Transcript HOW BIG A PROBLEM IS AGE RELATED HEARING LOSS IN …

PRIMER ON AGE RELATED
HEARING LOSS
AUDIOGRAM OF “TYPICAL PATIENT”
WITH AGE RELATED HEARING LOSS
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)
PERSON CENTERED
COMMUNICATION
ADEQUATE HEARING
IMPROVED PATIENT
CENTERED
COMMUNICATION
DURING THE PATIENT
ENCOUNTER
INCREASED PATIENT
KNOWLEDGE, BETTER
INFORMED DECISION
MAKING, INCREASED
ADHERENCE
IMPROVED QUALITY OF
LIFE AND WELL BEING
FEATURES OF AGE RELATED
HEARING LOSS
Invisible
Insidious
Impacting
Interfering
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?
What are Risk Factors for Hearing Loss?
 Dementia
 Smoking
 Age
 Noise Exposure
 Hypertension
 Male Sex
 Cardiovascular disease
 Ototoxic Medication
 Diabetes
 Noise Exposure
What are Some Consequences of Untreated
Hearing Loss?
 Increased odds of falls
 Increased odds of developing dementia
 Higher likelihood of experiencing functionally disability
 Increased risk of repeat hospitalizations
 Increased risk of experiencing emotional distress and social
engagement restrictions
 Poorer self rated health
 Impaired Patient Centered Communication
 Compromised transition in care
Hearing Loss and Multimorbidity (BHI)
Which Functional Problems are Age Related
Hearing Loss Linked To?
Senile
Dementia
Poor Self
Rated
Health
Mortality Risk
Falls
Social
Isolation
Health Benefits That Hearing Impaired Who
Use Hearing Aids Can Anticipate
 Improved Health Related Quality Of Life
 Reduced Depressive Symptoms
 Increased Functional Independence
 Reduction in Caregiver Burden
Why Should Clinicians Screen
For Hearing Loss?
 To Promote Improved Physician Patient Communication
 To Optimize Person Centered Care
 To Identify If Persons At High Risk for Falls Have a
Concomitant Hearing Loss
 To Improve Quality of Health Care Delivery
 To Improve Patient Safety
 To Promote More effective Transitions in Care
What are the Recommended Methods for
Screening for Hearing Loss?
 Little evidence for one method over another
 Choose a method that fits your population,
practice setting, personal preference
 A Three Tiered Screening Should Include
 Otoscopy
 Objective Impairment Screen
 Self Report of Hearing Problems
To Whom Should I Refer?
 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
Who Has the Greatest Potential To
Benefit From Treatment?
 Persons who Perceive Themselves to Have
Difficulty Hearing and Understanding
 Persons Who Are Actively Engaged and Take
Responsibility for Managing Their Care
 Persons Who Are Motivated or Activated to
Maintain Function and Prevent Further Decline
Readiness for Hearing Loss Treatments:
Stages of Change
 Pre-Contemplation
 “I do not have difficulty hearing/understanding others
 Contemplation
 “I am concerned about my hearing, but am not ready to do any thing about
it
 Preparation
 “I am ready to have my hearing tested and inquire about treatment options”
 Action
 “I am ready to purchase hearing aids; I am ready to consider a cochlear
implant”
 Maintenance
 “I go to the audiologist for a tuning of my hearing aids every six months”
Five R’s To Motivate Patients To Have Their Hearing
Tested ( Modified from ACP)
 Encourage Patient to Think of Relevance of Knowing
How Well They Can Hear
 Assist Patient to Recognize the Risk of Not Treating Their
Hearing Loss
 Assist patient to Recognize Rewards of Treating Their
Hearing Loss
 Discuss Roadblocks to Having Hearing Tested and
Hearing Loss Treated
Interventions for Hearing Loss
(Modified from Weinstein, 2012; Abrams & Chisolm, 2013)
Counseling
Based Audiologic
Rehabilitation
Individual or Group
Web Based/Virtual Audiologic
Rehabilitation (LACE)
Hearing Aids, Hearing Assistive Technology
Hearing Assistive Technology, PSAPS, Communication
Strategies Training
What Behavioral Interventions Are Helpful for
Communicating with the Hearing Impaired
 Make sure face and mouth are visible when speaking to the
patient
 Make sure to keep distractions (auditory/visual) to a
minimum when speaking
 Make sure to be within three to six feet of the patient
 If patient owns a hearing aid, make sure h/she is wearing it
and it is turned on
 If 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
Practice Improvement - Tips for Avoiding Poor
Patient/Physician Communication (Krupa, 2012)
 Minimize background noise
 Know patient’s literacy level
 Use plain language and visual aids especially if patient shows signs of
hearing loss
 Speak slowly and face the patient with lips at same level as patient
 Make sure the room in which you are speaking has good lighting
 Verify listener comprehension through teach-back
 Paraphrase what you have said if patient did not appear to
understand