Promoting hearing and cognitive health in audiologic rehabilitation for the well-being of older adults

Figures & data

Table 1. Minimum HCP competencies for working with people who may have some degree of cognitive impairment.

1. Person-centered and understand the unique needs of each individual patient/client.

2. Comfortable having a conversation about a brain-healthy lifestyle and the importance of good hearing and sensory input.

3. Understand the trajectory of cognitive decline from changes associated with normal ageing to dementia.

4. Understand and communicate responsibly on the connection between hearing status and cognitive decline, and the role of hearing interventions (no causal relationships have been established so we must be careful to not mislead clients or to set unrealistic expectations).

5. Able to use communication technologies including thoughtful seating arrangements and body language, and identify psychosocial needs, symptoms, and patient priorities.

6. Appreciative of management goals when working with people with cognitive decline and why hearing health is relevant (e.g. engaging in activities that give meaning and purpose is a critical goal and optimising auditory function can assist in realising this goal).

7. Familiar with how to communicate effectively with people with cognitive impairment and their family members.

8. Able to identify whether the patient/client has the capacity to make decisions on his/her own regarding the purchase of hearing technologies or surgical intervention with cochlear implants.

9. Understand the needs of people with cognitive impairment (e.g. need to be included, need to be valued).

10. Have referral pathways for clients with sensory loss and cognitive impairment, as well as for caregiver support.

Figure 1. Infographic: Dementia, a public health priority, (WHO, 2019a).

Figure 2. Intervention options in audiology by cognition trajectory from normal ageing to dementia by a Public Health Prevention Approach; adapted from Powell et al. 2021).

Table 2. Selected non-pharmacologic management goals for older adults with hearing loss; adapted from (Jennings et al. 2017).

1. Providing opportunities for, and engaging in, social activities for emotional well-being and maintaining independence

2. Individualising care

3. Enhancing cognition, mood and behaviour and maximising the ability to communicate

4. Reducing stress on family members associated with communicative and processing challenges

5. Providing a safe environment in the home (e.g. wear hearing aids, cochlear implants when home)

6. Maximising quality of life

7. Validating and incorporating the subjective perceptions and experiences of your clients

8. Adapting how to communicate as the client’s ability to communicate evolves

9. A dignified life despite auditory deficits

Table 3. Format of appointment letter (modified from Dawes et al. 2022 Jul-Aug 01).

When the appointment will take place: The appointment will take place over two brief sessions on __________

Where the appointment will take place: Name of building and room number and perhaps any signage that could be helpful

Who will accompany the patient to the appointment: It is important that a family member accompany Mr. Smith to help outline hearing needs in daily life and to assist in decisions regarding treatment options.

What the appointment will entail: At the first appointment a hearing test will be performed and an overview of findings will be discussed including an outline of an action plan. At the second appointment, details of hearing care intervention options will be discussed in detail and initial steps will be taken to manage hearing difficulties uncovered

Recommended communication strategies: Always face the person with hearing loss; Get the person's attention before you begin to speak; Make sure to be in the same room when communicating.

NOTE: The office will call to confirm the appointment. Please make sure a family member accompanies the patient for the hearing test.

Table 4. Evidence-based suggestions for optimising hearing aid use (adapted from Hooper, et al. 2022).

Domains	Barriers	Facilitators/enablers
Handling skills and fit	Difficulty handling, removing, inserting, and maintaining; Uncomfortable fit.	Being able to handle hearing aids proficiently; comfortable fit; being able to maintain; using compensatory strategies to optimise handling.
Environmental/listening context and resources	Lack of financial resources; Excessive noise in the home; Perceived lack of need in differing listening situations at home; Presence of circumstances at home that may discourage the development of skills and abilities.	Having a set place for storage; Rehabilitation that targets how to use hearing aids in real-life situations to improve functioning in areas meaningful to the patient; Goal-oriented targets; Family members or other supporters who work collaboratively to help choose relevant and meaningful goals relating to everyday activities.
Psycho-social influences	Lack of a SO/care partner or a care partner with poor handling skills; Poor memory-misplaces hearing aids; Lack of self-efficacy; Lack of confidence in the ability to succeed with hearing aids; Forget to use hearing aids; Resistance to change; Short attention span; Concern about visibility of hearing aids.	Experiencing positive consequences from hearing aid use; Teaching SO/care partner good handling skills; Receiving social reinforcement in the form of prompts and encouragement; Positive relationships with the practitioner; Encouragement and support of the clinician; If poor memory and ability to retain information, provide this to SO/care partner; Habitual routines in terms of use and storage; High confidence in ability to handle hearing aids; Provide knowledge and awareness of the presence of disabling hearing loss; Support for belief in client’s physical and cognitive ability to engage and to participate; Identification of goals re hearing aid use; Development of strategies to maintain independence, social competence, and adaptive behaviour
Reinforcement	Little motivation to communicate due to difficulty understanding even with hearing aids.	Presence of a significant other or care partner with optimism; External prompts; Proactive partner; Improved knowledge about hearing aid use and maintenance from audiologist to enable users.

Table 5. Strategies which can reduce the communication challenges attending appointments with older adults with hearing loss, with and without/cognitive impairment.

• Focus on what people can do rather than what they cannot do

• Offer a couple of options/choices you know they would like

• Break down requests into simple steps

• Identify distractions in the person’s environment and try to minimise them

• Reduce background noise (turn down the television, the radio, or stereo when communicating)

• Make eye contact to help focus their attention

• Speak clearly, using short and simple sentences

• When speaking, use actions to help give meaning to what you are saying; communicate through the senses using touch

• Be flexible and encouraging

• Stay positive - connect instead of direct

• Communicate in quiet settings as much as possible

WHO 2019a. Integrated care for older people (ICOPE): guidance for person-centred assessment and pathways in primary care Retrieved 11 April 2022, from https://www.who.int/publications/i/item/WHO-FWC-ALC-19.1

 Google Scholar

Jennings, L. A., A. Palimaru, M. G. Corona, X. E. Cagigas, K. D. Ramirez, T. Zhao, R. D. Hays, N. S. Wenger, and D. B. Reuben. 2017. “Patient and caregiver goals for dementia care.” Quality of Life Research: An International Journal of Quality of Life Aspects of Treatment, Care and Rehabilitation 26 (3):685–693. https://doi.org/10.1007/s11136-016-1471-7

 PubMed Web of Science ®Google Scholar

Dawes, P., J. Littlejohn, A. Bott, S. Brennan, S. Burrow, T. Hopper, and E. Scanlan. 2022 Jul-Aug 01. “Hearing assessment and rehabilitation for people living with dementia.” Ear and Hearing 43 (4):1089–1102. https://doi.org/10.1097/aud.0000000000001174

 PubMed Web of Science ®Google Scholar

Hooper, E., L. J. Brown, H. Cross, P. Dawes, I. Leroi, and C. J. Armitage. 2022. “Systematic review of factors associated with hearing aid use in people living in the community with dementia and age-related hearing loss.” Journal of the American Medical Directors Association 23 (10):1669–1675.e16. https://doi.org/10.1016/j.jamda.2022.07.011

 PubMed Web of Science ®Google Scholar