Hearing and vision
People with mild hearing loss are twice as likely to develop dementia than those with normal hearing. People with severe hearing loss are up to five times more likely. There’s also research suggesting a link between vision impairment and dementia in later life.
These links aren’t well understood yet, but research is ongoing. If you have hearing or vision loss, you’re not guaranteed to develop dementia, you just have a higher risk. Taking care of your hearing and vision can help you reduce your risk of developing dementia.
What you can do: hearing
The best way to protect your hearing is to prevent damage. You can do that by:
- avoiding loud noise
- wearing hearing protection
- quitting smoking
- having your hearing tested regularly.
Even with the best prevention, some level of hearing loss is common. Signs of hearing loss include:
- trouble engaging in conversations with friends and family
- asking people to repeat what they’ve said
- finding noisy environments more challenging
- needing to turn the television or radio up louder than usual.
If you or someone close to you notices problems with your hearing, talk to your doctor as soon as you can. They can test your hearing and refer you to a specialist to work out what’s going on. Early diagnosis and intervention can help improve your quality of life and reduce your risk of dementia.
Some hearing services can be subsidised by the Australian Government’s Hearing Services Program or private health insurance.
In this video, Adult Specialist Audiologist Catherine Hart explains how we hear, the warning signs and impacts of hearing loss, how hearing aids and other assistive devices can help, the importance of communication tactics, and how to access hearing services.
Transcript
[Beginning of recorded material]
[Title card: Hearing and Dementia. Dementia Australia.]
Catherine: Hi, everyone. Thanks for dialling into our webinar today - Hearing and Dementia. I'm Catherine Hart, an audiologist at Hearing Australia. Before we start, Hearing Australia would like to acknowledge and pay respects to the many traditional owners of the lands on which we are meeting today. I pay my respects to Elders past, present, and emerging, and acknowledge the longest continuing culture on earth. I also extend that respect to any Aboriginal and Torres Strait Islander people joining us today.
So, what are we going to cover in this session? We're going to look at hearing loss facts and figures, and how we hear, also hearing tests and audiograms, the warning signs and effects of untreated hearing loss, hearing aids, assistive devices, and how they can help people living with dementia, and in fact, all with a hearing loss, communication tips, and how best to access hearing services.
So, hearing loss facts and figures. Hearing loss is probably a lot more common than you may think, with most Australians to be touched by hearing loss at some point in their lifetimes. One in six of us over 15 years of age has a hearing loss, and this is predicted to rise to one in four by 2050. Hearing loss is more common as we get older, so by 60 years of age, 60% of us will have a hearing loss. 70% of us will by the age of 70 years, and 80% of those 80 years of age. It's also more common in men than women.
Seven in 10 indigenous Australians also have some form of hearing loss, and half of all childhood hearing loss is preventable, as is over a third of adult hearing loss, and that's typically noise-induced type hearing loss. You can also see in the graph here that more than 80% of residents in aged care facilities in Australia also have a hearing loss.
So, how then do we hear? Welcome to the world's most advanced sound system. It's pretty incredible. There are three parts to the ear. There's the outer ear, which is this section here, including the pinner that you're all very familiar with, and the ear canal. We also have the middle ear which is this middle component there, including the eardrum and the ossicles, which are the three smallest bones in the body. We also have the inner ear here which includes the cochlear, which is this snail-shaped structure, and the semicircular canals, which help with balance. Sound is harnessed by the pinner and sent into the canal. This then causes the eardrum and the three little ossicles to vibrate. This sets up travelling waves in the cochlear, which is actually fluid field. There are tiny hair cells in the cochlear that converts sound into electrical impulses that are sent up this auditory nerve to the brain.
Depending on which part of the hearing system is affected, a hearing loss is either a conductive hearing loss, so that's a problem with the sound being conducted through that pathway. For example, wax, perhaps, in the ear canal, or perhaps a middle ear infection in this section here. It can be a sensory neural hearing loss, which is a permanent hearing loss, and that's often an issue with the little hair cells in the cochlear we were just talking about, or it can be mixed, which is a mix, of course, of the two. Perhaps the person might have some wax in their ear canal that's blocking it, and they might also have a noise induced, or an age-related hearing loss affecting the cochlear. Hearing loss can be congenital so people can be born with hearing loss, or it can be acquired. There's a lovely video showing all of that in action, and the link is there at the bottom of the screen.
So, how then do we test hearing? Hearing tests are plotted on an audiogram, and this is a graph of the very softest sounds that a person can hear. On the left-hand side of the graph here, you can see sound in decibels, from very soft at the top to very loud at the bottom. So the further up, the better the hearing. Across the top, we have pitch or frequency. From low pitches, to mid pitches, to very high pitch sounds like S for Sally, F for Fred, for example. Here, you can see an audiogram of everyday sounds. So, a fridge is a low-pitched soft sound, whereas an aeroplane is a loud, high-pitched sound.
And in terms of hearing loss on the right-hand side here, you can see that we have the normal section of the audiogram, moving down to a mild hearing loss which would be affecting communication in a mild way, moderate hearing loss, right down to a profound hearing loss where there isn't much hearing at all there except, perhaps, for very loud sounds or environmental sounds.
