Word of Mouth on Radio 4 today was about carers and language, and I already spoke about it a bit here. It was such a goldmine of interesting discussion that it deserves a second post, looking at their discussion of hearing impairment and dementia.
They start off by saying that hearing problems can compound the communication problems in dementia. So far this isn’t surprising, as anyone with a hearing impairment will have increased difficulty communicating.
But if you have dementia, your ability to process information coming in may have slowed, but the rest of the world keeps going as fast as it always did. You have to comprehend, remember what has been said, decide what you want to say and then respond. By the time you get to where you can respond, the conversation has moved on.
It’s easy to see why people give up, especially when helpful communication partners fill in the gaps all the time.
With a hearing impairment, you have a double whammy. You add an extra layer of time and difficulty to the comprehension of language. So then poor understanding may not be purely due to the dementia, though everyone around you may assume that it is. Giving a hearing aid may actually reduce the cognitive capacity required to comprehend and improve function.
As a therapist, why should I care?
- It’s my job to reveal competence where possible, and distinguishing between sensory difficulties and comprehension difficulties is something I should be aware of.
- It gives me cold shivers to think about how many people with dementia and poor hearing I see every week.
On the other hand, this is a complex issue – hearing aids are not a magic wand and they cannot restore hearing as it was, particularly in presbycusis (age-related hearing loss), because delicate inner hair cells that are lost as we age don’t just make sound louder. There is often poor compliance with wearing aids and I am told that it takes a while to learn to get the best from them. Add technical difficulties such as remembering to change batteries and suddenly they don’t seem like such a no-brainer.
I suppose the answer is the same as in many aspects of dementia care – you have to get in there early and get the person used to the dentures/hearing aid/communication aid while they are finding it relatively easy to learn.
But add another action point:
- I can teach carers strategies for use with hearing loss even if the person with dementia is not going to be wearing a hearing aid.