It is hard enough to imagine the emotional journey of someone living out his or her last months of life. Now imagine going through that while only partially able to understand what your loved ones and doctors are telling you – seeing their frustration and confusion as they repeat things for you. Sherry Queen’s dissertation published this month describes a scenario in which this may be the case for a large portion of hospice patients.¹  The work describes itself as a toolkit for audiologists working in palliative care. However, the lessons contained in Queen’s work would be important for anyone who has a patient or loved one in end-of-life care.

About Age-Related Hearing Loss

Almost three-quarters of people age 70+ have some sort of hearing loss.² That hearing loss is in both ears for two thirds of our septuagenarians. Age-related hearing loss comes on so slowly, that many people don’t realize how much they are missing.³ What’s more, seniors with hearing loss commonly don’t speak up or ask people to adjust for them. Instead, they nod in agreement and glean what information they can while trying to not be a bother.   

The Importance of Communication During Hospice Care

Loss of hearing like this can mean loss of communication. That would be a critical loss during hospice care. Thorough, accurate, unambiguous communication serves as a key component in discussing prognosis, help with advance directives, emotional support, spiritual support, teaching pain control strategies, and so many other hospice functions. Moreover, hospice can be a time for sharing memories and saying final words to loved ones. Unrecognized hearing impediments would be a tragic loss.

The Effect of Hearing Impediments in Hospice Care

Hearing impediments require effortful listening. This is known to result in fatigue, which would have a negative, interactive effect with the fatigue people already experience from their hospice diagnosis. Effortful listening is also known to reduce people’s ability to retain information.³ Perhaps more importantly, disruption of normal communication can lead to feelings of isolation, loneliness, and depression.⁵  

Action Steps for Families

• Notify the hospice: Be sure to notify the hospice if you or your loved one has a hearing impediment.
• Request a screening: If you suspect a hearing impediment, request a screening from an audiologist or speech/language pathologist.
• Request an intervention: When hearing impediments are affecting healthcare or quality of life, there are often more easy solutions than people realize. An assessment and action plan from an audiologist, speech/language pathologist, or occupational therapist can help.
• Use hearing assistive technologies: Hearing aids can be expensive, require the services of an audiologist, and can take months for a patient to be able to use well. This makes them a bad fit for many hospice situations. However, hearing assistive technologies are available for retail purchase and can be quickly implemented. The Williams Sound Pocket Talker, for instance, is a microphone that picks up conversation in the room and a headset that plays voices more loudly for the wearer.
• Standard communications strategies
  • Eliminate background noise such as radios, televisions, and side conversations.
  • Have a patient’s attention before you begin speaking.
  • Have eye contact during speech. Avoid speaking while looking down at notes or an electronic device.
  • If infection control protocols permit, make sure the person can see your lips while you speak.
  • Speak with a strong volume.
  • Use a clear sentence structure.
  • Speak at a slower pace. 
  • Keep a notepad or dry-erase board handy for a patient.  

References

1. Queen SE. Optimizing Communication in Palliative and Hospice Care: A Toolkit for Audiologists. CUNY Academic Works.
2. Goman AM, Lin FR. Prevalence of hearing loss by severity in the United States. American Journal of Public Health. 2016 Oct;106(10):1820-2.
3. Smith AK, Jain N, Wallhagen ML. Hearing loss in palliative care. Journal of Palliative Medicine. 2015 Jun 1;18(6):559-62.
4. Rosemann S, Thiel CM. The effect of age-related hearing loss and listening effort on resting state connectivity. Scientific Reports. 2019 Feb 20;9(1):1-9.
5. Smith AK, Ritchie CS, Miao Y, Boscardin WJ, Wallhagen ML. Self‐reported hearing in the last 2 years of life in older adults. Journal of the American Geriatrics Society. 2016 Jul;64(7):1486-91.