Emerging and Existing Hearing Solutions
for Nursing Home Populations
Natalye M. Faison Au.D.
Audiologist/Trainer
Panasonic Healthcare Group
Agenda
• Prevalence rates of hearing impairment/ hearing
aid use in older adults
• Problems facing hearing impaired, nursing home
residents
• Solutions
• Consumer resources
Hearing aid use in older adultsA literature review
Statistics
•Hearing impairment is the third most commonly
reported chronic problem affecting the aged
population
•Greater incidence of hearing loss in nursing
homes. Why?
Yet….
•It is reported to be the most frequently
unrecognized condition in patient’s with
Alzheimer’s disease
•3 out of 5 older American’s do not use hearing
instruments
National Counsel on Aging (1999)
Hearing Aid Users and Family Members Reporting Improvements from Hearing Aid Use
Hearing Aid users (%)
Family members (%)
70
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20
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The National Council on the Aging. (1999) The Consequences of Untreated Hearing Loss in Older Persons. Washington, DC: Author. Retrieved from
http://www.ncoa.org
Hearing loss left untreated can cause…
•
•
•
•
•
•
Sadness/depression
Worry/anxiety
Social isolation
Insecurity
Auditory deprivation
Diminished cognitive function
Department of Otolaryngology, Johns Hopkins School of Medicine and the
Center of Aging and Health (2011)
Purpose: To investigate the association between hearing
loss and cognitive function in a nationally representative
sample of older adults
Subjects: 605 participants ages 60-69 years that were
included in the Nat’l Health and Nutritional Examination
Survey
Methods: Audiometric data and scores from the Digit
Symbol Substitution test (DSST) were analyzed to
determine if there is a correlation between hearing loss
and cognition. Data were obtained from the 1999-2002
cycles of the Nat’l Health and Nutritional Examination
Survey
Department of Otolaryngology, Johns Hopkins School of Medicine and the Center of Aging and Health. (2011). Hearing loss and cognition among older
adults in the United States. J Gerontol A Biol Sci Med Sci. 2011 October; 66A(10):1131-1136DOI:10.1097/01JAM.0000136962.50070.F6
DOI: 10.1093/gerona/glr115
Digit symbol substitution test (DSST)
A measure of attention, perceptual speed, motor speed,
visual scanning and memory. The subject is given a
piece of paper with nine symbols corresponding with
nine digits. Next on this piece of paper are three rows of
digits with empty spaces below them. The subject is
asked to fill in as many corresponding symbols as
possible in 90 seconds.
#
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!
*
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=
Department of Otolaryngology, Johns Hopkins School of Medicine and the
Center of Aging and Health (2011)
Conclusion: Greater hearing loss was significantly
and independently associated with lower scores
on the DSST after adjustment for demographic
factors and medical hx.
Hearing aid use was significantly associated with
higher cognitive scores on the DSST (small
sample size)
Department of Otolaryngology, Johns Hopkins School of Medicine and the Center of Aging and Health. (2011). Hearing loss and cognition among older
adults in the United States. J Gerontol A Biol Sci Med Sci. 2011 October; 66A(10):1131-1136DOI:10.1097/01JAM.0000136962.50070.F6
DOI: 10.1093/gerona/glr115
Department of Otolaryngology, Johns Hopkins School of Medicine and the
Center of Aging and Health (2011)
Discussion
• Suspect a shared (but unknown) neuropathologic
etiology
• Artificially induced hearing loss does not yield the same
correlation
• Hearing loss can lead to social isolation in older adults .
Studies have linked poor social networks and decline
cognitive function and dementia
• Cross-sectional data vs. longitudinal study
Department of Otolaryngology, Johns Hopkins School of Medicine and the Center of Aging and Health. (2011). Hearing loss and cognition among older
adults in the United States. J Gerontol A Biol Sci Med Sci. 2011 October; 66A(10):1131-1136DOI:10.1097/01JAM.0000136962.50070.F6
DOI: 10.1093/gerona/glr115
Documented benefits of amplification for individuals with
Dementia Cohen-Mansfield & Taylor (2004)
• “Decrease in communication-related problem behaviors
(making negative statements, forgetting, repeating
questions, saying “I can’t hear you”).” Cohen-Mansfield &
Taylor (2004)
• Increase in alertness, more interactive and paid more
attention to environmental stimuli
• Improvement in orientation after 3 months of hearing aid
use
Cohen-Mansfield & Taylor (2004)
Purpose:
Assess rates of hearing
impairment and hearing aid
use among residents in a large
(562 beds) nursing home.
