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International Journal of AudiologyPublication details, including instructions for authors and subscription information:http://www.informaworld.com/smpp/title~content=t713721994

Candidature for and delivery of audiological services: special needs of olderpeopleJ. Kiessling a; M. K. Pichora-Fuller b; S. Gatehouse c; D. Stephens d; S. Arlinger e; T. Chisolm f; A. C. Davis g;N. P. Erber h; L. Hickson i; A. Holmes j; U. Rosenhall k; H. von Wedel l

a Universitäts-HNO-Klinik der Justus Liebig Universität, Giessen, Germany b University of Toronto,Mississauga, Ontario, Canada c MRC Institute of Hearing Research, Glasgow, UK d Welsh Hearing Institute,University Hospital of Wales, Cardiff, UK e Department of Audiology, University Hospital, Linköping, Sweden f

Department of Communication Sciences & Disorders, University of South Florida, and Audiology & Speech-language Pathology Service, VAMC-Bay Pines, Florida, USA g MRC Institute of Hearing Research, UniversityPark, Nottingham, UK h School of Audiology, University of Melbourne, Melbourne, Victoria, Australia i

Communication Disability in Ageing Research Unit, Department of Speech Pathology and Audiology, TheUniversity of Queensland, Queensland, Australia j Department of Communicative Disorders, University ofFlorida, Gainesville, Florida, USA k Department of Audiology, Institution of Clinical Neurosciences/Section ofTechnical and Clinical Audiology, Karolinska Institute, Karolinska Hospital, Stockholm l University of Cologne,ENT Hospital, Cologne, Germany

Online Publication Date: 01 January 2003

To cite this Article Kiessling, J., Pichora-Fuller, M. K., Gatehouse, S., Stephens, D., Arlinger, S., Chisolm, T., Davis, A. C., Erber, N. P.,Hickson, L., Holmes, A., Rosenhall, U. and von Wedel, H.(2003)'Candidature for and delivery of audiological services: special needsof older people',International Journal of Audiology,42:6,92 — 101

To link to this Article: DOI: 10.3109/14992020309074650

URL: http://dx.doi.org/10.3109/14992020309074650

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Consensus

Tntcrnational Journal of Audiology 2003; 42:2 S92-2 SlOl

.l Kiessling* M . K. Piclzoru-Fullef,r" S. GuteliouseS D. Steplwn.ns$ s. A dirl@?r 11 7: c~'lzisoIln~ A. c. Duvis"" A! l? Erher2+ L. Hickson:: A. Hohne.@ L;. Rose~iliaNII 1; H. ,'on WedePV

*Universitals-HNO-Klini k der Justus Liebig Universitlt. Giessen, Germany, 'University of Toronto, Mississauga: Ontario. Canada, ZMRC institute of Hearing Research, Glasgow, CK. *Welsh Hearing Institute, University Hospital of Wales. Cardill; U K . IIDepartnient of Audiology, University Hospital. Linkopitig. Sweden. ?Department of C:ommunication Sciences & Disorders, University of South Florida, and Audiology 8~ Speech-language Pathology Service. VAMC-Say Pines. Florida, USA, **MRC: Institute of Hearing Research, Cniversity Park. Nottinghnm, UK, "School of Audiology, University of Melbourne+ Melbourne. Victoria, Australia, -Communication Disiibility in Ageing Rcscarch Unit. Department of Speech Pathology and Audiology. The IJnivcrsity of Queensland. Q ueenslantl . Ausl ra iia, SDeparlnient of Communicative Disorders, I!niversity of Florida. Gainesville. Florida. USA, IIhstitution of Clinical Neur~~sciences/Scction of Technical and Clinical Audiology. Karoliiiska Institute, Dcpartinenl or Audiology. Karolinska Hospital, S1ockholm, 'WJniversity of Cologne, ENT Hospital, Cologne. Germany

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Candidature for and delivery of audiological services: special needs of older people

Aetiologies, sites of lesion and functional consequences of hearing loss

As people become older, there is an increase in thc prcvalence of hearing impairment. For many years, the general term 'presbyacusis' (presbycusis) has bccii used to describe age- related hearing loss resulting from a varicty of aetiological factors (for a definition, see Willott (1991), pp. 2-3). Yet this general term may be mislcadinp. because hearing toss i n older people is no1 restricted to any singlc cause, site of lesion. or typc of auditory processing disorder. At present, the value of the word seems to bc limited to reassuring the patient that his or her hearing problems are not da t ed to other more medically distressing causcs. For this rcason. it may be important to keep this vague eXprGSSiOn, but as our knowlcdgc of thc causes of hcaring loss in older people increases, the need for a global tcrm like 'presbyacusis' will diminish. I n this supplenienl, we avoid tlic labcl 'presbyaeusis' in Favour of morc spccific actiological tcrms.

There are many causes of hearing loss in older pcoplc, including environmental factors (e.g. noise exposure), genetic factors, and generalized effects of ageing (e.g. cell damage due to free radicals). The inajority o f age-related hearing impairments are types of sensorineural hearing loss (SNH L), and they have similar eWects on auditory proccssing (e.g. elevated thresholds, reduccd freqircncy discrimination, rcduced temporal discrimination, and changes in loudness perception), a s does SNHL that ca.n occur at any age. Therefore, our knowledge of cochlear pathology and its ell'ects on auditory processing and many issues pertaining to hearing aids can be readily generalized across the adult age range.

Although the majority of hearing impairments in older adults include a cochlear compon- ent similar to that ol' many younger adults. the auditory systems of older adults miy also be damaged in ways that are not typical of younger people. Classifications according to the sites of lesion affected in oldcr adults an: well known (Schuknccht, 1964, 1995: Willott, 1991). Unfortunately. the correspondence between damage at various sites and the nature or extent of auditory proccssing dcficits is not straightforward (for a discussion, see (Willott) 1991). Nevertheless. it is likely that damage iU multiple sites contributes to the diffcrcnces in auditory processing that are observed. Clcarly, thc typical high-frcquency sensitivity loss evident on the audiogram only begins to inform us of age-related differences in auditory processing.

In addition to affccling basic psychoacoustic abilities, sensorineural and/or cenlral hearing impairment (regardiess OF ageing) affects listening, comprehending, and communicating. As rehabilitative audiologists interested in the everyday needs of older adults, we must advancc our understanding of how auditory and non-auditory aspects of ageing combine to alter listening. coniprchcnding and communicating as functions that arc crucial for activity and participation in daily life. Consistcnt with this vicw, wc expandcd an approach focused on impairrncnt and amplification 10 a more holistic approach that would include rehabilitation directed not only at impairment, but also at function, activity and participation (World Health Organization, 3001) in older adults.

Auditory functions

Audition is a central element of interaction bctween human beings. Often, the term 'hearing' is used to describe the contribution of thc auditory system to such interactions. The unsatisfactory nature of this term became increasingly apparent during thc Workshop

J. Kiesslinp I!nisersitiits-l INO-Klinik dcr Just us Liebig Lniversitiit. Frulpnstiasse 10, D-35385 Gicssen. Gcrmany P-niail: jue~~n.kicsslin~~~hnu.mtd.uni-giesscn.de

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