Speech language swallowing and hearing disorders: What you need to know - Part 2
Q: How can I communicate more effectively with elderly patients who are hard of hearing?
A: Approximately 10 per cent of the population is hard of hearing, but the percentage increases to more than 50 per cent for the 65-and-over age group.
Most hearing losses are the result of damaged nerve cells. The sound can travel into the ear, but the hair cells in the cochlea are damaged and don’t relay information to the brain properly. Hair cells cannot be regenerated, but hearing aids can help the remaining hair cells function more efficiently. Hearing aids make speech easier to hear, but not every word will be perfectly clear. The hard-of-hearing listener has to try to fill in the gaps, a challenge that can be particularly stressful in any health-care setting. An assistive listening device can be helpful for individuals with hearing loss who do not have hearing aids. These portable amplifiers, about the size of a deck of cards, are relatively inexpensive and are easy to use with either earphones or earbuds.
There are several strategies you can use to improve the communication process. Before starting to speak with your patient, make sure you have eye contact. If the patient uses hearing aids, make sure they are in and turned on. In addition, if the patient wears glasses, have her put them on to help with lip-reading. If it is clear that the patient hasn’t heard you or has misunderstood you, don’t repeat the words you’ve just used. Only about 30 per cent of speech sounds can be seen on the lips; rephrasing will provide more conversational clues and an opportunity for the patient to see and hear different sounds. If you are wearing a mask, remove it so your lips can be seen.
Where possible, reduce background noises and try to have light on your face. Avoid standing with a window behind you because the light will create shadows on your face, making it difficult for the person to lip-read. Use facial expressions and body gestures to help convey your message. Many hard-of-hearing people cannot tolerate loud sounds, so yelling doesn’t help! A good strategy is to try to speak just a bit louder and slower than normal. But don’t overdo it because this exaggerates your facial expressions and makes it more difficult to lip-read.
Social banter helps build social connectedness and reduces feelings of isolation. When you are chatting with patients and it appears they haven’t heard you, try rephrasing rather than saying “never mind” or “it was nothing,” which cuts people off and isolates them. Likewise, if you are sharing important information, confirm that you have been heard by having patients repeat what you have said. People may feel embarrassed when they haven’t heard you properly. They may smile and nod as if they understood you, but double check to ensure your message got through.
Finally, if verbal communication is not working, don’t be afraid to use pen and paper. If there is a sign language interpreter present, continue to look at and speak to the patient.
Your efforts in implementing these simple strategies will be greatly appreciated.