Teaching Residents/Students to Identify Patients with Hearing Loss and to Respond Effectively (Communication, Advice, Treatment) Amy Trelease-Bell, MD, FAFP Faculty, Maine-Dartmouth FMRP Dennis Baker, PH.D. Emeritus Professor of FM, FSUCOM

Disclosures We have nothing to disclose except: –Dennis is hearing impaired with sensoneural hearing loss –Amy is hearing impaired with tinnitus and sensoneural hearing loss

Objectives 1.Describe what hearing loss is like for the “hard of hearing” (HOH) person/patient. 2.Describe strategies for identifying HOH patients and teaching these strategies to learners. 3.Describe strategies for communicating more effectively with HOH patients and teaching these strategies to learners. 4.Describe strategies for discussing with the patient actions to take for hearing enhancement (e.g. hearing aids) and teaching these strategies to learners.

What it is like to Have Hearing Loss or Could you repeat that? Dennis –“ Hearing loss is frustrating and requires a lot of effort and energy. My hearing aides are a blessing and a curse.” Amy –Familial follies and foibles with Phonak Audience members experiences with hearing loss

Fast Facts Men more likely than women to report having hearing loss 2% of adults 45 to 54 have disabling hearing loss (DHL) 8.5% age 55 to 64 have DHL 25% age 65 to 74 have DHL 50% age 75 and greater have DHL

Fast Fact Cont’d Among adults age >70, with hearing loss who could benefit from hearing aids, fewer than 30% have used them. Among adults age 20-69, with hearing loss who could benefit from hearing aids, only 16% have used them.

Fast Facts Cont’d Risk factors for hearing loss: –Aging Common for older adults is degeneration of hair cells in inner ear –Systemic diseases –Exposure to noise or ototoxic agents –Genetics –Reoccurring inner ear infections

Objectives 1.Describe what hearing loss is like for the “hard of hearing” (HOH) person/patient. 2.Describe strategies for identifying HOH patients and teaching these strategies to learners. 3.Describe strategies for communicating more effectively with HOH patients and teaching these strategies to learners. 4.Describe strategies for teaching the learner to recommend hearing enhancement strategies to the HOH patient.

Patient Behaviors That Indicate Hearing Loss? Your Experiences Patient asks you to repeat. Patient gives answer to question you did not ask. Patient looks confused regarding what you said or asked.

How Do You Screen for Hearing Loss and What Do You Teach To Learners? Guidelines? –The U.S. Preventive Services Task Force (USPSTF) concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for hearing loss in asymptomatic adults 50 years or older –American Speech-Language-Hearing Association recommends that adults be screened at least every decade through age 50 and at 3-year intervals thereafter.

What Do You Teach Learners Relative to Screening for Hearing Loss? Clinical tests –Whisper, finger rub, watch tick Single-item screening –Do you have difficulty hearing? Patient questionnaire –Hearing Handicap Inventory for the Elderly (screening version) Handheld audiometer –Ear Trumpet (app)

Objectives 1.Describe what hearing loss is like for the “hard of hearing” (HOH) person/patient. 2.Describe strategies for identifying HOH patients and teaching these strategies to learners. 3.Describe strategies for communicating more effectively with HOH patients & teaching these strategies to learners. 4.Describe strategies for discussing with the patient actions to take for hearing enhancement (e.g. hearing aids) and teaching these strategies to learners.

Communication Strategies Pair and Share

Communication Strategies (Use Active Modeling as Teaching Strategy when teaching students/residents) Smile and make eye contact. Be sure patient sees your face (remember this when using computer). Speak slowly and enunciate. Lower tones at normal volume is best. No shouting!!!!!! If your pitch is high, try to lower. Write or print out key information. Use “teach back.”

Objectives 1.Describe what hearing loss is like for the “hard of hearing” (HOH) person/patient. 2.Describe strategies for identifying HOH patients and teaching these strategies to learners. 3.Describe strategies for communicating more effectively with HOH patients & teach strategies to learners. 4.Describe strategies for discussing with the patient actions to take for hearing enhancement (e.g. hearing aids) and teaching these strategies to learners.

How Do You Motivate HOH Patients to Seek Solutions Motivational Interviewing Tell about other patients’ success Explain benefits Listen to their story Put yourself in patient’s shoes Increase your knowledge of hearing loss and hearing aids

Review, Reflections, Summary What is most important thing you learned today?

References/Resources Walling, A. and Dickson, G. Hearing Loss in Older Adults. American Family Physician, vol. 85, no. 12, June 15, 2012, pp Hines, J. Communication Problems of Hearing –Impaired Patients. Nursing Standard, vol. 14, no. 19, January 2000, pp dfhttp://familymed.uthscsa.edu/geriatrics/tools/Hearing_Assessment.p df Screening for Hearing Loss in Older Adults: Recommendation Statement Am Fam Physician Jan 15;87(2):online.

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