Why hearing loss in care homes should not be tolerated

Hearing loss in later life is frequently undiagnosed or too often regarded as one of the inevitable aspects of ageing that must be accepted or tolerated.  The impact of hearing loss on quality of life and on people’s social participation can be profound.  A greater understanding of some of the policy and practice implications of addressing these matters is provided by a report from Action on Hearing Loss (formerly RNID), highlighting the particular issues that hearing loss creates for residents in care homes. 

Based on in-depth research in three homes, the findings demonstrate that where hearing loss is diagnosed and managed effectively there is an improvement in residents’ quality of life.  But the reverse is also true, and where hearing loss is poorly diagnosed or managed, residents’ daily life is more limited, constrained and frustrating than it could be.

Action on Hearing Loss estimates that in England alone there are around a quarter of a million older people in care homes who have, or would benefit from hearing aids. The study found – on the whole – that care staff had “a good understanding of how to communicate effectively with residents with hearing loss”, such as in looking directly at residents when speaking to them, but there is scope for improved awareness of such matters. Background noise levels from television or radio are often a significant hurdle for residents struggling to distinguish sounds or decipher voices from a general hubbub. Again, while many staff were aware of such issues and tried to address them, this was not universal.

Poor experiences of hearing aids

For those residents who did use hearing aids, experiences were often poor, with problems caused by flat batteries and equipment whistling for example, or there was little knowledge of how to adjust hearing aids for best results. Researchers also observed or were told about people’s hearing aids falling out, aids getting lost and residents waiting a long time to get them repaired.

A hearing check carried out with residents who did not use hearing aids indicated relatively high levels of undiagnosed hearing loss: 13 out of 20 residents had hearing loss and a further 4 were judged borderline). When discussing the findings with residents and offering advice about possible courses of action to mitigate the hearing loss, the researchers found residents typically unwilling to take any action that might improve their hearing. 

Comments made by the older people revealed a belief that they would expect their hearing to have deteriorated by their age, and that they should just put up with it along with other losses and deterioration in their health and wellbeing. Clearly, some people just didn’t want all the hassle that they anticipated might be involved in taking any action; and for those people who had some dementia or level of confusion, there were additional issues, particularly if they were unable to indicate their hearing problems, or intolerant of being touched or handled. 

Lack of conversation

As the research also explored, people’s motivations to have good hearing are an important mediating factor, and older people referred to being able to hear what they wanted to hear, or not being bothered by things they missed. If there is little going on in an environment that requires people to hear, hearing loss may also be seen as relatively unimportant. Residents referred to a lack of general conversation, and to fellow residents not being “that talkative”. 

Clearly, such a situation can become a downward spiral – if hearing loss makes conversation more difficult, people tend to talk less, and with little conversation there may be scant motivation to hear what is happening.  Sometimes conversation can be further reduced by having to compete against other sounds – notably loud televisions. Where there is a low level of conversation, people’s engagement and general interaction with other residents and staff are likely to be further curtailed. It was notable that the research found that the residents who were the most engaged and socialising with other residents “tended to be hearing aid wearers.”

Clearly, this research is small scale and the levels of hearing loss among residents may not be representative across all care homes, but equally there are no reasons to assume the findings are not typical. Certainly, the consequences of hearing loss for older people are often poorly recognised, and these findings should stimulate wider debate. 

Lonely and isolating

Hearing loss can without doubt have a major impact on people’s quality of life and their capacity to engage with their surroundings and interact with other people. The world of silence they find themselves in can be a lonely and isolating place. Action on Hearing Loss argues that steps can and should be taken to improve the situation and that diagnosing and managing hearing loss in care homes is “challenging but crucial.” 

Early intervention is seen as key, particularly in enabling identification of hearing loss and organising appropriate hearing aids for people before they become residents in care homes. Action on Hearing Loss is therefore calling for an adult hearing screening programme for the population aged over 65, and for recognition of hearing loss as a major public health issue.

Appropriate training and information for care home staff about identifying hearing loss, managing background noise, providing appropriate assistive technology and managing residents’ hearing aids, are also crucial.  Further attention to such matters might also be achieved by the Care Quality Commission introducing clear standards around communication.

Shifting attitudes

Greater attention to improved awareness and better diagnosis and treatment of age-related loss are clearly important. Perhaps the biggest challenge however lies in shifting the attitudes and assumptions that surround the ageing process. Putting up with deteriorating capacity and function may sometimes be unavoidable, but often intervention could greatly improve hearing and thereby increase the opportunities for older people to participate more fully in social interaction, engage in activities and generally benefit from an improved quality of life and mental well-being. It is time to disturb the sound of silence.  

 Melanie Henwood is an independent health and social care consultant