Emily Frost Adult Audiology Clinical Lead PhD Student - Hearing - - PowerPoint PPT Presentation

The Challenges in Audiology for Patients with Dementia

Emily Frost Adult Audiology Clinical Lead PhD Student - Hearing Loss and Dementia Imperial College Healthcare NHS Trust Emily.frost2@nhs.net

Discussion Points

• Significance of hearing loss
• The Audiology Service
• Challenges at each stage for a person with dementia
• Role of hearing loss in dementia assessments
• What can we do to improve?

Vital Statistics

• 11 million people in the UK

have hearing loss.

• By 2035 there will be approximately

15.6 million.

• People wait on average 10 years before

seeking help for their hearing.

• GPs fail to refer 30-45% to NHS audiology services.
• Hearing loss may increase the risk of dementia

by up to 5 times.

• Around 40% of people who need hearing aids actually wear them.

Action on Hearing Loss, (2015)

Living with a Hearing Loss

Lin, (2011)

Social Withdrawal Isolation Depression Participants with a mild, moderate and severe hearing loss had a 2, 3 and 5-fold increased risk of dementia compared to normal hearers after 10 years of follow-up.

?

Access to Services

The Challenges…

• Direct Access Service
• Audiology is an AQP Service
• E-Referral System

Access to Services

The Solutions…?

• Community Services
• Domiciliary Service
• Vulnerable patients discharge policy

Assessment

• 45 Minute Appointment
• Detailed History
• Red Flags
• Patient-Centred Approach
• Ear Examination
• Wax Removal

Assessment

• Pure-Tone Audiometry

I’m going to give you this button to hold, I would like you to press the button every time you hear a beep, even if that beep is very quiet. I’m now going to play a rushing sound into

• ne of your ears, I would like you to ignore

the rushing as much as possible and press

• nly when you hear the beeps.

Assessment

• Results
• Audiogram
• Management
• Often Hearing Aids
• Type of Hearing Aid?
• Severity of HL
• Manual dexterity
• Eyesight
• Patient preference

Treatment

• 60 Minute Hearing Aid Fitting Appointment
• Set the hearing aids up
• Real Ear Measurements
• Fine-Tuning
• Subjective testing
• Rely on patient feedback

https://www.youtube.com/watch?v=F9n 6b3Yy5Sg

Treatment

• Give instructions
• Can be simplified

On/Off

Changing batteries Right/Left

Using the phone

Cleaning

How to put hearing aids in and take them out

Volume Control

Loop System

• Practise

Treatment

INFORMATION OVERLOAD!

• Batteries
• Battery Book
• Instructions
• Cleaning Wires
• Boxes

Follow Up

• 30 Minute Appointment
• 6-8 weeks after fitting appointment
• Check use
• Answer questions
• Fine-Tune
• Explain after-care

Aftercare

• Batteries
• Re-tubing every 6 months
• Troubleshooting
• Self-management

The Hearing Aid in the Drawer…

• What happens next?
• 1. The hearing aids aren’t comfortable
• 2. Expectations
• 3. Difficult to maintain
• 4. Stigma
• 5. The hearing aids weren’t useful

Lost Hearing Aids

• Hospital Admissions
• Care Homes
• Carers
• Misplaced

Hearing Loss in Cognitive Assessment

• Hearing Loss and Cognitive Impairment

are often mistaken for each other.

• Is hearing screened in assessments?
• How many of the questions in the

assessments are delivered verbally?

Age-related Hearing Loss as a Predictor?

• Livingston et al. (2017)
• Dementia prevention, intervention and care.
• Mid-life hearing loss was the

highest potential modifiable factor at 9%

• Depression 4%
• Social Isolation 2%
• Causality and the impact of treatment is still unknown.

Overcoming These Challenges in the Future…

• Ensuring hearing aid services are re-commissioned.
• Focus on combined sensory health.
• Collaborative approach between audiology and memory clinics.
• Improve ‘dementia friendly’ approach in audiology.
• Invest more in research.

Using Serious Games- My PhD

• Number of ‘games’ in dementia research
• Sea Hero Quest: Navigational Skills.
• Developing a novel training application
• Training for auditory, attentional and cognitive skills.
• Testing with mild age-related hearing loss and

subjective cognitive impairment.

• Possibility of delaying decline with training.

Tha hank nk yo you fo for list stening. ening.