During a recent dinner conversation, my wife Alison Grimes and I were sharing experiences of that day at work. Our work settings are quite different, but since we are both audiologists, it isn’t unusual for us to have similar experiences with patient care involving hearing aids.
Alison was describing the troubles an older patient was having coping with the compromises he was having to make in life, some of which centered around his hearing, but many that were related to other issues he is encountering that involve adaptation and change. The central theme of his comments had to do with him being disgruntled about having to make accommodations, or being unwilling to do so.
My story for that day was on a similar theme, but had to do with a couple. Both are hearing aid patients, but one is having early challenges with cognition and memory. The partner affected by the cognitive deficits is pretty mellow about it, but his spouse is concerned and not looking forward to the upcoming changes in their lives. They had asked for the appointment for me to check him out to make sure some of his symptoms weren’t due to additional hearing loss or a problem with his hearing aids.
Many of us are at a life stage where we end up participating in the care and support of others in generations ahead of and behind us. That may or may not prepare us for dealing with patients who are complicated by the fact that they are in need of help that may be beyond our scope of practice and beyond our control.
Along with visual, tactile, mobility, and other issues, our aging patients develop patterns of behavior and preferences that may interfere with hearing aid use. It is not uncommon for some to be affected with varying degrees of cognitive impairment. We may understand that mild cognitive impairment that affects memory may not affect reasoning and judgment capabilities, but the affected individuals still have difficulty with many activities as a result, including the management of hearing aids. Those further along the spectrum in a cognitive decline have even more problems making critical decisions about hearing aids and maintaining them. The typical “4Cs” issues of Cost, Cosmetics, Convenience, and Comfort can grow out of proportion in the perspective of someone with enough cognitive impairment to affect reasoning and judgment.
Part of the patient assessment process is to establish an effective communication style so we can learn about the patient’s specific needs. We typically don’t perform formal cognitive testing, but my experience is that we can discover how effective their decision-making capabilities are during that process. When we are aware that there may be difficulties, how do we adapt so that appropriate decisions are made about the treatment plan and that the patient will have the best opportunity for success?
Personalizing the rehabilitative treatment plan for our patients is something that doesn’t happen with an off-the-shelf or Internet purchase of a product. Working as closely as we do with our patients, we are in a good position to quickly sum up their needs and help them make decisions about hearing aids and care appropriate for their specific needs and capabilities.
In discussions with my colleagues who are particularly good at dealing with patient populations with unique needs, a number of common themes emerge:
- The common advice to have a third party attend an evaluation session is always important simply because of the amount of information presented and the ease of making a decision when a partner or family member is in attendance to offer assurance. When it turns out that the patient may have a compromised ability to clearly reason, the third party can be crucial because they (hopefully) will ensure that any decision is appropriate.
- Simplicity, especially in the selection of a hearing aid for a new user, can be very important. Fortunately, contemporary hearing aids often have the option of starting with very simple controls and adding additional functions as the patient becomes proficient with the operation.
- If a patient has been successful with a certain style of hearing aid that needs replacement, top on the list of styles to consider for the new aids should be a very similar style. Likewise, specifying the same control functions is also helpful. If the patient is accustomed to turning a volume-control wheel down to a stop, then rotating it to a point of comfort, a digital wheel that has no stop may be very difficult for them to learn to use. Of course, if a different style offers features that may significantly improve the patient’s ability to use and benefit from the hearing aids, the improved performance may trump the consistency rule. Personalization is a process that looks at all options, and makes a choice that best meets the needs of the patient.
The Final Word? Many of our patients are quite capable of fully participating in the selection process of the style and features of hearing aids that are part of their personalized comprehensive treatment plan. Our expertise is best used in educating them about the full array of options, fitting the aids, and recommending additional action beyond acquiring the hearing aids that will offer them the best performance. Other patients need more focused guidance in the basic selection and training on the use and care of the aids. All of our patients are unique, and while we perform similar services for all of them, the best gift we have is to recognize their unique differences and personalize our recommendations so that their needs are met.
Correspondence can be sent to HR or Dr Van Vliet at: