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Age-related changes in hearing are normal. Around one-third of people between the ages of 65 and 74 and nearly half of people over 75 have hearing loss. Hearing loss affects all aspects of people’s lives, from answering the telephone to carrying on a conversation with a family member or friend. Hearing loss can be detrimental to socializing and may lead to increased isolation and feelings of depression. Furthermore, older adults with unmanaged hearing loss have an increased risk of cognitive decline and may be at higher risk of developing dementia.
Since hearing loss is so prevalent in elderly people, as a CNA you are sure to care for someone who is experiencing some form of hearing loss. Making some changes in the way you speak and how you interact with your patients can go a long way to make someone feel included and comfortable under your care.
Normal Hearing Changes
A certain amount of hearing loss is a normal part of aging. With age the eardrum thickens and the ability to process sounds decreases. There is also an increased tendency for the wax to build up in the ear canal in elderly people due to the decreasing function of hair fibers, which aid in removing ear wax.
Age-related Hearing Loss
The loss of high-frequency hearing is called presbycusis and is the most common form of hearing loss. Inside your ear are tiny hair cells that pick up sound waves and change them into nerve signals sent to your brain. If these small hairs are damaged or die, then hearing is affected. Many times, the damage to these hair cells occurs as a result of the combined effects of aging and overuse (exposure to loud noise). Other conditions such as diabetes and certain medications like chemotherapy also contribute to similar forms of hearing loss.
Often people with presbycusis are unable to hear high pitched sounds such as t, s, th, sh, z, ch. People with hearing loss also have difficulty isolating a noise in a loud environment. Background noise often adds to your patient’s communication difficulties and they may not be able to hear you if other people are talking nearby.
Effect on Communication
Changes in hearing can affect communication in many ways. They may require more time to process sound and interpret what is said and respond to you. They may have a hard time hearing high pitched voices and sounds such as the voices of women or children. They may have difficulty carrying on a social conversation in a crowded room such as a dining room. They may also have trouble using intercoms or telephones. Because of all these challenges patients may feel isolated, afraid or frustrated. They may feel left out of a conversation going on at lunchtime, or frustrated when trying to speak to a loved one on the phone.
Communication Strategies
There are many strategies to aid communication in elderly people with hearing loss.
Lip Cues
Even if they do not read lips many people with hearing loss use some form of lip cues to understand what is said to them. Try to optimize your patient’s ability to see your lips when communicating with them. Make sure to get your patient’s attention before speaking by touching an arm or shoulder before speaking. Make sure they can see your mouth and lips by positioning yourself at eye level and always facing the patient. Be careful not to cover your lips or mouth when speaking and be sure not to chew gum or eat while talking as this will distort your lips.
Stick to the familiar
People are much more likely to understand you if they are already familiar with the words you are using. Try to use familiar words and phrases, keep sentences short, and try to avoid small talk. Start conversations with a keyword or phrase to cue the patient. While jokes and puns are entertaining, they are often difficult to understand for people who are hearing impaired so keep the joking to a minimum.
Don’t shout
People with age-related hearing loss have a more difficult time hearing high pitched voices or sounds. Raising the volume of your voice often increases the tone, making it more difficult to hear. Also, shouting distorts your lips and makes it more difficult for your patients to understand what you are saying. Instead, speak in clearly in a low-pitched tone at a steady pace, not to fast or to slow.
Be Patient
Be patient and give your patient time to process what is said. Sometimes they may need to think about what you said before they respond so don’t immediately jump in, give them some time.
Abrupt subject changes should be avoided as well. It is already difficult to follow a regular conversation, let alone one that is bouncing around from subject to subject. Stick to one topic and wait a little before changing the subject.
If the patient doesn’t understand what you said rephrase rather than repeat the same words over and over. Chances are they are not going to understand you no matter how often you repeat the same words, but sometimes saying something differently may be easier to understand or may provide more clues to what you are saying.
Reduce background noise
Most people with hearing loss have difficulty isolating one voice from other sounds in the room. Before speaking to your patient make sure to reduce background noise from TV or radio or take the patient to a quiet place to have a conversation.
Use tools
Using all tools available for communication is essential. If they use a hearing aid, make sure the batteries are working, and they are cleaned regularly and functioning correctly. Many people, however, don’t like using hearing aids so consider using a hearing amplifier if the patient is unwilling or unable to use hearing aids. A hearing amplifier is a little microphone attached to earphones that the patient wears. This device not only amplifies the sound but allows the patient to identify your voice in a noisy room if you speak directly into the microphone.
When all else fails, make sure to keep a pad or pencil or dry erase board handy to write down anything the patient is not able to understand. Also, make sure to evaluate their ability to use the telephone or intercom before such interaction is required. You would not want the patient in an emergency when you realize that they are unable to use these devices.
Communication with people with hearing loss can be tricky. Understanding your patient’s limitations and needs will go a long way to understanding how to communicate with them. By using a few strategies, you can help your patients become more social and reduce feelings of loneliness and depression.