Emerging and Existing Hearing Solutions for Nursing Home Populations

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

2. Agenda • Prevalence rates of hearing impairment/ hearing aid use in older adults • Problems facing hearing impaired, nursing home residents • Solutions • Consumer resources

3. Hearing aid use in older adults- A literature review

4. 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

5. National Counsel on Aging (1999) 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

6. Hearing loss left untreated can cause… • Sadness/depression • Worry/anxiety • Social isolation • Insecurity • Auditory deprivation • Diminished cognitive function

7. 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.F6 • DOI: 10.1093/gerona/glr115

8. 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.

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10. Department of Otolaryngology, Johns Hopkins School of Medicine and the Center of Aging and Health (2011) 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) • 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.F6 • DOI: 10.1093/gerona/glr115

11. Department of Otolaryngology, Johns Hopkins School of Medicine and the Center of Aging and Health (2011) 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 • 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.F6 • DOI: 10.1093/gerona/glr115

12. 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

13. 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

14. Cohen-Mansfield & Taylor (2004) Method Prevalence of hearing loss Structured interviews of residents Questionnaires from residents Structured interviews of caregivers Chart review Data from MDS

15. Cohen-Mansfield & Taylor (2004) 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

16. Cohen-Mansfield & Taylor (2004) Results: Hearing aid use • 12% as reported by the nursing staff/MDS • 17% as reported by researchers

17. Cohen-Mansfield & Taylor (2004) 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

18. Barriers to Hearing Aid Use

19. Barriers to hearing aid use among hearing aid and non hearing aid users Societal Institutional Individual Cohen-Mansfield & Taylor (2004)- Part 2 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

20. 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

21. 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

22. Societal- Level Barriers • MDS requirement- Assessment by means of interview, observation and staff/family consultation • Cost for amplification • Medicare/Medicaid reimbursement • Private insurance coverage

23. Hearing Solutions for Nursing Home populations

24. Hearing Aid Styles Completely in the Canal In the Canal In the Ear Mini Canal Half Shell Custom Hearing Instruments • 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

25. Hearing Aid Styles Implantable Devices Behind the ear Receiver in the canal Body Aid 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

26. 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

27. Directional Microphones Front Left Right Back Cardioid Figure 8 Omni directional

28. Noise Reduction ≠

29. 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

30. Hearing Aid options • Features/ add-ons • Telecoil • Bluetooth • FM • Remote

31. Additional options Right Left • Identification • Color coding hearing aids or earmolds (nail polish works) • Initials/name/ID number etched into shell or case of hearing aid NMF

32. Additional Options Eargear • 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 Loop ‘em

33. 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)

34. Hearing Aid Maintenance Batteries Battery testers Zinc air tabs rechargeable Opening battery door Cleaning/storing

35. Hearing Aid Maintenance Troubleshooting • Check for visible debris in the mold or microphone • Replace battery (check placement) • If possible check patient’s ear

36. Assistive Listening Devices

37. Assistive listening devices Receiver NOISE Microphone/Transmitter

38. Assistive Listening Devices Receiver options for use without hearing instruments Ear level FM Personal Sound Amplifier Desktop amplifier

39. Assistive Listening Devices Receiver options for use with hearing instruments (BTE) Direct audio input Ear-level or integrated FM

40. Assistive Listening Devices Induction devices Phone Silhouette Neckloop Silhouette

41. Assistive listening devices • Room looping

42. Assistive listening devices • Alerting Devices • Tactile: • Visual: • Auditory:

43. Assistive Listening Devices • 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

44. Consumer resources Hearing Loss Association of America (HLAA) www.hearingloss.org Better Hearing Institute www.bettterhearing.org Healthfinder www.healthfinder.gov Tec Ear www.tecear.com American Academy of Audiology www.audiology.org