Understanding Presbycusis: Age-Related Hearing Loss
By Barbara E. Weinstein, PhD
Hearing loss is one of the most prevalent chronic conditions affecting older adults. Of the 28 million people with hearing loss in the US, nearly 10 million are over the age of 65. And hearing loss prevalence increases with age: While 31 percent of those over age 65 present with hearing loss, that percentage increases to 70 percent for people over 85 years of age.
Hearing loss due to the aging process -- referred to as presbycusis -- is, in its purest form, attributable to degenerative changes in the peripheral auditory system (e.g., the snail-shaped cochlea) and/or the central auditory mechanism, which includes the auditory brainstem pathways and the temporal auditory cortex.
Noise exposure, vascular disease and selected medications can exacerbate age-related hearing loss. High-frequency sensorineural hearing loss, the hallmark of presbycusis, oftentimes is indistinguishable from the hearing loss accompanying prolonged exposure to noise. In both cases, hearing loss is slowly progressive, tends to affect both ears in the same way and has an adverse effect on speech understanding. Speech understanding difficulties are most pronounced in large rooms, in noisy environments and when the speaker is at a distance from the listener. The typical complaint of older adults with "classic presbycusis" is that they can hear people talking, but they cannot make out the words. A statement to this effect should signal the need for a referral to an audiologist, a certified professional who specializes in hearing health care.
Common Functional Effects
The sensorineural hearing loss experienced by older adults can have dramatic effects on communication and psychosocial function. Older adults typically experience interpersonal difficulties in a range of circumstances: at home, at work, during leisure activities, when listening to speech from a distance (e.g., at bingo games, church or synagogue), and while on the telephone and watching television. Personal safety may be compromised by hearing loss, as it's often difficult to hear car horns, smoke and fire alarms, or the doorbell. Difficulty hearing warning signals can interfere with one's sense of security and independence. Older adults with cognitive impairments and dual sensory loss are at a particular disadvantage in the safety domain.
What Can Be Done
The adverse effect of hearing loss on functional status, emotional well-being and quality of life can be reversed with proper hearing aid use. A recent study by the National Council on Aging revealed that hearing aid users experience significant improvements in many areas of life, ranging from interpersonal relationships at home, to functional independence and social life.
While hearing aids have proven effective in promoting improved communication and interpersonal relations, the majority of older persons with hearing impairment do not own hearing aids. The high cost of hearing aids, the sense that a hearing loss is not severe enough and the belief that hearing aids are not for people with sensorineural hearing loss are all major deterrents to hearing aid use.
The advent of high-end hearing aids with directional microphones should help to resolve problems with understanding speech that older adults with impaired hearing experience in noisy environments, and should serve as an inducement for them to attempt hearing aid use.
Assistive listening devices should be considered as an adjunct to hearing aids, or in lieu of hearing aids for persons with hearing problems. These devices -- which are available commercially, are inexpensive and ideal for selected listening conditions -- can be used to better understand sound from the television, and to understand speech in large rooms such as theaters and auditoriums. Telephone amplifiers are very useful for those who have difficulty understanding speech over the telephone. And alerting devices, which include vibrating alarm clocks and fire alarms with flashing lights, also are invaluable.
In short, hearing aids and audiologic rehabilitation can improve the prolonged quality of life for older adults with sensory impairments. People with hearing impairments have at their disposal a variety of amplification devices to assist in overcoming communication and interpersonal difficulties. An individual who has difficulty deciphering noise from the television and/or hearing others when they speak should consider a referral to an audiologist, who can determine one's hearing status, as well as the need for any assistive devices to make life easier.
Barbara E. Weinstein, PhD, teaches at Lehman College, CUNY, Graduate School and University Center, New York, NY.
Source: Lighthouse International's Aging & Vision newsletter (Summer 2002 issue)
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