Judith Graham, a health care journalist who writes the column Navigating Aging for Kaiser Health News, recently wrote an inspiring piece on what's in store for aging baby boomers in 2020.1 Allow me to extract and build upon what will be relevant to the profession of audiology as we move into this next decade. By way of background:
- Americans are living longer and healthier lives, and facing an unprecedented demographic growth.2,3
- A dynamic process, aging takes place over three decades, with considerable individual variability in the rate and way that people age, underscoring the importance of person-centered care for older adults.
- Ageism affects our society, and the reality that aging is misunderstood creates significant obstacles that hearing care professionals face daily. Combating ageism is a priority.
- With the growing aging population, it's important to ensure that we are not only adding life to years, but years to life. Promoting health and independence, facilitating social connection, and optimizing well-being are critical to healthy aging.
- The ability to effectively communicate is central to social connectedness, which in turn is fundamental to healthy aging and life expectancy (Table 1).
SOCIAL ENVIRONMENT & COMMUNICATION
According to Graham's report,1 experts are looking for solutions that promote healthy aging. Some popular global themes include aging in a more age-integrated society, smart environments, and age-friendly health systems. Increasing access to and the use of technology to support the needs of older adults is an important healthy aging initiative. Emerging technologies are increasingly geared toward integrating and empowering older adults to remain socially and physically engaged. This is where hearing health care technology comes into play.
Hearing loss is a modifiable risk factor for loneliness and social isolation, and policymakers are recognizing the importance of innovative efforts to combat loneliness. As clinicians, we can be part of the solution. We should make every effort to ensure that interventions really help patients derive satisfaction from their interpersonal connections and social contacts, albeit limited for some. Loneliness and social isolation do not share a one-to-one relationship, so each should be explored as a beneficial outcome of hearing aid use. The World Health Organization (WHO)4 recently acknowledged that the inability to effectively communicate can significantly affect one's daily life and result in feelings of loneliness and isolation. Accordingly, the WHO has recommended that older adults be offered timely hearing screenings, followed by the provision of hearing aids. Notably, the recommendation was categorized as strong despite the low quality of available evidence.
Graham1 and other experts on longevity also reported that our physical and social environments are closely tied to healthy aging. Technology has an important role to play in helping to connect people, but the provision of hearing aids must come with counseling on self-management of communication difficulties.5 Coping capacity or the ability to successfully use communication strategies in challenging listening situations and social environments is directly related to stress levels and health issues. Hogan and colleagues5 found that feeling stressed and tired due to hearing difficulties in challenging listening environments can trigger negative health outcomes, including social distress.
One final point relating to social infrastructure is the importance of a public health approach to hearing health care.6 Given the downstream consequences of communication difficulties in noisy listening environments, hearing care professionals should advocate for the use of sound-absorbing materials (e.g., carpet, curtains, ceiling tiles) in independent living and assisted living settings, hospitals, and nursing homes. We should also advocate for the use of portable hearing assistance devices and the practice of universal communication precautions (e.g., reduce extraneous noise, face the speaker, speak to the patient and not the care partner during care transitions) to enhance communication in medical settings, particularly in noisy areas such as emergency departments and intensive care units (if permissible).7
VIRTUAL ASSISTANTS & E-HEALTH
Another important point raised by Graham1 is the role of innovative technology in helping older adults remain independent and age in place. Virtual assistants like Alexa are increasingly playing valuable roles. If your patient has a virtual assistant, as many baby boomers do, suggest that they set up reminders for them to put (and keep) their hearing aids on and make sure the batteries are fully charged. With the advent of e-health, consumers are demanding easier access to services and embracing telehealth. E-health applications allow patients to communicate remotely with health care providers, schedule appointments, and receive test results. This technology also allows remote monitoring of hearing aids, although this should not replace face-to-face encounters but perhaps be integrated into a hybrid approach that will benefit all stakeholders. Finally, look to the new generation of hearing aids with artificial intelligence technology to change the conversation about hearing aids. The ability to measure social engagement, detect falls, and analyze environmental sounds may be game-changers in terms of both hearing aid uptake and adherence. In this regard, it is critical that we make our primary care colleagues aware of advances in hearing technology that incorporate health and wellness applications designed to enhance the lives of our patients.
As we move further into 2020, we need to prepare for the far-reaching consequences of the demographic reality of population aging. Let's focus on service and business models that foster people's independence and well-being as they age. Let's demonstrate to patients and primary care providers how hearing technologies are helping older adults remain active, productive, and socially connected, thereby dispelling the stereotyping and stigmatization associated with hearing loss and hearing aid use. Let's lead the way in promoting how the restoration of hearing ability provides opportunities rather than challenges.
2. Frameworks Initiative (2017a). Gaining Momentum: A FrameWorks Communications Toolkit.
4. Frameworks Institute (2017b). Framing Strategies to Advance Aging and Address Ageism as Policy Issues https://frameworksinstitute.org/toolkits/aging/elements/items/aging_frame_brief.pdf
5. WHO (2017). Integrated care for older people: guidelines on community-level interventions to manage declines in intrinsic capacity. Geneva: World Health Organization; 2017. License: CC BY-NC-SA 3.0 IGO.
6. Hogan, A., Phillips, R., Brumby, S., et al. (2015). Higher social distress and lower psycho-social wellbeing: Examining the coping capacity and health of people with hearing impairment. Disablity and Rehabilitation
. 37: 2070-2075.
7. Reavis, K., Tremblay, K., & Saunders. G. (2016). How Can Public Health Approaches and Perspectives Advance Hearing Health Care? Ear and Hearing
. 37: 376-380.