Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Evolution of mammalian auditory ossicles wikipedia , lookup
Telecommunications relay service wikipedia , lookup
Lip reading wikipedia , lookup
Hearing loss wikipedia , lookup
Hearing aid wikipedia , lookup
Sensorineural hearing loss wikipedia , lookup
Noise-induced hearing loss wikipedia , lookup
Audiology and hearing health professionals in developed and developing countries wikipedia , lookup
Emerging and Existing Hearing Solutions for Nursing Home Populations Natalye M. Faison Au.D. Audiologist/Trainer Panasonic Healthcare Group Agenda • Prevalence rates of hearing impairment/ hearing aid use in older adults • Problems facing hearing impaired, nursing home residents • Solutions • Consumer resources Hearing aid use in older adultsA literature review 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 National Counsel on Aging (1999) Hearing Aid Users and Family Members Reporting Improvements from Hearing Aid Use Hearing Aid users (%) Family members (%) 70 60 50 40 30 20 10 0 Re l ati o ns h ip Fe eli ng s sa th om e Lif e ab ou tm M ov er all ys elf So Se Re W Se Se Ab Ph De en illi cia lfns ns ilit ys lat pe ta ng c y i i e e nd l c o o lh life to al ns nfi of of to en ea h p d h i s p n e l ce en ip s afe lt h ay ar de alt t ce on ici ca h pe ty wi pa rd th nd ot t / he e bo my en i rs n c a ch e rd g r ild ou g am re p n/ ac es gr t i an vit ies d. .. 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 Hearing loss left untreated can cause… • • • • • • Sadness/depression Worry/anxiety Social isolation Insecurity Auditory deprivation Diminished cognitive function 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 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. # % > + $ ! * ? = 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 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 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 Cohen-Mansfield & Taylor (2004) Purpose Assess rates of hearing impairment and hearing aid use among residents in a large (562 beds) nursing home. Subjects: Gender 21% Male Female 79% Subjects: • 279 resident/caregiver pairs (average age 86.7) • 16 nurse managers • 44 certified caregivers Avg. MDS Cognition Scale 32% 34% Not Impaired Moderately Impaired Severely Impaired 34% 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 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 Cohen-Mansfield & Taylor (2004) Results: Hearing aid use • 12% as reported by the nursing staff/MDS • 17% as reported by researchers Cohen-Mansfield & Taylor (2004) Discussion • Major underdetection of hearing impairment by nursing staff – Lack of staff awareness – Insufficient screening of residents • Underuse of hearing aids • Lack of other assistive listening devices • Inconsistent reporting Barriers to Hearing Aid Use Barriers to hearing aid use among hearing aid and non hearing aid users Cohen-Mansfield & Taylor (2004)- Part 2 Individual- Level BarriersBarriers identified by the hearing impaired individual, caretaker, dispenser, family Institutional- Level BarriersBarriers associated with the policies and practices set forth by the nursing home Societal-Level Barriers- Barriers associated with policy/laws Societal Institutional Individual 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 Institutional- level barriers • • • • Lack of policy related to ENT/Aud referrals Oftentimes there is not Audiologist on site No on site training Lack of delegation of responsibility – Screening – Referral – Hearing aid maintenance • No tools needed for care – Battery testers – Otoscopes Societal- Level Barriers • MDS requirement- Assessment by means of interview, observation and staff/family consultation • Cost for amplification • Medicare/Medicaid reimbursement • Private insurance coverage Hearing Solutions for Nursing Home populations Hearing Aid Styles Custom Hearing Instruments Completely in the Canal Mini Canal •Smaller in size •Shorter battery life •Limited fitting range In the Canal Half Shell •Limited real estate for added features •Made specifically to fit one ear In the Ear •Might be more susceptible to damage from moisture and debris Hearing Aid Styles Non- Custom Hearing Instruments Behind the ear Receiver in the canal •Larger in size •Longer battery life •Flexible fitting range •Less susceptible to damage Body Aid •Typically all features are available •Can be specifically to fit one ear •Not as easy to misplace Implantable Devices • Cochlear Implants and BAHA Hearing Aid Technology/ options •Technological considerations •Analog vs. Digital, size, style, Pwr/Gain, Channels, Directional Microphones, Noise Reduction, Feedback Reduction, automatic/manual, CROS technology, frequency transposition, implantable device, Hearing Aid options • Features/ add-ons – Telecoil – Bluetooth – FM – Remote – Additional options Additional options • • • Identification – Color coding (hearing aids or earmolds) – Initials etched into shell or case – Scan-dent Retention – Fish line – Ear gear – Double sided tape/toupee tape/ roll on adhesives – Loop ‘em or Lose ‘em- connects hearing aid to eyeglasses – Lanyards – Huggie Aid 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) Hearing Aid Maintenance Batteries • Battery testers • Zinc air tabs • rechargeable • Opening battery door Cleaning/storing 10A 312 13 675 Hearing Aid Maintenance Troubleshooting 1. Check for visible debris in the mold or microphone 2. Replace battery (check placement) 3. If possible check patient’s ear Assistive Listening Devices • Using hearing aids Assistive Listening Devices • Without hearing aids Assistive listening devices • Room looping Assistive listening devices • Alerting Devices • Amplified phones • Mobile devices – Apps with amps article 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