Age related hearing lossMost of us have an uncomfortable relationship with ageing, especially when it comes to our hearing. If Jodie Foster, at 51, can wear hearing aids and continue to work in an industry defined by its dedication to youth and beauty, then perhaps we should follow her lead!

Hearing HQ looks at why action on hearing health sooner rather than later is vital, the complex psychosocial impacts and how to initiate a conversation about hearing loss with someone you care about.

Almost a must-have fashion item, today many people who don’t need them for seeing wear funky colourful frames. Yet, less than a generation ago glasses would have attracted ridicule.

Chances are you’d be called “four eyes” or a nerd. The phrase “guys don’t make passes at girls who wear glasses” didn’t seem too far from the truth.

If you previously had 20/20 vision, reading glasses were viewed with fear and embarrassment – an outward sign of ageing. Hearing health is every bit as important as vision health when it comes to maintaining a high quality of life into our later years.

Despite the positive changes around visual impairment, there is still widespread reluctance to embrace treatment for hearing impairment because of the perceived social stigma about hearing aids. Yet if left untreated, hearing loss not only impacts relationships, it can pose a real safety risk and is associated with an increased risk for a variety of health conditions from heart disease to dementia.

Due to the fact we are living longer healthier lives, hearing loss is a condition that most of us will have to accept. Technically the hair cells in our ears, which do not regenerate, are designed to last about 70 years.

The medical term for the gradual deterioration of hearing due to ‘wear and tear’ is presbycusis. A life of exposure to noise starts the deterioration of the hair cells many years before we realise we can’t hear as well as we used to.

One of the most prevalent yet unaddressed chronic health conditions in the developed world, hearing loss is a hidden disability. More than 20% of Australians over 15 and two in three people over 60 have a hearing loss. This figure will increase sharply as our population ages and we see just how much damage the iPod generation have done to their ears.

Australians on average take 7 to 10 years from recognising they have a hearing problem to doing something about it. Not a life-threatening condition, it does not receive the public education attention it rightly deserves, so people do not understand that damage to our auditory system is not just about dying hair cells and then getting acoustic information through a hearing aid or cochlear implant.

The really important issue is taking early action because our hearing sense is cognitive not just peripheral like vision. If you can’t hear, the brain’s auditory pathway is not stimulated and like a muscle that shrinks from lack of use, you begin to lose cognitive function (the ability for your brain to understand the sounds you hear).

So 7 to 10 years of degraded hearing means by the time you decide to get a hearing aid your brain needs to relearn how to hear. Hearing is a case of “use it or lose it” and why there is so much exploration into the possible link between hearing loss and dementia.

Research indicates that hearing loss is anecdotally associated with a long list of issues: tension and stress, fatigue, irritability, embarrassment, anger, avoidance of and withdrawal from social activities, depression, negativism, rejection by others, reduced general health, loneliness, social isolation, less alertness to the environment, danger to personal safety, impaired memory, less adaptability to learning new tasks, paranoia, reduced coping skills and reduced overall psychological health.

Research also overwhelmingly shows hearing devices are linked with impressive improvements in the psychological and physical wellbeing of people with hearing loss in all categories from mild to severe.

Quality of life

In 2000, the world’s largest study on The Impact of Treated Hearing Loss on Quality of Life was released by the US National Council on Aging (NCA). Based on 300 ‘quality of life’ questions and a hearing assessment control tool, the study had a nationally representative sample of 2,069 hearing loss subjects aged 50 and over and for the first time involved their significant others (usually a spouse).

Consistent with other correlational and randomised studies, strong evidence was found that hearing aid usage is positively related to:

  • improved interpersonal relationships (especially for mild to moderate losses) including greater intimacy and lessening of negative dysfunctional communication
  • the improved belief that the subject is in control of their lives
  • improved cognitive functioning
  • improved health status and less incidence of pain
  • enhanced emotional stability
  • enhanced group social activity
  • reduced discrimination toward the person with the hearing loss
  • the reduced difficulty associated with communication
  • reduced hearing loss compensation behaviours
  • reduced anger and frustration
  • reduced incidence of depression and depressive symptoms
  • reduced self-criticism • reduced anxiety symptoms
  • reduced paranoid feelings
  • reduced social phobias
  • greater earning power

Respondents and their family members independently reported that hearing aid use significantly improved relationships at home and with family, feelings about self, life overall, mental health, social life, emotional health and physical health. Based on these findings, few would disagree that uncorrected hearing loss is a serious issue.

