Anthony Hogan

The health impact of a hearing disability on older people in Australia.

Objectives: A series of studies has proposed that hearing loss has adverse effects for other aspects of health. This article examines the health effects associated with self-reported hearing disability on older people. Methods: The study utilized the 2003 Australian Survey of Disability, Ageing, and Carers (n = 43,233), a weighted population-based survey providing data on self-reported disability and quality of life, to examine hearing disability among older Australians (55 years plus). Results: Of the estimated 654,113 people reporting hearing disability, 71% experienced limited communication and 60% used hearing aids. Compared with population norms, hearing disability at all levels was associated with poorer physical and mental health scores on the SF-12 measure, especially for people with severe or profound hearing loss, thus suggesting a threshold effect at advanced levels of disability. Discussion: Data support emerging literature suggesting a causal relationship between hearing disability and quality of life. Prospective studies to further examine this relationship are indicated.

Evaluating the health-related quality of life effects of cochlear implants: a prospective study of an adult cochlear implant program

This paper prospectively documents the health-related quality of life (HRQoL) and social participation benefits of adult patients receiving cochlear implants in Australia and New Zealand. Thirty-four consecutively implanted patients completed the Assessment of Quality of Life (AQoL) and Hearing Participation Scale (HPS) instruments before implantation, and at 3– and 6–month follow-ups. Implantation resulted in significant improvements in AQoL and HPS scores. The effect size was 1.09 for both measures. Those in the top socio-economic tertile obtained the greatest gains. The HRQoL and social participation benefits were slightly larger than those reported elsewhere. This may be because participants used more recent technology (Nucleus 24 rather than Nucleus 22) and received auditory and self-efficacy training as part of their rehabilitation. The results suggest that cochlear implants have a large beneficial effect. They show that social and HRQoL outcomes can be parsimoniously measured using the HPS and AQoL instruments. Sumario Este artículo documenta prospectivamente los beneficios de la relaciön calidad de vida/salud (HRQoL) y de la participaciön social en adultos implantados en Australia y Nueva Zelanda. Treinta y cuatro pacientes consecutivos, completaron antes de implantarse el Cuestionario de Calidad de Vida (AqoL) y la Escala de Participaciön Auditiva (HPS) y después, a los 3 y 6 meses de operados. La implantaciön permitiö una mejoría significativa en el AQoL y la HPS. El efecto fue de 1.09 en ambos. Obtuvieron la mejor ganancia quienes estaban en el tercil socio-econömico superior. La HRQoL y los beneficios de participaciön social fueron ligeramente más amplios que los reportados en otros estudios, lo que puede deberse al uso de tecnología más reciente (Nucleus 24 en vez de Nucleus 22) y al entrenamiento auditivo y de autoeficacia que fue parte de la rehabilitaciön. Esto sugiere que los implantes cocleares tienen un efecto benéfico amplio y muestran que los resultados sociales y de HRQoL pueden ser adecuadamente medidos con el uso de la HPS y el AQoL.

Hearing loss and paid employment: Australian population survey findings

This paper provides an analysis of participation in paid employment for people with a hearing loss over the full span of adult ages. The paper is based on original analysis of the 2003 Australian survey of disability, aging and carers (SDAC). This analysis shows that hearing loss was associated with an increased rate of non-participation in employment of between 11.3% and 16.6%. Advancing age and the existence of co-morbidities contribute significantly to reduced participation in employment. A disproportionate impact is evident for women and for those having low education and communication difficulties. Controlling for co-morbidities, hearing loss was associated with a 2.1% increase of non-participation in employment, a proportional difference of 1.4 times the population. People with hearing loss were less likely to be found in highly skilled jobs and were over-represented among low income earners. The SDAC data set provides self-report findings on the experience of disability rather than hearing impairment. As such, these findings serve as a conservative estimate of the impact of hearing loss on accessing well-paid employment.

Carving out a space to act – acquired impairment and contested identity

Historically, rehabilitation clinics concerned with assisting those who have acquired a profound hearing loss have worked to promote practices that legitimate a culture centred on hearing and speech. Their practice of rehabilitation indicates a lack of appreciation of the social and identity issues confronting deafened adults. In consequence, deafened people have to carve out a sense of identity by developing associations and communicative strategies that validate their own way of engaging the social. Such practice encompasses the development of a dual or multiple identity centred on differing forms of communicative practice.

