Emerging and Existing Hearing Solutions for Nursing Home Populations Natalye M. Faison Au.D. Audiologist/Trainer Panasonic Healthcare Group

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 adults- A 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

0

10

20

30

40

50

60

70

Relationships at home

Feelings about myself

Life overall

Mental health

Self-confidence

Relationships with my children/grand...

Willing to participate in group activities

Sense of independence

Sense of safety

Ability to play card/board games

Social life

Physical health

Dependence on others

Hearing Aid users (%) Family members (%)

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.F6DOI: 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.

# % > + $ ! * ? =


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)



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


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: • 279 resident/caregiver

pairs (average age 86.7)• 16 nurse managers • 44 certified caregivers

Subjects: Gender

79%

21%

Male

Female

Avg. MDS Cognition Scale

32%

34%

34%Not Impaired

ModeratelyImpaired

Severely Impaired


Method Prevalence of hearing loss• Structured interviews of residents • Questionnaires from residents• Structured interviews of caregivers• Chart review• Data from MDS


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


Results: Hearing aid use• 12% as reported by the nursing staff/MDS• 17% as reported by researchers


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

Societal-Level Barriers- Barriers associated with policy/laws

Institutional- Level Barriers- Barriers associated with the policies and practices set forth by the nursing home

Individual- Level Barriers- Barriers identified by the hearing impaired individual, caretaker, dispenser, family

Individual

Institutional

Societal

Cohen-Mansfield & Taylor (2004)- Part 2

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 InstrumentsCompletely in the Canal

Mini Canal

In the Canal

Half Shell In the Ear

•Smaller in size

•Shorter battery life

•Limited fitting range

•Limited real estate for added features

•Made specifically to fit one ear

•Might be more susceptible to damage from moisture and debris

Hearing Aid Styles

Non- Custom Hearing Instruments

•Larger in size

•Longer battery life

•Flexible fitting range

•Less susceptible to damage

•Typically all features are available

•Can be specifically to fit one ear

•Not as easy to misplace

• Cochlear Implants and BAHA

Behind the ear

Receiver in the canal

Body Aid Implantable Devices

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

Figure 8

Omni directional

Cardioid

Front

Back

Right

Left

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)

– Initials/name/ID number etched into shell or case of hearing aid

Right Left

NMF

Additional Options• Retention

– Scandent http://www.scan-dent.com/why.html– Fish line– 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

Eargear

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

Troubleshooting1. Check for visible

debris in the mold or microphone

2. Replace battery (check placement)

3. If possible check patient’s ear

Assistive Listening Devices

NOISE

Assistive listening devices

Microphone/Transmitter

Receiver


Personal Sound Amplifier Desktop amplifier

Receiver options for use without hearing instruments

Ear level FM


Ear-level or integrated FM

Receiver options for use with hearing instruments (BTE)

Direct audio input


Neckloop Silhouette

Phone Silhouette

Induction devices


• Room looping


• Alerting Devices– Tactile:– Visual:– Auditory:


• 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 resourcesHearing Loss Association of America (HLAA)www.hearingloss.org

Better Hearing Institutewww.bettterhearing.org

Healthfinderwww.healthfinder.gov

Tec Earwww.tecear.com

American Academy of Audiologywww.audiology.org

Documents

Emerging and Existing Hearing Solutions for Nursing Home Populations Natalye M. Faison Au.D. Audiologist/Trainer Panasonic Healthcare Group