Louise Hickson

Outcomes of hearing aid fitting for older people with hearing impairment and their significant others

As hearing impairment affects communication, it seems intuitive that both the person with hearing impairment and the significant other (SO) will experience effects as a result of the impairment and subsequent rehabilitation. The present study examined the effect that hearing impairment and aural rehabilitation has on the person with hearing impairment and the SOs quality of life (QOL). Ninety-three people with hearing impairment completed a measure of hearing-specific QOL (Hearing Handicap Inventory for the Elderly) and health-related QOL (Short Form-36), while 78 SOs completed a modi- fied version of the Quantified Denver Scale and the Short Form-36, prior to and 3 months following hearing aid fitting. The results emphasize the significant impact of hearing impairment on both the person with hearing impairment and the SO. The results also demonstrate the effective role that hearing aids play in reducing such negative effects for both parties. Sumario Conforme un trastorno auditivo afecta la comunicación, podemos intuir que tanto la persona con hipoacusia como sus seres significativos (SO) experimentarán efectos relacionados con el trastorno y la rehabilitación subsecuente. El presente estudio examina el efecto que el trastorno auditivo y la rehabilitación aural ejercen sobre la calidad de vida (QOL) de la persona con una hipoacusia y su SO. Noventa y tres personas con hipoacusia completaron una medida de la QOL específica para la audición (Inventario del Impedimento Auditivo para el Anciano) y de la QOL relacionado con la salud (Fórmula corta 36), mientras que 78 SOs completaron una versión modifi- cada de la Escala Cuantificada de Denver y la Fórmula corta 36, antes y 3 meses después de la adaptación del auxiliar auditivo. Los resultados enfatizan el impacto significativo del trastorno auditivo tanto en la persona con hipoacusia como para su SO. Los resultados también demostraron el papel efectivo que el auxiliar auditivo juega en reducir tales efectos negativos en ambas partes.

Social participation for older people with aphasia: The impact of communication disability on friendships

Abstract Purpose: The language changes experienced by a person with aphasia following a stroke often have sudden and longlasting negative impact on friendships. Friendship relationships are core to social engagement, quality of life, and emotional well-being. The aims of this study were to describe everyday communication with friends for older people with and without aphasia and to examine the nature of actual friendship conversations involving a person with aphasia. Method: This naturalistic inquiry drew data from two phases of research: a participant observation study of 30 older Australians, 15 of whom had aphasia following a stroke, and a collective case study using stimulated recall to examine friendship conversations involving an older person with aphasia. Results: People with aphasia communicated with fewer friends and had smaller social networks. “Friendship” was a core domain of communication for older people and participation in leisure and educational activities was focal in everyday communication with friends. Case study data of conversations between three older people with aphasia and their friends illuminated features of “time,” the role of humour, and friends having shared interests. Conclusion: Aphasia has been found to impact on friendships. A need exists for research and intervention programs to address communication with friends for older people with aphasia.

Music perception of cochlear implant users compared with that of hearing aid users.

Objectives: To investigate the music perception skills of adult cochlear implant (CI) users in comparison with hearing aid (HA) users who have similar levels of hearing impairment. It was hypothesized that the HA users would perform better than the CI recipients on tests involving pitch, instrument, and melody perception, but similarly for rhythm perception. Design: Fifteen users of the Nucleus CI system and 15 HA users participated in a series of music perception tests. All subjects were postlingually deafened adults, with the HA subjects being required to meet the current audiological criteria for CI candidacy. A music test battery was designed for the study incorporating four major tasks: (1) discrimination of 38 pairs of rhythms; (2) pitch ranking of one-octave, half-octave, and quarter-octave intervals; (3) instrument recognition incorporating three subtests, each with 12 different instruments or ensembles; and (4) recognition of 10 familiar melodies. Stimuli were presented via direct audio input at comfortable presentation levels. The test battery was administered to each subject on two separate occasions, approximately 4 mo apart. Results: The results from the rhythm test were 93% correct for the CI group and 94% correct for the HA group; these scores were not significantly different. For the pitch test, there was a significant difference between the HA group and the CI group (p < 0.001), with higher mean scores recorded by the HA group for all three interval sizes. The CI subject group was unable to rank pitches a quarter-octave apart, only scoring at chance level for this interval size. In the instrument recognition test, although there was no significant difference between the mean scores of the two groups, both groups obtained significantly higher scores for the subtest incorporating single instrument stimuli than those incorporating multiple instrumentations (p < 0.001). In the melody test, there was a significant difference between the implantees’ mean score of 52% correct and the HA group’s mean of 91% (p < 0.001). Conclusions: As hypothesized, results from the two groups were almost identical for the rhythm test, with the HA group performing significantly better than the CI group on the pitch and melody tests. However, there was no difference between the groups in their ability to identify musical instruments or ensembles. The results of this study indicate that HA users with similar levels of hearing loss perform at least equal to, if not better than, CI users on these music perception tests. However, despite the differences between scores obtained by the CI and HA subject groups, both these subject groups were largely unable to achieve accurate or effective music perception, regardless of the device they used.

