MEDICAL

Sensory Loss in Older Adults: Hearing; Behavioral Approaches for Caregivers

As we age, our sensory systems gradually start to decline. Because our brain requires a minimal amount of input to remain alert and functioning, sensory loss for older adults puts them at risk for sensory deprivation. Severe sensory impairments, such as in vision or hearing, may result in behavior similar to dementia and psychosis, such as increased disorientation and confusion. Added restrictions, such as confinement to bed or a Geri-chair, increases this risk. With nothing to show the passage of time, or changes in the environment, the sensory deprived person may resort to repetitive problem behaviors (calling out, chanting, rhythmic pounding/rocking) as an attempt to reduce the sense of deprivation and to create internal stimulation/sensations.

This article is the second in a series of three articles that discuss the prominent sensory changes that accompany aging, and considers the necessary behavioral adjustments or accommodations that should be made by professional, paraprofessional, and family caregivers who interact with older adults. Though the medical conditions are not reviewed in depth, the purpose of this article is to introduce many of the behavioral health insights, principles, and approaches that should influence our caregiving roles. This article addresses age-related changes in hearing.

HEARING

A. The changes in hearing that accompany aging include:

1. Presbycusis: a type of hearing loss that is more common in men, especially for high-pitched sounds. Men have more trouble hearing high pitched voices, and have poorer sound discrimination (e.g., for letters s, z, t, f, g). Decline typically begins after age 60, and increases up to 80% for those over age 80;
2. Screening out background noises is a common difficulty.

B. How the hearing impaired can be impacted by caregivers:

1. Raising the volume of our voice also raises pitch of our speech, usually making it harder to understand. Recommended: lower your pitch of voice;
2. Background noise (TV, vacuums, plane flying overhead) interferes with hearing and understanding. Recommended: wait for a quieter time to get our point across;
3. Hearing loss creates more social withdrawal and reduced interaction due to the high level of frustration of the person, and annoyance with others who speak too quietly or indistinctly;
4. When the TV is too low and hard to hear and understand, there is a possibility of friction and bickering with others who are also watching;
5. In many cases of hearing loss, there is an increase in suspiciousness and paranoia, anger and bitterness at the frustrating situation, and helplessness to control the situation. This often contributes to depression and a sense of resignation;
6. There is a tendency for the hearing disabled person to agree with what everyone is saying, just to reduce the frustration and disappointment. Recommendation: ask the person to repeat back what was just said to verify the communication.

C. How changes in hearing affect persons with dementia:

1. Difficulties with comprehension and understanding of communication are further compounded, increasing his or her withdrawal and isolation;
2. The use of hearing aids requires more support and motivation, persistence in the face of unpleasant sounds, and care for the device. Recommendation: remind the dementia person to wear the hearing aid, help him to turn it on, clean and change batteries, and store it safely.

D. Warning signs of changes in functioning due to hearing loss:

1. More avoidance of social situations and withdrawal
2. Less small talk
3. Shorter attention span or tendency to daydream, wander
4. Blank looks
5. Asking you to repeat, making inappropriate responses
6. Arguing or blaming others, more irritability

GENERAL PRINCIPLES FOR CAREGIVERS

The following general principles will guide caregiving approaches with older adults who have diminished sensory function. Increased sensitivity and insight to the needs of these individuals improves their quality of life and improves our effectiveness:

1. Observe his or her behavior, and look for cues and signs of pain or discomfort;
2. Help the person work through the emotional impact of the sensory changes, allowing expression, acceptance, and support of the grief and sadness accompanying these losses;
3. Do not try to fix the unpleasantness; acceptance and support goes a longer way toward healing than a quick fix or a patronizing attitude;
4. Reduce excess disability by maximizing whatever functioning is still left, such as proper eyeglass prescriptions, or functioning hearing aids;
5. Consider assistive devices (phone amplifiers, large text books, headphones, and the Braille Institute for a variety of useful visual aids).

Approaches for Impairments in Hearing:

1. Get his attention before speaking to him;
2. Face him or her directly, not from behind;
3. Eliminate as much background noise as possible;
4. Speak slowly and clearly, keeping your hands away from your face, and avoid chewing or eating when talking;
5. Allow an adequate amount of time for a response;
6. Do not talk as if the hearing impaired person is not there;
7. Provide opportunities for interaction that require little conversation e.g., cards, walking, cooking.

Even with normal aging, functioning of our five senses is not like it was when we were younger adults. This article offers caregivers who work with hearing-impaired older adults some insights into the special needs and adjustments that will turn unpleasant, frustrating situations into more caring, helpful, and sensitive interactions. The next article in this series addresses age-related losses in touch, taste, smell, and facial expressiveness, and what steps can be taken by caregivers to support the person experiencing these changes.

Copyright 2008 Concept Healthcare, LLC

About the Author

Joseph M. Casciani, PhD, is a geropsychologist who has devoted his professional career to working with older adults and their caregivers. His company, Concept Healthcare, http://www.cohealth.org, offers online resources to integrate behavioral health approaches in the health care of older adults.

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