Enhancing Communication in Adults with Dementia and Age-Related Hearing Loss

Abstract

For many adults with dementia, age-related hearing loss is undiagnosed and/or untreated. Untreated hearing loss can exacerbate common dementia-related behavioral symptoms, such as depression, apathy, agitation. Despite the potential benefits to the individual and the family, pursuing and adopting hearing aids for persons with dementia presents with many challenges. As such, this group of vulnerable older adults is well suited for alternative approaches that adopt an interventional audiology framework. This article reviews alternative hearing care models that we have tested when working with older adults with cognitive impairments. We have found that some individuals show improvements in dementia-related problem behaviors and/or in measures of social engagement after brief aural rehabilitation interventions that provide non-custom amplification. We have developed simple training materials to help family and professional caregivers use communication strategies and non-custom amplification. Providing services that can be integrated into the person's broader dementia care has the potential to improve communication and quality of life for individuals and families. There are opportunities in this population to provide basic, simple strategies and make substantial improvements as long as we adopt approaches that bring the services to the people, instead of bringing the people to us in the audiology clinic.

Keywords

Dementia - communication strategies - over-the-counter amplification

• References

• 1 Alzheimer's Association. 2016 Alzheimer's disease facts and figures. Alzheimers Dement 2016; 12 (4) 459-509
• 2 Benner M, Steiner V, Pierce LL. Family caregivers' reports of hospitalizations and emergency department visits in community-dwelling individuals with dementia. Dementia 2016; 1471301216653537 [Epub ahead of print]
• 3 Lyketsos CG, Carrillo MC, Ryan JM , et al. Neuropsychiatric symptoms in Alzheimer's disease. Alzheimers Dement 2011; 7 (5) 532-539
• 4 Gitlin LN, Kales HC, Lyketsos CG. Nonpharmacologic management of behavioral symptoms in dementia. JAMA 2012; 308 (19) 2020-2029
• 5 Beeri MS, Werner P, Davidson M, Noy S. The cost of behavioral and psychological symptoms of dementia (BPSD) in community dwelling Alzheimer's disease patients. Int J Geriatr Psychiatry 2002; 17 (5) 403-408
• 6 Murman DL, Chen Q, Powell MC, Kuo SB, Bradley CJ, Colenda CC. The incremental direct costs associated with behavioral symptoms in AD. Neurology 2002; 59 (11) 1721-1729
• 7 Fauth EB, Zarit SH, Femia EE, Hofer SM, Stephens MA. Behavioral and psychological symptoms of dementia and caregivers' stress appraisals: intra-individual stability and change over short-term observations. Aging Ment Health 2006; 10 (6) 563-573
• 8 Cohen-Mansfield J, Dakheel-Ali M, Marx MS, Thein K, Regier NG. Which unmet needs contribute to behavior problems in persons with advanced dementia?. Psychiatry Res 2015; 228 (1) 59-64
• 9 Cohen-Mansfield J. Nonpharmacologic interventions for inappropriate behaviors in dementia: a review, summary, and critique. Am J Geriatr Psychiatry 2001; 9 (4) 361-381
• 10 Palmer CV, Adams SW, Bourgeois M, Durrant J, Rossi M. Reduction in caregiver-identified problem behaviors in patients with Alzheimer disease post-hearing-aid fitting. J Speech Lang Hear Res 1999; 42 (2) 312-328
• 11 Cohen-Mansfield J, Taylor JW. Hearing aid use in nursing homes. Part 1: Prevalence rates of hearing impairment and hearing aid use. J Am Med Dir Assoc 2004; 5 (5) 283-288
• 12 Cohen-Mansfield J, Infeld DL. Hearing aids for nursing home residents: current policy and future needs. Health Policy 2006; 79 (1) 49-56
• 13 Cohen-Mansfield J, Taylor JW. Hearing aid use in nursing homes. Part 2: Barriers to effective utilization of hearing aids. J Am Med Dir Assoc 2004; 5 (5) 289-296
• 14 Nirmalasari O, Mamo SK, Nieman CL , et al. Age-related hearing loss in older adults with cognitive impairment. Int Psychogeriatr 2017; 29 (1) 115-121
• 15 Nieman CL, Marrone N, Mamo SK , et al. The Baltimore HEARS pilot study: an affordable, accessible, community-delivered hearing care intervention. Gerontologist 2016 [Epub ahead of print]
• 16 Mamo SK, Nirmalasari O, Nieman CL , et al. Hearing care intervention for persons with dementia: a pilot study. Am J Geriatr Psychiatry 2017; 25 (1) 91-101
• 17 Mamo SK. Improving communication for persons with dementia. Paper presented at: Acoustics Week in Canada. ; September 21, 2016; Vancouver, Canada:
• 18 Verbrugge LM, Jette AM. The disablement process. Soc Sci Med 1994; 38 (1) 1-14
• 19 Cohen-Mansfield J, Dakheel-Ali M, Marx MS. Engagement in persons with dementia: the concept and its measurement. Am J Geriatr Psychiatry 2009; 17 (4) 299-307
• 20 Carson AJ, Dillon LM. Being part of the solution: an epilogue commentary. CJSLPA 1997; 21 (3) 209-211
• 21 Prince MWA, Guerchet M, Ali GC, Wu YT, Prina M. World Alzheimer Report 2015: The Global Impact of Dementia. 2015, London, UK: Alzheimer's Disease International;
• 22 National Academies of Sciences, Engineering, and Medicine: Hearing Health Care for Adults: Priorities for Improving Access and Affordability. 2016, Washington, DC: The National Academies Press;
• 23 President's Council of Advisors on Science and Technology. Aging America & Hearing Loss: Imperative of Improved Hearing Technologies. 2015, Washington, DC: Executive Office of the President;