The Quiet Problem: older Australians and hearing loss

Australians of all ages deserve to be safe from harm, treated with respect, and heard.

Yet the World Health Organisation estimates that at least one in six people over 60 years of age experienced some form of abuse, exploitation or neglect in the last year1.

Just like hearing loss, elder abuse is often invisible and hard to spot. It is also more likely to occur when older people are physically frail, socially isolated, and/or have additional disabilities such as significant vision impairment, cognitive delay, or hearing loss2.

Hearing Loss and the Elderly

Hearing Loss is probably more common than you think, and most Australians will be touched by hearing loss at some point in their lifetime.

One in six Australians have some form of hearing loss – that’s 3.6 million of us! And with our aging population this is predicted to rise to 1 in 4 Australians by 20503.

Hearing loss affects men more than women, and is also more common as we age3. This age-related hearing loss is called presbycusis.

Whilst hearing aids, assistive devices and cochlear implants enhance a person’s ability to communicate and connect with the people and the places they love, many Australians who could benefit from hearing devices do not have them3.

What are the warning signs of hearing loss?

Hearing loss is often called the invisible handicap.

Not all sounds are affected equally, so the older person may hear some parts of speech but not others. The high pitches (eg. ‘s’ and ‘f’) are usually affected first, and these tend to make up the beginnings and endings of words. This means that they can sometimes hear but not understand.

Instead of ‘she hears when she wants to’, it’s more often a case of ‘she hears when she can’!

For this reason some older Australians may be able to follow conversation fairly well in quiet when they are facing the person, but may struggle in noisy situations - especially if they can’t see the speaker’s face and usually rely on lipreading cues.

They may also need the TV turned up louder than others, and struggle with the phone. They may also mishear when their back is turned and visual cues are no longer available. If one ear is worse than the other the older person may also have trouble localising the direction a sound is coming from.

What about the impacts of hearing loss?

Hearing loss can cause a range of psychological, social, emotional and physical effects – on both the hearing-impaired older person and their significant others.

It may also cause people to miss key information and alerts, and struggle with conversational turn-taking. Unfortunately this can put them at risk of exploitation, abuse, ridicule, and/or social exclusion.

Other effects include:

• Fatigue, tension, frustration, stress and depression

• Social withdrawal, loneliness and isolation

• Danger – can’t hear phone, smoke alarm or doorbell, reduced alertness when out and about and a risk to personal safety

• Reduced opportunities to interact with others

• Reduce quality of life, especially for those with a moderate or worse untreated hearing loss

• Tiredness from increased listening effort and filling in the gaps

The good news is that there is much we can do within our community to support older Australians with a hearing loss and their caregivers and support networks.

Hearing aids and assistive devices can also help! When worn and properly maintained these allow the hearing-impaired person to feel empowered, more connected, and better able to enjoy the people and the places that they love.

Preventing elder abuse in older Australians with hearing loss

For many of our hearing-impaired older Australians, elder abuse far too often occurs in the form of neglect2. The caregiver may miss scheduled hearing appointments, and/or fail to help the older person manage, wear and care for their hearing aids. This then makes them vulnerable in other settings.

Caregivers may also fail to support and assist with other aides such as glasses2 – this also has negative flow-on effects given the importance of lipreading to this group.

Older people are highly reliant on their hearing devices and other strategies (eg. positioning and room acoustics) to communicate, understand what is happening around them, and to express their preferences and opinions.

What can we all do to support hearing-impaired older people and their caregivers, and to prevent elder abuse from happening in our community?

Access to hearing services including regular hearing health checks

It is important that older Australians have regular hearing checks, and an opportunity to trial hearing aids or other assistive devices where appropriate (eg. personal amplifier worn with headphones).

Hearing-impaired older people who use hearing devices report higher confidence, reduced anxiety, and better relationships with others5.

Many older Australians are eligible for subsidised hearing services under the Commonwealth Hearing Services Program. For more information see www.hearingservices.gov.au, or contact Hearing Australia for a free hearing check or call 131 797.

Support older Australians to wear their hearing devices and stay connected

Hearing devices are often integral to helping older people to stay connected, communicate with others, and to self-advocate.

They are also sophisticated electronic instruments that require ongoing care and maintenance.

Older Australians often require the support of family and friends to maintain their hearing aids, and to help them persevere should things go wrong such as when repairs are required4.

Tips for keeping hearing devices in good working order:

• Keep clean – wipe over with a dry tissue or cleaning cloth

• Avoid storing in extreme heat, such as the glovebox of your car

• Keep devices in their case when not being used, and ensure the batteries are fresh

• Clean plastic earpieces

• Ask your hearing provider for simplified instructions

• Check for whistling – whistling can mean the plastic earpiece isn’t fitting properly, or that there is excessive wax in the ear canal

• Consider hearing aid retainers or clip-accessories if the person is having trouble keeping their hearing aids in. Your hearing provider will be able to help here

• Ensure the GP regularly checks for wax - wax can affect reliability and sound quality

Use hearing tactics and strategies when talking to hard of hearing people

We can all be better communicators! Use the following tips when talking to hearing-impaired people of all ages:

• Face the person, and get their attention before you speak

• Stand approximately 1.5 metres apart and at the same eye level – this helps with lipreading and ensures the sound doesn’t have to travel too far

• Turn down any background noise (eg. TV or radio), or move to a quieter area with soft furnishings

• Speak clearly and be prepared to repeat or rephrase parts of the message if needed

• Be understanding – although hearing aids and assistive devices help enormously, they are an aid rather than a cure and don’t restore the hearing back to normal

• Wireless devices and/or Bluetooth streaming can also help the hearing-impaired person follow conversation in less than ideal listening conditions.

Practical tips for older Australians in Residential Care

The World Health Organisation estimates higher elder abuse rates in Aged Care facilities1, so what can families do to help prevent neglect and exploitation among hearing impaired older Australians in residential care?

• Develop a good working relationship with facility staff and visiting professionals

• Ensure hearing devices are clearly labelled, and that the facility has plenty of fresh batteries

• Clean the device and change the batteries yourself weekly where you can – choose a certain day of the week to make it easier to remember

• See whether any of the facility staff are hearing impaired themselves – they may be good advocates and able to assist on site

• If facility staff are inserting hearing aids each morning, are they also ensuring the devices are working and checking each residents’ response?

• Are hearing loss and communication strategies included in resident care plans?