Hearing health in the broader context of healthy living and well-being: changing the narrative

Living a long and healthy life does not necessarily mean living without encountering adversity. Challenges are ubiquitous; thus, healthy aging may be about being resilient in the face of adversity and being able to manage changes or challenges. The World Health Organisation (WHO, n.d.-a, para. 3) describes healthy aging as “the process of developing and maintaining the functional ability that enables well-being in older age”. It encompasses upholding a person’s individual capabilities, as well as creating opportunities and environments, all of which allow people to do what they find important in life, and to be who they want to be (WHO, n.d.-a, paras. 1 and 2). The concept of “Well-being” has been gaining attention within the context of health care. Aiming for adaptation, resilience, and the highest possible level of well-being, for instance, has been put forward as the ultimate goal of population-level health services (Plough 2015).

Of course, there is a clear connection between well-being and the WHO (1948) definition of health: “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. While this definition has not changed since 1948 (WHO, n.d.-b), the concept of well-being, which lies at its core, does not have a consensus definition. The debate has given rise to opposing recommendations on how to measure well-being (e.g. see Ryff, Boylan, and Kirsch 2020; VanderWeele et al. 2020). These include objective and subjective measures of well-being. Objective well-being is typically assessed using variables that reflect standards of living, such as education, income, housing, or life expectancy (VanderWeele et al. 2020). Subjective well-being can be conceptualised in different ways, based on the so-called hedonic, eudaimonic, and evaluative conceptions of well-being (OECD. 2013; Ryff 1989; VanderWeele et al. 2020) and thus would be evaluated dependent upon the concept applied. Hedonic perspectives on well-being focus on the experience of positive emotions – such as contentment, happiness, or pleasure – and being without pain. Eudaimonic perspectives on well-being focus on the development of one’s own potential, and having a sense of purpose (Patel et al. 2018; Ryff 1989; VanderWeele et al. 2020). Evaluative perspectives on well-being relate to experiencing satisfaction with (different aspects of) life (Ryff 1989; VanderWeele et al. 2020). Despite these different views on well-being, it is generally agreed upon that well-being is a multidimensional construct and that there are cross-cultural differences to how well-being is experienced (Patel et al. 2018; Ryff, Boylan, and Kirsch 2020; VanderWeele et al. 2020).

While the concept of well-being has also been gaining attention in audiology (e.g. Heinrich et al. 2016; National Academies of Sciences, Engineering, and Medicine, 2016; Pichora-Fuller et al. 2013; Pierzycki et al. 2020; Wallhagen et al. 2004), we have yet to achieve a clear understanding of exactly what and how it should be measured pertaining to the domain of hearing loss. It seems obvious that there would be an association between well-being and hearing loss, as hearing loss affects so many aspects of life. Also, there is considerable discussion among members of the audiological community that suggests hearing care should move from focussing solely on perceptual impairment to include consideration of hearing loss in the broader context of health and well-being. In this special issue, we have brought together some of the recent work on well-being and hearing loss. We hope that it will encourage further discussion and collaboration aimed at supporting persons with hearing loss, their families, and clinicians.

This special issue consists of eight peer reviewed manuscripts, and a concluding discussion paper. By design, the manuscripts cover a wide range of topics, underscoring that hearing loss is linked to the well-being of people with hearing loss and their communication partners in multiple health domains, including social, emotional, physical, and cognitive health. The summaries below will help you navigate through the different articles.

Four articles in this special issue discuss psychosocial aspects of hearing loss, all of them with a link to clinical practice. There is a discussion paper by Clark, English, and Montano (2020) that calls for sharpened awareness of patient well-being in audiology practice – especially in terms of psychosocial difficulties that patients may experience beyond, or that are amplified by, hearing loss. This need is clarified by a number of case studies, including illustrative conversations that can increase clinicians’ confidence to recognise and address disparate concerns (e.g. elder abuse, cognitive decline, etc.). Bennett et al. (2020) investigate the perceived benefit and likelihood of use of 93 clinical approaches that were identified in a previous study to address the psychosocial impact of hearing loss. Their research highlights the importance of these clinical approaches, as recognised by both audiologists and adults with hearing loss. The research article by Ekberg et al. (2020) describes the development of an intervention for clinical audiology staff, aimed at increasing family member attendance and involvement in adult hearing rehabilitation – approaches that have the potential to enhance well-being, for patients and their family members. A scoping review by Bott and Saunders (2021) investigates the associations between social isolation, loneliness, and hearing loss/rehabilitation. In this paper, the authors discuss how social isolation and loneliness are constructs that deserve unique consideration and interact with healthy aging and well-being.

The next four articles address hearing loss as it relates to other factors of health. A literature review by Holman et al. (2021) highlights the importance of daily-life work, social, and physical activity levels for the complex relationships between hearing loss, hearing device use, listening-related fatigue, and well-being. Starting from a definition of workplace well-being then, a scoping review by Granberg and Gustafsson (2021) investigates working life for people with hearing loss. Their narrative review identifies three themes that contribute to workplace well-being in this population: (1) individual perspectives and experiences of persons with hearing loss; (2) the physical, organisational, and psychosocial work environment; and (3) the organisation of work, such as occupational sectors, and employment status. The research article by Nuesse et al. (2021) shows interrelationships between self-reported hearing-related quality of life in adults and health-related factors, such as age, frailty, mental health, and willingness to use hearing aids – urging to keep these in mind when providing hearing healthcare. A discussion paper by Wallhagen, Strawbridge, and Tremblay (2021) gives us an idea of what it means for healthcare systems when we put hearing loss in the broader context of health and well-being. The article summarises the associations between hearing loss and other health concerns to emphasise the need for a comprehensive hearing health care approach, with patient/family centred care and interprofessional coordination as key elements. It also familiarises us with the Age Friendly Health System initiative as a framework to move forward.

We end with a paper by Saunders et al. (2021), that is a call-to-action and reflection on next steps for the field of audiology. Interdisciplinary education and awareness, counselling education in audiology programs, and the inclusion of aspects of well-being in therapeutic goal setting and assessment of hearing outcomes are proposed as being steps necessary if audiology is to take a more holistic approach to hearing health care. It is noted that scope of practice and well-being of our clinicians must be considered in parallel.

Acknowledgements

The authors thank all authors and co-authors for their contributions, and Phonak AG for sponsoring open access publication of this supplement. It was a privilege to work together with all contributors, and we truly hope that you will find this special issue an inspiration for future collaboration and discussion.

Additional information

Funding

This work was supported by Phonak AG, Staefa, Switzerland.