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Dementia and hearing

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Topics: 
approaches to dementia care, communication, dementia awareness

About a year ago I applied for a new position within the audiology department that I work in. Little did I realise quite how much it was going to change my life and change me. The post I applied for was to “further develop the provision of services for patients suffering dementia and hearing loss”. I had some experience in dementia care previously when as a recent graduate back in the depths of recession I had taken a job as a trainee care assistant in a care of the elderly hospital. The patients that most stick in my mind from this time were diagnosed with dementia, living somewhere between our world and their own. For example, there was the gentleman who had been a driver on the night train from Edinburgh to London. Every night just before bed time he would get up and declare he had to go or he would be late for driving the train and we had to convince him that on this particular night he didn’t need to go.

I don’t remember anyone talking of the connections between dementia and hearing loss back then, but the unique individuals I met have stuck in my mind ever since. So how can we improve services for these people? It is about making sure patients with dementia who come to us receive care adapted to them. This would help them get the best out of their hearing aids, which in turn would help them get the best out of the world.

It is also a question of awareness. Once you know that hearing loss and dementia are closely linked and can impact each other, it seems fairly obvious. If somebody can’t hear you, how can they remember what’s been said? The confused answer to a question you just asked. Maybe it wasn’t the dementia this time; maybe she heard the question differently. The connection between hearing loss and dementia goes beyond this obvious first level though. Research shows that people with hearing loss are more likely to develop dementia. Results so far are inconclusive as to why, but there are various theories. One is that the extra strain on the brain from hearing loss causes extra deterioration. Another theory is that hearing loss causes social isolation, less stimulation of cognition, which leads to a deterioration.

Knowing this, and knowing that the patients most likely to have hearing aid and dementia are older, it seemed obvious to us that what we had to take our services to the patients, rather than waiting for them to come to us. Time in hospital can be very stressful to patients, especially those who struggle to make sense of their surroundings. Add to that a broken hearing aid and you might be labelled aggressive, uncooperative or said to have “selective hearing”. So I see patients in hospital, and help them with their hearing and hearing aids. Having done this regularly and often for almost a year now, it seems to be paying off. We’re getting more and more referrals to the service as doctors and other health care staff realise just how big an impact hearing can have on cognition.

In this way I feel our service has become crucial to patients and staff. It increases communication, enables capacity assessments which might in turn enable faster appropriate discharges and fewer readmissions. Patients will be enabled, and staff members don’t have to watch patients struggle on with lost/broken hearing aids or poor hearing.

In some ways it seems impossible to help every person. For each person I see I am convinced there is another one that could do with the same help, but hasn’t come to our attention. But hopefully as our service grows and gets more imbedded in people’s consciousness more and more people will get the help they need. In the meantime I focus on those I know I have helped, and doing what I can to make their lives better. And in the end, isn’t that what makes it all worthwhile?

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Tom Dening

Developing dementia is dreaded more than any other medical condition, at least by people of middle age and upwards. It’s often said in conversation that we would rather be dead than live like that.

Tom Dening

We’re just getting going on a project about hearing loss, dementia and care homes. As research projects do, it has a short title, ORCHARD, which is a contraction of Optimising Hearing Related Communication for Residents with Dementia.

Kate Swaffer

In the 1970’s when I commenced my nursing, most people with dementia were diagnosed nearer to the end stage of the disease process, and little was known about dementia.