HOW BIG A PROBLEM IS AGE RELATED HEARING LOSS IN THE UNITED STATES

PRIMER ON AGE RELATED HEARING LOSS

AUDIOGRAM OF TYPICAL PATIENT WITH AGE RELATED HEARING LOSS

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HOW BIG A PROBLEM IS AGE RELATED HEARING LOSS IN THE UNITED STATES?

ADEQUATE HEARING IS A LINK BETWEEN PERSON-CENTERED COMMUNICATION AND OPTIMAL HEALTH OUTCOMES (MODIFIED FROM LEVINSON, LESSER & EPSTEIN, 2010)

FEATURES OF AGE RELATED HEARING LOSS

How Can I Tell If My Patient May Have A Hearing Loss?Does your patient consistently ask what when you are taking a history?Does the patient offer incorrect responses to simple questions?Does your patient appear confused at times because of misunderstanding?Does caregiver or spouse frequently answer questions for the patient?Does your patient turn his/her head toward you to better understand?SmokingNoise ExposureMale SexOtotoxic MedicationNoise ExposureDementiaAgeHypertensionCardiovascular diseaseDiabetes

What are Risk Factors for Hearing Loss?7Increased odds of fallsIncreased odds of developing dementiaHigher likelihood of experiencing functionally disabilityIncreased risk of repeat hospitalizationsIncreased risk of experiencing emotional distress and social engagement restrictionsPoorer self rated healthImpaired Patient Centered CommunicationCompromised transition in care

What are Some Consequences of Untreated Hearing Loss?Hearing Loss and Multimorbidity (BHI)

Which Functional Problems are Age Related Hearing Loss Linked To? Improved Health Related Quality Of Life Reduced Depressive Symptoms Increased Functional Independence Reduction in Caregiver Burden

Health Benefits That Hearing Impaired Who Use Hearing Aids Can AnticipateTo Promote Improved Physician Patient CommunicationTo Optimize Person Centered CareTo Identify If Persons At High Risk for Falls Have a Concomitant Hearing LossTo Improve Quality of Health Care DeliveryTo Improve Patient SafetyTo Promote More effective Transitions in Care

Why Should Clinicians Screen For Hearing Loss?Little evidence for one method over anotherChoose a method that fits your population, practice setting, personal preference A Three Tiered Screening Should IncludeOtoscopyObjective Impairment ScreenSelf Report of Hearing Problems

What are the Recommended Methods for Screening for Hearing Loss?An Audiologist: a doctor of audiology who has specialized training in diagnosing, measuring degree and type of hearing loss and treating non medical causes of hearing loss An Otolaryngologist: a medical doctor who specializes in diagnosing and treating diseases of the ear, nose, throat and neck

To Whom Should I Refer?Persons who Perceive Themselves to Have Difficulty Hearing and UnderstandingPersons Who Are Actively Engaged and Take Responsibility for Managing Their CarePersons Who Are Motivated or Activated to Maintain Function and Prevent Further Decline

Who Has the Greatest Potential To Benefit From Treatment?Pre-ContemplationI do not have difficulty hearing/understanding othersContemplationI am concerned about my hearing, but am not ready to do any thing about itPreparationI am ready to have my hearing tested and inquire about treatment optionsActionI am ready to purchase hearing aids; I am ready to consider a cochlear implantMaintenanceI go to the audiologist for a tuning of my hearing aids every six months

Readiness for Hearing Loss Treatments: Stages of ChangeEncourage Patient to Think of Relevance of Knowing How Well They Can HearAssist Patient to Recognize the Risk of Not Treating Their Hearing LossAssist patient to Recognize Rewards of Treating Their Hearing LossDiscuss Roadblocks to Having Hearing Tested and Hearing Loss Treated

Five Rs To Motivate Patients To Have Their Hearing Tested ( Modified from ACP)

Interventions for Hearing Loss(Modified from Weinstein, 2012; Abrams & Chisolm, 2013)Individual Cognitive Based Auditory Training

18Make sure face and mouth are visible when speaking to the patient Make sure to keep distractions (auditory/visual) to a minimum when speakingMake sure to be within three to six feet of the patientIf patient owns a hearing aid, make sure h/she is wearing it and it is turned onIf the patient appears to be having difficulty understanding, use a commercially available hand held amplifier (e.g. Pocket Talker) to make it easier to communicate

What Behavioral Interventions Are Helpful for Communicating with the Hearing ImpairedMinimize background noiseKnow patients literacy levelUse plain language and visual aids especially if patient shows signs of hearing lossSpeak slowly and face the patient with lips at same level as patientMake sure the room in which you are speaking has good lightingVerify listener comprehension through teach-backParaphrase what you have said if patient did not appear to understand

Practice Improvement - Tips for Avoiding Poor Patient/Physician Communication (Krupa, 2012)