HEARING AID

FITTING FOR OLDER

ADULTS

BY
NIVEDA.N
BASLP II YR
*Older adults typically have characteristics,
needs, and predicaments that are quite
different from younger populations, and
audiologists need to prepare to address their
unique needs.
Challenges faced by older adults with hearing loss and the
audiologists who serve them include:

* pre-fitting concerns (lack of problem awareness and

readiness for hearing aids),
* personal characteristics during fitting (increased likelihood
of cognitive and psychoacoustic auditory processing
components to the listening difficulties),
* manual dexterity compromises, and sensory difficulties
beyond hearing loss (touch and vision), and special issues
in adjusting to hearing loss and hearing aid
 A comprehensive model of audiologic
management is needed, one designed to help
older adults deal more effectively with their
hearing difficulties
In recent years, practitioners in allied health
disciplines have discovered that it is better for
older adults to collaborate with health
professionals, rather than assume a passive,
compliant role (Haber, 2003).

* Pre-Fitting Considerations for

the Older Adults
*Many audiologists were educated in a
traditional medical model, with the
professional serving as the "expert", providing
one-way information to patients, and outlining
a plan of intervention with little input from the
patient or family.
*In this model, the audiologist collaborates with
older adults in the management of their hearing
losses.
* According to MarkeTrak VII data, less than half
of the 65+ age group who could benefit from
hearing aids actually purchase them (Kochkin,
2005). Further, market research has shown
that almost 20% of older adults who actually do
purchase hearing aids discontinue their use as
they relegate their hearing aids to the dresser
drawer (Kochkin, 2000).
* Researchers has frequently heard audiologists
lament the denial of hearing loss by older
adults. Although research by Smith and Kricos
(2003) provided evidence that older adults with
hearing loss usually do acknowledge their
hearing losses, many of them downplay the
negative effects that their hearing losses have
on them and their frequent communication
partners.
* Similar findings were reported for a survey on effects of
untreated hearing loss on older adults conducted by the
National Council on Aging (1999). Two-thirds of the
respondents who reported hearing loss but who did not
use hearing aids stated that their hearing losses were
not "bad enough to get a hearing aid".

* Smith and Kricos (2003) speculated that there may be

three broad levels of acknowledgement of hearing
difficulties in the older adult population: complete
acknowledgement, partial acknowledgement, and non-
acknowledgement, with different interventions
depending on the level of problem awareness shown by
the older individual
* For the non-acknowledger and partial acknowledger,
an intervention might be designed to help the patient
become aware of everyday communication difficulties.
If they are fit with hearing aids before realizing the
degree of difficulties caused by the hearing loss, the
probability of the hearing aids being returned or
relegated to the dresser drawer is likely to be
significantly increased.

* The risk entailed by fitting non-acknowledgers and

partial acknowledgers with hearing aids before they
are aware of the effects that their hearing losses are
having on them, as well as on their families, friends,
and coworkers, is that they do not appreciate how
much the hearing aids are helping them.
* One way to identify older individuals who are not fully
acknowledging their hearing difficulties is simply to ask them if
they think they have a hearing loss. The non-acknowledger will
state that they do not have a hearing loss and may make
comments that most audiologists have heard over and over,
such as "I can hear when I want to," or "Folks just don't speak
clearly anymore." The partial acknowledger may say "I know I
have a hearing loss, but it's not causing any problems."
* Another option for helping non- or partial
acknowledgers is to ask them to return to the
dispensing clinic in 3 to 6 months, but in the
meantime, to monitor their hearing abilities in a
number of situations so that they may become more
aware of how their hearing losses are affecting them
and their families.
* For older adults who fully acknowledge their
hearing loss and its effects, it is essential to
obtain the older adults' perspectives on
communication problems. When evaluating
older patients, it may not be enough to
consider pure-tone and speech thresholds, and
speech recognition measured via word lists
presented in quiet. Facets of communication
that are actually encountered in everyday
communication also need to be addressed.
Several questions that may be addressed include:
* What type of situations does the patient find
most troubling?,
* Does the patient have difficulties separating
out and attending to voices from multiple
talkers?
* How much effort is required in difficult versus
easy listening conditions, and what effect does
this have on the patient?
* Does the patient seem to have difficulties
attending to the talker, or switching attention
between talkers?
* Does the patient think that his hearing loss is
affecting him psychosocially?
* There are a number of factors to consider
when providing hearing assistive technology to
older patients. Manual dexterity may be a
problem for many older adults, especially given
that arthritis is the most common chronic
condition experienced by this population.
Other sources of dexterity problems include
Parkinson's Disease, secondary effects of
strokes, and other neurological problems.

* Factors Affecting the

Provision of Hearing
Assistive Technology to
Older Adults
* Thus, it is essential to assess dexterity of the fingers,
hands, and wrists, as well as the ability to raise the
arms to the ears.
* Souza (2004) suggests that if physical dexterity is a
problem, the audiologist may want to consider
automatic directional hearing aids because a toggle
switch or push button may be difficult to manipulate.
Likewise, she suggests that hearing aids with
automatic telecoils and hearing aids that
automatically select the electroacoustic program for
different listening situations might be considered for
those with dexterity compromises.
* In addition to dexterity issues, older adults may also have
reduced tactile sensation that may interfere with their
abilities to manipulate hearing aid controls, insert hearing
aid batteries, and position the hearing aids in their ears.
* The Semmes-Weinstein Monofilaments test (Bell-Krotoski
and Tomancik, 1987; Weinstein, 1993) is an easily
administered test of the patient's cutaneous sensory
perception, although as with manual dexterity, the
audiologist may use informal tactics to determine patient
issues with handling the hearing aids.
* Depending on the patient's word recognition
abilities and input, it may be advisable to assess
the contributions of the central auditory system
to the patient's listening difficulties. If the
patient's pure tone thresholds and word
recognition in quiet appear to be fairly good, but
the patient complains of having hearing
difficulties, it is advisable to assess word
recognition in noise.
* Because auditory processing disorders (APD) typically
result in difficulties understanding speech in noisy
settings, speech-in-noise tests such as the Quick SIN
(Etymotic Research, 2001) may be useful, both as pre-
and post-intervention measures

* Pichora-Fuller and Singh (2006) and Kricos (2006) have

described how normal age-related changes in
cognition, such as working memory, attention, and
speed of processing, may contribute to everyday
listening challenges of older adults. Particularly when
listening in acoustically hostile environments, auditory
information may be adversely affected due to central
cognitive resources being reallocated to support
auditory processing.
* As audiologists and hearing scientists have started
identifying the unique challenges faced by many
older adults with cognitive components to their
hearing difficulties, the hearing aid industry has
responded by offering hearing aid signal
processing strategies for older adults with hearing
loss and cognitive and auditory processing
disorders (Souza, 2004). One promising strategy
appears to be use of a slower speech-processing
algorithm (Cienkowski, 2003). There is some
research evidence that older listeners with
reduced cognitive abilities may obtain greater
benefits from hearing aids when slow-acting
compression is used (Gatehouse, Naylor, and
Elberling, 2003).
* There is some research evidence that older listeners
with reduced cognitive abilities may obtain greater
benefits from hearing aids when slow-acting
compression is used (Gatehouse, Naylor, and Elberling,
2003).

* When the older adult exhibits pronounced difficulties in

speech recognition in noise, the audiologist needs to be
proactive in recommending assistive devices beyond
hearing aids. Although many older adults reject the use
of FM devices (Boothryd, 2004; Chisolm, McArdle,
Abrams, and Noe, 2004), they should still be made
aware of the options available to help them understand
speech in noisy settings.
THANK YOU