Untreated HL / Nursing Home

Question 1

Li-Korotky, 2012 #1

Answer 1

Health care professionals with a special interest in serving the geriatric population need to understand the fundamental changes associated with age-related hearing loss (ARHL) that affect auditory and cognitive processing of speech and aural communication

Question 2

Cruickshanks et al. (1998)

Answer 2

ARHL is the third most prevalent chronic condition in older Americans after hypertension and arthritis

Question 3

Schneider et al., 2010

Answer 3

ARHL significantly decreases the autonomy of affected older persons by increasing their reliance on others for support

Question 4

(Edwards, 2007)

Answer 4

Beyond auditory processing, cognitive processing is crucial to the basic functions of listening, comprehending, and communicating

Question 5

Li-Korotky, 2012 #2

Answer 5

In geriatric patients with hearing impairment, the age-related declines of peripheral and central auditory processing interact with the diminished cognitive functions and support, leading to reduced auditory perception of speech

Question 6

(Lin et al., 2011)

Answer 6

Research has demonstrated that hearing loss is independently associated with dementia (Lin et al., 2011)

Question 7

National Council on Aging, 1999

Answer 7

A survey of 2,300 hearing impaired adults age 50 and older found that those with untreated hearing loss were more likely to report depression, anxiety, and paranoia and were less likely to participate in organized social activities, compared to those who wear hearing aids. Hearing aid users from this study reported significant improvements in many areas of their lives, ranging from their relationships at home and sense of independence to their social life.

Question 8

(Bess et al, 1989; Bess et al, 1990; Mulrow et al, 1990; Keller et al, 1999; National Council on the Aging, 1999; Strawbridge et al, 2000).

Answer 8

Also, it is well known that mental, emotional, and social consequences of untreated hearing loss in adults can have negative impacts on an individual’s overall health related quality of life

Question 9

(Sprinzl & Riechelmann, 2010)

Answer 9

Hearing aids and CIs are the most commonly used devices for treating mild-severe ARHL (Sprinzl & Riechelmann, 2010) and may still be a viable option for these patients.

Question 10

(Cienkowski, 2003) / (Gatehouse, Naylor, & Elbering, 2003).

Answer 10

From the audiologist’s perspective, certain hearing aid signal processing strategies may increase the likelihood of successful hearing rehabilitation of the patient with diminished cognitive function. These strategies include the use of a slower speech processing algorithm (Cienkowski, 2003) and the slow-acting compression (Gatehouse, Naylor, & Elbering, 2003).

Question 11

Humes et al. (2001)

Answer 11

o Humes et al. (2001) evaluated hearing aid outcome measures in a group of 173 elderly participants once month after hearing aid fitting.
“ Results of this study indicated that the aided HHIE scores were significantly lower (better) than unaided scores for the emotional subscale, the social subscale, and the total HHIE score.
“ Thus, after one month of hearing-aid use, the perceived hearing handicap had been reduced significantly.

Question 12

Barbosa et al. (2015)

Answer 12

Barbosa et al. (2015) evaluated the Self-perception of the hearing-impaired elderly before and after hearing-aid fittings in a cohort of 125 individuals with hearing loss over the age of 65
“ This study revealed significant decreases in self-perceived general, social and emotional handicap after hearing aid use evident in scores on the Hearing Handicap Inventory for the Elderly, and the percentage of patients with severe hearing handicap decreased from 45.6% to 8.8% with hearing aid use.

Question 13

(Jerger and Martin, 2005)

Answer 13

In complex perceptual tasks, older listeners are more likely to demonstrate inter-hemispheric differences, changes in event-related potentials (Jerger and Martin, 2005), and supra-threshold deficits in addition to the effects of reduced audibility.

Question 14

(Sprinzl & Riechelmann, 2010)

Answer 14

Depending on the type and severity of the HL and the specific needs of the patient, electrical stimulation through a cochlear implant (CI) may also be appropriate solutions for intervention of ARHL (Sprinzl & Riechelmann, 2010).

