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Interview: Older Adults Avoid Hearing Aids


Dr. Timothy Kelly

Three million Canadians suffer from hearing loss, but only one in six wear hearing aids according to the Hearing Foundation of Canada.

Studies in other countries show similar results. In 2012, researchers from John Hopkins University found that of 26.7 million Americans, aged 50 and older suffering from hearing loss, only one in seven used hearing aids.

Now, U.K. researchers have turned to older adults to find out why.

The study focused on three types of hearing-impaired older people:

1. long-term users of hearing aids
2. new hearing aid users, and
3. people on a waiting list for audiological services.

Nearly half of older adults surveyed reported not receiving the practical assistance they required to adjust to wearing a hearing aid. Many more complained of the deplorable lack of information about hearing aids. The results have huge implications for the overall health and well-being of older people.

The new research was led by Timothy Kelly, professor of social work in the school of education, social work and community education, University of Dundee, Dundee, U.K.

The findings were published online Feb.2, 2013 in the journal Health and Social Care in the Community.

AHB reached Dr. Kelly at the University of Dundee.

RD: Participants complained of a lack of general information.

Timothy Kelly: That’s right. For instance, some people thought that their hearing aid would restore their hearing to "normal" and they were very disappointed that their hearing was not perfect.

They also reported that they didn’t understand hearing and hearing loss, so even basic information was lacking.

People on the waiting list didn’t know what to expect or how long it would take to get their hearing aid.

People who had just been fitted had many, many unanswered questions . . . ranging from how to clean the hearing aid to how long they should wear it. One person wore the hearing aid for 24 hours, not knowing this was not a good idea.

RD: They wanted more practical assistance to help them adjust to the aid.

TK: Yes, 48 per cent said they did not get the practical assistance they needed.

This included things such as:

  • how to reassemble aid after cleaning
  • adjusting uncomfortable ear pieces
  • how to use assistive devices (e.g. doorbells, telephones and alarm clocks for people with hearing impairments)
  • electronic security devices interfering with the aid, and
  • difficulty changing batteries.

Really basic help was needed.

Just imagine being 75-years-old, wearing tri-focal or vari-focal glasses, having arthritic fingers and trying to find and open a tiny compartment, remove a small battery, replace the battery and close the tiny compartment again – all without the benefit of clear and easily understandable instructions.

These "simple" tasks became barriers for people and the lack of information was compounded by a lack of practical assistance when needed.

RD: Some described difficulties with the devices themselves. For instance, some heard a piercing whistling sound when the aid was inserted.

TK: Some participants did mention the whistling. Others spoke about the discomfort of wind blowing in the microphone, the aid setting off security devices when entering stores, uncomfortable ear pieces and a host of other problems.

Many of the problems could easily be remedied but, unfortunately, people lacked the necessary information.

RD: The study suggests people had unrealistic expectations about what a hearing aid could do.

TK: Yes, some thought they would have the same level of hearing they had as a young person. So they were very disappointed and wondered if it was worth the hassle.

Even with the digital technology, older adults found it difficult to hear in social settings such as dinner with friends in a restaurant.

The gap between reality and unrealistic expectations remained large if they did not know what was "normal" with a hearing aid, how to manage their hearing environment or that they could ask a restaurant to turn background music off or down.

A good example of this was a gentleman who, shortly after being fitted with a hearing aid, went to a football match between two rival teams from the same city. He was looking forward to being able to better experience the match with his new "normal" hearing. He was very unprepared for the roar of 70,000 screaming football fans from the West of Scotland! It was not the pleasant experience he anticipated.

RD: Others had cosmetic concerns.

TK: Yes, this issue came up in the focus groups, though it was not universal.

Some in the groups expressed cosmetic concerns, but others did not. Those who were unconcerned said they knew they were not standing out because so many older people wore hearing aids. And in today’s world everyone walks around with wires hanging out of their ears listening to music.

This positive reframing of the issue came as a surprise to those who felt self-conscious about wearing an aid. It gave them something to think about and it appeared to lessen the stigma they felt.

RD: Many had concerns about how to care for the hearing aid.

TK: Yes. Some remembered getting an "owners manual" and others did not. Those who looked at the manual said it was not that useful as it was too technical.

People described feeling overwhelmed when being fitted with a hearing aid, and getting home and not remembering what the audiologist told them.

Interestingly, few of the participants had or wanted family involvement.

RD: Some reported pressure from private dispensers. Can you give me an example?

TK: The National Health Service in Scotland (NHS) is free at the point of service and hearing aids are part of the NHS service provision. At the time of data collection, the waiting list for audiology services could be long in some areas of Scotland.

However, there are also private companies that provide audiological assessments much quicker but for a fee. Some of the participants expressed concerns about the hard sell tactics of some of these providers.

Examples included time sensitive offers for a reduced price. "The cost is £3,000, but if you buy today we’ll knock £1,000 off." Or "Your other ear could benefit from a hearing aid. So we’ll give you two for the price of one if you buy today."

Other examples included typical up-selling techniques. So people would be offered the ultra-deluxe model with incredible numbers of channels. Salespersons would suggest that the top of the range model would be the one that they really needed when a middle-range or basic range hearing aid would have been more than sufficient.

Others said salespeople told them that the NHS did not provide digital hearing aids, which was patently false.

RD: According to one expert, "Hearing aids require two or three months of auditory rehabilitation to use them properly." So what can be done?

TK: Well, first and foremost, we have to be clear that auditory rehabilitation is more than just providing technology. There is ample evidence that providing technology alone does not meet the needs of older persons.

Secondly, a range of rehabilitation services are required. These could include:

  • well-timed individual support
  • better designed information packages available at different points along the rehabilitation journey (e.g before, during and after the fitting)
  • online support and information
  • group-based programs offering information and support, and
  • written information for families.

And finally, older users can and should be involved in shaping these services.