Typical excuses used by those who delay action on their hearing loss are “my hearing isn’t bad enough yet” or “it’s so mild I can get by”. The tragedy is they aren’t aware of just how far their quality of life has deteriorated, let alone the enormous stress and aggravation it is causing family, friends and even associates.

For those still working, their overall effectiveness, the opportunity for promotion and earning power are all negatively impacted. Key reasons that eventually motivate them to seek help are:

  1. Their hearing problems become so unmanageable they can’t put it off any longer.
  2. Family members, tired of communication difficulties, drive them to do something about it.

Hearing, listening, connecting

As the actual capacity to hear declines, so too does the closeness and intimacy that good communication brings. Continually repeating what is said breaks down spontaneity, so simple statements and questions start to replace longer, more interesting discussions.

In a 2010 online survey by a major UK hearing aid retailer more than 1,000 people over 40 with hearing loss revealed they often feel upset that their spouse is unable to empathise in terms of how the condition affects their daily life.

A third said their inability to hear properly had caused major arguments with the family; 1 in 16 claimed their partner had threatened to leave or divorce them unless they sought help; 1 in 5 said they lied about their hearing loss to friends and family; two-thirds admitted to bluffing their way through conversations, and half said they had become depressed and isolated.

Therapists and marriage counsellors draw a distinction between hearing and listening, but for couples where one or both have a hearing loss, this could be the root of many arguments. Feelings of frustration from being misunderstood during simple conversations can develop as the strain of repeating oneself reaches intolerable levels.

The person with hearing loss can often miss the tone of voice in conversations leading to misunderstandings and feelings of hurt and resentment.

In 2009 Energizer’s US Specialty Batteries Division conducted an online survey to understand how hearing impairment can affect relationships between parents and children. The survey polled two groups – baby boomers (born between 1946 and 1964) who suffer from hearing loss and adult children who have a boomer parent suffering from hearing loss – and found:

  • Hearing loss hinders relationships. 45% of children said a parent’s hearing loss had an effect on the relationship they have with that parent. 36% said their parent misses important details about their lives; while 10% said they don’t communicate or share information with their parent as much as they would like because hearing loss gets in the way.
  • Putting appearance before family? Although 72% of boomers said their hearing loss has affected the relationship they have with their children, only 11% choose to wear a hearing aid. Among the reasons for not wearing a hearing aid? 1 in 3 said they don’t like the way hearing aids look or feel and they believe the device will make them look or feel older than they really are.
  • Do as I say, not as I do. More than 80% of boomers said it was extremely or very important for their adult child to have their hearing checked; however less than half had their own hearing screened within the past 2 years!
  • Dad, can you hear me now? 44% of children said their parent needs a hearing aid.
  • You’ve got to see it to believe it. When it comes to having a visual impairment, 99% of the boomers polled said they wear glasses/contacts all the time or for specific tasks; only 11% wear a hearing aid.

What’s stopping you?

In September 1983, 30 years ago, former US president Ronald Reagan, then 72, publicly got fitted with hearing aids causing the demand for hearing aids to double literally overnight. He let the public know that there was something out there that was very small and comfortable to wear.

Today we have “smart” digital hearing aids and some are so small they fit into the ear canal and are entirely hidden from sight. Some models connect wirelessly to TVs and phones.

Technology is developing so rapidly that one day it is likely hearing aid users will do better in difficult listening situations than people with normal hearing.

In one US study, close to 3,000 individuals with self-reported hearing loss were polled regarding their reluctance to try hearing aids. Their reasons were:

