Dementia and sensory loss: hearing loss
Hearing loss: how common is it?
Hearing loss is widespread – it affects 10 million people in the UK while six million people have or could benefit from a hearing aid(s). As our society ages, this number is set to grow: current predictions are that by 2031 there will be more than 14.5 million people with hearing loss in the UK (Action on Hearing Loss, 2011).
Age-related damage is the single biggest cause of hearing loss. Seventy-one per cent of people over the age of 70 have hearing loss (Action on Hearing Loss, 2011). This means that older people are very likely to experience hearing loss alongside other long-term conditions – such as dementia. Other causes of hearing loss include exposure to loud sounds, drugs that are harmful to the cochlea and/or hearing nerve, some infectious diseases and genetic predisposition.
Hearing loss and dementia: Advice for care staff
On average, people who develop hearing loss wait ten years after they first notice symptoms before they seek help (Action on Hearing Loss, 2011). This means that a person may have developed other long-term conditions – such as dementia – alongside their hearing loss. Their circumstances may have changed (for example, they may live in a care home) and may well lose the opportunity to get hearing aids.
Types of hearing loss
People with hearing loss can fall into one of three groups: people who are hard of hearing, those who are deaf and those who are deafened.
In most cases people who are hard of hearing have developed age-related hearing loss. In some cases this has developed through exposure to loud sounds. This is the largest group – roughly 90 per cent – of the total number of people with hearing loss (Action on Hearing Loss 2011).
People who are deaf are severely or profoundly deaf. They use sign language as their preferred language and belong to the Deaf community (deliberately written with a capital ‘D’ to signify this). There are no reliable figures on how many people in the UK use British Sign Language (BSL): estimates vary enormously from 22,000 to over 100,000 in the UK (see Action on Hearing Loss/DCAL 2013 and BDA 2013). Read the feature on ‘Deafness and dementia’ to find out more about the issues for people who are Deaf and live with dementia.
I have been a 24-hour carer for my wife for over four years. She has vascular dementia and Lewy body disease. About two years ago she suddenly became unresponsive – just staring, wide-eyed when I talked to her. A conventional hearing test proved impossible to conduct but a very patient audiologist, after taking casts of her ears, made aids which could be set to amplify in steps until it provoked a response. This changed her demeanour immediately and, although I can hear the aid’s output from the leakage of sound from my wife’s ears, she now responds and converses.A husband’s story, posted on an Alzheimer’s Society’s website forum
People who are deafened have acquired a severe or profound hearing loss – for example through trauma, injury or some medications – and usually use English as their preferred language.
How a person with hearing loss communicates – that is, whether with the help of a hearing aid, by using BSL, lip reading or so on – will depend on the person’s own life history and preferences.
Hearing loss and dementia
There is a strong link between hearing loss and dementia. According to one study, people with mild hearing loss are two times as likely to develop dementia, and this increases to three times for those with moderate hearing loss (Lin et al 2011). The reasons for this relationship are not clear, but communication difficulties may be one reason, as both hearing loss and dementia can make communication more difficult.
Hearing loss and dementia: Nancy’s story
It is essential to recognise and respond sensitively to hearing loss in people with dementia. If a person with dementia is unable to communicate problems they are having with their hearing, this is likely to cause distress. They may well be frustrated or aggressive, but unable to say why – and these reactions then may be interpreted as being a result of the dementia.
Both identification and management of hearing loss are particularly important where a person has dementia. Without this, the dementia may appear worse or get worse. For example, if a person with dementia is having difficulty using their hearing aid – say they don’t remember to use it or don’t recognise it as their hearing aid – this is likely to make it harder for them to follow communication and may make them seem more confused and withdrawn.
Both hearing loss and dementia can cause social isolation. Where someone is experiencing both of these, this can be compounded. For example, the person may be unwilling to attend social functions or participate in activities because their problems with hearing and memory make social situations so much more uncomfortable.
Identification of hearing loss
It is important that older people with dementia have regular hearing checks, particularly because the symptoms of hearing loss – for example, not following a line of conversation – can be mistaken for dementia. In the first instance, the GP should be contacted as they will be able to refer the person for a hearing check, where appropriate.
It can be more challenging to diagnose hearing loss for people with dementia. A person has dementia may well find it hard to understand instructions given during the diagnostic process or they may be unable to report the history of their hearing loss because of their memory problems.
It is possible to adapt testing procedures so that they meet the needs of people with dementia. This makes it vital that care providers communicate effectively, where appropriate, with health professionals to ensure that they are aware of long-term conditions, such as dementia, that may have implications for testing procedures.
Some audiology departments have specialists who are qualified to assess people with dementia. They will often use specialist diagnostic tests, which are easy to understand and take account of the communication and memory difficulties that can go along with dementia.
It is also not unusual for older people to have high levels of wax in their ears. This can make it more difficult to hear and can also mean that hearing aids do not work effectively. Provision of wax syringing services varies between localities. It is important that staff in care homes understand local protocols around wax management, both at the local GP surgeries and within the care home.
Management of hearing loss
There are various options for the management of hearing loss. The most commonly used equipment is digital hearing aids. These work by amplifying noise and delivering this to the air canal. It is important that hearing aids are cleaned and maintained and batteries replaced as appropriate.
Audiology clinics usually provide maintenance and battery replacement services. In some areas there are services for care homes where staff are supported to carry out basic maintenance of hearing aids. Care providers should be aware of how to access these.
Other equipment or interventions include cochlear implants, which are suitable for people with severe or profound deafness who cannot use hearing aids.
