By Oran Aviv
Dementia is often associated with memory loss and confusion, but less commonly recognized are the sensory changes that accompany both aging and dementia.
One significant sensory change is hearing loss, which can affect older adults and individuals living with dementia. It's important that we address this issue to prevent social withdrawal and further cognitive decline.
In this blog post, we will explore the reasons behind hearing loss, its impact, and effective ways to assist those experiencing hearing difficulties.
Hearing Loss and Aging
Age-related hearing loss (ARHL) is one of the most common health conditions affecting older adults. As people age, they are more likely to experience hearing problems.
According to the National Institute on Deafness and Other Communication Disorders (NIDCD), about one in three people between the ages of 65 and 74 has hearing loss, and nearly half of those older than 75 have difficulty hearing.
Hearing loss can lead to difficulties in communication with family and friends. Older adults with hearing loss may feel isolated or left out of conversations, which can contribute to social withdrawal and feelings of loneliness.
Research has shown a significant connection between hearing loss and cognitive decline. Cognitive functions such as memory and problem-solving can be negatively affected by untreated hearing loss.
The Lancet International Commission on Dementia, Prevention, Intervention, and Care has estimated that mid-life hearing loss if eliminated, might decrease the risk of dementia by nine percent.
Dementia and Hearing Loss
Most of us associate dementia with memory loss and confusion, but sensory challenges are very prevalent in those living with dementia and often they and their care partners are not aware of this. You can learn more about sensory changes in our blog post: Dementia and Sensory Changes
Fifteen Years ago Angela Houston was diagnosed with young-onset Alzheimer’s. Since that diagnosis, Agnes has been researching and teaching about the sensory changes people living with dementia often experience. She continues to teach as part of the staff at Edinburgh University.
I’ve found that professionals in both the vision field and the auditory field don’t know that people with dementia can have sensory issues. The professionals and nurses in the dementia world aren’t knowledgeable about it either… But I was meeting other people with dementia, and they were having similar symptoms and getting no help, so I knew that something wasn’t right.
In her booklet about Dementia and Sensory Challenges, Agnes explains how sensitivity to noise and certain tones can cause information overload in people who are living with dementia which can lead to agitation as well as isolation.
Sadly many people living with dementia and their care partners are not aware of this. They may not understand why an individual may suddenly become agitated for what seems like no reason but is actually due to background noise. Imagine for a moment that you're trying to enjoy a peaceful chat with a friend over a cup of coffee. However, every minute or so, you hear the high-pitched, screechy sound of someone nearby scraping their nails on a chalkboard. This causes you to jump in discomfort. Can you picture how this would make you feel? It would likely be difficult to relax, and you might become increasingly irritated and stressed, dreading the next time you hear that unsettling noise.
Now, think about someone living with dementia. For them, it could be that every time they hear a chair being moved when someone gets up from the table, it is like experiencing that same sense of discomfort and distress we would feel when we heard nails on a chalkboard.
The noise disrupts an individual’s peace and can lead to anxiety as they anticipate the next occurrence. This constant state of unease can be challenging for individuals with dementia, making it difficult for them to find comfort and relaxation in a coffee shop, restaurant, or in almost any place where there are other people.
Sensitivity to Specific Sounds
I’ve written about the inspiring Wendy Mitchell, who was diagnosed 9 years ago with Young-onset Alzheimer’s and since her diagnosis has written 3 books, travels to lecture on her own, and writes a daily blog with photos of her daily walks in the beautiful area where she lives. I am now reading Wendy Mitchell’s second book, What I Wish People Knew about Dementia, where she again allows us to understand better what life is like for someone living with dementia and how we can help.
In this book, Wendy describes how for 5 years certain sounds made her jump. She tried earplugs, but they did not help. Wendy had to move out of the city and into a quieter village because of her sensitivity to sounds. She describes these hearing changes in her book:
The new disease changed the landscape of the beloved city of York… Suddenly it was as if the city had turned up the sound dial. Every step outside of my home was more and more overwhelming Now hazards awaited me on every street corner: the piercing ring of ambulances that stopped me in my tracks, clutching at my head to still the pain; the growl of car engines as they waited for lights to change; a gabble of voices that could render the Shambles [a historic street in York] disoriented and frightening. It was as if my city and I had become strangers to one another overnight.
