Susan Richmond, AuD, CCC-A Metro Hearing

Transcription

1 MANAGING DAY-TO-DAY FUNCTIONAL CHANGES IN THE AGING PATIENT HEARING LOSS: AGING EARS AND AGING BRAINS Susan Richmond, AuD, CCC-A Metro Hearing Learning Objectives: Describe functional and social impacts of hearing loss on older adults and their communication partners. Review audiologic assessment, hearing technologies, and the potential applications of both. Recognize the relationship between hearing loss and cognition in aging adults. DISCLOSURE OF COMMERCIAL SUPPORT Susan Richmond, AuD, CCC-A does have a significant financial interest or other relationship with manufacturer(s) of commercial product(s) and /or provider(s) of commercial services discussed in this presentation. Employment: Employee, Metro Hearing 1

2 Aging Ears and Aging Brains Hearing Loss and its Impacts on Older Adults Arizona Geriatrics Society 2015 Fall Symposium Susan A. Richmond, AuD, CCC-A Clinical Audiologist, Metro Hearing Human Hearing Peripheral Auditory System 2

3 Inner Ear High pitch Low pitch Central Auditory Anatomy Contributing Factors to Hearing Loss Aging ( Presbycusis ) Noise exposure Genetics Circulatory problems or events Viral or bacterial infections Trauma Structural damage Ototoxicity Auto-immune conditions 3

4 Categorizing Hearing Issues Peripheral Conductive (outer or middle ear structures) Sensorineural (cochlea and/or auditory nerves) Mixed (conductive + sensorineural) Central Auditory processing dysfunction ( listening or what we do with what we hear A Note on Sudden Hearing Loss If no clear indicators of outer/middle-ear issues, sudden sensorineural loss must be considered Often, but not always, accompanied by tinnitus or dizziness Steroid treatment may be indicated Time may be of the essence Impacts of Hearing Loss 4

5 Possible Consequences Tinnitus Sensitivity to loud sound (recruitment) Reduced awareness of surroundings Irritability, frustration, stress, paranoia Fatigue Social embarrassment and misunderstandings Just smile and nod! Withdrawal, avoidance Exacerbation of other disorders memory loss, dementia, anxiety Denial of Difficulty Many older adults with significant hearing impairments tend to deny the extent of their hearing loss and to believe that they do not need treatment. (NCOA, 1999) Tendency to under-rate difficulties in self-reports (Joore et al, 2002) May lead to response shift after experiencing intervention Or, I didn t realize how much I ve been missing Hearing difficulty is common, but not normal When one person has a hearing loss the whole family has a hearing problem. -- Mark Harris 5

6 Quality of Life In hearing aid non-users vs users, significantly higher reports of Sadness and depression Worry, anxiety, insecurity, paranoia Reduced social activity Improvements in perceived communication and social interaction on surveys (NCOA, 1999); also on QoL / handicap scales at multiple intervals post hearing-aid fitting (McCardle et al, 2005) Relationship to Cognition Effortfulness hypothesis (Tun et al, 2009) Expending extra effort decoding sensory input leaves fewer resources for processing/retention Those receiving earlier intervention (i.e. hearing aids) may outperform un-aided peers (Obuchi et al, 2011) Relationship to Dementia Lin et al (2011) showed significant correlation of incidence of HL and dementia Independent of sex, race, education, diabetes, smoking, hypertension Gurgel et al (2014) showed increased rate of developing dementia and more rapid decline on 3MS-R in those with HL Controlled for gender, education, baseline age, and cardiovascular risk factors 6

7 Intervention Intervention Hearing loss should be a routine topic of discussion for older persons and their doctors (NCOA, 1999) Start with a comprehensive audiology evaluation Can be covered by Medicare Part B with a script from physician; device coverage depends on insurance Seek hearing care professionals Know what Audiologists offer vs Hearing Aid Dispensers Pursue medical treatment, if indicated Common Adult Audiological Evaluations Loud VOLUME Soft Low PITCH High 7

8 Professional Support Hearing aids cannot make people talk slower or turn to face you, or completely remove background noise Realistic expectations are important However, with professional support, appropriate devices Optimize residual hearing Emphasize the sounds of conversation Provide stimulation to central auditory system (aka use it or lose it. Real-Ear Measurement Measuring output of hearing aids in a patient s ear Avoids errors based on average ears Can verify audibility at a safe level Standard of care for past several years Fitting verification mandated by state law hearingresearch.org Directional Microphones Improving focus in background noise Automatic in most new hearing aids ihsinfo.org 8

9 Wireless Technologies Ear-to-ear Convenient manual controls Binaural processing A pair of hearing aids as opposed to two individual aids Can help with localization, noise Accessories Remote control Connectivity (Bluetooth, Made for iphone) Companion microphone Digital Frequency Lowering Can improve access to high-frequency speech information Tinnitus Management Hearing aids have long been recommended for tinnitus intervention Most manufacturers now offering active features Sound generation(masking noise, chimes, ocean sounds) Typically set by audiologist with some user control 9

10 Beyond Traditional Hearing Aids Osseo-integrated devices (aka BAHA) CROS / BiCROS Middle-ear hearing aids Cochlear implantation Aural rehabilitation Care Doesn t Begin or End with Devices Understand patient s hearing loss, lifestyle, and budget to make appropriate recommendations Dispensing according to current best practices Follow-up visits within trial period Routine follow-up / maintenance visits Periodic re-evaluation Thanks for listening! Susan A. Richmond, AuD, CCC-A sr@metrohearing.com Glendale Phoenix Sun City Sun City West Goodyear 10

11 Academic References Gurgel et al (2014). Relationship of hearing loss and dementia: a prospective, population-based study. Otol Neurotol. 35(5): Joore et al (2002). Response shift in the measurement of quality of life in hearing impaired adults after hearing aid fitting. Quality of Life Research 11: Lin et al (2011). Hearing loss and incident dementia. Arch Neurol. 68(2): McCardle et al (2005). The WHO-DAS II: Measuring outcomes of hearing aid intervention for adults. Trends in Amplification 9(3): Obuchi et al (2011). Age-related changes in auditory and cognitive abilities in elderly persons with hearing aids fitted at the initial stages of hearing loss. Audiology Research 2011; 1:e11 National Council on Aging (1999). The consequences of untreated hearing Loss in older persons. Retrieved from Tun et al (2009). Aging, hearing acuity, and the attentional Costs of effortful listening. Psychol Aging 24(3): Recent Media Coverage Stein, Anne (2015, Jan 25). Studies show link between hearing loss, mental decline. Chicago Tribune. Retrieved from lifestyles/health/sc-health-0121-hearing-lossdementia story.html Brody, Jane (2015, Sept 28). Hearing loss costs far more than ability to hear. New York Times. Retrieved from hearingloss-costs-far-more-than-ability-to-hear 11