In this blog post, LaRonda shares her experiences working with senior citizens with age-related hearing loss, and the reasons she has discovered that some seniors choose not to wear hearing aids.

There was a recent blog post on DeafRead entitled: The best place for hearing aids is in ears, written by Steve Claridge, who lives near Oxford, UK. The focus of Steve’s blog is on “Deafness and Hearing Aids.”

I started to leave my comment on Steve’s site, but as I did, I realized I had a lot more to say. So I decided to add my own post here on the subject of Age-Related Hearing Loss since I haven’t seen much written about the topic, and being that part of my work includes working with seniors who are losing their hearing.

In Steve’s blog post, he learns from his parents that his aunt (who I’m assuming might be in the older-age cohort), who was fitted for digital, behind-the-ear (BTE) hearing aids 2 years ago, is not wearing them. In fact, they remain at home in her cupboard. He goes on to say that this is probably his aunt’s form of denial about her hearing loss. He also contends that her concerns of their disabling cosmetic appearance might be another reason why they remain unused.

“More than nine million Americans over the age of 65 have a hearing loss. About three out of five older Americans with hearing loss don’t use hearing aids.”
~ National Council on Aging

Why is this?

This question that apparently puzzled Steve and his parents, often concerns the spouses, families and caregivers of seniors with age-related hearing loss.

A part of my job as the Family Life Coordinator / Parent Educator at St. Joseph’s Center for the Deaf, is to offer Education, Guidance and Support to families in the deaf community (D/deaf, hard of hearing, late-deaf, and deaf-blind) across the lifespan. As a part of our Community Support program, I provide both seniors with age-related hearing loss, and their spouses, families, caregivers, and medical staff who work with them, with education and adjustment support as they all learn to understand, cope with, adapt to and accept this physiological and psychological change.

So what are the barriers to Hearing Aid use among this senior late-deafened cohort?

The following reasons are from a number of sources, including the National Council on Aging, and personal interviews from seniors I have worked with as to why some of the people in this age-group choose not to wear their hearing aids.

• Some seniors feel that their hearing loss is not “bad enough” to require them to use a hearing aid.
• Some accuse everyone else of mumbling. “I don’t have a hearing problem! Everyone else just mumbles!”
• Some seniors feel they can get along just fine without hearing aids.

These first 3 responses may be part of the denial Steve and his folks attributed to his aunt. Other reasons late-deafened seniors choose not to wear hearing aids:

• The visibility of the hearing aid causes self-consciousness. Some seniors are concerned what others might think of them if they see them wearing hearing aids. They don’t want to be seen as disabled. They don’t want people to only see the broken body part. They want to be seen as a whole, intelligent, capable and independent individual. So there is a stigma in wearing hearing aids.
• Many seniors are psychologically still adjusting to their hearing loss and the change it brings to their identity. They may not be ready to accept their loss. Getting fitted for and using a hearing aid seems like a final admission that they must surrender their identity as a person with normal hearing.
• In addition, hearing aids to some are “just one more thing” that signifies their bodies are slowing down and wearing out — not something every senior is willing to accept.

Other barriers to getting hearing aids include:

• High cost. About 1 half of non-users cite that the high cost of hearing aids prevent them from getting fitted. Many insurances will not cover the full cost. Some seniors, especially those on limited income, cannot afford them.
• Those that do scrape up the money to buy hearing aids are usually sold models that are “top of the line.” They spend $4000 on the latest digital model only to discover that a few months, maybe a year down the road, their hearing took a significant turn. Their loss became more severe or profound and their brand new state of the art hearing aid is now obsolete! They must now be fitted for a new, more powerful hearing aid, which is usually more expensive, includes more appointments and adjustment, and still there is no guarantee it will help them hear again.
• Seniors may be wary of being “ripped off” and simply choose not to purchase or wear hearing aids anymore.

There are still more reason why some seniors choose not to wear their hearings aids once they have purchased them.

• Some environmental sounds can be painfully and abnormally loud with hearing aid use and cause great discomfort, confusion and stress.
• Noises that are unusually loud (possibly caused by recruitment or hyperacusis – conditions that amplifies certain sounds at certain frequencies), can actually cause physical pain.
• Older people are more easily startled and cannot turn as quickly as they could in the past to check out the source of the noise. Some of the noises from their hearing aids can be quite frightening. Some seniors have actually told me that when they wore their hearing aids, they had “the jitters.” They kept jumping at all the sounds that startled them and their anxiety was higher when wearing them.
• Some claimed that hearing aids were just too physically uncomfortable to wear.
• Others said that with hearing aids, the background noise that they were unable to block out, was simply too annoying.