Luckily, Wendy met with Rebecca Dunn, a clinical physiologist specializing in audiology at Hull and West Yorkshire Hospitals NHS Trust, who diagnosed Wendy with Hyperacusis.
Hyperacusis is a condition characterized by an increased sensitivity to sounds, often causing discomfort or pain at lower volume levels than what would typically bother most people.
Dunn prescribed hearing aids for Wendy that would block out the range of noises that made Wendy uncomfortable. The result for Wendy was life-changing. She was able to hear city sounds, but they no longer induce stress and panic.
Rebecca Dunn suggests that all people who are diagnosed with dementia should be screened for hearing issues immediately. Sadly, there aren’t funds for this, even though earlier screening may prevent hyperacusis and faster progression of dementia.
Please make sure that if you know someone who has been diagnosed with dementia, they consult with a specialist in audiology.
Difficulty Hearing “T” and “S”
Another hearing issue Wendy Mitchell mentions in her book, What I Wish People Knew about Dementia, is difficulty discerning T and S sounds which can make following conversations difficult.
I was not familiar with this phenomenon, so I researched it and this is what I learned:
Speech sounds like “S” and “T” and called high-frequency consonants. These sounds are produced at higher pitches and require precise articulation, involving the tongue, lips, and airflow
As we age, we often lose the ability to hear high-frequency sounds clearly. Consequently, individuals may have difficulty distinguishing or hearing these sounds.
These high-frequency sounds are easily masked by background noise. In noisy environments, individuals, regardless of age or cognitive status, may struggle to hear and understand speech sounds like "S" and "T."
Even in the absence of hearing loss, speech clarity can vary between individuals. Some people naturally have more difficulty articulating or hearing high-frequency consonants, making it challenging for them to recognize these sounds.
If you feel you are having difficulties following conversations, check if the reason may be difficulty distinguishing between these high-frequency sounds.
When Wendy Mitchell’s hearing aids were adjusted, she was also able to hear “T” and “S” sounds more clearly and began to follow conversations more easily.
Reduce Background Noise for Better Communication
In our daily lives, we're constantly surrounded by various sounds, often overlapping. Normally, we can carry on a conversation while, for instance, the TV plays in the background. This is because we're skilled at focusing on the person's voice and filtering out the background noise.
However, many older individuals, especially those living with dementia, may find it challenging to filter out background sounds. This makes it difficult for them to comprehend spoken words, leading to frustration, irritation, or even withdrawal from conversations.
To improve communication with older adults, particularly those facing these challenges, consider these steps:
✔️ Turn Off Background Noise: Before you start speaking, ensure that background noises like the TV, vacuum cleaner, washing machine, and other appliances are turned off. This reduces distractions and makes it easier for them to focus on what you're saying.
✔️ Choose Quiet Settings:
When going out, opt for venues that are not excessively noisy, have good acoustics, and are not overly crowded. Avoid places with loud music or environments where it's difficult to hear clearly.
Direct Eye Contact for Better Communication
In Naomi Feil’s Validation Method for communicating with people who have a cognitive impairment, one of the important techniques we teach is direct eye contact.
Participants learned the Validation Direct Eye Contact technique at our Hands-on Dementia Workshop last month in Vancouver, BC, Canada.
By using direct eye contact when talking to someone who has hearing loss, especially if they also have dementia, we can help the person stay focused on what we are saying.
In her first book, "Somebody I Used to Know," Wendy Mitchell shares the challenges she faces when engaging with others, particularly over the phone where visual cues are absent. She vividly describes the experience of conversing with "faceless voices," highlighting the difficulty she has trying to understand the conversation:
The phone with faceless voices has become the enemy. When you speak to someone who has dementia on the phone, you are not able to see their facial cues, so you do not know if the person has processed what you have said
Avoid using the phone when speaking to someone who has hearing issues. Choose instead to speak in person, use a video call, or write messages to them.
When you meet in person, ensure that you maintain eye contact while speaking. This helps in establishing a connection and allows the person to better focus on your facial expressions and lip movements. These cues can aid people to understand better what you are trying to say.
