Hearing loss and dementia: Is isolation a factor?
by Chelle Wyatt
The link between hearing loss and dementia has been big news for the last couple of years. Because of this news, people seem to think if someone has hearing loss they’d better get hearing aids to keep from getting dementia. Also seen are giant ads with information that scares people into buying hearing aids. This is wrong; this is people selling a product. The link between hearing loss and dementia is there, but by focusing on hearing aids only they are missing the bigger picture. Hearing aids are only PART of the answer.
Dr. Frank Lin, Otolaryngology, John Hopkins, has been researching the connection between hearing loss and dementia which you can find here. Lin says currently the main rehabilitative care being offered is hearing aids, and he goes on to say it’s not just about hearing aids, but ensuring people with hearing loss can communicate in all settings.
“Hearing loss is very treatable in later life, which makes it an important public health target to reduce risk of cognitive decline and dementia.” – Dr. Frank Lin
I believe it’s the isolation factor that typically comes with hearing loss that causes dementia, and that idea comes from personal experience. My grandma didn’t have hearing loss, she had diabetes. She thought her life was over as she knew it. There was no more joy to be had. (Sounds like the hearing loss diagnosis?) Once a very active and social person, she withdrew from those activities, her friends, and she stayed home running errands for necessity only. Her mental health began to decline, slow at first, and later it picked up speed. It was frightening to witness and from then on I associated isolation with mental decline.
Twenty something years later, hearing loss and dementia were linked – and my first thought was social isolation. People with hearing loss tend to isolate themselves, as it’s a noisy world out there, and hearing devices are far from perfect. Audiologists hand out hearing aids, program them, reprogram them if needed, and people still struggle socially.
Even though hearing aids may have a noise reduction program for restaurants, separating the waitress’s voice though the clattering of dishes, background music and talk from other patrons remains difficult. Poor acoustics in these environments make the situation worse, reverberation confusing hearing aids/cochlear implants further. Not just words are lost but whole sentences. This is where people start bluffing because they just want it over with.
Reasons We Avoid Social Situations
There’s a lot less of this confusion at home. Home is safer where the environment can be controlled. There are captions on the TV, books as easy friends, and embarrassing repeats can be avoided. It’s too risky in public, maybe that’s why my grandma stayed home. We aren’t given the proper tools and strategies to deal with this when they hand out hearing aids.
Another bummer is high dollar hearing aids can’t keep up in social venues such as theatres or at the movies. Dialog is lost in the booming background noises and/or overriding music. The dialog is delivered at a fast pace, just like some family functions. Conversation bounces around and by the time we figure out who’s talking, someone else is already speaking. This makes people with hearing loss feel left out, like an outcast in a sea of noise. They might resort to bluffing to give the appearance of fitting in, especially around people they know and love. Why? The words “never mind” or “I’ll tell you later” (which rarely happens) are also a dismissal. Maybe they were brave enough to ask for a repeat and then heard, “are your ears in?” We are shut out of the world communication.
Hearing Aids Aren’t a Magical Fix
Yes, we are wearing our hearing aids and they aren’t a magical fix. They are flawed, so repeats and certain accommodations will be needed. I’ve worn hearing aids for over 25 years now. For the first 16 years I thought something was wrong with me. I had expensive hearing aids, and I still had a hard time understanding speech. The feeling of inadequacy and the fear of judgement kept me socially withdrawn. What if I said something off the wall, again? Or maybe I’ll repeat what someone else already said, again. Easy street, in the short run, is to stay away from all dangerous situations.
Hearing aids do help and they have their place, but their limitations are not often discussed in full. If you’re lucky you run across someone knowledgeable about hearing loss, or happen to find the right book or article. It was a book for me and reading it, I finally understood why I hear the way I do and that hearing devices have their limits. What a relief to find out it wasn’t me after all, I’m just sorry it took me 16 years to learn that. It was freeing but anger soon followed. Why didn’t any of the audiologists I had over the years tell me that? Why didn’t they offer me more support? Isn’t that their job? After that I was on a mission to learn all I could about hearing loss and hearing aids. Here’s some of what I learned….
The big 3 of hearing aid limitations:
- They only work well within 4-6 feet, after that their ability goes down.
- If it’s a high frequency hearing loss, then hearing aids only replaces some hearing.
- Even though digital hearing aids are better at masking some of the background noise, some noise is still overpowering for hearing aids. Bad acoustics can wreak havoc on hearing aids rendering them nearly useless.
