Factors Influencing the Success of Hearing Aid Use in the Elderly

Introduction

The present article examines the association between the audiological, non-audiological factors and the success obtained with the use of hearing aid among the elderly populations. The study is a retrospective one consisting of 160 elderly patients suffering from unilateral or bilateral hearing impairment (HI) of age above 60 years who had been using hearing aid within the past two years. The following parameters were evaluated such as the audiological factor; the health model based attitudinal beliefs, demographics of the client, factors associated with age and the psychological factors to study the outcomes with respect to the use of hearing aid among elderly populations. The participants were assigned into the following two groups: the successful owner of hearing aid and unsuccessful owner of hearing aid based on the report given by self. The results were analysed by using a multivariate binomial logistic regression model, which is an extension of the simple regression where two or more independent variables are considered simultaneously to predict the value of the dependent variable and it highlighted the significance of the non-audiological parameters on the successful health outcomes obtained after the use of hearing aid. Four factors that were self-reported were highlighted behind the success: a) the positive approach obtained from the others; b) the immense level of difficulties faced by the patient in their day to day life activities prior the use of the hearing aid; c) the positive attitude towards the user of hearing aid; d) enhanced level of self-confidence and efficacy with the use of the hearing aid.

Hearing impairment (HI) is one of the common persistent conditions among the aged populations. Out of the total world’s populations, more than 5 per cent of them suffer from hearing loss or impairment and approximately one-third of them were above 65 years of age according to the report of World Health Organisation, 2012. Though the rate of prevalence of the hearing impairment cases is high, they often remain unrecognised and are designated as “the invisible disability” (Shohet and Bent 1998). Moreover, it is also reported that health professionals often ignore the problem of hearing loss or impairment among the aged populations and focus on the other aspects what they consider to be important among them in terms of health problems(Yueh et al. 2003; Wallhagen and Pettengill 2008; Meyer and Hickson 2012). It is also observed that age-associated hearing impairment often results in the decreased level of cognitive activities, the level of depression increases, the associated comorbidities also rises (Albers 2012; Amieva et al. 2015). Therefore, because of all these factors, the quality of life gets hampered (Chisolm et al. 2007).

Treatments are available to lower down the negative impact of hearing impairment; particularly the use of hearing aid can help to improve the quality of life. Several studies had previously stated that individuals who were using hearing aid reported less mental and physical exhaustion, the reduced signs of depression and anxiety observed among them, better sleep, increased memory and better relationship status with the members of the family in relation to the non wearers. Therefore, it is effective in reducing the negative aspects such as the psychological, emotional and social aspect in relation to loss of hearing. The use of hearing aid had also helped to manage the symptoms of depression (Acar et al. 2011; Boi et al. 2012). As per the data available from the United Kingdom Biobank data set the use of hearing aid had been linked up with the improved level of cognition activities among a large sample study group. Moreover, several additional benefits also have been observed with the use of hearing aid with respect to speech understanding for many listeners (Stark and Hickson 2004; Cox et al. 2005; Takahashi et al. 2007; Smith et al. 2008; Metselaar et al. 2009; Johnson et al. 2010).

The management of the hearing aid demands knowledge and skill for the proper handling, application, protection and care. The significance of all these factors has been associated with the enhanced outcome with the use of hearing aid. The factors related to the participants with the use of hearing aid includes the following: age of the individual, gender, age of the hearing aid in use, the style of the hearing aid which relates to the comfort level achieved after the fitting of the hearing aid and the number of years spent with the hearing aid. The better level of knowledge and skill observed with the use of hearing aid is often associated with improved health outcomes. The outcomes are described in terms of the higher level of self-satisfaction with the use of hearing aid, apparent benefits observed with the use and also the outcome observed with the fitting of the hearing aid which is evaluated by the International Outcomes Inventory for Hearing Aids. The literatures available also suggested about the significance of the written materials provided with the hearing aid compiling with the principles available in the health literacy, the available video-based explanation of the elderly people using the hearing aid and involving the family patterns while providing instructions concerning the management of the hearing aid to improve the self-efficacy of the patient regarding the use of hearing aid (Bennett, et al, 2018). The term “self efficacy” denotes about the capacity of the individual to attain the targeted achievements. The use of hearing aid was reported to be declined with the increasing age of the individuals as majority of the person used the hearing aid on a selective basis in comparison to full time approach. The post fitting training duration increased the use of hearing aid. The factor of excessive background noise and eventually the lack of need discontinued the use. Therefore, the process of hearing rehabilitation is considered to be joint decision approach which includes both the patients to adopt the changes in their own behaviour to augment the use of hearing aid, the implementation of the newer strategies to communication along with the maintenance of the balance. The self efficacy is considered to be an important part of the HBM for the prolonged health behaviours related to rehabilitation. It involves the self confidence of the patients to adopt the behavioural change in order to deal with the disorder. The four different approaches which enhances the self efficacy of the patients are: mastery in the experiences, verbal point of view, sensational experiences and the reduction of the perception of stress (Surr, et al, 1978; Gregory, 2011).

