Hospitals can be daunting places at the best of times. They are bright, noisy, unfamiliar and crowded. For many older people these factors are compounded by hearing loss, and being unable to hear clearly can make the situation overwhelming. Kaye Gooch, a former patient who sits on the board of the Victorian branch of Better Hearing Australia, says “hearing loss - because it's ‘invisible’ - tends to be overlooked” by staff in hospitals and that this can be a very isolating experience.
The audiology and speech pathology team at Alfred Health’s Caulfield Hospital recognised the risks associated with being ‘overlooked’ and set about improving the experience and outcomes for their older patients who had difficulty hearing. The team recognised that not being able to hear made it difficult for their older patients to understand clinical staff or participate in their care planning, which could have a negative effect on their recovery. As Kaye Gooch pointed out, difficulties with hearing were not always picked up, and other issues such as cognitive decline could be mistakenly blamed. Sometimes hearing loss had not been previously diagnosed; sometimes it had but the issue lay in the person’s equipment or lack thereof. Patients do not always arrive at the hospital with their hearing aids; sometimes hearing aids would be broken, or not working due to a flat battery or need for cleaning. Additionally, in the noisy environment of a hospital, hearing aids do not always work well because of the large amount of background noise.
"At the first try, I asked my dad can he hear my voice, he said 'yes' with a big smile. I couldn't forget this smile! It seems my dad is back to our world. We were happy!"
With such a broad array of issues to contend with, an innovative solution was needed. The team took a multi-pronged and multi-disciplinary approach to improving the recognition and treatment of older people with hearing loss at the hospital, utilising the framework and principles of the Improving Care for Older People (ICOP) program. The team looked at practical ways to help patients hear and communicate more effectively during their hospital stay and to refer them for further intervention if complex testing was needed.
This approach included employing a part-time audiologist to provide education to nursing and allied health staff on communication strategies and using and troubleshooting with hearing equipment. The role also included providing assistive listening equipment to patients during their hospital stay.
Personal amplifiers, one of the assistive listening devices introduced, has had a big impact on individuals. These amplifiers are just that – they increase the volume of the sound they pick up. This means they are particularly useful for one-on-one conversations, as one person can speak into the microphone and the volume at which this is heard through headphones can be adjusted by the wearer. Speaking into the microphone eliminates much background noise, unlike hearing aids. There are other advantages to the amplifiers – for one thing they are quite large compared to a hearing aid, making them easier to manipulate for people with limited dexterity. They are also useful when hearing loss had reached a point where aids are of limited use. Privacy for the person with hearing loss is also maintained, as people can speak at normal volume into the microphone and earphones ensure only the wearer experiences a loud volume. They can also be used by a person at the same time as a hearing aid.
For Guang Dong Yu, using a personal amplifier made a huge difference to her father’s wellbeing and quality of life. Prior to his hospital admission, his hearing had deteriorated to the point where he was unable to hear clearly even with a working hearing aid. Guang Dong Yu says that because of this her father had “lost his self-confidence and… started to doubt what other people were saying about him. For example, he thought he might get cancer after I talked to the doctor about something like the weather and did not report to him.” She says he became embarrassed to talk to people and seemed despairing.
Seeing this change in Pat has been, “Joy, pure joy! To see someone hearing, understanding and linking in with it.”
Her father was provided with an amplifier to use while at Caulfield: “At the first try, I asked my dad can he hear my voice, he said "yes" with a big smile. I couldn't forget this smile! It seems my dad is back to our world. We were happy!” says Guang Dong Yu. He was also able to understand doctors and other clinicians and answer their questions; factors which she says helped his recovery. They found the amplifier so useful that on leaving the hospital they bought their own!
The amplifiers have also helped to improve quality of life and communication for some long-term patients with dementia. When a person has moderate to severe dementia, it is easy to assume that their communication difficulties are entirely the result of their condition, however this is not always the case. As Lynda Loughridge, a Registered Nurse working with dementia patients, says of one her patients Pat, “we weren’t quite sure whether she wasn’t understanding what we were saying or wasn’t hearing, and a lot of it was that she wasn’t hearing… When we put the amplifier on her… absolute enlightenment! Now she still has the dementia, but we understand that cognitive level – but she could actually hear what we were saying.”
Lynda says using the amplifier has improved Pat’s quality of life immensely, allowing her to communicate more effectively with family members and staff, and engage with her surroundings, alleviating some of the aggression that has been a symptom of her dementia. For Lynda, seeing this change in Pat has been, “Joy, pure joy! To see someone hearing, understanding and linking in with it.”
For clinicians, patients and their families, this joy of hearing and understanding anew is an experience being repeated all over Caulfield Hospital thanks to the team and the ICOP program.