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Wednesday, December 17, 2014

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I hear you – or maybe I don’t

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Michael Gordon

It was one of those unusual clinics where I saw more than one case in which the exact same issue surfaced. It confirmed something I know to be true, but because I have residents in training with me, it gave me the opportunity to demonstrate to them an important component of geriatric care.

The first encounter was with a couple accompanied by two generations of family members. The couple lived at home with personal care help – each had some degree of cognitive impairment, but not enough to completely interfere with their reasonable and safe functioning as long as there was some supervision. I was interviewing the husband, and my resident was assessing his wife.

As I did my assessment, it became clear that the gentleman was quite hard of hearing. According to his son, however, he refused to wear his hearing aids because “they bothered him” and he had problems adjusting them.

The patient explained that he had “no problem with hearing,” while at the same time, leaning toward me to hear my question or answer and turning to the son to repeat the question. I retrieved my office Pocket Talker, a portable amplifier that gives users the ability to hear more clearly in difficult listening situations.

I put the earphones on him and gradually increased the volume. Suddenly his face lit up when I asked if he could hear me, and he said, “Very well.” He could now readily engage in a three-way conversation with his son and me using this low-technology device. The son agreed to borrow a device from the audiology department for a one-month trial before deciding to purchase one.

My resident was ready to review the wife’s issues with me, her son and her husband. The resident told me about his assessment before we entered the room. In addition to mild dementia, he mentioned that she was quite hard of hearing, but had previously refused hearing aids. I retrieved the Pocket Talker, and as with her husband, her face lit up when she heard my questions. I looked at the son and the husband and said, “Maybe there’s a two-for-one deal.”

Later in the clinic, a different resident saw another patient. This resident had not been apprised of the previous patients’ hearing issues. She recounted a history of progressive cognitive decline and said that the accompanying daughter had mentioned an apparent hearing impairment. The patient absolutely refused to go for a hearing assessment, said she did not want hearing aids, and, in any event, they were “a waste of money.”

I repeated the same manoeuvre that I had used with the previous couple. Although not as dramatic, the way the patient responded to my questions clearly indicated that she could hear better with the device.

Since this was a first visit, I was uncertain about whether some of the apparent cognitive impairment may have been due to or aggravated by the hearing impairment. As I explained to the daughter when I said I was not yet sure of the degree of cognitive impairment: “If you can’t hear it, you can’t remember it.”

In this one clinic, with three patients out of a total of eight, I had the opportunity to demonstrate to the young residents the importance of hearing when assessing cognition.

It can be hard to convince older people to utilize hearing aids or pay for them. Sometimes the small size and technical difficulties with them cause them to be abandoned. For many, a simple, inexpensive Pocket Talker may be a device that can be used either as an introduction to the benefits of hearing enhancement or may, on its own, solve the problem for an individual to enhance social communication.

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