How to conquer those limitations:
LEARN ALL YOU CAN ABOUT YOUR SPECIFIC HEARING LOSS.
How do you hear and why? Where do you fall on the speech banana and what sounds of speech do you miss? If your audiologist didn’t explain this to you, make an appointment right now and have him/her explain it to you. They owe you that. That way you know more of what you need to make communication easier on you and those around you. In fact, take your significant other with you so they too understand
FIGURE OUT WHAT YOU NEED TO MAKE COMMUNICATION EASIER.
So many people with hearing loss don’t know what they need so let me give you a starting list.
- People need to be within 4-6 feet.
- They need to get your attention first so you’re prepared to focus.
- At all times they should face you when talking (you lip read some whether you know it or not).
Just those 3 rules will make communication easier on both parties. Create a habit together.
ADVOCATE FOR YOURSELF.
When you tell people what you need, you’re advocating for yourself. Woo-hoo! That’s a giant step forward and it’s absolutely okay to tell people what you need. The next step would be introducing yourself to new people with your needs. Here’s what I say: “I lipread.” (It gets them to face me pushing sound right at me and I can use lipreading in combination with my remaining hearing.) “I hear well enough to know you are talking but unless I’m looking at you I won’t understand much.” I’ve given them direction on how to communicate with me, there’s no guessing. If I don’t answer a question while looking down, I’m not rude, I didn’t hear/see.
USE ASSISTIVE LISTENING DEVICES (ALDs).
Hearing aids pair wonderfully with assistive listening devices (ALDs). While out in public look for the symbol, an outline of an ear with a slash/dots. Typically there are FM systems and if you’re lucky you’ll find hearing loops which are even better. There’s also live captioning, called CART (Communication Access Real-time Translation) and caption devices in theaters (CaptiView and Sony Caption Glasses). If the public venue’s devices don’t work well, be sure to let them know because you’re not only advocating for your needs but you’re also advocating for people with hearing loss who come after you.
LOOK FOR CLASSES ON HEARING LOSS.
Most states have a Deaf and Hard of Hearing Center/Commission and offer some form of help. Here in Utah we have Hard of Hearing Assistants in rural areas who go to senior centers (younger people are able to attend some) to teach classes, free. They teach lipreading, Living with Hearing Loss (based on Sam Trychin’s work), tinnitus, hearing aids 101 and slow paced sign language classes.
Most states aren’t exactly like Utah but they should be able to offer some direction or support. Lipreading and the sign language classes helped me. I can use my lipreading ability in noisy situations such as restaurants, even taking my hearing aids out so the noise isn’t distracting me. My husband learned the ASL (American Sign Language) alphabet to help me when I’m stuck on words. I now have more tools at my disposal, helping me to be more successful in a variety of situations. If a state agency isn’t available, check for other resources such as college classes, local hearing loss support groups and online support (SWC is a great start with email lists and Facebook groups) and…
FIND YOUR TRIBE!
Look for others with hearing loss. Find the role models who make themselves available to help others. Because they were once where you are, they can help you climb out of the isolation hole. The SayWhatclub (SWC) saved me twice in my life after big hearing drops; once in the late 90’s and again in 2009. Seek local support groups, and go to the hearing loss conventions each organization offers. SWC has an annual convention I can’t get enough of it, because I feel like I’ve come home. The conventions have given me something to look forward to, to learn from (every single time) and enables me to meet new friends and greet old ones. It’s socialization in my environment with people who know how to talk to me. All workshops are captioned and have hearing loops. It’s a world catered to me.
What can audiologists do to help?
Hearing aids alone will not combat dementia. Audiologists need to expand their services, or at least point all clients in a direction where they can grow with hearing loss. I might believe ads about combating dementia with hearing aids AND rehabilitative services. What if all audiologists made themselves aware of state agencies for deafness and hearing loss, and passed out that information to every client? If audiologists offered mentoring services, someone with personal experience in hearing loss to help with questions, would that decrease doubts and improve self-confidence? Would once a month talks on different aspects of hearing loss and communication at the audiologist’s office make a difference? Only then would I believe they were focusing on the link between hearing loss and dementia.
Hearing loss is not the end; it’s just a matter of learning another way of doing things.
Chelle Wyatt is a long time SayWhatClub member and former president of SWC’s board of directors. Currently, she teaches lip reading courses online. Visit her website, Hearing Loss Live, to learn more about lip reading.