Question 15

Horn et al. (1991)

Answer 15

Horn et al. (1991) surveyed 67 patients implanted at age 65 or older with a Nucleus 22 (Cochlear Corp.) device and showed similar benefits to younger implant recipients, including increased confidence. Additionally, 63% of the patients reported an increase in participation in social activities and 86% reported an overall improvement in quality of life.

Question 16

(Francis et al., 2002).

Answer 16

In a study relating to functional health status and cost-utility ratio of cochlear implantation in 47 older adults (aged 50-80 years), subjective benefit in hearing and emotional health attributes were major contributors to postoperatively improved scores on the Ontario Health Utilities Index Mark 3 survey scores (Francis et al., 2002).

Question 17

(Jerger and Martin, 2005)

Answer 17

In complex perceptual tasks, older listeners are more likely to demonstrate inter-hemispheric differences, changes in event-related potentials (Jerger and Martin, 2005), and supra-threshold deficits in addition to the effects of reduced audibility.

Question 18

(Ramachandran, 2005).

Answer 18

Fortunately for humans, the central nervous system has a remarkable capacity to compensate for limitations, central or peripheral (Ramachandran, 2005).

Question 19

Burk and Humes (2008)

Answer 19

Non-device hearing rehabilitation, such as auditory training, can have positive effects on cognitive and social function in older adults.
o For example, Burk and Humes (2008) demonstrated that older listeners could improve their ability to understand words in noise as a result of a 12-week auditory training program that included orthographic and auditory feedback on a closed-set task
“ The training was shown to generalize to other talkers and participants maintained improved performance over an extended period of time.

Question 20

Humes et al. (2009)

Answer 20

Using an auditory training protocol which emphasized frequently occurring words in American English, Humes et al. (2009) observed a significant improvement in speech recognition performance in a group of older listeners with hearing loss. These listeners demonstrated these improvements across several measures which ranged from single word recognition to sentence recognition with familiar and unfamiliar talkers.

Question 21

(Tye-Murray et al., 2012).

Answer 21

The use of auditory training for patients with hearing loss has been shown to increase self-confidence and self-perceived abilities on auditory tasks (Tye-Murray et al., 2012).

Question 22

(Sweetow & Sabes, 2006).

Answer 22

Management of the elderly patient with hearing loss and diminished cognitive function may also include auditory/listening training, when possible. LACE (Listening and Communication Enhancement) is an individualized training program designed to engage the adult hearing-impaired listener in the hearing rehabilitation process, provide listening strategies, build confidence, and address cognitive changes characteristic of the aging process (Sweetow & Sabes, 2006). This program was developed with the intentions of being cost-effective, interactive, practical, and individualized for the user. In a verification study including 38 participants who completed the LACE computer-based training program, statistically significant improvements were observed on two subjective questionnaires, the Hearing Handicap for the Elderly and the Communication Scale for Older Adults, between the pre-test and post-test (Sweetow & Sabes, 2006).

Question 23

Olson, Preminger, and Shinn (2013)

Answer 23

The LACE program can also be completed in a DVD format. Olson, Preminger, and Shinn (2013) examined the behavioral effects of LACE in DVD format using a prospective, randomized, repeated-measures design and found that both new and experienced users improved their understanding of speech in noise, understanding of competing sentences, and communication function after training in comparison to a control group.

Question 24

Haber (2003)

Answer 24

Additionally, health-care professionals should continue to engage these patients in their rehabilitation processes. Haber (2003) demonstrated that better outcomes with older patients are more likely to occur when a collaborative partnership is established with the patient rather than having the patient assume a passive, compliant role.

Question 25

(Helfer, 1998; Lin et al., 2004).

Answer 25

Specific to the management of patients in a nursing home with hearing loss and reduced cognitive function, it will be important to engage administrative and healthcare staff in discussions of good communication strategies and considerations of room acoustics. Staff could receive training on the use of clear speech, as the use of clear speech has been shown to improve speech intelligibility for listeners with hearing loss by approximately 20% (Helfer, 1998; Lin et al., 2004).

Question 26

Gates et al., 2008

Answer 26

the central auditory function is affected by even mild memory impairment (Gates et al., 2008).