With states implementing quarantines and physical distancing mandates due to the COVID-19 pandemic, people with hearing loss may be at risk of heightened social isolation and loneliness. In a recent systematic review, the authors concluded that “hearing loss was associated with a higher risk of loneliness and social isolation,” adding to the body of research connecting untreated hearing loss with increased risk of depression, dementia, and falls (Otolaryngol Head Neck Surg. 2020 Mar 10:194599820910377.).
“It was not surprising to learn that numerous studies show a significant connection between hearing loss, loneliness, and social isolation,” said study co-author, Jonathan J. Suen, AuD, of the Johns Hopkins School of Nursing and the Cochlear Center for Hearing and Public Health at the Johns Hopkins Bloomberg School of Public Health. “Even anecdotal assumptions about a link make sense because we know that hearing loss affects our communication patterns, which therefore can impact our relationships with others.”
Addressing this as well as other communication barriers may be critical as audiologists explore telehealth services for patients with hearing loss.
PHYSICAL DISTANCING & LONELINESS
One concern during quarantine is that the increased reliance on remote communication technologies may be difficult for people with hearing loss.
“Individuals with hearing loss lose the ability to ‘put a voice with a face,’ and the sound distortion that occurs with e-conferencing technology makes it difficult to distinguish who is talking and what they are saying,” said Archelle Georgiou, MD, the chief health officer at Starkey.
“As a result, individuals with hearing loss risk (1) being disruptive if they ask for clarification, (2) being misinformed if they misinterpret speech content, and/or (3) being disengaged if they cope by avoiding active participation in these communication forums.”
“Closure of audiology offices without alternatives for device repairs and adjustments puts patients at risk of abruptly abandoning the use of their hearing aids or significantly decreasing their wearing time,” added Georgiou. “This could create communication, safety, and health issues more akin to acute hearing loss.”
As concerns of seclusion build as physical distancing mandates are fortified, Suen emphasizes that social isolation does not necessarily lead to loneliness. “It's well established that loneliness and social isolation are distinct,” he explained. “A recently published National Academies consensus report reinforced this concept. While the report identified sensory impairments such as hearing loss as a risk factor for loneliness and social isolation among older adults, it also asserts that someone who is socially isolated may not necessarily feel lonely.”
“Indeed, the current public health mandates for quarantining and physical distancing impact everyone on varying levels,” stressed Suen—but he cautioned: “While we also know that older adults with an acquired hearing loss already have increased risks for experiencing loneliness and social isolation, we cannot say for sure how these measures may acutely affect these risks right now.”
Still, patients with hearing loss do face unique concerns. He specifically cited that facial coverings—which the Centers for Disease Control and Prevention (CDC) has recommended to help avoid transmitting the novel coronavirus to others—may also affect speechreading.
Speakers and listeners also need to practice effective communication strategies, such as repeating, rephrasing, and summarizing what was heard, Suen noted.
“When someone with hearing loss does use facial coverings, it is important to be mindful about their ear-level devices,” Suen said. “There's always the risk of inadvertently knocking them loose and off of one's ear(s) when removing facial coverings. I've already heard about this occurring to a few people I know.”
RECOMMENDATIONS FOR AUDIOLOGISTS
As the pandemic continues to demand physical distancing measures, how can audiology professionals help address increased loneliness among people with hearing loss?
“While remote strategies will never completely replace face-to-face professional services, hearing providers can continue to safely meet many patients’ needs by implementing telehealth services,” said Georgiou.
“In addition to telehealth capabilities, hearing providers can proactively reach out to patients by using the most basic remote technology: the telephone. Consider calling patients to simply ask, ‘How are you? Is there anything I can do to help you?’ Let them know that you are available. In addition to addressing their hearing aid device issues, your phone call may help the social isolation and loneliness that people with hearing loss are disproportionately experiencing.”
Suen agrees, noting that “the quality of relationships is often key and not necessarily just the quantity.”
“Audiologists can support clients and their families through thinking creatively about how they can generate and appropriately reinforce a quality professional relationship in their own circumstances and practice settings. Some approaches for showing that you're a professional whom your clients can count on may involve a video/phone call or even just a note sent through the post sharing that you recognize the gravity of the current public health situation and that you are available to support their communication needs in a way that is aligned with safety precautions.”
Providing extra care for hearing aids and amplification devices is vital, particularly for patients who rely on these technologies to communicate and stay connected with their support system.
“The ongoing pandemic has raised our consciousness around proper handwashing and overall infection control,” noted Suen. In line with this increased concern for proper hygiene, audiologists can encourage patients to develop helpful habits such as wiping down hearing aids or other amplification devices daily, he suggested. They can encourage patients to check their user manuals for specific instructions on appropriate cleaning methods. Patients must be reminded to avoid alcohol-based disinfectants since they can dry out the silicone piece that's inserted into the ear canal and make them brittle over time.
Audiologists can also share tips with caretakers of patients with hearing loss. Alicia Arbaje, MD, MPH, PhD, writing for Johns Hopkins Medicine, offered these recommendations for caretakers of older adults with hearing loss:
- Keep yourself well through health and sanitation precautions.
- Teach and encourage patients to better use video chatting technology.
- For homebound elders, keep them involved in household projects and activities.
- Plan with the elder on how to manage interruptions in their routines and the possibility of getting sick.
Finally, Suen believes that just catching up with patients can go a long way.
“Going back to basics, simply contacting clients and their families to share that they're on your mind because you care about their well-being can be a powerful display of social solidarity and have a profoundly positive impact. In a collective sense, we could all benefit from a little bit of that solidarity right now.”
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