  1. Stigma and cosmetics. Many people with impaired hearing lose self-confidence and believe others will think they are less competent or attractive and so are embarrassed to wear hearing aids. But, as they experience the improved quality of life provided by hearing devices, this concern usually passes.
  2. Lack of awareness. Because people lose their hearing gradually they adapt to it without realising and so may not be aware they have significant hearing loss. It is often not until something embarrassing happens that they recognise their hearing has got worse.
  3. Misdirected medical guidance. A hearing test should be part of a regular medical check-up but is rarely recommended. In medical school GPs receive minimal training in this area, so don’t expect your family doctor to be knowledgeable about hearing loss, brands of hearing aids and whether you need them or not. Many patients end up receiving misinformation from well-intending GPs, for instance, they may believe you are not a candidate for a hearing aid if you have a hearing loss in only one ear or if you can still conduct a conversation in quiet.
  4. Not realising the importance of hearing. Of all our five senses hearing is perhaps the most important as it enables us to engage richly with people and the world around us. We forget how important this is for our quality of life as we live in such a visually-orientated society, so it is easy to take for granted. Most psychosocial barriers are built up over years of compensating for and denying the existence of the impairment.
  5. Misbelief that hearing aids don’t work. Too many people with hearing loss mistakenly believe that hearing aids are not effective. While they will never replace natural hearing, research shows that 76% of modern hearing aid users report satisfaction with their ability to improve their hearing and 66% report they have significantly improved their quality of life.
  6. Failure to trust in a hearing aid provider. Training, education and experience has greatly increased over the years for both audiologists and audiometrists. Most provide a risk-free 30-day trial period.
  7. Unrecognised value of hearing aids. Many people who avoid amplification tend to believe that they won’t derive any benefit from hearing aids. The average person and most GPs have little knowledge of the long list of positive benefits of hearing aids.
  8. Hearing aids are too expensive. They will probably be one of the smartest investments you will ever make if you follow the rehabilitation process and advice of your hearing health professional. While the upfront cost can be high (prices range from budget to premium), based on a three to five year life span, the cost per day is probably what you pay for a cup of coffee. If improved hearing keeps your brain working and helps you communicate effectively and maintain a good quality of life into your later years, surely that is worth the investment. Just ask your family if the cost is worth it.

Denial and resistance

More than two-thirds of people who refuse hearing aids do so because they think “my hearing isn’t bad enough” according to the NCA study. Because they fail to recognise the problem (denial), they do not take responsibility for it (resist treatment).

Because hearing loss occurs gradually and is characterised by difficulty only in certain situations (like in noisy environments, when someone speaks from another room or has their back turned), a person with mild hearing loss often mistakenly thinks their hearing is normal or perfectly fine for their age.

Family members, friends and co-workers are likely to spot the problem before the person does. Signs to look for include:

  • getting frustrated when talking to people (everyone mumbles)
  • straining to hear when someone talks
  • turning their head to the direction of the sound
  • responding with a smile and nod but no further comment
  • listening to the TV or radio at a loud volume
  • unable to hear the phone or doorbell ringing
  • asking people to repeat themselves
  • answering questions incorrectly
  • avoiding conversations on the phone or in the car
  • avoiding noisy social events or activities
  • trouble hearing children and women
  • trouble distinguishing between words that sound alike
  • missing dialogue at the theatre or cinema

Easing the way

There are many ways to make communication better with someone who can’t hear well and who is in denial.

  • Be patient. A person coming to terms with hearing loss is like a child learning to talk and listen. All the conditions of communication are changing.
  • Accept reality. New elements are being introduced into your relationship but they are still the person you love; hearing loss doesn’t change who they are.
  • Speak slowly. A person with hearing loss has to concentrate much harder to hear what is being said.
  • Don’t shout. It doesn’t help and can give the impression you’re angry. Only talk louder if you have a naturally quiet voice. Speak distinctly and enunciate your words clearly.
  • Don’t compete. For the best chance to be heard, understand difficult listening situations like when the TV, washing machine or dishwasher are on or if someone in the room is having an animated phone conversation. Even loud fans and whirring fish tanks can be distracting. People with hearing loss find it hard to block out sounds while they are straining to hear your words. Over the holidays consider using paper plates and plastic cutlery in place of silverware and china to cut down on noise. Don’t talk with your back to the person with hearing loss. Keep your hands away from your face. If they can see your face they can get a better sense of what you are saying and the sound quality is better.
  • Don’t lean into an ear. If you do they can’t see your lips move. We all lip read unconsciously to some degree. It’s a skill many people use without realising as their hearing starts to go.
  • Make sure you have their full attention. Use their name to alert them you are speaking to them. A hearing-impaired person who is cooking dinner is not likely to pick up much kitchen chatter.
  • Don’t walk away while you are still talking as your words will frustratingly get cut off. Don’t expect them to hear you from another room.
  • In a small group, speak one at a time. A hearing-impaired person will struggle to pick up anything from overlapping conversations. Dinner parties, meetings and book clubs can be difficult.
  • Don’t give up. It’s frustrating to repeat something several times, but instead of shrugging it off as not important try rephrasing it in a way that may be more easily understood.
  • Avoid patronising, particularly with seniors. While they may be hard of hearing it doesn’t mean they don’t understand. Speak in simple sentences with appropriate pauses and they should be able to hear what you are saying.
  • Pay attention. Facial features often indicate what is going on in someone’s mind. A puzzled look probably means you are not communicating effectively so try rephrasing what you are saying.
  • Avoid low lighting. Communication is significantly better if the hearing- impaired person can see people’s faces clearly and pick up non-verbal communication hints.
  • Agree on a signal to discreetly let your loved one know when they are speaking too loudly around company. People with hearing loss often cannot hear their own voice well enough to judge their volume.
  • Don’t show annoyance. Though you may be frustrated, hearing loss is worse for the afflicted person. One day you may have to learn to live with your hearing loss (the price we pay for living beyond the biblical three score and ten years).

