Hearing problems in the elderly. Outsider and insider perspectives of presbyacusis

Abstract

What insight can be gained from an epidemiological perspective into factors affecting elderly people with hearing difficulties both individually and in relation to their surroundings? How is hearing impairment perceived by the elderly? How great is the need for audiological rehabilitation for elderly people with hearing impairments?Study I is a cross-sectional study within the framework of the age study H70 where a comparison was made between a) tone audiometry and self-assessments of hearing, b) tone audiometry and the prescription of hearing aids and c) self- assessments of hearing and the prescription of hearing aids. Three age cohorts were studied: 1) year of birth 1901-1902 (n=210: 133 f and 77 m), 2) year of birth 1915-16 (n=168: 94 f and 74 m) and 3) year of birth 1922-23 (n=237: 129 f and 108 m). Study II is a prevalence study of tinnitus where the H70 cohort born in 1901-02 was followed up on three occasions, at the ages of 70 (n=377: 197 f and 180 m), 75 (n=266: 140 f and 126 m) and 79 (n=158: 89 f and 69 m). A strict longitudinal study was also made of this material which was studied on each of the three occasions. A cohort comparison was also made of those born 1901-02 and those born 1906-07 (n=297:171 f and 126 m) as to the prevalence of tinnitus in relation to the duration of exposure to noise. Study III is a selected hearing study of people living in Johanneberg (n= 154: 95 f and 59 m). The aim of this selection was to study a group with more "pure presbyacusis" in relation to psychosocial problems. The participants were divided into three hearing groups according to severity of their hearing impairment and were studied according to a self-assessment form with 20 different psychosocial statements about hearing. Study IV is a qualitative study. Its direction is phenomenographic. The inclusion criteria for participation were those from H70 born in 1922 and with a slight to moderate hearing impairment of the presbyacusis type in both ears when tested in 1992-93. Exclusion criteria were other types of hearing impairments than presbyacusis, and dementia. In all, 14 individuals participated. The in-depth interview consisted of an informal conversation about how it is to live your daily life with impaired hearing. The interviews were taped, transcribed word by word and analyzed according to the phenomenographic approach. The results of the study showed that there is a tendency for the elderly to make light of the problems associated with presbyacusis, tinnitus, psychosocial conditions and the need for a hearing aid. The 88-year-old group in particular assessed their hearing problems as less severe than those in the younger groups (70 and 75 years). At the same degree of hearing impairment, the younger groups reported more problems. The prevalence of tinnitus was 8-42% at the ages 70, 75 and 79 years. Tinnitus did not increase significantly with increasing age. Tinnitus was, however, correlated with hearing impairment and duration of exposure to noise. In study IV, three people were found to have tinnitus and they described an inhibition of sounds. The effect of presbyacusis on the psychological situation was found to be less than expected. In spite of their fear of worsening hearing, few wanted a hearing aids. The situations which posed the greatest problems were conversation with several people and hearing sounds from another room. When elderly people with hearing impairments themselves described their experiences, it, however, appears that hearing was important not only for communication and spatial ability but also for affirmation of identity and existence. Conclusion: The elderly with hearing difficulties tone down the importance of factors related to themselves as individuals and in relation to their surroundings. They believe that it is normal to hear less well as you get older. The explanation for such reasoning may be that presbyacusis develops slowly and you have time to adapt to your impaired hearing, e.g. by avoiding situations which are communicatively demanding. This is made clear in study IV where the elderly people's own experiences are described. It is important that elderly people with impaired hearing are identified at an early stage, so that their enthusiasm for dealing with their hearing problem does not have time to ebb. When the ability to hear is seen as important not only for being able to participate in a social context but also for the experience of existence there is motivation to do something more radical about the situation.