Assistive technology such as FM or infrared listening equipment and induction loops are also available – again, this works by amplifying and directing sounds. Other assistive devices for daily living include vibrating alarm clocks, flashing doorbells and flashing smoke alarms.
We can also make adjustments to a person’s environment that can help manage hearing loss, for instance, limiting the amount of background noise and ensuring good lighting to enable people to lipread.
Dementia and ongoing management of hearing loss
Where a person has dementia, people working with them may need to take additional steps to help them to manage their hearing loss. For example, a person with dementia may really struggle to adjust to using a hearing aid. They may not be able to recall that they have a hearing problem or that they have a hearing aid. They may not recognise what the hearing is for or when they do remember to wear it, how to use it effectively. They may fiddle with it or refuse to wear it regularly – and intermittent use may create more difficulties with remembering how to use it.
For all these sorts of problems, the help of other people can make a huge difference. If care or support staff are observant, they can pick on a person’s behaviours and know what to look out for and offer in supporting that person best.
These observations should then be recorded clearly. All those offering care and support to a person with dementia need to know the person’s communication needs – and this should be recorded in the care or support plans. This information needs to be put to good use – in day-to-day situations, but also in more complex situations, such as supporting the person at a hospital appointment.
Making communication as clear as possible
There are some general approaches that people can take to communicate more effectively with people with hearing loss – all of which are applicable to communicating with a person with dementia.
Here are some of the top communication tips that Action on Hearing Loss suggest:
- Find a suitable place to talk, with good lighting and away from noise and distractions.
- Make sure you have face-to-face contact with the person you are talking to.
- Get the listener’s attention before you start speaking, maybe by waving or tapping them on the arm.
- Even if someone is wearing hearing aids it doesn’t mean they can hear you perfectly. Ask if they need to lipread.
- Speak clearly but not too slowly, and don’t exaggerate your lip movements – this can make it harder to lipread.
- Use natural facial expressions and gestures.
- Don’t shout. It can be uncomfortable for hearing aid users and it looks aggressive.
- If someone doesn’t understand what you’ve said, don’t keep repeating it. Try saying it in a different way instead.
- Check that the person you’re talking to is following you during the conversation. Use plain language and don’t waffle. Avoid jargon and unfamiliar abbreviations.
- To make it easy to lipread, don’t cover your mouth with your hands or clothing.
Help with hearing aids
There is a lot to learn about using hearing aids and this can be particularly difficult if a person has dementia. Care and support staff can play a vital role in ensuring that a person with dementia benefits reliably from their hearing aid.
Here are some basic tips from Action on Hearing Loss:
- Make sure hearing aids are checked every day to make sure they are working and that the person is wearing them correctly.
- Learn how to use the t-switch and controls on hearing aids, how to change batteries and how to clean hearing aids
- Make sure arrangements are in place for hearing aid re-tubing, repairs and battery replacement. Local audiology departments should be able to help with this.
- Try to minimise the number of lost hearing aids, and ensure that lost hearing aids are replaced as quickly as possible.
- Get to know who to consult (for example a GP or nurse) to examine ears for wax and to arrange ear syringing, where appropriate.
Access and download additional resources
Further reading Open
Action on Hearing Loss and Deafness Cognition and Language Research Centre (2013)
Joining up: Why people with hearing loss or deafness would benefit from an integrated response to long-term conditions. London: Action on Hearing Loss.
Action on Hearing Loss (2012) A world of silence: the case for tackling hearing loss in care homes. London: Action on Hearing Loss.
Action on Hearing Loss (2011) Hearing matters, London: Action on Hearing Loss.
Action on Hearing Loss provides information, advice and support for people with hearing loss and their carers. Online information covers topics such as ‘Communication tips’, ‘Helping you care for people with hearing loss’ and ‘Types and causes of hearing loss’. It runs a free telephone information line on 0808 808 0123.
British Deaf Association (2013) British Deaf Association reacts to census figures with dismay’. Press release. 8 March 2013.
Lin, F.R., Metter E.J., O’Brien, R.J., Resnick, S.M., Zonderman, A.B. and Ferrucci, L. (2011) Hearing loss and incident dementia. Archives of Neurology vol 68, no 2, pp. 214-20.
Useful links Open
Dementia and deafness: What you need to know
This 2005 booklet from Deaf Action in Scotland is based on an exploratory study into the experience of being Deaf with dementia conducted by Deaf Action and the University of Stirling’s Dementia Services Development Centre.
Dementia and sight loss
The RNIB website has an extensive section on dementia and sight loss, including a leaflet on ‘Dementia and sight loss’, frequently asked questions, and a factsheet on ‘Cataracts and dementia’.
Good practice in the design of homes and living spaces for people with dementia and sight loss
These 2014 guidelines from Thomas Pocklington Trust and Stirling University present practical steps to improve the independence of people with dementia and sight loss, whether they are living in their own home or a care home. The resource is available in audio format as well as in written text.
This 2013 report from Action on Hearing Loss and the Deafness Cognition and Language Research Centre (UCL) argues that a joined-up approach is needed to the assessment, diagnosis and management of both hearing loss and dementia.
The Dementia and Sight Loss Interest Group
This is an interest group within VISION 2020, and brings together a range of organisations working in this area. In 2016, VISION 2020 UK and the Royal College of Ophthalmologists launched a quality standard to help ophthalmology departments adapt and design their services to meet the needs of people with dementia..
Related pages from this section Open