Sections in this chapter:

Understanding the Problem
When To Get Professional Help
What You Can Do To Help
Possible Obstacles
Carrying Out And Adjusting Your Plan

Understanding the Problem

Fifty percent of Americans over 65 suffer from hearing loss. Problems can be small (missing certain sounds) or large (not hearing at all). Unfortunately, not many older people with hearing problems visit a hearing specialist or wear a hearing aid. The result is many older people who cannot understand what others are saying. Hearing loss doesn't happen over night. It happens slowly. One of the first signs to watch for is that the older person turns up the volume on the television. In addition, the older person frequently requests you to repeat yourself or misinterprets what you have said. However, when you do repeat yourself in a louder tone, the older person may ask you to stop shouting. This is because the problem is not because you are not speaking loudly enough for the person to understand, but that he or she is having trouble in hearing and understanding certain sounds. High pitched tones may sound fuzzy and certain consonants such as "s", "f", and "t" are misinterpreted.

Infections, certain medicines, and exposure to very loud noises over a long time can lead to hearing loss. However, for the most part, hearing loss in older people is the result of age-related changes in the ear.

If the older person is cupping his or her ear after everything you say or is asking "What?" frequently, you should urge the older person to have his or her hearing checked by a doctor. The doctor may make a referral to an otologist or otolaryngologist (doctors who specialize in hearing disorders).

Although hearing loss may be permanent, there are amplification devices for the telephone and radio, hearing aids, and certain techniques like lip reading. These can lessen the effects of hearing loss.

Your goals are to:

Be aware of the symptoms of hearing loss
Make an appointment with a physician for an evaluation
Help to make the loss easier to deal with
Encourage using a hearing aid or other assistive devices

When To Get Professional Help

In case of an emergency

Hearing loss in itself is not an emergency. However, sudden hearing loss or hearing loss in combination with other symptoms may be serious. Seek medical help immediately if the following happens:

Sudden and complete hearing loss in either one or both sides. This could be due to a serious infection, a tumor, or stroke.
Sudden hearing loss in combination with nausea, vomiting, dizziness, or unsteadiness. This combination of symptoms could be due to an inner ear disturbance or a condition called Meniere's disease.

When symptoms are not an emergency but should be reported:

The following are common signs of hearing problems. Call the doctor during office hours if the older person does any of the following:

Misunderstands words
Has trouble following a conversation
Turns up the volume on the TV so loud that others complain
Avoids parties or restaurants because of hearing problems
Does not answer the door or phone
Does not respond to conversation

Ways to check hearing at home

Ask the older person if he or she can hear the sound of a ticking watch.
Sit in a quiet room and rub two shoes together or on the carpet. Can the older person hear the sound?
Ask the older person to close his or her eyes while having a conversation. Is he or she able to understand what the other person is saying?

Know the answers to the following questions before calling the doctor:

When is hearing a problem? (during ordinary conversation? in a noisy room? while listening to the radio?)
When did the hearing loss begin?
Was it sudden or gradual?
In which ear is the hearing problem worse?
Is there ringing in the ears, dizziness, or vomiting?
Has there been repeated exposure to noisy environments?
Has he or she had any major illness/medical conditions such as diabetes, stroke, etc.?

Here is an example of what you might say when calling:

"I'm calling because my mother, Genie Jackson, is having a hearing problem. It has come on gradually over the last couple of years, getting a little worse each year. She has trouble understanding what people say to her when they speak in low tones or when she's in a noisy room."

back to top

What You Can Do To Help

Don't shout. Shouting or speaking too slowly will distort the sound and make it harder for the older person to understand you. Speak at a normal speed (or slightly slower) in a normal tone of voice with modest amplification, and try to use a lower (deeper) pitch to your voice.
Turn off the TV, radio, or running water when you are talking. Background noise makes it harder to hear what is being said.
Talk face-to-face. The older person needs to see your face when you talk. Seeing the mouth move and facial expressions helps the listener determine what you are saying. (We all read lips informally for clues to what is being said, but it becomes even more important for someone with a hearing problem.) Be sure not to cover your mouth with your hand while speaking. Use body language like pointing or nodding to make your message clearer and be sure you are in a good light.
Speak clearly. Don't mumble or talk with your mouth full. Use simple sentences or rephrase a sentence if asked to repeat it. Enunciate clearly, but don't exaggerate for this can make it difficult to read lips.
Encourage the older person to ask for help. People with hearing problems should be open and direct about having difficulty hearing and should tell others what they can do to help. For example: "I need you to look at me so I can hear you better" or "Let's go into a quieter room."

