BY PROFESSOR PIERS DAWES
About 90% of the 213,400 people in Australian residential aged care communities have a hearing impairment, and more than 50% are also living with dementia.
Hearing impairments exacerbate the impact of dementia on quality of life, increasing behavioural and psychological symptoms (agitation, hallucinations, aggression and depression), leading to increased use of pharmaceutical and physical restraint, communication barriers and social isolation, cognitive decline, higher care need and care costs. Hearing impairments also impact on carers, increasing social isolation, depression, relationship stress and care burden (for both informal and paid carers).
Hearing interventions are effective in improving quality of life, functional ability, mental wellbeing and social participation, including for people living with dementia. Unfortunately, hearing impairments often go under-identified and under-treated, among people in residential aged care communities.
Reports identify critical shortcomings
According to the Royal Commission into Aged Care Quality and Safety Final Report: Care, Dignity and Respect, people in aged care settings do not receive regular hearing checks, and there is under-engagement between aged care and hearing services.
The parliamentary ‘Still waiting to be heard’ report on the Inquiry into the Hearing Health and Wellbeing of Australians cited numerous submissions from consumer and community organisations and identified high unmet hearing needs of older Australians in the aged care system.
The report recommended service models be adjusted to better meet the needs of people in residential aged care. While up to 90% of people in residential aged care have a hearing impairment, less than 15% use hearing aids. Stigma, difficulties handling devices, as well as discomfort when wearing hearing aids contribute to poor uptake and adherence with devices.
Hearing aid uptake and use is even lower for people with dementia compared to those without dementia suggesting that additional barriers exist for people with dementia. Even when hearing aids are used, they are often poorly maintained, with up to 70% being faulty, having dead batteries, clogged vents and volume, tubing or sound malfunctions. Background noise is particularly a concern for people with dementia, triggering confusion, behavioural changes (i.e. agitation and aggression) and non-adherence with hearing aids.
Barriers to effective hearing care
Our review of barriers and facilitators to hearing support for people with dementia in residential aged care found that people with dementia benefit from hearing interventions but need additional support to successfully use hearing aids and rely on staff to access hearing services.
The Royal Commission into Aged Care Quality and Safety report identified that the aged care workforce is under pressure and lacks key skills. We recently completed an international study involving more than 1,000 aged care staff and families in seven countries (UK, Australia, India, Bangladesh, Korea, Greece and Indonesia) to ascertain knowledge, attitudes and practice regarding hearing health for people with dementia in aged care settings.
Universally, we found that:
- knowledge regarding screening/diagnosis/impact of hearing-cognitive co-morbidity was low;
- hearing impairment was mostly unaddressed, with no linked-up care pathways for hearing-cognitive health; and
- staff had a strong desire to implement better hearing care. Support for use of hearing aids is lacking due to lack of staff awareness, poor task delegation and lack of clear referral pathways. Staff report not prioritising hearing, insufficient training, high workload and nihilism all contributing to low levels of awareness and recognition of hearing as a priority.
The solution
Supporting hearing care and quality of life of people with dementia in residential aged care settings is a critical national priority. Effective management and support of hearing loss in residential aged care relies on several factors including those concerning the residents themselves, the staff, the local environment, as well as the wider care ecosystem. Hearing care professionals must identify opportunities to work more closely with aged care providers to improve quality of life for people in residential aged care settings.
About the author:
Name: Professor Piers Dawes
Affiliations: Director of the Centre for Hearing Research (CHEAR) and Professor of Audiology at the University of Queensland, and Professor of Audiology at the University of Manchester. Professor Dawes leads NHMRC funded SENSEcog projects, working with people who have hearing and vision difficulties, aged care staff, families, and hearing and vision professionals to provide home-delivered sensory support to people living independently at home, as well as support for people in residential aged care settings.
Location: Brisbane, Queensland.
Years in industry: 19.
References
Dawes, P., Wolski, L., Himmelsbach, I., Regan, J., & Leroi, I. (2019). Interventions for hearing and vision impairment to improve outcomes for people with dementia: a scoping review. International Psychogeriatrics, 31(2), 203-221. https://www.intpsychogeriatrics.org/article/S1041-6102(24)01901-X/fulltext
Commonwealth of Australia. Royal Commission into Aged Care Quality and Safety. Final Report: Care, Dignity and Respect. Canberra; 2021. https://www.royalcommission.gov.au/aged-care/final-report
Standing Committee on Health Aged Care and Sport, Still waiting to be heard… 2017: Canberra. https://www.aph.gov.au/Parliamentary_Business/Committees/House/Health_Aged_Care_and_Sport/HearingHealth/Report_1
Cross, H., Dawes, P., Hooper, E., Armitage, C. J., Leroi, I., & Millman, R. E. (2022). Effectiveness of hearing rehabilitation for care home residents with dementia: a systematic review. Journal of the American Medical Directors Association, 23(3), 450-460. https://www.jamda.com/article/S1525-8610(21)00981-6/abstract
Dawes, P., Leroi, I., Chauhan, N., Han, W., Harbishettar, V., Jayakody, D. M., … & Worthington, M. (2021). Hearing and vision health for people with dementia in residential long term care: Knowledge, attitudes and practice in England, South Korea, India, Greece, Indonesia and Australia. International Journal of Geriatric Psychiatry, 36(10), 1531-1540. https://onlinelibrary.wiley.com/doi/10.1002/gps.5563
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