Social interaction, support of family and friends, and living a purposeful life all contribute to quality of life. Social connectedness reduces stress levels and offers positive physical and mental health benefits. Social relationships (i.e., quality and quantity of social support) appear to be protective with respect to a number of health outcomes (Seeman. Ann Epidemiol 1996;6:442-451). A low-quality and quantity of social relationships is associated with cardiovascular disease, high blood pressure, delayed cancer recovery, and slower wound healing (Umberson. J Health Soc Behav 2010;51[Suppl]:S54-S66). Quality and quantity of social ties is also associated with such physical markers like inflammatory disease and immune function. Social engagement has repeatedly been found to prolong life and enhance life quality.
Looking at the definition of the various components of social connections shown in the Table, it is clear that hearing and communication are integral to social connectedness.
One of the mechanisms by which social ties may influence health is through social support, a term that refers to the emotionally sustaining qualities of relationships (e.g., being listened to) (Cohen. Am Psych 2004;59:676-684; Uchino. Social Support and Physical Health: Understanding the Health Consequences of Relationships.New Haven, CT: Yale University Press; 2004). Social support may influence health indirectly by fostering a sense of meaning or purpose in life or it may trigger physiologic reactions, including a release of stress and happiness hormones.
Two recent studies relating social support and social connections to hearing aid use and outcomes should be of interest to audiologists in private practice who are thinking of new approaches to inform various stakeholders about the value of audiologists and hearing health care interventions. Singh, Lau, and Pichora-Fuller reported on the significant link between social support and positive hearing aid outcomes, specifically hearing aid satisfaction (Singh. Ear Hear 2015;6:664-676). Amieva, Ouvrard, Giulioli, et al., theorized that in restoring the ability to communicate, hearing aids may help increase social interactions, and in doing so, may slow down cognitive decline (Amieva. J Am Geriatr Soc 2015;63:2099-2110).
WILL HEARING AID USE PREVENT COGNITIVE DECLINE?
We now have an evidence-based response to the question posed by so many of our clients, namely, “If I buy hearing aids, will they protect me from going senile?” A circuitous answer is perhaps, but only indirectly through the contacts and social networks patients will be able to maintain because hearing aids and accompanying rehabilitation should restore the ability to communicate effectively and more easily. Traditionally, hearing aid satisfaction has been tied to hours of use and device-related factors, including sound clarity, instrument reliability, and comfort level of loud sounds (Wong. Trends Amplif 2003;7:117-161). We can now add perceived social support to the mix (Singh. Ear Hear 2015;36:664-676). For new users, in fact, the relationship to hearing aid satisfaction may be stronger than for experienced users. Social support is indeed multidimensional. We must tap in to the various domains when intervening with hearing aids to optimize social connectedness, especially the emotional and informational support from family and friends.
The counseling and rehabilitative implications of the contribution of social support to hearing aid satisfaction are significant, as discussed at length by Singh and colleagues. We must consider and emphasize communication strategies with the other when working with persons with hearing loss, be it a communication partner, a co-worker, a friend, a physician, or a caregiver. The import of encouragement and motivation from communication partners and the use of communication strategies must be underscored throughout the fitting and post-fitting process and in our communication with various stakeholders (e.g., physicians where respect and communication are integral to patient centered care). Communication is enhanced when it is reciprocal with both parties making every effort to make sure the message is heard and understood. We tend to stress battery insertion and hearing aid removal, leaving little time for discussion of self-management strategies and communication habits important to hearing health, especially the social ties that can once again be honed.
SOCIAL SUPPORT MATTERS
Social relationships can be stressful, particularly in the face of significant hearing loss. Restoration of hearing and the ability to communicate via hearing aids and rehabilitation can foster one's social connections, thereby contributing to one's sense of purpose in life, which, sociologists contend, enhances mental and physical health (Antonovsky. Unraveling the Mystery of Health. San Francisco, CA: Jossey-Bass; 1987). Audiologists should consider linking the discussion of communication strategies to a patient's social history and their everyday communication experiences, with an emphasis on how improved hearing through use of hearing aids may restore social ties. Delivering hearing aids in the context of group aural rehabilitation, be it face to face or online, provides the advantage of social support in a setting conducive to overcoming psychosocial difficulties posed by hearing loss. The work of Singh, et al. should shift the emphasis in our clinical encounters from the focus on increasing hours of use to the use of improved hearing and communication to restore the web of one's social support networks disrupted by hearing loss. By fostering support from family and friends, audiologists may assist hearing aid users in coming closer to achieving their best health and wellness.