hear

It’s the case in many elderly: I hear you, I hear you, or maybe I don’t.

The clinical scenario

 

 

 

 

 

 

It was one of those unusual clinics where I saw three similar cases in which the exact same issue surfaced and I was able to demonstrate that in “real time” to residents in training with me in the care of the elderly. The first of the encounters was with a couple accompanied by two family members. The couple lived at home with some personal care help and each had some degree of cognitive impairment, but not enough to completely interfere with reasonably safe functioning when under some supervision. I was interviewing and examining one member of the couple and my resident was doing the same to the other.

Denial or hearing impairment: a common scenario

As I embarked on my interview with the patient it became clear that as noted in previous visits, he was quite hard of hearing and according to the son who was with him, refused to wear his hearing aids because “they bothered him” and he often stated that he had “no problem with hearing”, while each time leaning closer to me to hear my question or answer and turning to the son to repeat the question.  With his wife, the resident also noted that in addition to some degree of cognitive impairment there was a significant degree of hearing impairment.

Low cost, effective hearing enhancement: very dramatic at times

I retrieved my Pocket Talker® which I keep in the office for such cases. I put the earphones first on him and gradually turned the volume and suddenly his face lit up as I asked if he could hear me and he said, “very well”. We practiced a bit with the device until it was clear that he could engage in a three way conversation with his son and me.

The resident was now ready to review the wife’s issues with me and the son entered the room with us as did his father. They had already learned from me that during the discussion, while I asked questions the son and husband were to sit quietly despite a desire to “help with answers” unless I asked them specifically to comment on something said to me by the patient. The resident had reiterated the story to me of mild dementia and emphasized that she was quite hard of hearing; she had refused hearing aids although the family was planning on acquiring them. I again retrieved the Pocket Talker® that I had just used with her husband, put on the head phones and as I increased the volume, like her husband’s, her face lit up when she heard my questions and I looked at the son and husband and said to them, “maybe you can get a deal if you get two of these”.

A hearing augmentation “hat trick” 

Later, a different resident saw another patient. This resident had not been apprised of the earlier experience that we had with the couple. She recounted a history of progressive cognitive decline in the patient and also mentioned an issue with hearing that the patient’s daughter raised. Like the previous couple the daughter said her mother absolutely refused to go for a hearing assessment and said that she did not want “hearing aids” as she “did not need them” and they were “a waste of money”.

I carried out the same manoeuvre that I had used with the previous couple. Although less dramatic than the previous cases, the way she responded to my repeated questions clearly indicated that she could hear better with the device.  In this particular case,  I was not convinced yet that some of the apparent cognitive impairment may have been perceived as such due to her hearing impairment or at least aggravated by it.  I explained to the daughter I was not yet sure of the degree of cognitive impairment, because “if you can’t hear it, you can’t remember it”.

Don’t overlook hearing as part of the cognitive assessment

In these three situations during one clinic session the young residents who in their careers would see many elderly people with cognitive impairment or dementia, the message of the importance in hearing was clearly demonstrated.  It can be hard to convince older people to utilize hearing aids or pay for them. For many a simple and inexpensive Pocket Talker® may be a device that can be used as an introduction to the benefits of hearing enhancement or may on its own solve the hearing deficiency problem for the purpose of social communication.

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Bart Mindszenthy APR, FCPRS, LM
In writing the original edition of Parenting Your Parents in 2002 and the subsequent revised second edition in 2005 and US edition in 2006, Bart Mindszenthy, APR, FCPRS, LM drew upon personal experience with his elderly father and mother, listening to hundreds of people deep into eldercare, plus his professional expertise in managing crises. Boomers can best help themselves and their parents by planning, understanding the challenges and being prepared, he says. The new, North American edition, Parenting Your Parents: Straight Talk about Aging in the Family is his ninth book. "Everyone who has aging parents should consider what issues and challenges lay ahead," says Bart. "Waiting until something happens isn't fair to anyone in the family. But the trouble is, in most families aging parents are in denial and their boomer kids are in avoidance," he says. Since the publication of Parenting Your Parents, Bart has addressed hundreds of groups and has appeared on dozens of radio and television interview and talk shows and national television specials. He is also a regular contributing writer to Hospital News (http://www.hospitalnews.com/columns/caregiver/). Bart also authored two books about family elder caregiving on his own in 2011: The Family Eldercare Workbook & Planner, a comprehensive self-directed complete guide to capture needed information and develop strategies for likely issues and difficult situations, and Aging Parents: 200+ Practical Support Tips from My Care Journey, a compilation of 40 columns that appeared in SOLUTIONS magazine tracking a range of specific caregiving issues and challenges with tips and tactics on how to deal with them; see www.famlyeldercareworkbook.com Bart holds a Bachelor of Philosophy degree with a concurrent major in journalism from Wayne State Univesity. He is Partner in The Mindszenthy & Roberts Corp., a Toronto-based firm with a subsidiary based in Michigan that since 1990 has specialized in issues and crisis communications management and strategic communications planning. Bart has received numerous awards for his work and is principle author of No Surprises: The Crisis Communications Management System (Bedford Press, 1988), which is considered a seminal work on the subject. He is also co-author of [email protected]: Be a Better Team Leader Anytime, Anywhere, with Anyone, originally published in 2001and which was the fifth best selling business book of the year in Canada. Since, it's been totally re-written, re-deisgned and re-issued in 2011. It's now also available as an iPad, iPhone and iPod app. For more, see www.leadershipatworkbook.com.

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