Communication disorders are a significant barrier to equitable access to healthcare services and can have a profound impact on a person’s quality of life. Speech, language and hearing difficulties represent a significant challenge to the healthcare professionals caring for individuals and their families. Speech-language pathologists and audiologists are important members of interprofessional teams and can provide expertise, collaborating with other team members to ensure full access to care and improved outcomes for patients with communication disorders.
The Department of Communication Disorders within the School of Public Health and Health Sciences at the University of Massachusetts Amherst currently has the only Audiology program in Massachusetts: https://www.youtube.com/watch?v=NY3wiEcvp4A. The students and faculty in the department regularly participate in interprofessional education initiatives with PV-IPEC partners in an effort to ensure that our students learn the value of interprofessional practice with the goal of improved health outcomes of their future patients. The department welcomes opportunities to educate other professions about audiology, sharing our particular expertise and collaborating with other professions in research, clinical practice, and community engagement.
In today’s blog we will share specific information about the profession of audiology and discuss the importance of including audiologists on interprofessional teams, where they can provide critical services in areas that are perhaps not well known or obvious to patients or other healthcare professionals. While hearing loss can affect all ages, today we will discuss hearing loss in older adults and the complex needs of this population that are best addressed by collaboration between audiology and other healthcare professionals.
Age-related hearing loss is so common that it is often swept under the rug with a comment like “I hear what I need to” (from the patient) or “you hear alright for your age” (provider). Unfortunately, the evidence related to hearing loss shows effects much more consequential than annoying one’s partner or family with how much the person doesn’t hear. Population-based studies find associations between age-related hearing loss and all sorts of poor health outcomes—increased rates of cognitive decline, increased incidence of dementia, increased prevalence of depression, increased falls, and reduced physical mobility—to name a few. (For an extensive review of adult hearing loss and hearing health care priorities, see the report from the National Academies of Science, Engineering, and Medicine: https://www.nap.edu/read/23446/chapter/1.)1 Many researchers are investigating the possible mechanistic pathways between these associations2, and that work is on-going, but suffice it to say, in the grand scheme of caring for older adults, age-related hearing loss should not be swept under the rug.
One particular pathway of interest is the increased social withdrawal that results due to age-related hearing loss and potential acceleration of poor mental and physical health outcomes due to social isolation. Moreover, the onset of mask-wearing in public increases the already burdensome communication for older adults with hearing loss.3 So, as we recognize the social isolation and loneliness that has had a negative psychosocial impact on all of us, especially our older adults who have been in the high risk category for COVID-19 since its onset, it is worth bearing in mind the increased communication difficulty for those with hearing loss.
Here are a few simple tricks to address hearing loss in team care settings:
- Don’t accept the notion that all adults have a bit of hearing loss and that make it ok!
- Encourage folks to get a hearing test.
- Do simple hearing screenings – even a single question regarding hearing difficulty can be useful4
- Practice good communication behaviors!
- Be face-to-face – this is important even when wearing a mask!
- Slow down so that your speech is clearer and gives the person time to process.
- When you are planning care and considering functional outcomes, ask yourself: Would this work better if they could hear well?
- For example, do they need amplification during therapy sessions? Plenty of good quality personal amplifiers are available without specialty care 5
- Are they withdrawn and experiencing psychosocial challenges that might be alleviated through improved hearing and communication? Connect them to an audiologist or speech-language pathologist, or at a minimum, connect them to resources that might help them consider the source of some of their frustrations, like ASHA (https://www.asha.org/public/) or Hearing Loss Association of America (https://www.hearingloss.org/).
Unfortunately for the field of audiology and for the older adults we serve, there is often no audiologist at the table when it comes to care teams. At UMass Amherst, we try to instill a dedication to holistic, comprehensive care that goes beyond practicing in our sound booth! Even without an audiologist on your rehabilitation team, there is great opportunity to provide simple communication supports for older adults, and we hope to build capacity for those opportunities through the PV-IPEC community. We look forward to future mutually beneficial IPE/IPE opportunities with our Pioneer Valley colleagues!
1. NASEM. Hearing Health Care for Adults: Priorities for Improving Access and Affordability. Washington, DC: The National Academies Press; 2016.
2. Lin FR, Albert M. Hearing loss and dementia – who is listening? Aging & mental health. 2014;18(6):671-673.
3. Saunders GH, Roughley A. Audiology in the time of COVID-19: practices and opinions of audiologists in the UK. Int J Audiol. 2021;60(4):255-262.
4. Zazove P, Plegue MA, McKee MM, et al. Effective Hearing Loss Screening in Primary Care: The Early Auditory Referral-Primary Care Study. Ann Fam Med. 2020;18(6):520-527.
5. Mamo SK, Reed NS, Nieman CL, Oh ES, Lin FR. Personal Sound Amplifiers for Adults with Hearing Loss. The American journal of medicine. 2016;129(3):245-250.
Lisa Sommers, M.A., CCC-SLP
Clinic Director and Clinical Associate Professor
Lisa has been a speech-language pathologist for 34 years, primarily in the area of neurogenic communication and swallowing disorders in adults. She has a passion for providing her students with interprofessional education opportunities, with a focus on addressing the needs of the whole person to improve equitable access to care, outcomes, and quality of life.
Sara K. Mamo, AuD, PhD, CCC-A
Dr. Mamo’s research focuses on improving the accessibility and affordability of hearing health care for older adults with age-related hearing loss. She has a particular interest in the needs of older adults and families living with dementia and providing tailored hearing care services to alleviate symptom burden related to the progression of dementia.