For most of us, we are busy with our daily lives engulfed with family activities, work, education, and all the things that consume our time. We never give it a thought and often take for granted how our senses keep us connected with our world.
As we age there are changes confronting us in the realm of our health and quality of life. These changes are age-related and present a disability to be addressed and remedied. Most of these are hearing, vision, speaking, various motor skills, and cognition. Hearing loss is estimated to affect some 39 to 50 million Americans.
Research has indicated that almost three out of every four individuals age 80 and above will have at least one disability to deal with. Most often, hearing loss is most common. Dr. Frank R. Lin, MD of Johns Hopkins University has been one of the leading researchers over the past ten years to make the connection with untreated hearing loss being a provocateur in the area of Dementia.
Our loved ones and senior friends impacted with hearing loss and some type of Dementia are especially at risk for decreased quality of life. Often these people require special care in a licensed facility with a professional medical staff 24/7.
Ideally, I recommend to every one of my patients to have a complete audiological evaluation on an annual basis. Following this guideline as an associated part of having an annual physical by their family physician, enables the audiologist to detect and monitor adverse changes in hearing acuity, abnormalities, and other medical issues to be addressed.
This evaluation provides the baseline and documentation on future tests that help the patient later in life. The protocol includes, but is not limited to case history, otoscopic inspection, pure tone (air & bone) audiometry, speech audiometry, tone decay, tympanometry, acoustic stapedial reflexes, and distortion product otoacoustic emissions testing.
One avenue where this documentation will be critical is in handling hearing health care for those requiring amplification and knowing what the previous status was for Dementia-affected patients.
For the reader of this article, you would undoubtedly be able to participate in and complete an audiological evaluation administered by an audiologist. For a person with advancing Dementia, in a facility such as a nursing home or special care unit, it may be that up to 95% cannot complete or tolerate the standard evaluation. Even though Congress in 1987 mandated a Minimum Data Set for a required evaluation of incoming residents to a facility, it does not guarantee a successful finding, in hearing, comprehending speech, and producing language.
For those people with mid to later stages of Dementia, alterations in testing protocol could be required. Behavioral tests are mostly eliminated from the battery.
There are many considerations in handling hearing loss, amplification, and proper examination and assessment for the person with Dementia. Since much of the protocol below is rather scientific-sounding and not easily expressed in lay terms, please print out this blog post and/or bring the information to your doctor to get the process underway.
A suggested protocol may include:
Case history – Since the patient may not be able to provide complete and accurate information, a family member or friend should be queried. This step will require a review of previous audiologic studies.
Otoscopic inspection – The audiologist will utilize an otoscope to examine the outer ear canals and visually assess for any apparent abnormalities.
Audiometry for pure tone and speech stimuli – This component requires participation by the patient and tests reliability in subjective responses. There will be some that may not tolerate the headset or canal inserts nor provide reliable information. Research has shown that only 5% may be able to complete this step.
Tympanometry and acoustic stapedial reflexes; impedance testing – This assessment will show whether a perforation, abnormal middle ear pressure or fluid is present and requiring otologic intervention.
Distortion product otoacoustic emissions (DPOAE) testing – This is a truly objective test to determine the status of the outer hair cells of the cochlea. Normal responses are seen in threshold levels up to 35 dBHL. The frequency range of DPOAE is 1500 to 6000 Hz.
Amplification check – The doctor of audiology will clean, check, repair as needed, readjust, and refit the patient’s amplification if they are a current wearer. If replacement is indicated, this will be noted. As for a new fitting to a patient who has not previously been fitted, it will not be advised due to issues involving the reliability of the assessment and tolerance of fitting.
If you wish to explore this subject further, please contact a board-certified & licensed private practice doctor of audiology today.
Hearing loss, once addressed, may result in a much richer and more meaningful quality of life for all those affected!
Dr. Patrick M. Murphy, Au.D., M.Ed., CCC-A, FAAA
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