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The Hearing Day

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approaches to dementia care, care services and care homes, communication, research

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. Both hearing loss and dementia are very common among people who live in care homes, so many people have both conditions, and this can lead to some major problems. For example, difficulty in being understood, becoming more confused, or losing hearing aids when these are supplied. Note that the smaller the hearing aid, the more expensive it is, but also easier to lose.

It isn’t clear at this stage what kind of intervention would make a difference to this challenging situation. Certainly it isn’t just a matter of giving everyone a hearing aid and hoping for the best. Also not many high quality research studies have been done in this area either. Paradoxically, though, there must be a lot of day-to-day experience among care home staff about how to support residents who have dementia and hearing loss. So, our research approach is what is known as a realist synthesis. We look for any published papers that may be relevant but we also talk to people whose job it is (whom we refer to by the grand title of ‘context experts’) and learn from their experience. We then combine what we learn from the literature with the hands-on experience and try to work out what’s going on.

We’re in the first couple of rounds of this work but already we have learned some interesting things. For example, people (with or without dementia) use hearing aids in selective ways. Not necessarily all the time but sometimes to target the times of day where they would otherwise struggle, e.g. watching television. There is an interesting concept of hearing aid efficiency, which refers to how the individuals use hearing aids in response to the situation in which they are listening as well as the characteristics of the hearing aid itself. Having a hearing aid can bring benefits (able to hear better and the social consequences of that) but also can have costs (e.g. fiddly, unsightly, batteries, excessive amplification) and so how someone uses it will reflect the balance of benefits and costs. There is something to be considered about hearing technology. How hearing aids look and what they signify in terms of the aging process matters just as much among care home residents as it does in our wider culture. So we shouldn’t rule out aesthetics and meaning as an impulse for some residents not wear them. But when considering the benefits and costs, if hearing aid use can be associated with positive listening and interaction, their utility might win over appearance.

In the care home setting, an important aspect is what we might call context facilitated hearing which is ensuring that the resident is able to hear at times when this is important (e.g. when making a choice about food, joining activities) but also recognising that there are times when the individual makes a positive choice to withdraw from surrounding noise, for example if there is a lot of noise from other residents. For those individuals who have dementia and hearing loss, care home staff are best placed to assist residents with choices about active listening and hearing aid use. Staff talk about judging the situation as to when residents might benefit from using their hearing aid. This, they said, comes as part of a combination of knowing residents’ preferences (e.g. for TV or chat), and reflecting on what would ‘matter to me’ in the situation. 

Thinking about this, we realise that we have our own sound cycle over the course of the day. There are many different phases, each of which has its own characteristic sound environment. This may include playing the radio during the drive to work but perhaps preferring silence when profound concentration is required. And there are different sound contexts for our social interactions, for example in sharing a quiet coffee compared to a night out in the pub. And if these levels are disturbed, it can be irritating or even distressing, for example hearing unwanted music or merrymaking from the room next door when we are trying to sleep in a hotel. And our hearing operates at different levels of alertness and concentration – sometimes the sound is merely background and at others it is what we are most interested in. These nuances are perhaps unsurprising but they must also occur if you live in a care home, and any adverse effects will be magnified by the fact that it’s harder to escape them. With this in mind individuals living in care homes might benefit from oases of quiet where they can retreat to.  We expect that we’ll be thinking a lot more about contexts and sound environments during ORCHARD, and maybe not quite as much about hearings aids as we first expected.

This blog summarises independent research funded by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number PB-PG-0815-20013). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

Tom Dening & Brian Crosbie


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