The effect of hearing impairment in older people on the spouse

The prevalence of hearing impairment (HI) in older people and its detrimental effects on their quality of life and well-being is well known. To date however, there have been few studies investigating the impact on the persons spouse. To investigate this topic, a qualitative study consisting of in-depth interviews was conducted with five female and five male spouses of older people with HI. The aims of the study were: (1) to describe the spouses’ experiences of living with someone with a HI; (2) to describe the effect of HI on the couples’ communication and relationship; and (3) to identify coping strategies adopted by spouses. An interpretive analysis revealed four themes that described the experience of spouses of older people with HI: (1) the broad ranging effects of the HI on the spouses’ everyday lives; (2) the spouses’ need to constantly adapt to their partners’ HI; (3) the effect of acceptance of the HI on the spouse; and (4) the impact of ageing and retirement. Spouses in this study experienced a wide range of effects as a result of their partners’ HI. Implications for audiological rehabilitation are discussed.

Identifying the communication activities of older people with aphasia: Evidence from naturalistic observation

Background : Increasingly there is a call from clinicians and researchers for measures that document the impact of aphasia on a persons everyday communication. Do existing assessments of communication disability adequately sample communication activities relevant to our clients? Communication skills and networks change with age. A need exists to determine the everyday communication activities of older people and in particular those with aphasia. Aims : The primary aim of this study was to describe and compare the everyday communication activities of older people with aphasia and healthy older people who are living in the community. A secondary aim was to investigate the content validity of the American Speech-Language Hearing Association Functional Assessment of Communication Skills for Adults (ASHA FACS, 1997) for older Australians. Methods & Procedures : Naturalistic observation was the method of choice for detailing the everyday communication of 15 older people with chronic aphasia following stroke and a matched group of 15 healthy older people who were living in the community. Researchers, in the role of participant observer, took field notes for 8 hours, over three occasions within a week. A total of 240 hours of observation have been coded in terms of communication activity, topic, communication partners, and place of communication. A brief 5-day diary served to check the representativeness of the observational data. After each hour of observation, the researcher checked which ASHA FACS items had been observed. Outcomes & Results : Naturalistic observation provided a rich, rigorous, and systematic methodology for detailing the dynamics and complexities of authentic communication. The most common communication activities for both groups were conversations at home and in social groups. Real-life communication was revealed to serve the dual purposes of transaction and interaction. Results indicate that older people with aphasia engage in similar communication activities to healthy older people although differences were evident in the frequency of communication and in specific activities such as story telling, writing, commenting, and acknowledging. ASHA FACS items were generally relevant to older Australians living in the community. Conclusions : This study demonstrated that communication activity is multifaceted in terms of the type of communication and contextual factors. The observational data describe the effects of aphasia on a persons everyday communication activity and reveal the impact of aphasia on the social functions of communication including sharing information, maintaining and establishing relationships, and telling ones story. Functional communication assessment requires a greater focus on the interactional and uniquely interpersonal aspects of social communication.

