. Care staff reported supporting management of hearing aids among residents, but acknowledged that hearing impairment was poorly managed for this population in that they did not tend to refer residents with dementia and hearing concerns to hearing services.
Family members emphasised a person-centred approach
Family members presented mixed views on the benefits of hearing aids for managing hearing impairment in this population. Family members described individualised approaches for managing hearing impairment as well as the importance of shared decision making, thus they emphasised a person-centered approach. For example, some caregivers felt hearing aids were vital to their family member’s communication and quality of life, yet others felt hearing aids were of no benefit, attributing communication problems to dementia rather than hearing impairment.
Individuals with dementia and hearing impairment had mixed views on the benefits of their hearing aids
One resident felt the benefit of their hearing aids was limited. “Oh, to a degree. But not real good. But sometimes they [hearing aid] could be alright.”
“Early in the piece, it [hearing aid] wasn’t that hot, but when I got used to it, it’s pretty good.”
Different stakeholder priorities for managing hearing impairment – audiologists emphasising hearing aids and care staff emphasising communication strategies – suggest that changes to hearing services are required. To improve management of hearing impairment for this population, audiologists should adopt a more patient-centered approach, ensuring that they recommend all options available for managing hearing impairment, rather than emphasising hearing aids.
FREE: Training resources for hearing assistance in aged care & hospitals
An effective hearing assistance program benefits staff as well as those they care for and, if performed systematically, should not be time consuming.
Deafness Forum has created free resources for hearing assistance training for staff in aged care facilities, hospitals and for family carers and volunteers who support hearing impaired people in the community.
There are also free resources for staff implementing an effective hearing assistance program; and resources for pre-service education.
Visit the Deafness Forum website