Hearing Aids

Choose a hearing aid specialist carefully. When the older person is ready for a hearing aid, you must find someone to recommend the right type and to properly fit it. An otolaryngologist (ear, nose and throat doctor), an otologist (ear specialist), a certified audiologist (who has a graduate degree in hearing impairment), or a licensed hearing aid dealer are all good choices to fit a hearing aid. When purchasing a hearing aid, ask about follow-up after the sale, help, warranties (there is always a 30 day trial period where you can return the aid for a full refund minus a small fee), and service. Make sure the person selling the aid is reputable and experienced.
Make sure the hearing aid fits properly. Hearing aids must be fitted snugly into the ear canal. If the hearing aid doesn't fit, it will not function properly and will probably whistle. Also, if it is uncomfortable, the older person won't wear it. The hearing aid specialist should carefully fit the hearing aid, give training in how to use it, and be available to make adjustments.
If the hearing aid does not seem to be working, try a different one. It may take several weeks for the older person to receive the full benefit from the aid. Wearing an aid makes the world seem louder; this takes getting used to. If the aid is not working satisfactorily after several weeks (within the trial period), take it back to the person who sold it, explain the problem, and ask if a different model would be better. There are many models and makes, from small aids that fit snugly inside the ear to larger ones that are visible on the outside of the ear. Sometimes people have to try several different models before they find the one that is effective.

Other Devices

Ask about amplifiers. Amplifiers have earphones and can be placed in a shirt pocket or held. They can be used for television so the hearing impaired person can hear normally without turning up the volume for the other listeners. They can be purchased inexpensively in electronic stores. Amplifiers are often available in theaters. Ask the theater manager how to obtain one and how they are used.
Ask about assistive listening devices. These include telephone amplifiers, alerting devices (telephones and doorbells that blink instead of ring), and vibrating alarm clocks. There are also microphone and headphone systems that make conversation in small groups easier to hear.

(For more information about these devices, ask an audiologist or contact any of the numbers at the end of this chapter.)

Possible Obstacles

"Mom refuses to wear her hearing aid."

Response: Sometimes people are ashamed or embarrassed when they have to wear a hearing aid. For some people it symbolizes getting old. Be encouraging. Give lots of support. Suggest that your mother try the hearing aid at home to get used to it. Be sure to encourage family members and friends to comment on how much communication has improved when your mom is wearing the hearing aid. Also, most women can cover up their hearing aids with their hair.
"My Aunt keeps losing her hearing aid."

Response: Make a ritual of taking it off and putting it in the same place every night.
"Dad won't tell people about his hearing problem."

Response: Women tend to be more aware of health problems and seek help more readily than men. Gentle but firm persuasion by family members may help direct your Dad to the doctor.
"My hearing is fine. You just have to speak up."

Response: Let's work on this together. I'll try to speak more clearly, but I've noticed that you have trouble hearing other people, too. So let's make an appointment to have your hearing checked. Then the doctor can tell both of us what we can do to help you hear better.

Think of obstacles that could interfere with carrying out your plan

What additional roadblocks could get in the way of doing the things suggested in this chapter? For example, will the older person cooperate? Will other people help? How will you explain your needs to other people? Do you have the time and energy to carry out this plan?

You need to develop plans for getting around these roadblocks. Use the six problem-solving steps in the chapter on "Using the Eldercare at Home book to solve caregiving problems."

back to top

Carrying Out And Adjusting Your Plan

It usually takes at least several weeks and sometimes longer for a person to adapt to a hearing aid. The older person first has to get used to having the aid in the ear and has to learn how to use the controls. Hearing aids do not produce normal hearing since all sounds are amplified ¯ background noise as well as speaking ¯ so it takes some time to learn to focus on key sounds. During the trial period, it is a good idea to return to the hearing specialist for fine adjustment of the aid and for counseling. It is also a good idea to use the aid along with lip reading and to avoid noisy places. The older person should feel comfortable with his or her audiologist and feel free to explain any problems and frustrations experienced with the hearing aid. The more information the audiologist has, the better the fit and adjustment of the hearing aid.

If your plan does not work

You can't force someone to wear a hearing aid. Gentle persuasion in a cooperative, supportive manner usually works. Don't give up. If, after a fair trial, the hearing aid is not satisfactory, go back to the hearing specialist and ask for suggestions. Hearing aids are not suitable for everyone. A remote microphone or headset may be the way to go.

back to top

For further information:

Better Hearing Institute
800-EAR-WELL
Provides listing of local hearing specialists, sources of assistance, information on hearing loss, hearing aids, and assistive devices.

Gallaudet University
202-651-5000
Information on deafness and hearing loss. Gallaudet University provides legal service for deaf people, and offers courses for the elderly on hearing technology, coping with hearing loss, and dealing with stress in the family.

Hear Now (Denver, CO)
1-800-648-HEAR

Committed to making technology accessible to the deaf and hard of hearing, Hear Now raises funds to provide hearing aids and related services to people who do not have the funds to purchase their own devices.