Guidance for health and social care practitioners
Identification and diagnosis
Having hearing loss can increase the risk of developing dementia by up to five times. Recent research has shown that hearing loss is the largest potentially modifiable risk factor for dementia. If the risk from hearing loss were eliminated in those aged 55 and over, it would result in a 9% reduction in dementia cases. Research has also indicated that hearing aids may help to prevent or slow the deterioration in cognitive function and help to prevent or delay dementia, as well as being effective in reducing the impact of dementia.
The following screening questions can help to identify patients with hearing loss:
- Do you have difficulty hearing other people clearly, especially in group situations?
- Do you have to ask people to repeat themselves or to speak more slowly?
- Do you find that you are listening to music or watching television with the volume higher than other people need?
- Do you have difficulty hearing the telephone or doorbell?
- Do you regularly feel tired or stressed, from having to concentrate while listening?
Recommendation: Health and social care practitioners should ask all patients over 55 screening questions for hearing loss and provide timely referral to audiology for all patients who answer ‘yes’ to any one of these.
The majority of people with dementia are over 70 and nearly three quarters of people over 70 have hearing loss.
For those already diagnosed with dementia, studies have shown that the earlier in an individual’s dementia diagnosis they can be fitted with a hearing aid, the more likely it is that they will wear it, benefit from it and be able to manage some of the care of it themselves.
Some of the issues that people with hearing loss have can mimic dementia. There is a risk, therefore, that hearing loss is misdiagnosed as dementia or that dementia is underdiagnosed because of hearing loss.
Recommendation: Health and social care practitioners should provide timely referral to audiology for all patients with dementia.
Management and communication
Unmanaged hearing loss can make the symptoms of dementia worse and management more difficult. When both conditions are present, it can compound the challenges faced by patients and families.
It can take time for anyone to get used to using a hearing aid for the first time but if the person has dementia, it may take a little longer to adapt to hearing differently and managing the device. In some cases, it may be that a relative or carer is required to assist in some tasks or manage the regular maintenance.
Tips for managing the use of hearing aids in people with dementia:
- Suggest using the hearing aid for short periods initially, then gradually extending the time wearing it
- Remember that things will sound very different to them at first and this may cause distress or disorientation, so reassure them
- It may be easier to start them using it in quieter, less busy environments
- For some people, providing simple, easy read or pictorial information about the aid might be helpful in encouraging them to wear it
- They may need help putting it in and changing the batteries, make this part of their daily routine of care so that both you and they know it is a normal, everyday thing
- The batteries will usually last about a week per hearing aid, so it is best to change the batteries once a week to avoid the battery running dead
- Carers should know how to check if the hearing aid is working or not and how to troubleshoot any issues - the audiologist will be able to provide information on this
Recommendation: Health and social care practitioners should follow the tips above to ensure effective management of hearing aids in people with dementia.
Both hearing loss and dementia can cause difficulty communicating with others. It is essential, therefore, that those communicating with people with both dementia and hearing loss adapt the way they interact with them, to ensure effective communication and reduce frustration and anxiety.
Tips for communicating with people with hearing loss and dementia:
- Make sure you have the person’s full attention before speaking
- Make sure that the person can see your face clearly. Do not cover your mouth as this will interfere with lip-reading
- Try to make eye contact. This will help them to focus on you
- Minimise competing noises, such as the radio, TV, or other people’s conversations
- Speak clearly and calmly
- Consider the physical environment – make sure the area is quiet and well lit
- Make sure that your body language and facial expression match what you are saying
- Speak at a slightly slower pace and make the sentences you say short so there is more time for the person to process the information and to respond. Also allow time between sentences
- Keep your questions simple and clear. If you have to, ask questions one at a time, and phrase them in a way that allows for a ‘yes’ or ‘no’ answer
- Try not to ask the person to make complicated decisions. Giving too many options can be confusing for them to remember
- If the person doesn’t understand what you are saying, try to get the message across in a different way rather than saying the same thing again
- Break down complex explanations into smaller parts or perhaps also use visual clues, written words, objects or pictures.
Recommendation: Health and social care practitioners should follow the tips above to ensure effective communication with people with hearing loss and dementia.
For further information, please contact Ayla Ozmen, Health Policy Manager at Action on Hearing Loss:
Telephone 0203 227 6178