Finally, other reasons why some seniors choose not to wear hearing aids is because:

• Their hearing loss was not the kind that could benefit from hearing aids. Either their hearing declined too rapidly or their loss was too profound.
• Some claimed that while their hearing aids might help with certain environmental sounds, they did not necessarily help reduce the distortion they heard in speech. Expecting their hearing aids to help them hear their spouse’s voice at dinner, but instead finding that all they could hear was their spouse’s fork scrape a plate, they simply determined it wasn’t worth the struggle and discomfort of wearing them.
• Still, there were a few who simply repeat the age-old saying: “Silence is golden.” They just felt more calm and comfortable in the silence than in the struggle to hear what they most often could not.
• There are those who simply say, “I forget.” They forget to put their hearing aids in or to turn them on once they are inserted in their ears. Some frequently end up with them in the shop when they forget to take them out when they step into the shower. Other forget where they put them or lose them and then can’t afford to replace them.
• Finally, seniors are often dealing with broken body parts, and at some point, they begin to accept that their bodily functions or body parts simply begin to wear out or do not work anymore. There is a gentle surrender that comes in their lives at some point and they begin to let go. They see no reason to fight to hang onto their hearing. They gracefully accept that this is how it is. Once they discover that the silence is actually comforting, they see no reason to go back to try to hear again.

In 1999, the National Council on Aging performed a study that found hearing impaired adults age 50 and older with untreated hearing loss (which means they had not been assessed or fitted for hearing aids) were more likely to report depression, anxiety, and paranoia. They were also less likely to participate in organized social activities, compared to those seniors who chose to wear hearing aids.

So, studies find that denial, cost, and vanity are biggest barriers to use of hearing aids. Studies also show that seniors with age-related hearing loss who use hearing aids cite better family relationships and improved mental heath. While this may be true, I would like to introduce another idea, other than hearing aid use, that promotes the well-being, dignity, and self-determination of older people who lose their hearing due to age.

A part of the education and support I give to seniors is to introduce them to other alternative modes of communication should they choose not to use, or no longer benefit from hearing aids. This includes teaching them to use computer assisted communication, such as real-time captioning, e-mail, IP Relay, Instant Messaging and chat groups. It also includes introducing them to Hearing Dogs, Captioned Telephones, Captioned TV’s, text pagers, TTY’s, CapTel and the VCO options through telephone Relay Services. But most importantly, I offer these seniors, their families and caregivers sign language classes for sign-supported communication. This last form of communication is always a BIG HIT with the seniors and their activity directors at retirement facilities and senior centers!

Though some seniors struggle to remember the signs they learn due to memory loss or dementia, and some struggle to form the handshapes with their arthritic and gnarled fingers, most seniors usually say that learning sign language:

1. helps keep their minds busy
2. gives them a goal to shoot for
3. improves their social connections with spouses, families and friends, and
4. keeps them connected to their world.

The possibility of accessing communication in a new way is a great motivator. Therefore, many seniors make a good effort in learning some essential signs or sign phrases to support their lip-reading skills or residual hearing. Signs for emergencies and medical information are often well received by both seniors and staff who work with them in retirement or rest homes, since some fear having a stroke that may leave them with the inability to speak. Having an alternative mode of communication gives them peace of mind.

On a final funny note, when I return for occasional visits to these seniors and their communities after teaching them sign language, there are 3 signs they never seem to forget:

1. ILY – The ASL sign for I Love You
2. Toilet
3. Me-Forget!

I have to admit, seniors with age-related hearing loss are one of my favorite groups to work with! They are the most respectful, gentle, jovial and wise creatures on earth. I always feel blessed when I am asked to share my education, guidance and support with them. I never fail to leave these encounters wondering which one of us was the teacher and which was the student.

In my earlier blog posts, I wrote often about my Grammie Lee, my dad’s mother, and my all-time favorite person. Grammie Lee was my partner in this silent journey. She was experiencing age-related hearing loss when I was brand new with my own at the age of 17. She eventually got herself a TTY and took ASL classes in her 70′s so that she and I could communicate in another way.

I like to think that another reason people choose not to wear their hearing aids is because they begin to accept their deaf identities. Grammmie and I both grew in our journeys into deafhood, gradually accepting our deaf identities more and more until we were comfortable in our own skin. I gave up wearing hearing aids for many of the same reasons stated above, and I’m glad I did. Being deaf is a part of me now. I’ve been deaf longer than I’ve been hearing. I can’t imagine going back to try to work at hearing again. This may sound strange, almost unfathomable to some, but this is a sign of my deaf identity, and I wear it proudly.

I was amazed at how much ASL Grammie remembered even through her increasing dementia. She was an inspiration to me and is right up there with my Angels, Sages, Mentors and Guides. While she is no longer with us, each time I extend my hand out to touch the hand of a senior with age-related hearing loss who I happen to work with, I feel her soft wrinkles once again, and I know she is with me forever.

I love you and miss you, Grammie. ~

Posted by LaRonda on Wednesday, June 13th, 2007 at 11:20 pm.