Tough love

It can be frustrating to live with someone who has hearing loss, but the secret to avoiding resentment and anger is to help them achieve independent hearing.

In his book How Hearing Loss Impacts Relationships: Motivating your Loved One , US audiologist Dr Richard E Carmen has done a masterful job offering help to family members caught in the trap of compensating for a loved one.

He suggests it is counterproductive to repeat yourself, speak clearly or louder or interpret for a loved one because it assists in their failure to seek help. By relying on your good hearing, they never realise how much communication they actually fail to understand or miss completely because you have become their ears.

Once you stop compensating for them it takes only a short time before they realise without your help they are in trouble and this usually inspires positive action. You need to create the need for your loved one to seek treatment. Your ultimate goal is to make them hear independently of you.

Starting the conversation

  • Discussing hearing loss can be a tough topic to bring up with someone you care about, especially for the first time. It’s important to ease into the conversation gently. They may be aware they have a problem but are afraid to talk about it. Or, because it has developed slowly over time and you’ve been compensating for them, they may be unaware of it.
  • Set the stage for a successful talk. Choose a quiet moment in a comfortable and familiar location and minimise background noises. Approach them with compassion and love and stay calm and objective. Respect that they may not be ready to accept their hearing loss – sometimes the conversation needs to take place in small steps over time.
  • It might be helpful to document their hearing loss behaviours and yours as a helper to refer to during the discussion. Share the impact the hearing loss has on your relationship (rather than the frustration you feel) like the missed opportunities for conversation, connection and shared experiences.
  • Using the phrase “I’ve noticed recently…” is a great conversation starter or “I’m concerned how often you ask people to repeat themselves”. Give real examples that demonstrate the hearing problem. Maybe it is that the grandchildren won’t play games with them because they get frustrated with not being heard. Or perhaps you’ve noticed they don’t talk on the phone much anymore or that they are becoming withdrawn and avoid connecting with friends.

Dealing with denial

  • Tell them you’re going to begin to practice “tough love” to help them hear independently and to make both your lives better. Explain it is not a step you are taking out of anger or vindictiveness but out of love and concern.
  • If it feels too extreme to stop helping them when they don’t hear something, use the phrase “hearing help” as a preface each time you repeat something or convey what others are saying or interpret a phone call for them. This reminds them you are acting as their ears without cutting off communication completely.
  • If you are really challenged by doing this, Dr Carmen suggests you may need to take an honest look at your own feelings about the situation. You may actually find some degree of satisfaction in being their link to the world and having them depend on you so much, locking you both into a pattern of co-dependency. If you suspect you’re caught in such a cycle, seeing a therapist for a session or two can help.
  • If the “hearing help” suggestion isn’t working and they still won’t address their hearing loss, even stronger action may be necessary as long as their personality can deal with a more direct (but still loving) confrontation. You could try recording a video of them in a situation where they struggle to hear such as a family get-together, then sit down and view it with them privately to prevent embarrassment. If that doesn’t work, stage an intervention. Without giving them prior warning have family members meet with them for 10 to 15 minutes to talk about how the problem is affecting them. The overall message should be how much they care about them and miss quality communication and how they want a better quality of life for the person with hearing loss. Achieving success Dr Carmen offers valuable steps to getting a loved one to take action.
  • Recognise life patterns. We are all creatures of habit. The way someone manages their health is probably predictable. Are they proactive or ambivalent? Someone who talks about it but does nothing or won’t discuss it at all? Recognising a behaviour or attitude can help you approach the discussion about their hearing. Or, have you maybe been assisting them for so long that it’s now expected and has become part of their pattern? If so, now may be the time for you to change your pattern and in so doing, necessitate a change in them by enlightening them to how much more difficult life is for you and others because of their lack of treatment.
  • Identify challenges. If you see their patterns, you will likely also know the challenges you’ll face. If they are ambivalent about treatment, make your challenges clear to them. Gently share feedback from friends and family who are concerned about them. Explore some of the ideas suggested above to deal with denial.
  • Commit to the changes. Don’t be afraid to be tough. Commit to no longer being an enabler by repeating or interpreting. You cannot force someone to change, but you can provide gentle helpful guidance in the form of love and compassion. Miracles can happen.