So what does a hearing loss sound like? Often, people assume that all sounds are equally affected, but that isn't the case. Some pitches are affected more than others. For example, the low pitches might be perfectly normal, dog barking, vowels of speech, clapping hands, those sorts of sounds the person might be hearing really well, but they might be struggling with some of those higher pitched sounds, such as the consonant sounds. It might be difficult for somebody to hear the difference between 60 with an S for Sally, and 50 with an F for Fred without looking, perhaps, at the person's lips. So, let's have a quick listen now to what a hearing loss might sound like. Here, we have a snip of speech for a normal hearing person, so this snip isn't filtered at all. Let's have a listen.
[Plays audio]
Speaker 2:
The show is a sellout.
Speaker 3:
Well, the weekend is always busy.
Catherine:
Now with a mild hearing loss,
Speaker 2: (slightly muted)
The show is a sellout.
Speaker 3: (slightly muted)
Well, the weekend is always busy
Speaker 1:
And now, a severe hearing loss, so moving down that audiogram we were just looking at.
Speaker 2: (very muted)
The show is a sellout.
Speaker 3: (very muted)
Well, the weekend is always busy.
Speaker 1:
Catherine: As you can see, it's not just losing volume, it's really losing clarity as well as we move down that range, so it can be really difficult. And instead of he hears when he wants to, it's often more a case of he hears when he can.
So, what are the warning signs and effects of hearing loss? Either yourself or a loved one may be asking for repeats a bit more often, they might need the radio and the TV turned up louder, and they may have lots of difficulties when it's noisy as well. They may struggle to hear on the phone, and/or even to hear the phone ring. They might not respond when their back's turned and the sounds going the wrong way, for example. Sometimes, there might be dizziness, or ear pain, or ringing, buzzing, pulsing, pounding noises in the ear called tinnitus, and sometimes, that can also be a warning sign of hearing loss. And, of course, those sorts of symptoms would be best checked with the GP too before you have your hearing check.
Unfortunately, often, people with hearing loss start to withdraw from social activities. They tend to really become a bit isolated at times, because it's quite exhausting having to fill the gaps as you're talking, and they really do miss out on quite a bit of speech and communication. If there's a difference between the ears, the person might also have trouble localising or telling the direction that a sound is coming from as well, so that can be a warning sign for those people.
Untreated hearing loss can have psychological, emotional, social and physical impacts, not just on the person with hearing loss, but also their family, friends, carers, and so on. We've talked a little bit about listening effort and fatigue – it can be frustrating as well, and stressful, and sometimes, can cause the person with hearing loss and their loved ones to feel depressed. We've talked a little bit about social withdrawal and isolation, and it can also be a real safety risk if that person's not able to hear the phone ring, for example, or hear traffic on a busy street, or a smoke alarm.
Untreated hearing loss in middle life is also associated with increased risk for dementia of course, as well. It can also cause reduced opportunities in the workplace if the person's communication is affected, and reduced quality of life, especially if it's a significant hearing loss, and/or the person has other disabilities in addition to hearing loss. For example, they might have a vision impairment, and that makes it really hard, then, for them to access visual cues, and that can be really difficult, and presents some unique challenges.
The good news, of course, is that hearing aids and assistive devices can help. Hearing devices help to improve the social, the emotional, the physical, and the psychological wellbeing of all people with hearing loss, including those living with dementia with a hearing loss. They also allow people living with dementia to stay connected and included, which is incredibly important, of course, too. There are different styles and levels of technology to suit people with all sorts of different hearing needs.
Hearing aids are individually set to the audiogram we just looked at, and they really help to keep those hearing pathways active. There are also other devices called assistive listening devices. Often, things like headphones, and those sorts of things that we'll talk about shortly, and they can also help. Hearing aids of course, do take a little time to get used to for new users, of course, and we'll talk about that a little bit more shortly.
Hearing aids have come a long way and are really very useful, and have some great benefits, but they are an aid, not a cure. They're a microphone, in effect – they still work best in quiet, and within one and a half metres of the person that you're talking to, or the sound you're listening to. Hearing aids can only safely give back half of the hearing that's been lost. If we were to give any more than that back, we would risk damaging the hearing that remains.
Modern devices are digital, they work harder in noise, and many are automatic. We talked about different styles and features. There are some rechargeable options. You can see here on the right-hand side, we have some ITE, or some in the ear type hearing aids, some behind the ear hearing aids. There's a variety of hearing aids, some are stronger than others, and they're available to suit people with various hearing and communication needs.
Hearing aid decision aids can be really useful for family and people as they're trying to decide which sort of hearing device might be best for them, but we touched on how tricky it can be to get used to hearing aids as a new user, and it's important that family, and friends, and carers are available to really support and help the person persevere. Some hearing aids have other features like Bluetooth streaming, which can be really useful, particularly for streaming telephone, or TV, or music directly to the person's hearing aids. And we know music is a great way for people to remain connected and to reminisce, and that can be really useful as well.
