Older people say they are aware of the importance of good hearing yet they routinely go without treating their own hearing problems.
A new survey of more than 2,200 American seniors not only underscored that apathy but put into sharp relief the challenge that hearing health care specialists face in making hearing health a key component of wellness.
More than 80 percent of respondents said hearing health is very or extremely important to them, and about half reported having untreated hearing issues, including one-third of respondents who said their hearing was not as good as it should be but did not believe it needed to be treated.
The survey of adults 50 and older, released in December, was a joint project of AARP and the American Speech-Language-Hearing Association. Pam Mason, the director of audiology professional practices at ASHA, said education and outreach initiatives need to focus on how hearing loss is much more than a medical issue. Instead, it interferes with a person's ability to maintain the personal connections so crucial to maintaining good health in old age.
“I think if older people knew their hearing loss was affecting relationships, they would be more eager to seek out treatment,” Ms. Mason said.
Nicole Duritz, AARP's vice president for health and family, said seniors commonly believe that hearing loss is an inconvenience but not a life-and-death issue. “It does have a significant impact on life,” she said, causing stress and a loss of social interaction. “When people start withdrawing from social situations, it can lead to depression.”
The survey, conducted in September 2011 using an online questionnaire and telephone interviews, asked 2,232 AARP members about their awareness and attitudes about hearing and barriers to care. Respondents reported that they were far more likely to get blood pressure checks and cholesterol screening than they were hearing tests. Vision tests were also more common.
Ana Anzola, AuD, an audiologist in McLean, VA, and Rockville, MD, said she thinks hearing is often not given priority by older persons and their families because the problem develops gradually. “Hearing loss is a slow and insidious process. If there were some pain related to the issue, people would be more prone to do something about it,” Dr. Anzola said. Families tend to compensate for a loved one's poor hearing, perhaps taking over the conversation during doctor appointments or other encounters.
“Families need to realize that they have to stop doing that because the person will never take action. There is no incentive to get help because other people are doing the hearing for them,” she said.
The AARP-ASHA survey also found that 46 percent of those surveyed said their hearing had gotten worse over the past five years, and 47 percent said they had untreated hearing health issues. That number included the 32 percent of respondents who said they did not need treatment though their hearing was less than optimal.
Only 43 percent of respondents had undergone a hearing test in the past five years, while 85 percent had blood pressure monitoring, 81 percent had cholesterol screening, and 88 percent had vision tests. Mammograms and prostate exams also were more likely to have occurred than hearing checkups.
Those surveyed said hearing issues affected daily living, sometimes in subtle but noticeable ways. Fifty-seven percent of those surveyed said they had trouble hearing when there was background noise, and 48 percent said they sometimes strained to understand a conversation. Conversations that involved multiple people also proved difficult.
Money not surprisingly was a barrier to treatment, the survey found, with 28 percent saying their health insurance did not sufficiently cover the cost of treatment and eight percent saying they had no health insurance. Twenty-seven percent said treating hearing problems was too costly. More than a third of respondents said it was easier for them to live with minor hearing problems than to seek treatment.
Having a hearing aid did not solve all problems, however, the respondents said. About 18 percent of respondents said they owned a hearing aid, and 73 percent of them said their hearing was much better or slightly better since wearing a hearing aid. Twenty-three percent, however, said their hearing was about the same, and three percent said things had gotten worse. Common complaints among hearing aid users were not being able to hear as well as expected in a crowded room, in one-on-one conversations, and hearing TV and radio.
NOT A ONE-STOP FIX
The findings highlight the need for patients to establish an ongoing relationship with a hearing specialist so that treatment can be fine-tuned to the patient's needs and abilities. Devices involving tiny batteries, for instance, could be problematic for someone with bad eyesight or arthritic hands. If the hearing aid is relegated to a drawer because it is seen as inconvenient or inferior, it reinforces the notion that wearers don't really need it or that they manage to get by.
“You can't just get fitted with a hearing aid and get sent out the door,” said Deborah Berndtson, AuD, a clinical supervisor at the Hearing & Speech Clinic at the University of Maryland-College Park. Improving hearing involves more than dispensing a hearing device, she said. “Often when people develop hearing problems they stop listening. We have to teach people how to listen again,” Dr. Berndtson said.
Strategies include being alert to visual and conversational cues, as well as conducting conversations in well lighted areas while facing the other person.
Dr. Berndtson said a number of psychological factors accompany hearing loss, particularly the stigma that accompanies hearing loss. “Wearing a hearing aid is associated with getting older, and people don't want to accept the fact they have a hearing loss,” she said.
Older persons might also have memories of their own elderly relative struggling with an old-fashioned hearing aid, which was light years away from today's technology. Often, patients only come through the door after much convincing by frustrated family members. It's not unusual for someone to seek treatment after five or more years of trying to cope with deteriorated hearing.
Dr. Berndtson said audiologists need to do a better job educating the public on what services they offer, emphasizing hearing health care. Reaching out to medical doctors in the community, retirement homes, and religious groups are all possible ways to build awareness.
“People know what a podiatrist does. They know what a dentist does,” she said. “But they don't necessarily know what an audiologist does.”
Many respondents in the AARP-ASHA survey said they would be more likely to seek treatment if they thought it would improve their quality of life or if they felt their hearing deficit was limiting relationships with family and friends. They also indicated that they might heed the advice if a loved one, even a grandchild, suggested they get their hearing treated. Many grandparents tend to be connected more than ever to their grandkids via cell phone calls, texts, and Skype, if not in person.
And that brings the issue back to relationships. Family members need be nonjudgmental but honest about a loved one's hearing problems, said Ms. Duritz of AARP. Giving specific examples can help. “You can say, ‘Mom, you're very quiet these days when we have family dinners,' or “Dad, I notice you didn't laugh at that joke.’”
Dr. Anzola agreed, saying the baby boom generation might end up helping to change societal attitudes toward hearing. “The trend is I'm seeing more and more baby boomers,” she said. “They realize that hearing loss is not just an aging problem.”
Keeping hearing sharp is vital to performing well in the workplace, Dr. Anzola said, and many baby boomers want to maximize their time on the job, especially amid the economic uncertainty of late. “If you're still out in the workforce, hearing loss becomes more of an issue,” she said.
Many of those responding to the AARP-ASHA survey said they would be more likely to get treatment for their hearing problem if they thought it would improve their mental and physical alertness. Perhaps that needs to be part of the message, too: Better hearing equals better relationships and better overall health.
• Read the AARP-ASHA hearing health survey at http://bit.ly/AARP-ASHAsurvey.
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