Subjects: Gender
21%
Male
Female
79%
Subjects:
• 279 resident/caregiver pairs
(average age 86.7)
• 16 nurse managers
• 44 certified caregivers
Avg. MDS Cognition Scale
32%
34%
Not Impaired
Moderately
Impaired
Severely Impaired
34%
Cohen-Mansfield & Taylor (2004)
Method Prevalence of hearing loss
• Structured interviews of residents
• Questionnaires from residents
• Structured interviews of caregivers
• Chart review
• Data from MDS
Cohen-Mansfield & Taylor (2004)
Results Prevalence of hearing loss
• 53% hearing impaired as ascertained by
self-report, MDS, nurses report,
researcher observation
• According to chart review; nearly 81% of
residents had not received any evaluation
or audiologic care despite having an
Audiologist consultant
Cohen-Mansfield & Taylor (2004)
Results: Hearing aid use
• 12% as reported by the nursing staff/MDS
• 17% as reported by researchers
Cohen-Mansfield & Taylor (2004)
Discussion
• Major under-detection of hearing impairment by
nursing staff
– Lack of staff awareness
– Insufficient screening of residents
• Under-use of hearing aids
• Lack of other assistive listening devices
• Inconsistent reporting
Barriers to Hearing Aid Use
Barriers to hearing aid use among hearing aid and non hearing
aid users
Cohen-Mansfield & Taylor (2004)- Part 2
Societal-Level BarriersBarriers associated with
policy/laws
Institutional- Level BarriersBarriers associated with the
policies and practices set
forth by the nursing home
Societal
Institutional
Individual- Level BarriersBarriers identified by the
hearing impaired individual,
caretaker, dispenser, family
Individual
Individual- level barriers
•
•
•
•
•
•
•
•
•
•
•
Cannot tolerate sound quality
Cannot tolerate physical fit
Loss
Unable to maintain hearing instruments
Cost
Unaware hearing loss exists
Not profitable
More time required for AR
Resident refusal to wear the hearing aid
Lack of knowledge about amplification
Fearful to be responsible
Institutional- level barriers
•
•
•
•
Lack of policy related to ENT/Aud referrals
Oftentimes there is not Audiologist on site in a private nursing home
No on site training
Lack of delegation of responsibility
– Screening
– Referral
– Hearing aid maintenance
• No tools needed for care
– Battery testers
– Otoscopes
Societal- Level Barriers
• MDS requirement- Assessment by means of interview,
observation and staff/family consultation
• Cost for amplification
• Medicare/Medicaid reimbursement
• Private insurance coverage
Hearing Solutions for Nursing Home
populations
Hearing Aid Styles
Custom Hearing Instruments
Completely
in the Canal
Mini Canal
•Smaller in size
•Shorter battery life
•Limited fitting
range
In the Canal
Half Shell
•Limited real estate
for added features
•Made specifically
to fit one ear
In the Ear
•Might be more
susceptible to
damage from
moisture and debris
Hearing Aid Styles
Non- Custom Hearing Instruments
Behind the ear
Receiver in the
canal
•Larger in size
•Longer battery life
•Flexible fitting range
•Less susceptible to
damage
Body Aid
•Typically all features
are available
•Can be specifically to
fit one ear
•Not as easy to
misplace
Implantable
Devices
• Cochlear Implants
and BAHA
Hearing Aid Technology/ options
•Technological considerations
•Analog vs. Digital,
•Pwr/Gain
•Number of channels
•tcoil
•Directional Microphones
• Noise Reduction
•Bluetooth accessories
•Feedback Reduction
•Automatic/manual
• CROS technology
•Frequency transposition
•Implantable device
•ALD use
Directional Microphones
Front
Cardioid
Figure 8
Left
Right
Back
Omni directional
Noise Reduction
≠
Telecoil
• Advantages
– Inexpensive
– Available in most types of hearing aids (not CIC)
– Blocks out unwanted background noise that the
hearing aid microphone would usually amplify
• Disadvantages
– Electromagnetic Interference
Hearing Aid options
• Features/ add-ons
– Telecoil
– Bluetooth
– FM
– Remote
Additional options
• Identification
– Color coding hearing aids or earmolds (nail polish
works)
Right
Left
– Initials/name/ID number etched into shell or case of
hearing aid
NMF
Additional Options
• Retention
– Scandent http://www.scan-dent.com/why.html
– Fish line
Eargear
– Ear gear http://www.gearforears.com/
– Double sided tape/toupee tape/ roll on adhesives
– Loop ‘em or Lose ‘em- connects hearing aid to
eyeglasses
– Lanyards/fish line
– Huggie Aid
Loop ‘em
Additional Options
• Comfort
– Cushion-Aid pads
– Hypo allergenic coating
– Phone pads
– Contac HCP if resident reports hearing aid is
uncomfortable (indicate position of pressure sore on
instrument or earmold)
Hearing Aid Maintenance
Batteries
• Battery testers
• Zinc air tabs
• rechargeable
• Opening battery door
Cleaning/storing
10A
312
13
675
Hearing Aid Maintenance
Troubleshooting
1. Check for visible
debris in the mold
or microphone
2. Replace battery
(check placement)
3. If possible check
patient’s ear
Assistive Listening Devices
Assistive listening devices
Receiver
NOISE
Microphone/
Transmitter
Assistive Listening Devices
Receiver options for use without hearing
instruments
Ear level FM
Personal Sound
Amplifier
Desktop amplifier
Assistive Listening Devices
Receiver options for use with hearing
instruments (BTE)
Ear-level or
integrated FM
Direct audio input
Assistive Listening Devices
Induction devices
Phone
Silhouette
Neckloop
Silhouette
Assistive listening devices
• Room looping
Assistive listening devices
• Alerting Devices
– Tactile:
– Visual:
– Auditory:
Assistive Listening Devices
• Amplified phones
– Good alternative to use with and without hearing aids
– Can usually connect directly to hearing aids via
Bluetooth
• Mobile devices
– Simple amplification of sounds
– Adjustable response based on results of an built-in
hearing test
– Memo recording (allows replay)
– Use with caution
Consumer resources
Hearing Loss Association of America (HLAA)
www.hearingloss.org
Better Hearing Institute
www.bettterhearing.org
Healthfinder
www.healthfinder.gov
Tec Ear
www.tecear.com
American Academy of Audiology
www.audiology.org