The audiological factors associated with the successful use of the hearing aid are four factors reported by self. They are the positive support obtained from others, the problems that they faced due to hearing impairment before the use of hearing aid, the positive approach towards the use of hearing aid and the higher level of self-efficacy observed with the use of hearing aid. The study included 160 adults patients of age above 60 years and excluded those patients who had owned hearing aid for a period longer than 2 years, staying within high care facility and suffering from mental health problem dementia. The present paper discussed about the audiological factors which include the total time period suffered due to the hearing impairment, the level of the hearing impairment, style of the hearing aid used, the presence and absence of tinnitus and the gain in insertion obtained with the hearing aid. Among the non- audiological variables which have significant impact upon the successful use of hearing aid includes the variables related to psychology of the patient such as the personality, motivation and the self-efficacy towards the treatment approach for audiological issues; the age and gender of the patient; the sociological variables include lifestyle, education, ethnicity and the social support obtained. These variables have a significant impact on the outcome of the treatment which includes the use of hearing aid and the other treatments related to audiological problems (Kricos, 2006; Hickson, et al, 2014). The study also reported about the 75 participants who were not satisfied with the use of hearing aid; 24 of them reported about the minimal use of the hearing aid due to the perceived low benefit, 15 of them stated that they used the hearing aid for 1hour daily due to the lower perceived level of satisfaction and the remaining 12 patients also used the hearing aid for 1 hour daily but they reported mild level of satisfaction with the use. Here the study indicated about the age related factors that inhibited the use of the hearing aid which had been discussed later.

As a part of the practice of audiology, practical suggestions are given on the issues to manage these problems. To provide quality care audiologist need to provide patient-centred care. Very few studies have been conducted on the patient-centred care approach of the audiologists (Grenness, et al, 2014). A study was conducted based on the research interview of a purposive sample consisting of ten elderly patients (above the age of 60 years) on the aspect of patient-centred care offered in audiological rehabilitation and the content was analysed qualitatively. The outcomes revealed about the three dimensions of the patient centred care approach in an audiological rehabilitation which includes the following: The beneficial association between the audiologist and the patient and the clinical procedures involved in the most comprehensive way. The study concluded about the two models; the first model deals with the opinions and beliefs of the old people with the hearing aid and the second model guides on the aspect of operationalised patient-centred care. The audiologist should also consider the attitudes of the family members along with the patient towards the use of the hearing aid and about the hearing impairment (Grenness, et al, 2014). Several authors in audiology have suggested including the family in the rehabilitation for determining the limitations of the communications activity, about the restrictions they face individually during the participation, setting goal regarding the rehabilitation, the improvement of valuable mutual communication measures and overall evaluation of the rehabilitations outcome based on the opinions of the family members along with the concerned patient (Dunst, 2002; Preminger & Lind, 2012; Hickson et al, 2007; Stark & Hickson, 2004; Hickson et al, 2006). The role of the family is considered to be central with respect to the process of decision making for the elderly patients as they give their opinion on behalf of the patient based on the interpersonal, personal, communicative and social aspects. Therefore, they have the potential to participate in the rehabilitation and seeking help and guidance for the use of hearing aid. Their role cannot be ignored by the healthcare professionals as the family members play the major role in resolving the difficulties in regard to the communication in daily life activities. Therefore, the family centred care (FCC) is considered to be the model of care stresses on the role of the members of family in the everyday conversation. According to the point of view of patients the initial realization about the loss of hearing comes with the interaction with their family members only (Hickson, et al, 2016).

