I Hear Fine: Everybody Mumbles

According to the National Institute on Deafness and other Communication Disorders, one in three individuals over the age of 60 and half of those over the age of 85 will have hearing loss. The hearing loss associated with aging is called presbycusis or high frequency, sensory neural hearing loss, caused by a deterioration of the VIII nerve where it ends in the cochlea. It is gradual, binaural, permanent and invisible.

Common symptoms of presbycusis are:
1. “I don’t have a hearing loss!” Denial is the number one symptom of age related hearing loss. Hearing loss has very strong connotations in our youth oriented culture of being OLD, and old is BADn2. “I hear just fine, it’s just that everybody mumbles.” In fact, everybody does mumble. The normal ear can organize even the most distorted sounds into a comprehensible signal.
3. “What?” This becomes such an automatic response that the hearing impaired adult won’t even notice that they are using it in every other sentence in a conversation.
4. “What did he say?” This is a corollary to number 3. It is the common ‘hearing aide’ for spouses.

The sense of hearing is poorly understood by the average person. The confusion comes from the fact that even someone with a severe, high frequency, sensory neural hearing loss can still hear. If an individual couldn’t see, they would understand they had a problem with their vision. Logically, if they had a problem with their hearing they assume it would mean they couldn’t hear, but they can.

The psycho-social effects of presbycusis are serious. The most debilitating is the diminished ability to filter speech from background noise. If there are any auditory distractions in the room, conversation can be almost impossible. It is a major contributor to depression in seniors. They will begin to withdraw and isolate themselves. They become angry, stressed, and cranky. Older adults with severe hearing loss are at higher risk for suicide.

There are some simple guidelines that can be observed to ensure that we are effectively communicating with all of our older clients (and parents!).
1. Speak more slowly, not louder. You will automatically enunciate if you speak slowly.
2. Get closer. When engaging in face to face communication, be no more than four feet apart. If they are truly challenged by the telephone, insist they get a handset amplifier.
3. Get their attention. Calling someone by name is a good way to focus their attention.
4. Be aware of the environment. Reduce background noise as much as possible. Do not communicate in the middle of a noisy room. Move to the wall and place your patient with their back to the wall. If possible, leave a noisy room and go to quieter surroundings.
5. Be on the same level. If your client is sitting, sit.
6. Be conscious of what’s behind you. It is difficult for someone to pay attention to you if they are fighting the glare of a sunny day behind your back.

There is no cure for sensory neural hearing loss. Our best treatment, hearing aides, have their limitations. Unlike glasses which give us normal vision, hearing aides do not give us normal hearing. In conclusion, when planning physical exams for your older clients, remember that knowledge of their hearing status can be of tremendous value to successful rehabilitation.