Factors influencing rehabilitation decisions of adults with acquired hearing impairment

Abstract Several rehabilitation interventions yielding comparable outcomes are available to adults with acquired hearing impairment. However, the reasons why people choose particular interventions and not others have not been systematically investigated. This study explored the factors influencing the rehabilitation decisions of adults with acquired hearing impairment. Four options (hearing aids, group communication program, individual communication program, and no intervention) were discussed using shared decision making with 153 adults with acquired hearing impairment who had not previously received hearing rehabilitation. A selected sub-sample of 22 participants described the factors that influenced their decision during a semi-structured interview. Using qualitative content analysis, seven categories of factors influencing rehabilitation decisions were identified: (1) convenience; (2) expected adherence and outcomes; (3) financial costs; (4) hearing disability; (5) nature of intervention; (6) other peoples experiences, recommendations, and support; and (7) preventive and interim solution. All categories of factors were a positive influence for a particular intervention for some participants and a negative influence for the same intervention for other participants. The results support a client-centred approach to decision making. Sumario Existen varias intervenciones en rehabilitación que conducen a resultados comparables, disponibles para adultos con trastornos adquiridos de la audición. Sin embargo, las razones por las que la gente escoge un tipo de intervención particular y no otro, no han sido sistemáticamente investigadas. El estudio exploró los factores que influyen en las decisiones de rehabilitación de adultos con trastornos adquiridos de la audición. Cuatro opciones (auxiliares auditivos, programa de comunicación grupal, programas de comunicación individual y ninguna intervención) fueron discutidas usando una toma compartida de decisiones con 153 adultos con trastornos adquiridos de la audición, quienes no habían recibido rehabilitación auditiva previa. Veintidós participantes de una sub-muestra seleccionada describieron los factores que influyeron en su decisión, por medio de una entrevista semi-estructurada. Utilizando un análisis cualitativo de contenido, se identificaron siete categorías de factores que influyen en las decisiones de rehabilitación: (1) conveniencia; (2) adherencia esperada y resultados; (3) costos financieros; (4) discapacidad auditiva; (5) naturaleza de la intervención; (6) las experiencias, recomendaciones y apoyo de otras personas, y (7) soluciones preventivas y provisionales. Todas las categorías de factores fueron una influencia positiva para cada intervención particular en algunos participantes y una influencia negativa para la misma intervención en otros participantes. Los resultados apoyan un enfoque centrado en el cliente para la toma de decisiones.

Interviews with people with aphasia: Environmental factors that influence their community participation

Background: Speech‐language pathologists have been encouraged to create communication‐friendly environments to enable the everyday participation of their clients with aphasia. However, we still do not know the scope of the negative environmental factors (barriers) and positive environmental factors (facilitators) that need to be addressed in order to create these types of environments. The authors wish to acknowledge the contributions of the research participants and RSL Care. This study was also proudly supported by the Queensland Governments Growing the Smart State PhD Funding Program and may be used to assist public policy development. The State of Queensland accepts no responsibility for decisions or actions resulting from any information supplied. The views and information contained in the research do not necessarily represent the views or opinions of the Queensland Government and carry no endorsement by the Queensland Government. Aims: This investigation explores the environmental factors that hinder or support the community participation of adults with aphasia. Specifically, the in‐depth interview study asked: (a) What environmental factors are perceived by people with aphasia to hinder their community participation? (b) What environmental factors are perceived by people with aphasia to support their community participation? (c) What themes underlie the environmental factors that are perceived to hinder or support the community participation of adults with aphasia? A companion study (Howe, Worrall, & Hickson, in press) reports the findings of an observational investigation that addressed similar research questions. Methods and Procedures: The study used the research strategy of qualitative description. Semi‐structured in‐depth interviews were conducted with 25 adults with aphasia. All participants had aphasia caused by a stroke, lived in the community, and were at least 6 months post stroke. Informants were 34 to 85 years old with varied aphasia severity as measured by the Western Aphasia Battery. Qualitative content analysis was used to analyse the data. Outcomes and Results: The study identified 156 barriers and 206 facilitators that were grouped into six types of environmental factors (i.e., Barriers Related to other People, Physical Barriers, Societal Barriers, Facilitators Related to Other People, Physical Facilitators, and Societal Facilitators). In addition, the research revealed seven themes: (a) Awareness of Aphasia; (b) Opportunity for Participation; (c) Familiarity; (d) Availability of Extra Support for Communication; (e) Communication Complexity; (f) Message Clarity; (g) Time Available for Communication. Conclusions: This study has identified a wide range of barriers and facilitators and several themes that speech pathologists and policy makers need to consider in order to make community environments more accessible for people with aphasia.

