For individuals aged 60 and older, spending time at the doctor’s office is a common occurrence. And, considering the prevalence of hearing loss in older people, it’s not too surprising hearing loss gets in the way of effective communication between the older individual and their healthcare provider during these routine encounters. A recent study, published online by JAMA-Otolaryngology on August 24th, indicates communication breakdowns that result from hearing loss in older people might be more common and debilitating than realized.
A group of researchers at University College Cork, Ireland, led by Vikki Cudmore, interviewed 100 adults between the ages of 60 and 80-plus years. Fifty-seven individuals reported hearing loss, and, as expected, the individuals over aged 80 had a much higher rate of self-reported hearing impairment.
Almost half of the group (43%) reported they misheard a physician or nurse during a primary care or hospital visit. Interestingly, the frequency of mishearing did not vary according to the age group.
As part of the study, respondents were asked to elaborate on the context of their miscommunications with physicians and nurses. Some patients explained why they misheard their healthcare providers, and their reasons fell into one of five categories. Descriptions of illnesses or instructions tripped up 36 percent of people, and 29 percent said they missed words or full sentences for no particular reason. People talking too fast, too many people talking at once and similar issues were cited by 27 percent of people. Pronunciation or similar-sounding words were an issue to 10 percent of people. Others reported intentionally not listening to their providers and some blamed the setting or the physician or nurse for not speaking clearly.
Hearing Loss and Patient-Physician Communication
The urgency for physicians and other healthcare professionals to shore up their ability to communicate with older individuals was reflected in an accompanying commentary to this research. Heather Weinreich of Johns Hopkins University wrote that physicians need to be improve their communication style with older patients, and intervene in other ways to help patients hear well during their interactions. One intervention cited by Weinreich was the use of temporary amplification devices.
“On a global scale, supporting legislation for hearing coverage, opening doors to alternative hearing devices and pushing for standardization of technology like personal sound amplification amplifiers are methods (of improving communication)” Weinreich writes.
“There are potential immediate short-term and long-term impacts of miscommunication with patients. We need more research into the medical errors and costs caused by hearing loss and to examine methods to provide effective communication so as to deliver high-quality patient-centered care,” Weinreich concluded.
As hearing care professionals continue to grapple with changes in device regulations, the research of Cudmore and her colleagues in Ireland could be a springboard to building stronger relationships with the physician community by providing low-cost, non-custom amplification devices that can be used during physician/nurse appointments with patients in the hospital or clinic. One example of this type of interventional service can be found at the University of Pittsburgh Medical Center and the work of audiologist, Lori Zitelli and her colleagues, while another can be found at Johns Hopkins University under the leadership of research audiologists like Nick Reed and Jon Suen.
Communication between medical staff and patients who have hearing loss becomes more difficult if they are admitted to hospital. They may have delirium / dementia or both. It is imperative that if they wear hearing aids these devices should be secured. Many patients lose their hearing devices which leaves them with poor communication, anxiety, confusion, isolation and the inability to discuss their medical condition. It is difficult for medical staff to deliver a Quality, Care Package, which may delay their discharge from hospital.
I have lots of e.g.s of this, from hospital and other health-care visits over time. I use them to train RNs about the importance of commuicating effectively. One e.g. is a patient at the pharmacy hearing: “now, you know not to take this medication with ibuprofen, right?”
The patient heard everything except the word “not.”
I am not ‘old’, but do have hearing loss and wear hearing aids. I was recently hospitalized for a short time. It was difficult to understand everyone, MD’s, RN’s, etc. Language Accents, speaking too fast because they are rushed, not facing you when they speak, were all issues. Normally, Un-hospitalized, I do fine. I can see how life threatening mistakes and misunderstandings can happen this way. Standardized questions such as ‘Do you have a hearing impairment?’ upon admission should be implemented, along with required CEU’s to educate practitioners on detecting hearing loss and how to interact optimally with patients who are affected by it.