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According to the National Institute on
Deafness and other Communication Disorders, one in three
individuals over the age of 60 and half of those over the age of
85 will have hearing loss. The hearing loss associated with
aging is called presbycusis or high frequency, sensory neural
hearing loss. It is insipid and gradual. For most hearing
impaired adults, their hearing loss began when they were in
their late 40’s or early 50’s. It is binaural, permanent and
invisible.
Common symptoms of presbycusis are:
-
“I don’t have a hearing loss!” Denial is the number one
symptom of age related hearing loss. Hearing loss has very
strong connotations in our youth oriented culture of being OLD,
and old is BAD.
-
“I hear just fine, it’s just that everybody mumbles.” In
fact, they are right. Everybody does mumble - because we can. We
spent a lifetime speaking rapidly, slurring our words and
mumbling without it ever interfering with conversation. The
normal ear is such a phenomenal sense organ, it can organize
even the most distorted sounds into a comprehensible signal.
-
“What?” This becomes such an automatic response when
something isn’t heard or understood that the hearing impaired
adult won’t even notice that they are using it in every other
sentence in a conversation.
-
“What did he say?” This is a corollary to number 3. It is the
common ‘hearing aide’ for spouses.
The sense of hearing is our most complex sense organ and
probably the most poorly understood by the average person. The
confusion comes from the fact that even someone with a severe,
high frequency, sensory neural hearing loss can still hear. If
an individual couldn’t see, they would understand they had a
problem with their vision. Logically, if they had a problem
with their hearing they assume it would mean they couldn’t hear,
but they can. Consequently, it is natural for someone to deny
they have a hearing loss even with severe presbycusis.
There are other serious communication issues caused by
presbycusis. The most debilitating is the diminished ability to
filter speech from background noise. If there are any auditory
distractions in the room, understanding conversation can be
almost impossible. Another side effect is recruitment - an
abnormal growth in loudness. If you intensify the volume of
your voice slightly, to the person with presbycusis, you will
sound like you are shouting. Tinnitus (ringing in the ears) is
also common with this type of hearing loss. Not only will
someone be struggling to hear you above the noise in the room,
they will be fighting against the noises in their head.
There are many psychosocial issues for the individual with
presbycusis which, when manifested, may be attributed to other
causes depending on the professional lens through which they are
being examined. It is amazing that older adults will be given a
so-called thorough physical exam and there will be no evidence
of an audiogram in the chart. “Mr. Jones, how’s your hearing?”
“Fine, Doc.” End of discussion!
Hearing loss is a major contributor to
depression in seniors. They become so frustrated by social
encounters, going to the movies, talking on the phone, etc.,
that they will begin to withdraw and isolate themselves. They
become angry, stressed, and cranky. Older adults with severe
hearing loss are at higher risk for suicide. They suffer a loss
of confidence, especially from the admonishments of their
children, “Are you deaf?” “You only hear what you want to
hear.” They can appear to suffer from dementia because they may
be answering a question that wasn’t even asked. I once asked my
Dad, “How’s business?,” and his response was, “Tickets?! What
tickets?! No one told me I was supposed to pick up tickets!”
There are some simple guidelines that can
be observed to ensure that we are effectively communicating with
parents (and friends!). There isn’t a single older adult who
wouldn’t benefit from these suggestions, whether they are
hearing impaired or not.
- Speak more slowly, not louder. If you slow your speech down,
you will automatically enunciate more clearly.
- Get closer. When engaging in face to face communication, be
no more than four feet apart. For older adults with whom you
communicate over the telephone, periodically assess their
comprehension of what you are saying. If they are truly
challenged by the telephone, recommend they get a handset
amplifier.
- Get their attention. Calling someone by name is a good way to
focus their attention. If you walk into a room and begin
speaking to someone, you may be halfway through your
conversation before they realize you are even speaking to them.
- Be aware of the environment. Reduce background noise as much
as possible. If it is difficult to eliminate background noise,
do not communicate in the middle of a noisy room. Move to the
side of the room and situate the person with the hearing loss so
their back is to the wall. You have just eliminated 180 degrees
of auditory distractions. If possible, leave a noisy room and go
to quieter surroundings.
- Be on the same level. If you are talking with someone who is
sitting, sit.
- Be conscious of what’s behind you. It is difficult for
someone to pay attention to you if they are fighting the glare
of a sunny day behind your back.
There is no cure for
sensory neural hearing loss. Our best treatment, hearing aids,
have their limitations. Unlike glasses which give us normal
vision, hearing aids do not give us normal hearing. Hearing
aides are simply amplifiers. Successful hearing aide users are
highly motivated to make the communication accommodations
necessary for their hearing aides to be effective. However,
delaying hearing aide usage until your hearing is “really bad,”
can negatively impact your successful adjustment in the long
run.
In conclusion, a hearing test performed by an audiologist should
become part of our regular physical exam. If you are not having
any hearing loss symptoms now, I recommend having your first
baseline exam between 50 and 55 years of age, then every two
years after that.
Sherry Netherland is available for seminars for community and
professional groups, Corporate Wellness Programs, or as a
keynote speaker for your organization.
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