Team Up to Treat Hearing Loss in Older Patients An audiologist and a speech-language pathologist share ways to address hearing loss in older patients—especially those with dementia. Overheard
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Overheard  |   March 01, 2017
Team Up to Treat Hearing Loss in Older Patients
Author Notes
  • Yvonne Rogalski, PhD, CCC-SLP, is an assistant professor in the Department of Speech-Language Pathology and Audiology at Ithaca College, where she teaches courses about acquired communication disorders such as aphasia, dementia, and right hemisphere and motor-speech disorders. Rogalski works with audiologist Amy Rominger to investigate the impact of hearing loss on cognition and memory in healthy older adults. She is an affiliate of ASHA Special Interest Group 2, Neurophysiology and Neurogenic Speech and Language Disorders. yrogalski@ithaca.edu
    Yvonne Rogalski, PhD, CCC-SLP, is an assistant professor in the Department of Speech-Language Pathology and Audiology at Ithaca College, where she teaches courses about acquired communication disorders such as aphasia, dementia, and right hemisphere and motor-speech disorders. Rogalski works with audiologist Amy Rominger to investigate the impact of hearing loss on cognition and memory in healthy older adults. She is an affiliate of ASHA Special Interest Group 2, Neurophysiology and Neurogenic Speech and Language Disorders. yrogalski@ithaca.edu×
  • Amy Rominger, AuD, CCC-A, is a clinical assistant professor in the Department of Speech-Language Pathology and Audiology at Ithaca College, where she teaches courses in basic audiology, aural rehabilitation and hearing loss in the elderly. She is an affiliate of ASHA Special Interest Group 7, Aural Rehabilitation and Its Instrumentation. arominger@ithaca.edu
    Amy Rominger, AuD, CCC-A, is a clinical assistant professor in the Department of Speech-Language Pathology and Audiology at Ithaca College, where she teaches courses in basic audiology, aural rehabilitation and hearing loss in the elderly. She is an affiliate of ASHA Special Interest Group 7, Aural Rehabilitation and Its Instrumentation. arominger@ithaca.edu×
Article Information
Hearing Disorders / Special Populations / Older Adults & Aging / Overheard
Overheard   |   March 01, 2017
Team Up to Treat Hearing Loss in Older Patients
The ASHA Leader, March 2017, Vol. 22, online only. doi:10.1044/leader.OV.22032017.np
The ASHA Leader, March 2017, Vol. 22, online only. doi:10.1044/leader.OV.22032017.np
Audiologist Amy Romenger and speech-language pathologist Yvonne Rogalski, assistant professors in Ithaca College’s Department of Speech-Language Pathology and Audiology, investigate the impact of hearing loss on cognition and memory in healthy older adults.
Participant: Does it matter the type of hearing loss (for example, noise-induced) when you consider the higher incidence of seniors with dementia?
Rominger: The evidence right now shows the correlation with presbycusis (age-related hearing loss). We don’t know about the specific relationship with noise-induced hearing loss and dementia. That being said, we do know that any kind of untreated hearing loss can lead to isolation and depression, which is also correlated with dementia.
Participant: When should a personal sound amplification product (PSAP) be recommended? Are they regulated? Should a family member or friend buy one and give it to a loved one without consultation with an audiologist?
Rominger: A PSAP is not the gold standard in treating hearing loss through amplification. Hearing aids remain the number-one choice. However, there are specific times when a PSAP is warranted—these include dexterity, compliance and cognition factors. These devices are more simple to use and can be handled more easily than a more complex hearing aid. In addition, they also may be a better choice when cost is a factor or when there is worry that devices may be lost in a nursing home. Unfortunately, they are not regulated. There is not equal output of sound across devices, which means there is a risk of overexposing people to sound. This can make it tricky for friends and family to just pick a device to purchase. I always recommend consulting with an audiologist prior to choosing a PSAP.
Participant: How do you get a reluctant patient over 80 to get an audiology evaluation and then to use the hearing aids? His cognition is still pretty intact. His caregiver is his wife, and she does not feel comfortable pushing him. He is also depressed and is reluctant to get any help for that.
Rominger: While it is difficult to make a full recommendation without seeing this patient or consulting personally, I don’t think this person sounds like the best hearing aid candidate. Even though we know that hearing aids are the best option auditorily, we also know that motivation is one of the biggest success factors. If he is not ready to accept having a hearing loss and does not want to do something about it—even if he reluctantly agreed to get them—they would likely become “in the drawer” hearing aids. If the idea is to just get him in for a hearing test, I think the statement I just made could be enough to alleviate the pressure he may feel. Some people are worried that a hearing test will turn into being strong-armed into getting hearing aids, but if they know there are perhaps other options, they may be more likely to get evaluated.

“Some people are worried that a hearing test will turn into being strong-armed into getting hearing aids, but if they know there are perhaps other options, they may be more likely to get evaluated.”

Participant: Could you explain the use of TimeSlips [a creative storytelling technique] as a creative imagination activity for the client?
Rogalski: We use variations of TimeSlips in our dementia group. Sometimes we have picture stimuli and the residents create stories. Sometimes the residents create poetry based on pictures. Sometimes we have them just “throw out” a key word, and we create a story or a poem around that. The residents really like this kind of activity. No matter what we do though, we always write the responses on a large whiteboard to aid with memory, and we always review the stories or poems multiple times.
Participant: How do you feel about using over-the-counter amplification devices for temporary use with those persons/families that don’t want to pay for hearing aids?
Rominger: I am really nervous about this becoming a more common practice. As I mentioned before, there is very little regulation on the sound output of these over-the-counter devices; therefore, if an individual or their family member is self-diagnosing and choosing the device, I worry about the potential damage that could occur. That being said, if they consult with a hearing professional and make sure the outputs are safe, I don’t see a problem using them as a temporary solution. I just think professional consultation and oversight are very important for patient safety in these cases.
Participant: In terms of the skilled nursing environment, it is a daily struggle to make sure that hearing aid placement continues not only in the residents with dementia, but all residents. Can you recommend some good key points to include in a training to encourage other staff members that hearing aid placement and care is crucial?
Rominger: I think it’s really important to emphasize the consequences of untreated hearing loss, like isolation, depression and withdrawal. If they’re depressed, not wanting to engage, they will ultimately need more/different care than those who remain social.
Rogalski: Try to emphasize that improving hearing and/or using modifications to enhance communication and understanding will make the staff’s job easier.

“It’s really important to emphasize the consequences of untreated hearing loss, like isolation, depression and withdrawal.”

Participant: You mentioned in your presentation that when a diagnosis of dementia is not noted, you administer the MoCA [Montreal Cognitive Assessment]. Is this typical across most audiologists? My grandfather has a long history of hearing loss, with (I suspect) the wrong type of hearing aids. I also suspect that he is demonstrating either MCI [mild cognitive impairment] or the early stages of dementia; however, he has never been tested. Is this something an audiologist would typically suggest he look into?
Rominger: No! Our approach is an unusual one. This is where communication between SLPs and audiologists is really important—audiologists can administer the MoCA, but a professional needs to interpret it. This is why we included it in our protocol. Through our appointments we were able to determine if hearing loss was contributing to the communication problems and/or if cognition could be contributing.
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March 2017
Volume 22, Issue 3