11 March 2020

How are attitudes towards older Australians shaped? Is it the initial appointment in the clinic, at the nursing home, the relationships formed with Grandparents or social stereotypes? How does one ‘get in touch’ with the emotional needs of this client base? Can these preconceived attitudes influence hearing healthcare delivery to the older population and if so, how can clinicians address this issue?

Savvy Audiology believes group rehabilitation and group education are aspects of hearing healthcare service delivery which should be utilised more often. Numerous advantages for participants are clear – exposure to different experiences, opinions, attitudes and ages encourages individuals to reflect and analyse personal circumstances. There are many common scenarios where hearing impairment affects communicating in noisy environments, hearing at a meeting or on the telephone, and the effects on relationships with loved ones. Openly discussing these challenges with others who experience similar frustrations, can lead to a better awareness of alternative coping strategies and solutions which could positively impact on quality of life for those living with hearing loss. For the facilitator, the audiologist, these discussions serve to highlight how their clients are coping and dealing with their sensory impairment. This type of reflection is not always possible when just the audiologist and client are in a small office, working through issues with the hearing devices, management and under time pressure to complete numerous tasks.

Observation in the home environment is a further recommendation for assessing and gaining a better understanding of the client’s unique listening challenges. It offers relevant information concerning decor and furnishings, the types of reflective or absorbent surfaces, noise sources, lighting and distances between seating positions and devices such as television and radio. The clinician is able to adjust hearing aid settings ‘live’ with immediate client feedback and discuss communication strategies specific to the room layout and acoustic environment. Savvy Audiology has written extensively about this ‘home visit advantage’ in the second edition of Savvy Insight, highlighting the numerous benefits for both clinician and client.

The Active Ageing Policy Framework (2002, p. 27-28), considers determinants related to the immediate physical environment. Savvy Audiology would like to highlight further advantages of conducting audiology and communication assessments within the home environment. As detailed in the WHO Framework, “Physical environments that are age friendly can make the difference between independence and dependence for all individuals but are of particular importance for those growing older”. References to isolation, depression, poor mobility, lower fitness levels, falls, lack of available support services and transportation in rural areas and the particular vulnerability of older displaced individuals during times of crisis, are identified as possible consequences of a less than adequate physical environment. If sensory loss is added to this equation, it follows that poorer quality of life outcomes are significant.

When an audiologist visits a client at home, a quick visual inspection can identify hazards in the physical environment which may cause injuries – uneven floor coverings, poor lighting, no support rails for moving about or a hot plate which has not been switched off.  Many older persons live alone and receive limited support from family and while many manage well, there are equally as many who do not. As stated many times, observation is a powerful tool in the audiology clinic and clinicians can initiate the appropriate referrals for additional support. Rarely is hearing loss the only ailment with which clients present in our clinic.

World Health Organisation (2002). Active Ageing. A Policy Framework. A contribution of the World Health Organisation to the Second United Nations World Assembly on Ageing, Madrid, Spain, April 2002.