Health-related quality-of-life outcomes from adult cochlear implantation: a cross-sectional survey

Abstract Purpose The purpose of this study was to examine the extent to which cochlear implants and related rehabilitation improve health-related quality-of-life (HRQoL) and social participation for deafened adults and their partners. Method A cross-sectional survey was used to examine HRQoL and social participation experiences of 202 deafened adults (148 with implants and 54 without) and 136 partners associated with cochlear implant clinics in Australia and New Zealand. Respondents completed a mailed survey consisting of the Assessment of Quality of Life instrument (a utility instrument), the Participation Scale and questions concerning their socioeconomic status. Both univariate and multivariate analyses were performed. Results Controlling for socioeconomic factors, people with cochlear implants reported improved HRQoL and social participation when compared with non-implantees. Implantees reported a relative gain in health utility of 50%, and a relative improvement in social participation of 31%. Such differences were not reported by partners, although patient and partner HRQoL were weakly correlated. Conclusion The results of this cross-sectional study suggest that cochlear implantation contributes significantly to improvements for deafened adults in everyday communication settings and makes a major contribution to their HRQoL. Nonetheless, when compared with population-based studies, this population continues to report considerably reduced quality of life. Partners also report significantly reduced quality of life when compared to population norms.

Perceptions of psychosocial adjustment to acquired communication disorders: applications of the Code-Muller Protocols

The Code-Müller protocols (CMP) were introduced in 1983 and originally aimed to compare perceptions of psychosocial adjustment to aphasia and related disorders from the separate perspectives of patients, relatives and speech and language therapists as a basis for counselling. In later studies the items of the CMP were also used to examine perceptions of their importance as possible therapy targets in the rehabilitation of people with communication disorders. This paper describes the development of the CMP and presents an overview of their application in aphasia, laryngectomy and acquired deafness and discusses some clinical implications. Studies published in the past 15 years show that aphasic people and their relatives or significant others are significantly more optimistic concerning psychosocial adjustment than their therapists. Furthermore, optimism changes during the course of illness. The relative weightings given for therapy or rehabilitation targets significantly differ between different professional groups concerned with aphasia rehabilitation (speech and language therapists/pathologists, physiotherapists, occupational therapists, psychologists and physicians) and are influenced by clinical experience.

Audiologists' attitudes to cochlear implants

Abstract 215 audiologists completed a cross-sectional survey concerning attitudes towards cochlear implants and associated referral behaviours. Audiologists were found to hold positive attitudes towards cochlear implants, with the majority (65%) having referred at least one client for an assessment. Audiologists reported that the implant was a safe and effective technology and that they were satisfied with the progress made by clients with the device. Nonetheless, 84% of audiologists expressed concern about the psychosocial needs of clients within the implant programme. Referral behaviours were primarily associated with knowledge on how and when to refer a person for an assessment. Secondary factors included funding awareness, professional experience and training, and knowledge of, confidence in, and relationship to, a local implant programme. Referrals to implant clinics may be enhanced by fostering relationships within the broader audiological community.

It's a whole new ball game! Employment experiences of people with a cochlear implant

Abstract Many implantees anecdotally report employment benefits being associated with implantation. This benefit has not been routinely reported in prospective studies of implant outcomes. It is important therefore to establish the nature of benefit reported by implantees so that further studies may document such outcomes in a representative fashion. To this end, a qualitative study of the experiences of 12 people with cochlear implants in the workplace is presented. A focus group methodology was used to collect the data. Patients use a before and after narrative style to relate the impact of the device on their working lives. Prior to implantation, deafened adults report being on the margins of the workplace, mostly concerned with holding on to a job that was quite difficult to obtain in the first place. Under-employment (working below their ability levels) was a key issue. Following implantation, working life was markedly better. Implantees report being able to pursue the jobs they were trained for with greater confidence. They also reported a greatly enhanced sense of job security. They had moved from the margins to the centre of working life, participating in non-vital, spontaneous conversations, and generally felt part of the workplace. Most notably, implantees felt able to take career risks such as seeking out better employment opportunities. Respondents note that a variety of accommodations still need to be made so that they can more readily take part in workplace communication. Overall, the post-implant transition back to work could be made simpler for implantees if appropriate vocational services were offered as part of their rehabilitation programme.

The business of hearing

A controversy surrounds the use of cochlear implant technology as a ‘cure’ for deafness. The deaf community has argued that proponents of speech and hearing (known as oralists) have imposed this technology on deaf people as part of their mission to eradicate deafness and therefore the deaf community. The use of power is at issue within this debate, where power may be taken to mean something that is possessed or something that is exercised. For the deaf community, cochlear implants have come to be used because oralists simply had the power to do so. This article contests this position. It offers a description of the development of the social process that has permitted and legitimated the production of a form of social relations that privileges the use of cochlear implants over sign language. Within this analysis it can be seen that the oralists’ capacity and opportunity to act resulted from their ability to build collaborative networks with a variety of actors, both individual and institutional. This understanding of power as exercised, forms an integral part of a broader framework for understanding the governance of deafness.