Monday, February 16, 2015

From Hearing Loss to Hearing Aids: Making an Important Decision

The reality of hearing loss and the need for hearing aids is a difficult subject
for many older adults to accept. The emotional issues involved too often
override the significant health and safety issues of not hearing well.



An enormous wave is beginning to build as ten thousand boomers turn sixty-five every day. This tsunami will continue until 2030 when it will crest. Within this population, and older adults in  general, hearing loss is a significant health issue. This article will discuss the health-care process experienced by someone who enters the system to be tested and fitted for hearing aids, as well as detail some of the physical, mental, and emotional issues related to those who suffer from untreated hearing loss. 

Anatomy of a Hearing Test
The ear examination. The hearing test process begins with a visit to an otolaryngologist, an ear, nose, and throat specialist, who will ask questions about the patient’s medical history, such as, previous head injuries, chronic ear infections, job or hobbies involving loud noise. Following a chronological history of the patient’s hearing loss, the doctor will examine the patient’s ears with a very bright light called an “atoscope” to look for a broken ear drum or other inner ear damage. If the results are negative, the doctor will refer the patient to an audiologist for a hearing evaluation. 

The hearing examination. The audiologist will administer two tests. The “pure tone” test identifies the quietest tones the patient can hear in the low, medium, and high frequencies. The “spoken word” test evaluates how well the patient hears and understands the spoken word at different levels of tone and frequency. Together, the tests provide information that allows the audiologist to determine the range and extent of hearing loss. 

Selection and fitting of hearing aids. After the audiologist has reviewed the test results with the patient, and the patient has decided to wear hearing aids, there will be a discussion concerning the extent to which aids will improve the person’s ability to hear, and the choice of hearing aids that will best meet the person’s needs. 

Understanding and Selecting Hearing Aids
Basic function of a hearing aid. A hearing aid is a sound-amplifying device made up of four basic components: 

• a microphone that picks up sound,
• an amplifier that increases volume,
• a receiver/speaker that changes the collected signal back into a sound and sends it to the ear,
• a battery to provide power to the process.

Hearing aids are produced in two technological designs: analog and digital.

Analog hearing aids make continuous sound waves louder. They amplify all sounds, such as speech and noise, in the same way. Newer analog aids can be programmed using a microchip for specific settings, such as library (quiet) and restaurant (loud). In summary, analogs are less expensive, have a limited ability to program, and make sounds louder but do not discriminate among them. 

Digital hearing aids have all the features of analogs, but can convert sound waves into digital signals and produce an exact duplication of sound. They convert sound to digital noise and speech, can suppress background noise, can be programmed to the person’s hearing test results by an audiologist, and are more expensive.

Hearing Loss Statistics
The Administration on Aging’s “A Profile of Older Americans 2012,” reported that in 2010, there were forty million boomers in the United States. By 2030, there will be seventy-two million. In 2010, one-third making it the third largest chronic illness among that population. Even though hearing loss is correctible in 95 percent of the cases treated, only 20 percent seek medical treatment. Although the boomer population continues to grow, the 2010 statistics are still considered accurate. 

Federal Government Study of Hearing Issues in America
Our government has recognized the severity of the hearing loss issue in America. As part of the Department of Health and Human Services’ (DHS) “Healthy People 2010,” a nationwide health promotion and disease prevention agenda, the Surgeon General has identified twenty-eight focus areas regarding the most significant, preventable threats to public health in the U.S. One of them is hearing, and “Healthy Hearing 2010” is DHS’s initiative to treat and prevent hearing loss. The National Institute on Deafness and other Communication Disorders (NIDCD) has contracted with DHS to lead the effort. 

Why Don’t People Who Need Hearing Aids Get Them? 
A Scholar’s Opinion. In his article, “Why People Won’t Wear Hearing Aids” (1995), Mark Ross, Ph.D., identified age as the primary stopper. “Our culture is obsessed with youth and the youthful image. It spends millions on cosmetics, plastic surgery, personal trainers, and so on to remain ‘young,’ while other cultures value age and the wisdom of experience. “We disparage and mock it. We deny the aging process,” he wrote. “We deny hearing problems.” 

Ross continues: “The pity of this attitude, of course, is that while they can refuse to wear hearing aids or use any other acoustic prosthesis, they cannot disguise communicative consequences of a hearing loss. They still miss and misunderstand much in everyday conversation. Their social and cultural activities gradually diminish and their lives become more and more constricted. Their attitude is self-defeating in trying to deny the reality of hearing loss, because of its association with aging.”

A Daughter’s Opinion. Susan Seliger, in her New York Times article, “Why Won’t They Get Hearing Aids” (2012), wrote about her parent’s inability to hear and her attempts to discuss the problem with them. The article relates the following communication between her parents.

Mom, in the dining room: “Did you take out the trash?” 

Dad, in the living room: “I have plenty of cash. What do you need money for?” 

Mom, still in the dining room: “What? I don’t want any money.” 

Dad: “Why did you ask for it?”

“I felt as if I was in the middle of that Abbott and Costello routine. The only difference is that after a while, the daily misunderstandings and frustrations of having to repeat yourself become a lot less funny,” Seliger wrote. 

She was never successful in getting her parents to consider hearing aids, but her experience with them led her to study the why of people’s failure to deal with hearing loss. She went on to report: 

• It is seven to ten years before the average person with a hearing loss seeks professional help;

• Of the 26.7 million people over the age of fifty with hearing impairment, only one in seven (14 percent) uses a hearing aid. The primary reason is denial of the problem; 

• Hearing loss can play a role in balance and can lead to falling;

• Hearing loss, in some studies, suggest a link to suffering from dementia;

• Hearing loss can cause isolation and depression;

• Vanity is a primary issue;

• Cost can be a deciding factor.

The Cost of Hearing Aids 
Tricia Romano, in her New York Times article, “The Hunt for an Affordable Hearing Aid” (2012), wrote about researching for replacement hearing aids when decade-old analog hearing aids failed. “A hearing aid is basically just a microphone and amplifier in your ear. It isn’t clear why it costs thousands of dollars.”

Unfortunately, Medicare does not cover any testing for or treatment of hearing loss or hearing aids, nor do most Medicare supplement plans. However, if the person has suffered hearing loss due to illness or injury, Medicare may pay for most or all costs of a hearing aid. Otherwise, the cost of quality hearing aids and implant systems can run from $3,600-$7,000, and paying for them comes out of the person’s pocket. The Veterans Administration will pay for hearing aids for all eligible veterans.

Summary 
CSAs and other professionals working with older clients should read the article by Marilyn Ellis, CSA, CTACC, “The Best Gift Ever: Learning How to Listen-Especially to Difficult People” featured in the CSA Journal (Winter 2013). Finally, David Solie’s book (2004), How to Say It to Seniors, offers excellent ideas on how to offer assistance, how to listen, and what to listen for.

When relating the large number of older adults suffering from impaired hearing and the small percentage who seek treatment, we as professionals are charged to improve our listening skills. We should also suggest to our hearing-impaired clients that they may want to visit a medical specialist and consider the use of hearing aids. •CSA

John Parr is a partner in the law firm of Parr Bylerly in Olympia, Washington. His focus is on estate planning, elder law, probate, and the “what if” questions of aging. He is a Fellow of the American Bar Foundation, and a member of The Washington Bar Foundation and American Bar Association. He can be contacted at JMP@50pluslaw.com. Visit his website at www.parrlawfirm.com/about_john_parr.html.

From Hearing Loss to Hearing Aids: Making an Important Decision was recently published in the Fall 2014 edition of the CSA Journal.

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