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The Challenges in
Audiology for Patients
with Dementia
Emily Frost
Adult Audiology Clinical Lead
PhD Student - Hearing Loss and Dementia
Imperial College Healthcare NHS Trust
Discussion Points
• Significance of hearing loss
• The Audiology Service
• Challenges at each stage for a person with dementia
• Role of hearing loss in dementia assessments
• What can we do to improve?
Vital Statistics
• 11 million people in the UK
have hearing loss.
• By 2035 there will be approximately
15.6 million.
• People wait on average 10 years before
seeking help for their hearing.
• GPs fail to refer 30-45% to NHS audiology services.
• Hearing loss may increase the risk of dementia
by up to 5 times.
• Around 40% of people who need hearing aids actually wear them.
Action on Hearing Loss, (2015)
Living with a Hearing
Loss
Lin, (2011)
Social Withdrawal
Isolation
Depression
Participants with a mild, moderate and severe hearing loss had a 2,
3 and 5-fold increased risk of dementia compared to normal hearers
after 10 years of follow-up.
?
Access to Services The Challenges…
• Direct Access Service
• Audiology is an AQP Service
• E-Referral System
Access to Services The Solutions…?
• Community Services
• Domiciliary Service
• Vulnerable patients discharge policy
Assessment
• 45 Minute Appointment
• Detailed History
- Red Flags
- Patient-Centred Approach
• Ear Examination
- Wax Removal
Assessment
• Pure-Tone Audiometry
I’m going to give you this button to hold,
I would like you to press the button every
time you hear a beep,
even if that beep is very quiet.
I’m now going to play a rushing sound into
one of your ears, I would like you to ignore
the rushing as much as possible and press
only when you hear the beeps.
Assessment
• Results
- Audiogram
• Management
- Often Hearing Aids
• Type of Hearing Aid?
- Severity of HL
- Manual dexterity
- Eyesight
- Patient preference
Treatment
• 60 Minute Hearing Aid Fitting Appointment
• Set the hearing aids up
• Real Ear Measurements
• Fine-Tuning
• Subjective testing
• Rely on patient feedback
https://www.youtube.com/watch?v=F9n6b3Yy5Sg
Treatment
• Give instructions
- Can be simplified
On/Off
Changing batteries
Right/Left
Using the phone Cleaning
How to put hearing aids in and take them out
Volume Control
Loop System
• Practise
Treatment
INFORMATION OVERLOAD!
• Batteries
• Battery Book
• Instructions
• Cleaning Wires
• Boxes
Follow Up
• 30 Minute Appointment
• 6-8 weeks after fitting appointment
• Check use
• Answer questions
• Fine-Tune
• Explain after-care
Aftercare
• Batteries
• Re-tubing every 6 months
• Troubleshooting
• Self-management
The Hearing Aid in the
Drawer…
• What happens next?
1. The hearing aids aren’t comfortable
2. Expectations
3. Difficult to maintain
4. Stigma
5. The hearing aids weren’t useful
Lost Hearing Aids
• Hospital Admissions
• Care Homes
• Carers
• Misplaced
Hearing Loss in
Cognitive Assessment
• Hearing Loss and Cognitive Impairment
are often mistaken for each other.
• Is hearing screened in assessments?
• How many of the questions in the
assessments are delivered verbally?
Age-related Hearing
Loss as a Predictor?
• Livingston et al. (2017)
- Dementia prevention, intervention and care.
• Mid-life hearing loss was the
highest potential modifiable factor at 9%
• Depression 4%
• Social Isolation 2%
• Causality and the impact of treatment is still unknown.
Overcoming These
Challenges in the Future…
• Ensuring hearing aid services are re-commissioned.
• Focus on combined sensory health.
• Collaborative approach between audiology and memory clinics.
• Improve ‘dementia friendly’ approach in audiology.
• Invest more in research.
Using Serious Games-
My PhD
• Number of ‘games’ in dementia research
- Sea Hero Quest: Navigational Skills.
• Developing a novel training application
- Training for auditory, attentional and cognitive skills.
- Testing with mild age-related hearing loss and
subjective cognitive impairment.
- Possibility of delaying decline with training.
Thank you for listening.
