Hearing loss is not a new concern in hospice and palliative care, but this condition is not formally addressed in these settings. In a new study, researchers found that hearing loss significantly affects the quality of care for patients in these facilities, and impaired lines of communication that are vital to patients' treatment.
Researchers from the University of California in San Francisco sent out questionnaires to hospice and palliative care practitioners on situations that were adversely impacted by an older patient's hearing loss. Of the 510 respondents, 91 percent reported some or great impact, with many citing specific encounters wherein the quality of care was curtailed because of hearing and communication difficulties.
"Making decisions about the types of care an individual would or would not want, especially in the context of a serious illness, involves a dialogue. Practitioners need to understand an individual's preferences," said Dr. Margaret Wallhagen, the study's lead author.
Since people with hearing loss can't easily and effectively participate in discussions, it becomes difficult for practitioners to get the information they need to understand a patient's needs and wants, as well as inform patients on how to best manage their medical and other concerns, explained Dr. Wallhagen.
"They [practitioners] aren't clear on what the individual really wants and may not be treating the symptoms because they don't get the right information," she explained. This puts patients at risk "for either not getting the type of care they wish to receive or getting the type of care they do not wish to receive."
GAPS IN ADDRESSING HEARING LOSS
Despite these challenges, age-related hearing loss remains overlooked in many hospice and palliative care facilities.
"One problem is that most practitioners don't really learn much about hearing loss and how it affects communication," noted Dr. Wallhagen, who has published significant works focused on the impact of hearing loss on older adults. Another issue, she noted, is the persistent "invisibility" of hearing loss.
"You can't 'see' that someone is having problems hearing you and many people won't acknowledge they can't hear or may even not be fully aware of how much they are missing."
Another issue raised by the study respondents is having limited time. "It takes more time to communicate with someone who has difficulty hearing. That's a frustration when your time is limited," said Dr. Wallhagen. However, she stressed that it would not take too much time to begin to address the problem.
MOVING TOWARD SOLUTIONS
The study authors recommended for hearing loss to be formally addressed in palliative care, including conducting hearing tests and providing assistive listening devices to those who may need them. But the basic but vital starting point, said Dr. Wallhagen, is awareness. For example, practitioners can start "thinking of the fact that hearing loss is very common, especially as we get older, and assessing hearing by asking about it and checking to be sure the person understands," she cited.
Devices such as a personal amplifier or "pocket talker" should be accessible in these facilities. Practitioners should also use effective communication strategies when dealing with patients with hearing loss.
"These strategies could make a difference—but the practitioner and the facility need to be aware and stay aware of hearing loss to make it happen," stressed Dr. Wallhagen.
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