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Project Success Stories - Silent treatment

Not many people like to grow old. Your hair goes white, your mobility decreases and for some, the hearing goes. Impaired hearing (not complete hearing loss) is usually under-diagnosed in elderly patients. A group of European researchers are now advocating early intervention as part of routine care.

Health

European demographics clearly show an ageing population. This has led to a growing percentage of elderly people relative to the workforce. The median age in Europe is set to increase from around 37 in 2003 to around 52 by 2050, according to the Brookings Institute. In fact, the elderly population in Europe will increase by 77 % between 2010 and 2050, according to the European Commission. This ageing population will bring additional pressures on society, not to mention the greater care needed for the elderly. Deafness is customarily associated with age, and is generally accepted as such: you grow old, you get deaf, and nothing can be done about it. Historically, the importance of having good hearing has been underestimated. Older people who suffer from hearing loss get frustrated by the general lack of communication. This can consequently lead to hearing loss being associated with depression and unwillingness to mix with others and further adds to the burden of those suffering from this condition. Despite hearing loss being quite prevalent in older people, it is largely under-diagnosed, and as a result, under-treated. Deafness is not an ailment that can be seen, and therefore quickly diagnosed and taken care of. It occurs over a longer period of time, which is one of the main reasons why it has escaped early intervention among the elderly. Precisely because this is such a major issue among the elderly an EU-funded project named 'Assessment of hearing in the elderly: ageing and degeneration - integration through immediate intervention' (AHEAD III) started work in 2008 to find evidence on the effects hearing impairment has on adults and especially the elderly. 'Deafness,' says project leader Ferdinando Grandori, 'until a few decades ago, was erroneously and incredibly associated with other types of disability, even mental retardation.' The project, which runs from 2008 to 2011, seeks to raise awareness among key stakeholders (policy-makers, administrators and healthcare professionals) involved. It is analysing the costs and feasibility of large-scale or nationwide programmes of hearing screening and intervention among adults, and at the same time presenting benchmarks these screenings have to adhere to. 'Almost all the classical methods for hearing screening do not screen for the ability of understanding speech, especially when there is background noise,' explains Mr Grandori. Disability versus dysfunction AHEAD III, made up of 17 partners in 13 European countries, is developing guidelines on the way screenings should be carried out in various formats. These include the newly proposed methods of telephone and internet screening. However, these benchmarks and guidelines have to be closely tuned to local or national social and economic conditions. Whatever the screening used, AHEAD III is emphasising the need to identify early hearing disabilities and not just hearing dysfunctions. The study is focusing on a number of aspects concerning hearing loss which are all interconnected. It is carrying out an etiological assessment (what the cause for hearing loss in elderly people is), and epidemiology of age-related hearing loss (studying patterns of hearing loss at the population level). Once this has been established, the main effects of age-related hearing loss and the methods used for screening can be examined. AHEAD III managed to apply the World Health Organisation’s (WHO) international classification of functioning, disability and health (more commonly known as ICF), to the screening of and intervention on adult hearing loss. The ICF is a standard used by the WHO to classify health components of functioning and disability. The partners then pinpointed the most relevant causes and patho-physiological mechanisms which occurred in hearing impaired adults. The social consequences of hearing loss are prevalent both in the affected individual, as well as in the people he/she associates with on a daily basis. Loneliness and depression as a result of isolation caused by the inability to communicate with friends and loved ones can steadily set in. There is also the frustration on the part of others who want to communicate with the affected individual but find their efforts thwarted and then having to adapt. 'Deafness produces isolation,' says Mr Grandori. 'In the medium to long term, relationships can be greatly distorted and the deaf tend to quit any type of communication.' Coming to terms with hearing loss can be a long and dark road that few elderly people would want to take. Psychological and social impacts, too This is an important aspect the researchers are concentrating on: the psychological and social impact of hearing loss in adults. Pure tone audiometry (PTA) is used to identify the hearing threshold levels of an individual, determining the degree, type and configuration of hearing loss. AHEAD III has identified a benchmark for screening with PTA. As the European population ages, the need to prevent, delay and reverse the functional decline of the elderly becomes even more pressing. This is why the project has evaluated adult hearing screening methods and technologies used. Once these screenings were successfully carried out, the project looked at whether any of the interventions on hearing impaired patients were successful. Indeed, the team researched this matter in depth, and reviewed the literature on screening technologies, as well as on intervention strategies, to get a more complete picture of how effective current methods are. AHEAD III has been in contact and reviewed current efforts under way in both the United States and in Europe on screening methods, to get a broader perspective. Mr Grandori hopes the project will raise awareness among the general public and health professionals. It could lead to new devices being used for screening hearing ability and pilot campaigns being launched in a number of countries. With technological development continuing apace, we will no doubt see some major changes being introduced in the years to come in hearing screening.