Besides direct eye contact, it can also be very helpful to add gestures when communicating. Maq who was diagnosed with frontotemporal dementia in 2010 at the age of 54. This important tip on the Dementia UK site:
My tip for family and friends is to use gestures as much as possible. I lip read which means body language is an important form of communication. Nodding to show you are listening, smiling to make us feel relaxed – they all count. These small things all make a difference.
To learn more about direct eye contact, read our blog post The Importance of Eye Contact
Speak Slowly and Clearly
In Naomi Feil's Validation Method, the tone of our voice plays an important role for communicating with people living with dementia
We use a low, warm, and loving voice tone. We avoid high-pitched, weak, or soft tones, as individuals with hearing difficulties, especially those living with dementia, may struggle to hear clearly. Instead, wee employ a low, warm, and caring voice tone to enhance understanding.
We also speak slowly and clearly. People with hearing difficulties, especially those with dementia, may require more time to process information. By speaking slowly and clearly, while maintaining eye contact, we can make processing a conversation easier.
It is also important to make sure each sentence or question is easy to comprehend. Keep your conversation simple by only focusing on one topic at a time. To ease understanding and processing, ensure that each sentence or question addresses only one topic at a time. Avoid complex language or multi-part questions.
For example, ask a simple question like:
Do you want a cup of coffee?
Do you want a cup of coffee now before we go out or would you rather first take a shower, get dressed, and then we can go shopping and have coffee at that cute little coffee shop we always liked to go to - remember the one Karen and Dan used to meet us at before they moved to Geneva to be closer to their daughter Jennifer who got a job working for the UN so they could help her with their grandchildren Amy and Yvette?
I think you get the idea. 😁
Focus Only on One Conversation
Have you ever been at a gathering where multiple conversations are happening simultaneously? Picture a family dinner or a dinner party, where one conversation at the other end of the table interested you. but it was challenging to follow what they were saying because of another conversation between the people sitting next to you.
Now, imagine this scenario from the perspective of an older adult with hearing loss, especially someone living with dementia. For them, attempting to keep up with two conversations at once is impossible. I've witnessed many individuals respond by either closing their eyes at the table or leaving in frustration.
Ensuring that only one conversation occurs at a time is one of the simplest ways to include and engage those with hearing loss and allow them to actively participate in discussions.
It may not always be easy to control multiple conversations. I often find myself playing the role of a "conversation cop," reminding others to have only one conversation at a time when an older adult is present. Even in when there are only 4 people, it's crucial to emphasize that two conversations cannot happen simultaneously.
Additionally, it's important to consistently check if the older person is following the conversation. If they seem lost, you can help them rejoin by providing a brief explanation of what was said and ask a relevant question to encourage their participation. For instance:
"Did you hear that? Heidi mentioned they're selling beautiful sweet potatoes at the market. Do you enjoy sweet potatoes? Do you have a favorite recipe for them?"
"Jerry thinks the weather is getting hotter. Do you also feel it's hotter today than it used to be?"
"Julie shared that her daughter is expecting her first child. Isn't that wonderful?"
Based on my experience, keeping individuals with hearing loss engaged in social conversations is one of the most effective ways to prevent their withdrawal and cognitive decline. It doesn't take much. Learn to be a “conversation cop” and be attentive to the older adult and the conversation dynamics, You can make a significant difference!
You Can Help Someone with Hearing Loss
It takes very little to help an older adult or a person with dementia who has hearing loss. This wonderful clip was produced by Dementia Friendly Canada. It shows how we can easily accommodate those who have hearing loss.
Here is yet another reason to love Canada! 💗🍁
In conclusion, when communicating with an older adult who has hearing loss, especially with someone who is living with dementia:
👉🏼 Reduce background noise. 👉🏼 Use direct eye contact.
👉🏼 Use a low voice tone.
👉🏼 Speak clearly and slowly.
👉🏼 Avoid using complex language.
👉🏼 Discuss only one topic at a time.
👉🏼 Be a “conversation cop”
By adopting these communication strategies, you may observe positive changes even in individuals who were previously considered to be non-responsive or non-verbal.
One client told me that he had difficulty understanding conversations, but when I spoke to him in this manner, he was able to understand me.
Make a difference in someone’s life!
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