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Audiologist Assistance to Family Caregivers

Colucci, Dennis A. AuD, MA

doi: 10.1097/01.HJ.0000489199.79089.a9
Hearing Matters

Dr. Colucci is a clinical and forensic audiologist in private practice in Laguna Hills, CA.

The explosion of older adults in need of home healthcare is overwhelming, leaving families and friends with the responsibility of caregiving, including hearing care. Hearing loss and changes to central auditory processing have been shown to affect brain size, memory and cognitive processing, and possibly, Alzheimer's disease (Colucci. HJ 2015:4;48 http://bit.ly/1YgIMgA). Because hearing aids can reduce the effects of central presbycusis, using them should be a daily priority. Implementing hearing care does not need to be burdensome; rather, it can be routine when hearing devices are easy to use and a simple written schedule of use, functional operations, and cleaning and maintenance is put in place.

According to the National Alliance for Caregiving, AARP, and The Public Policy Institute's 2015 Report, “Caregiving in the U.S.,” there are 43.5 million unpaid caregivers, with 85 percent taking care of a relative or friend (http://bit.ly/1YgGy0w). Forty-nine percent are taking care of a parent, 15 percent are caring for a friend, and 14 percent are caring for a child. Eighty-two percent are providing care to a single individual. On average, caregivers are 49 years old; 7 percent are 75 years or older.

Audiologists should be aware of the circumstances that place families and others at a disadvantage in providing care. Giving simple and useable instructions can significantly reduce the burden on the caregiver and increase the usability of hearing devices.

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THE RECIPIENTS OF HOME CARE

The report also cites the demographic for care recipients as 65 percent female with an average age of 69.4 years. Nearly half of caregivers provide care for people 75 years of age or older. More than half (59%) of the recipients have long-term physical conditions; 26 percent have memory loss, dementia, or Alzheimer's disease; and 8 percent have surgery wounds. More than a third (37%) of the recipients have multifocal conditions with more than half (53%) hospitalized in the past 12 months.

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THE CHALLENGE OF CARING

Half of caregivers reported having no choice in taking on caregiving responsibilities. A third of these have no other household, managerial, or physical help, and consequently report experiencing worse health, physical strain, and emotional stress. Caregiving hours can range from an average of 24.4 hours a week to 44.6 hours for spouse or partner caregiving. Furthermore, most higher-hour caregivers (57%) also perform menial tasks and nursing responsibilities without prior preparation or training. Approximately 50 percent find providing care difficult and personal care the most challenging.

The burden of care varies depending upon the conditions of the recipient. For example, those taking care of a person with dementia or Alzheimer's disease have the greatest burden (www.alz.org). According to the Alzheimer's Association, warning signs of caregiver stress include: being in denial of their recipient's disease, anxiety, depression, social withdrawal, sleeplessness, exhaustion, irritability, lack of concentration, and health problems.

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THE ROLE OF AUDIOLOGISTS

Caregiving is a challenging task that needs significant support. Of all caregivers, only 32 percent report that a healthcare clinician asked about the daily needs of the recipient and 84 percent report needing more information. To reduce the burden associated with hearing caregiving, products should be easy to use and transparent to daily activity. Gadget use should be minimal and their instructions should be kept cookie cutter simple.

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THE BENEFITS OF COUNSELING

The desired outcome of proper counseling is to ensure that the patient and caregiver have coordinated their activities and that they have the proper skills and tools to confidently work with the hearing instruments and impairment. Counselling can also help caregivers create a normalized and maximized environment for engagement. Caregivers should establish realistic expectations in order to minimize errors, make communication easier, and generate a sense of success. Specifically, because of the nature of hearing loss and aging, it is not always possible for all seniors to engage in moderate levels of background noise or follow conversation spatially due to auditory processing issues, especially if the talker uses fast speech or a foreign accent. Hearing aid technology has its limits. Caregiver counseling on communication skills by distance (Colucci. HJ 2015;12:40 http://bit.ly/1YgH6DT), hearing in background noise, and speaking skills can enhance the outcome. Using simple communication and hearing aid checklists can also be helpful.

Fortunately for most patients, hearing technology such as hearing aids—and, if absolutely necessary, some assistive devices for television and telephone—can make home life and daily activities functional with little burden on the caregiver. Helping caregivers understand their role in hearing care makes it easier for the patient, and also for their caregiver.

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