What factors influence help-seeking for hearing impairment and hearing aid adoption in older adults?

Abstract Objective: The purpose of this review paper was to identify factors that influence older adults’ decisions to seek help for hearing impairment and to adopt hearing aids. Design: A literature search of abstracts within peer-reviewed journal articles published in English between 1990 and 2010 was conducted in online bibliographic databases using the keywords: hearing; impair* or loss; seek* or candidate* or applicant* or acquir*; and hearing aid* or help or advice. Results: Twenty-two articles that were directly relevant to this topic were included in this review. Conclusions: The evidence suggests that individuals are more likely to seek help for hearing impairment and/or adopt hearing aids if they: (1) have a moderate to severe hearing impairment and self-reported hearing-related activity limitations or participation restrictions; (2) are older; (3) perceive their hearing as poor; (4) consider there to be more benefits than barriers to amplification; and (5) perceive their significant other/s as supportive of hearing rehabilitation. A barrier to help-seeking for hearing impairment and hearing aid adoption appears to be general practitioners’ management of age-related hearing impairment.

Rehabilitation of Older Adults With Hearing Impairment: A Critical Review

Objectives: Hearing impairment, which affects both peripheral and central structures of the auditory system, is highly prevalent among older adults and has serious consequences both for the people with hearing impairment and for those around them. This article provides an updated overview of the rehabilitation of this population. Methods: This article critically reviews the rehabilitation interventions available to older adults with hearing impairment: hearing aids, hearing assistance technology, and communication programs. Results: Current evidence suggests positive outcomes of similar magnitude for the three rehabilitation interventions, however their availability/uptake and adherence are suboptimal. Discussion: To improve the current situation, two changes to practice are warranted. First, availability of the range of rehabilitation interventions should be improved. Second, in accordance with the self-management of other chronic health conditions, older adults with hearing impairment should be invited to be actively involved in their rehabilitation.

Hearing-impaired adults are at increased risk of experiencing emotional distress and social engagement restrictions five years later

BACKGROUND we aimed to assess both cross-sectional and temporal links between measured hearing impairment and self-perceived hearing handicap, and health outcomes. METHODS in total, 811 Blue Mountains Hearing Study participants (Sydney, Australia) aged ≥55 years were examined twice (1997-99 and 2002-04). Hearing levels were measured with pure-tone audiometry. The shortened version of the hearing handicap inventory (HHIE-S) was administered, scores ≥8 defined hearing handicap. RESULTS baseline hearing impairment was strongly associated with 7 of the 10 HHIE-S questions, 5 years later. Individuals with and without hearing impairment at baseline reported that they felt embarrassed and/or frustrated by their hearing problem, and that it hampered their personal/social life, multivariable-adjusted OR: 11.5 (CI: 3.5-38.1), OR: 6.3 (CI: 2.5-15.7) and OR: 6.0 (CI: 2.1-17.5), respectively, 5 years later. Hearing-impaired, compared with non-hearing-impaired adults had a significantly higher risk of developing moderate or severe hearing handicap, OR: 3.35 (CI: 1.91-5.90) and OR: 6.60 (CI: 1.45-30.00), respectively. Cross-sectionally (at wave 2), hearing handicap increased the odds of depressive symptoms and low self-rated health by 80 and 46%, respectively. CONCLUSION older, hearing-impaired adults were significantly more likely to experience emotional distress and social engagement restrictions (self-perceived hearing handicap) directly due to their hearing impairment.