The settings where we receive medical care are often noisy, bustling and stressful. Overlapping conversations, beeping monitors and PA announcements create a din of background noise over which it can be hard to have one-on-one conversations, particularly for patients with hearing loss. How does this fact impact the quality of care that hard of hearing patients receive?
Jan Blustein, professor of health policy and medicine at NYU believes that in noisy hospital wards and emergency rooms across the country, older patients–a large percentage of whom have hearing loss–are experiencing poorer health outcomes. She and her colleagues have been researching this issue and have recently published an analysis in the BMJ (formerly the British Medical Journal) outlining the problem, as well as a few simple steps clinicians can take to ensure their patients understand vital information about their care.
How does hearing loss affect the quality of care patients receive?
Using patient-oriented language and communicating clearly with patients is something medical professionals are trained to do. But how many of them account for hearing loss in the people they are treating? Professor Blustein believes that hearing loss in older patients is rarely considered, to the detriment of the care they receive.
In an interview with Navjoyt Ladher, clinical editor of the BMJ, Blustein commented on the way that hearing loss can negatively impact health outcomes in medical settings:
“If patients can’t hear what we’re saying they’re unlikely to be able to communicate with us, or to understand, or to for example follow up appropriately. If you discharge someone in a noisy emergency room and change the medications, for example it’s going to be difficult, if that person hasn’t heard you, for that person to be able to comply…And I’m quite confident that it’s more of a global problem. People who have hearing loss, when they’re in noisy situations, or in stressful situations, or when they’re in situations where an unfamiliar vocabulary is being used, will simply check out and not follow what’s going on.”
Simple steps which can improve the care of hard of hearing patients:
1) Face patients while speaking. People with hearing loss tend to lip read. With this in mind, medical personnel should make sure to face their patients the whole time they are communicating with them, and also ensure not to cover their mouth.
2) Speak clearly at a reasonable volume. When communicating with hard of hearing patients, doctors should make sure to articulate (but not in an exaggerated fashion) and speak at a loud enough volume to be heard over background noise. Shouting, however, doesn’t help and can actually impede understanding.
3) Make the environment as quiet as possible. This means turning off the television, asking people in the room to speak one at a time, and taking any other steps that will help to create a quiet, calm setting for listening.
4) Use a pocket amplifier. Also called a personal sound amplifier, this device consists of a unit that is easy to hold in your hands (similar to the size of a small cell phone) that has headphones attached. When the patient with hearing loss is communicating with the doctor they simply put on the headphones, turn on the device and listen. These devices are stocked in many hospitals across the US and are simple to use and maintain. Many older patients appreciate using them, as they can greatly assist with one-on-one conversations.
Why has hearing loss in older patients been under recognized for so long?
According to professor Blustein, the lack of awareness surrounding this issue stems in part from the fact that disability, as opposed to dramatic, acute illness, is not something that medicine tends to focus on. Hearing loss in particular is often dismissed as being “normal for aging”, and the fact that older people don’t catch as much is taken for granted, an occurrence which Blustein attributes to a pervasive ageism in medical settings. She also points to the fact that people with hearing loss are sometimes reluctant to disclose their disability and that wearing hearing aids can be stigmatizing. There is still a dearth of published research on medical outcomes for patients with hearing loss, but Blustein hopes that as doctors become more aware of how pervasive this condition is, they will be able to improve care for patients in acute situations.
1) Due to competing noise and poor sound insulation, hospital settings are often difficult, stressful listening situations for people with hearing loss.
2) Communication is vital for good, effective healthcare, so the hard of hearing are at risk of receiving a lower quality of treatment.
3) Clinicians should keep in mind that older patients may struggle with speech recognition and should use proven strategies to facilitate understanding.
4) Hospitals should focus on providing hearing assistive devices as needed, as well as routinely testing older patients for hearing loss.
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