HEARING TESTS, WOMEN AND ALZHEIMER'S
Two recent reports examining hearing loss--one among women and the other among Alzheimer's disease patients--highlight the overwhelming need for routine hearing tests for all older adults. The research on those with Alzheimer's disease also revealed the benefits of treating hearing loss among caregivers.
In the first major study focusing exclusively on women and hearing problems, a Northwestern University research team revealed that the majority of older women do not receive hearing tests as part of their routine healthcare. Funded by the Retirement Research Foundation, the recent study showed that even though hearing loss is one of the most common chronic conditions in older women, many have hearing loss that remains undiagnosed and, therefore, untreated.
Hearing
loss has been linked to "feelings of isolation, stress, depression and loss
of confidence," according to research audiologist Susan Erler, who conducted
the study along with principal investigator Dean Garstecki, professor of communication
sciences and disorders. Both are at Northwestern University in Chicago.
The study, which involved more than 200 women between the ages of 35 and 80, found a gradual decline in hearing beginning at midlife. For example, by age 55, 13% had impaired hearing although fewer than 20% had had their hearing tested in the previous five years. In the oldest age group examined, ages 7580 years, the incidence of impaired hearing jumped to 33%, yet only 40% had been tested in the previous five years. The authors concluded that "hearing screening is not a part of most HMO plans."
Garstecki and Erler have developed a rehabilitation program for coping with hearing loss. The program includes training to "maintain face-to-face communications; learn to read body language and facial expressions; converse in quiet, well-lit places; let others know when you have trouble understanding; and [not] monopolize the conversation." They also stress the importance of audiological tests to "determine the best treatment for hearing loss." In some cases, a rehabilitation program may not be enough to compensate for the hearing loss, and women may need medication, surgery or a hearing aid.
Another finding is that women are decreasingly reluctant to wear hearing aids as they age. Younger women in the study saw hearing aids as stigmatizing and embarrassing, but older study subjects were much more likely to find them helpful.
The researchers are beginning further studies with their database to look specifically at how women with diagnosed hearing loss adapt to this deficit. Erler noted, "Because hearing loss occurs very gradually, and not overnight, people have time to adjust. They often change their lifestyle to accommodate the hearing loss but don't realize they're withdrawing from routine activities, such as playing bridge or going to church and concerts."
ALZHEIMER'S
Not only has there been little previous research examining gender and hearing loss, there also has been sparse research into auditory deficits related to Alzheimer's disease. Investigators at the University of Pittsburgh Medical Center explain that although an estimated 60% of Alzheimer's patients may have impaired hearing, the condition usually remains unrecognized and untreated.
"Studies and clinical procedures related to Alzheimer's disease have largely ignored the hearing ability of either the patient or caregiver," according to Catherine V. Palmer, director of the university's Center for Audiology. "Yet," she continued, "the majority of Alzheimer's disease treatment and investigation depends on communication ability, and caregiver complaints often involve communication-based issues."
She added that hearing loss is "often masked by other behavioral symptoms of Alzheimer's disease, and patients may communicate adequately in ideal quiet conditions. Furthermore, patients with Alzheimer's traditionally have been considered difficult to test for hearing loss and difficult to manage because of anticipated patient noncompliance."
Palmer was principal researcher on a study in which audiologists in Pittsburgh conducted an in-home examination of eight Alzheimer's patients and their family caregivers. The center did the research in conjunction with the university's Communication Science and Disorders Program. The patients had a diagnosed hearing loss, but had not previously worn hearing aids. They were outfitted with hearing devices that they could adjust themselves.
For two months before the Alzheimer's patients were given a hearing aid, caregivers were asked to keep a diary of the patient's hearing-related problems, such as hearing things that were not there; inability to hear; nonstop talking; playing the TV or radio too loud; repeating questions; and forgetting recent responses to questions. Each patient then wore a hearing aid for four to 18 hours per day.
CAREGIVERS SAW IMPROVEMENTS
Caregivers continued to monitor patients' behavior and hearing-related problems. All eight caregivers reported reduced incidence of problem behaviors. Three of the eight caregivers stated that problem behaviors were diminished significantly; for another three, all but one of the problem behaviors abated. Furthermore, some caregivers noticed that hearing-aid use increased the Alzheimer's patient's likelihood of engaging in conversation and daily interactions. They were generally more alert to what was happening around them.
The research team recommended that future studies measure patients at various stages of the disease, look at treatment of caregiver hearing loss and the effectiveness of binaural hearing-aid fittings, and make a more in-depth examination of positive behaviors caregivers say they would like to see increased.
The study, funded by the National Association for Alzheimer's Disease, was published in the Journal of Speech, Language and Hearing Research (April 1999).
For more information about the women's research, contact Susan Erler, Women and Hearing Study, Northwestern University, 2299 N. Campus Dr., Evanston, IL 60208; (847) 467-4448. To learn more about the Alzheimer's study, contact the Center for Audiology, University of Pittsburgh Medical Center's Center for Hearing and Balance at (412) 647-2030. *
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