Breaking down resistance

When discussing hearing treatment, focus on the benefits. Be specific and provide real-life examples like “you’ll be able to hear your grandson sing in church” or “when Bill tells a joke you’ll be able to hear every word”.

Ease into the idea of a hearing test. If they are still hesitant to visit a hearing health professional, an interim step could be to try Australian Hearing’s Telscreen online hearing test from the comfort of your home by phoning 1800 826 500 FREE from anywhere in Australia at any time.

It only takes a few minutes and provides an idea of what some parts of a professional hearing evaluation might be like to reduce any fear. The whole family could take one to show support.

While you’re online explore the different types of hearing aid options together. Point out how sophisticated, cosmetically-appealing and unnoticeable modern digital hearing aids are.

Hopefully by this stage they will be open to getting an expert diagnosis. Ask your GP for a referral to an audiologist so you can claim the evaluation on Medicare. Attend the appointment together so you too can understand the options available and ask questions.

Taking responsibility

At the 2013 Better Hearing Australia conference in Sydney in October, Australia’s second longest-serving prime minister (1996-2007), the Honourable John Howard AC who has been hearing-impaired since youth and has worn two hearing aids throughout his professional career said:

“We are living healthier longer lives and there is absolutely no reason why we shouldn’t have the maximum available assistance and aids to allow us to enjoy those additional years to the full. Making sure that you can hear and that your sight is as good as it can be is all part of enjoyment of a longer life.”

Self-monitoring

The Better Hearing Institute suggests consciously self-monitoring situations in which you may be experiencing communication problems due to hearing loss to highlight the connection between these and your emotional response.

For example, you may not realise that lately you feel tense in social situations, become tired more easily after a busy day at work or a social situation, that you bow out of previously enjoyed activities or are fighting more with your spouse over seemingly small things.

Try monitoring your hearing for a few weeks in situations with your family, friends and workplace. What everyday communication problems are you experiencing?

Is it difficult to hear female voices, understand in background noise or participate in a conversation when multiple speakers are talking?

A simple awareness test you can do weekly is to ask yourself how often the following scenarios happen to you on a scale of 1 to 5 (where 1 is never and 5 is all the time). If you score 3 or higher you may have a hearing loss:

  • A friend or family member accused you of not listening
  • You find yourself intently watching the speaker’s mouth
  • Family members complain you turn the TV or radio up too loud
  • You have difficulty hearing alarms and warning signals
  • You have difficulty hearing a voice from another room
  • You have difficulty hearing conversations in a moving car
  • You have difficulty hearing during family dinners or gatherings
  • You heard a person’s voice but it sounded like gibberish
  • You understand only part of what someone said
  • Someone was talking to you but you didn’t realise it

Nothing to lose, much to gain

Be proactive. Get tested. Find out exactly what your problem is. Do you have trouble hearing vowels or consonants? High or low frequency?

Get a copy of your hearing evaluation and ask for it to be explained to you so you understand how to manage various listening environments better. Other people may not be aware of your problem hearing unless told, so improve your odds of better communication and let them know.

Stop pretending you can hear things that you miss and be frank about telling people how they can help you hear better. Ask them to get your attention before they start talking by tapping you on the arm or using your name.

If you can’t understand someone because they are shouting (shouting distorts speech) calmly tell them that you would understand them better in a loud but normal voice.

Be practical. Carry a notepad and pen with you and ask people to write down names, addresses or financial amounts so you can be sure you have them correctly. Explain this is why you want it written down.

With instructions, repeat what you think you heard for clarification like “So you want me to bring dessert on Saturday night?”

Learn coping strategies. In a noisy place the closer you get to the sound source the better you can hear. Sit in a booth rather Jodie Foster hearing aidsthan a table. If possible, sit with your back to a wall so there is no noise coming from behind you.

Pick a place with good lighting so you can see faces and non-verbal information.

While people in the public eye may not make a big deal about wearing hearing aids for obvious reasons, it is reassuring to know that they are people just like us.

They are not immune to hearing loss whether congenital like John Howard’s or acquired like Halle Berry’s (she was beaten by a boyfriend) or age-related as we suspect with the intensely-private Jodie Foster who was first photographed wearing a hearing aid in her left ear in Rome in 2007 at age 44.

What is important is that they are being proactive about their hearing loss and hearing quality of life.

Originally published in HearingHQ magazine Dec 2013