Therefore, the audiologist and the student audiologist should perform the following functions such as to diagnose and manage the disorders related to human hearing, tinnitus, balance along with the evaluation of the results of the behavioural measures. Counselling the patient about the psychological issues is also an important part of the job beside the treatment procedure. They also guide regarding the speech and sign language related to communication impairment for the patients suffering from hearing impairment and communication disorders. To suggest and offer the patient with patient audiological rehabilitation, education of the patient about the procedures involved in the prevention of the hearing impairment and other associated problems, evaluate the value of the rehabilitation based on the patient satisfaction, health outcomes and effectiveness of the treatment. They should guide the audiologist assistant who provides support in the practice of audiology and help in the development of technical and professional standards (English, 1991; Maltby, et al, 2015). The research conducted by Gatehouse, 1994 about ten years ago suggested about the potential impact of the psychological variables concerning the adjustment issues with the hearing impairment as well as on the benefits, satisfaction regarding the use of the hearing aid which indicates about the speech clarity and background noise due to the fitting of the hearing aid. In his study, he used a regression model analysis and he stated that not a single audiological variable which he considered matched with the equation used for defining the psychological and social effects of hearing disability. The significance of using the regression model is because it can investigate the relationship between two or more variables and interprets one variable based on the other. He observed that 20 per cent of the variance could be explained in terms of the following factors such as the age, personality, level of anxiety and depression of the lesser extent of the patient involved. The author also stated that four major psychological variables such as depression, hysteria, anxiety and sickness accounted for about 30 per cent of the variation observed. The benefits obtained after the use of the hearing aid eventually improved the confidence level and the personality of the patient. Therefore, the critical analysis conducted by Gatehouse clearly indicated about the significant impact of the social and psychological variables on the success linked with the use of hearing aid in comparison to the electro-acoustic and audiological parameters. Other studies conducted by Smith, Kricos, and Holmes (2001) and Smith and Kricos (2002) revealed the importance of age on the outcomes of the audiological rehabilitations which includes the problems associated with the vision, decreased level of manual agility and the impaired cognitive abilities. The aspect of impaired cognitive abilities is a matter of huge attention for the audiologist and hearing scientists in the past few years (Pichora-Fuller, 2003; Humes, 2005; Larsby et al, 2005). Though several aspects of cognition remains undisturbed with ageing, some abilities turns down with age of the patient which includes the following parameters such as division of the attention skills, speed of the patient, the ability to switch over among the several auditory inputs, the memory of the patient concerning the work and the persistent and selective concentration (Hooyman and Kiyak, 2005).

Another study conducted by authors Wingfield and Tun (2001) mentioned about the several factors concerning the impact of age on the cognitive abilities which alters the perception of speech by the elderly patients, the decreased speed while processing, lowered efficiency observed for the task demanding divided attention and the shortcomings observed in the capacity of memory of the patient. The significance of the capacity of the memory lies in the fact that it is required for processing and storing of the information. The impairment of the cognitive functions results in the compromised ability of the patients for its day to day activities (Tun et al, 2002; Larsby et al, 2005). The suggestions about the management of the difficulties associated with the hearing aid are specifically for three different groups: the elderly patients, women, and those who were wearing hearing aid of behind-the-ear style. There lies the importance of the positive association of the knowledge and skill about the hearing aid and the importance of training and educating the patient about the use of hearing aid which will definitely improve the health outcome of the audiological rehabilitation.

Conclusion:

The present study reported about several audiological and non- audiological factors which may impact on the successful outcomes of the use of hearing aid by elderly patients within two years of the fitting. Four factors that were self-reported were highlighted behind the success: a) the positive approach obtained from the others; b) the immense level of difficulties faced by the patient in their day to day life activities prior the use of the hearing aid; c) the positive attitude towards the user of hearing aid; d) enhanced level of self-confidence and efficacy with the use of the hearing aid. Thus Heath Belief Model provided valuable insights about the attitudinal aspects of using hearing aid upon the success of health outcomes which includes such as apparent inclination, severity, self efficiency and benefits to deal with perceived barriers. Based on this study another author have developed a questionnaire specifically concerning this purpose. The significance of the audiological factor “insertion gain testing” was discussed though it’s contribution in comparison to the self-reported factors were much less with respect to the success obtained concerning the health outcomes with the use of hearing aid. The significance of the insertion gain testing was to make certain that the clients obtained the correct levels of gain with respect to the targets mentioned in the prescription. It was observed that the successful users of hearing aid had insertion gain curve close to NAL-NL1 targets. The other measuring scales can be considered such as COSI which is an open ended scale where the patients targets to improve the listening situation based on amplification. GHABP can also be considered as it consists the four predetermined patient nominated items. The present study conducted by the authors is a retrospective one discussing about the number of new findings but these findings cannot predict the success with the fitting of the hearing aid. The other factors related to age, life incidents and health associated factors also need to be determined to suggest about the success of use of hearing aid. Therefore the author suggested that further research should be conducted in future to estimate the influence of the factors identified in this study.

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Additional References:

Gregory, M., 2011. Self-efficacy and successful hearing rehabilitation. Hearing Review, 18(8), pp.28-32.

Surr, R.K., Schuchman, G.I. and Montgomery, A.A., 1978. Factors influencing use of hearing aids. Archives of Otolaryngology, 104(12), pp.732-736.

Hickson, L.O.U.I.S.E., Lind, C.H.R.I.S.T.O.P.H.E.R., Preminger, J.E., Brose, B.R.I.T.T.A.N.Y., Hauff, R. and Montano, J.J., 2016. Family-centered audiology care: Making decisions and setting goals together. Hearing Review, 23(11), pp.14-19.