There are also other devices such as remote microphones, and you can see this man in the picture here on the right-hand side is wearing what we call a neck loop system, and that talks to a microphone on the table. The neck loop system can be worn by itself, or it can be used with hearing aids as well. Remote microphones really help reduce the effects of distance from the speaker, background noise in the room, and a really echoey, reverberate sort of environment. And some offer other features too, we've talked about Bluetooth, but Telecoil can be very useful as well.
There are other listening devices out there, of course, as well, including television devices where the person pops the little headset on and listens to the TV without any background noise. Personal amplifiers – instead of wearing a hearing aid, the person pops the headphones on, and this turns all sounds up, and that can be really useful for some people as well. Amplified telephones with large buttons, and smoke alarms for people with hearing loss - so very loud smoke alarms so people can hear them, amplified doorbells, that sort of thing.
Sometimes, hearing aids aren't enough. We know that hearing aids only give half back of the hearing that's been lost, so for people with a fairly significant hearing loss, hearing aids might not be enough. You may have heard of the cochlear implant, and that's a surgically implanted option for people who obtain little or perhaps no benefit from hearing aids, and that can also be suitable, sometimes, for people living with dementia. There are also some implantable bone conduction devices available too.
So now, we've talked a little bit about the hearing devices and all the options that are out there, let's look more at communication tips, and I think we can all be better communicators. We know hearing aids are an aid, not a cure, and can never be the full answer, because they're only giving half back of the hearing that's been lost. So, what else can we do to really help communicate with people with hearing loss?
The first thing, of course, is to face the person directly, be at the same eye level, and that, again, really helps with the lip reading. Also important not to shout, just speak normally – hearing aids tend to distort if you're shouting, so that's something to avoid. Obviously, keep your hands away from your face. That really helps as well with the lip-reading component, reducing background noise, turning off the TV or radio, if you have the choice of two rooms, one cozy, and carpeted, and cushions, and upholstered chairs, always choose that over a hard floor room, or a large auditorium room, or hard chairs, that sort of thing. Cozy is best.
Make sure the light isn't shining in the person's eyes, because that can make things very hard for lip reading, of course, as well. And it's important that if you're not being understood, always try to find a different way of saying the same thing. We know that not all sounds are equally affected, and often, consonants are more affected than vowels for some people. So again, it's just about making sure that you are understood, and be ready to rephrase as needed, of course, as well. And be patient – the person might have trouble understanding speech even with the hearing aids in.
Other communication tips that can be useful when communicating with people living with dementia. Of course, calm and friendly approach and taking it slow. Keeping sentences short and simple if needed is important, particularly if the person is tired, it might be the end of the day, and these sorts of tips really help when communicating with anybody. Removing distractions is important as we've said, and really allowing time for the person to respond. Showing and telling with actions and gestures can be really useful as well. For example, if you're showing your loved one, how to change the hearing aid battery, instead of just using words you could show, demonstrate as you go, that can be really helpful. And as always, be flexible and positive, and check that the person has understood.
We've talked a lot about hearing aids working best within 1.5 metres of the speaker, and of course, that's been a real challenge more recently with social distancing and mask wearing. Here, hearing tactics and strategies become even more important. Speech sounds are softer, further away, and background noise is also more intrusive because the speech has to really compete with the other sounds going on in the environment. When you're at a distance, it's also harder for the person to lean in, or try and access visual cues and see the lips as easily. And often, then, the person you're talking to has to increase their vocal effort, they have to speak louder, and that can be really hard as well. And the last thing we want is for them to say, “You know what? Don't worry about it.” That would not be good at all either.
There's some great speech to text apps out there such as NALScribe, and they can really help by converting speech to text on an iPad, for example, or on a smartphone, and it's easy, then, for people to follow that in real time, and they're available in a number of different languages as well. Speech to text apps can be really useful also when people are wearing masks, because masks really muffle those high pictures.
So, how best to go about accessing hearing services and having your hearing checked, or the hearing of a loved one checked? Hearing Australia was established in 1947 for the World War II vets, and also, at the same time, there was the rubella outbreak and lots of deaf babies were born. Hearing Australia is a Commonwealth Statutory Authority, and we're part of the Department of Government Services. We have over 180 permanent hearing centres, and more than 600 visiting sites and outreach locations in various communities around Australia.
We offer home visits and telehealth services too, if that's appropriate. We also offer aged-care education programs. We have our own research arm, which is the National Acoustic Laboratories, and you can see our website there. Hearing Australia is the sole provider of specialist hearing services, to hearing impaired children under 26 years of age, eligible adults with complex hearing and communication needs, and many Aboriginal and Torres Strait Islander clients, seen under the Commonwealth Government's Hearing Services program.
People can contact either a Hearing Australia or their local hearing provider to arrange a hearing check. It's really important that hearing is checked as often as vision. Subsidised hearing services are available under many programs such as the Commonwealth Hearing Services Program. It's always important that people see their GP first to rule out any medical causes of hearing loss, for example, wax, ear infection, those sorts of things.
What you can do: vision
Talk to your doctor about your vision and get regular eye examinations. Early diagnosis and intervention are key to improving your quality of life and reducing your risk of dementia.
If you have glasses or contact lenses, wear them when you need them to reduce the strain on your eyes and brain.
