PP603 - Identification and Management of Hearing Loss in Institutionalized Older Adults

POSTERS

Location: Halls A1-A2

Instructional Level: Fundamental

Lead Presenter(s)

Ruth Stabosz-Danyo (she/her/hers)

Audiology Extern
Captain James A. Lovell Federal Health Care Center
Rush University Medical Center
Chicago, Illinois

Disclosure(s): No financial or nonfinancial relationships to disclose.

PDF Handouts Slides

Presenter(s)

Uzma Akhtar, PhD, AuD

Assistant Professor
Rush University Medical Center
Rush University

Disclosure(s): No financial or nonfinancial relationships to disclose.

Abstract: There is a high prevalence of hearing loss among older-adult patients in institutional healthcare settings, and treatment with amplification is not common. Untreated hearing loss can negatively impact health, wellness, and quality of life. Hearing loss often goes unrecognized or overlooked by institutional healthcare providers. Currently, no protocol exists for reliable identification and management of hearing loss or amplification usage in this population. A comprehensive screening and management tool combining otoscopy, cognitive impairment screening, hearing loss screening, assessment of hearing loss management needs, and hearing loss management-treatment planning could be implemented to address this widespread and insidious public health crisis.

Summary:

Objectives:
1) Advocate for the role of audiology in the care of institutionalized older adults.
2) Create a tool to guide hearing loss screening and management for institutionalized older adults.

RATIONALE:
In institutional healthcare settings, there is a high prevalence of hearing loss among older adult patients (Cohen-Mansfield & Taylor, 2004; Jerger et al., 1995; Palumbo, 1990). Hearing device use is not common in this population (Chien & Lin, 2012; Cohen-Mansfield & Taylor, 2004). Untreated hearing loss negatively impacts health, wellness, and quality of life; It is a risk factor for the progression or onset of cognitive impairment and dementia (Lin et al., 2011), social isolation, loneliness, depression, anxiety, and fatigue (Kochkin & Rogin, 2000). Hearing loss often goes unrecognized or overlooked by institutional healthcare providers (Shukla et al., 2019). Currently, there is no screening protocol for reliably identifying hearing loss or hearing aid use in the institutionalized older adult population (Cohen-Mansfield & Taylor, 2004; Hopper et al., 2016).

Design:
The Hearing Care Protocol for Institutionalized Older Adults (HCP-IOA) is a new tool that aims to guide hearing loss screening and management of hearing loss in institutionalized older adults. It is designed for use by audiologists, speech-language pathologists, audiology assistants, and audiologist-trained community healthcare workers or medical assistants. The proposed administration schedule for the HCP-IOA is identical to the RAI-MDS schedule; performed upon admission, every 90 days (if applicable), and with a significant change in health status (Centers for Medicare & Medicaid Services, 2010). The HCP-IOA is presented in the form of a flowchart and has seven steps, within which are are six tools that may be implemented depending on a given patient's flowchart pathway. Each tool was created by modifying pre-existing validated tools (i.e. MARS-HA, HAUQ, etc.), or by referencing ideas and concepts from widely-cited publications.

Results:
The HCP-IOA has seven steps: 1) Otoscopy, 2) Reporter Status Determination, 3) Cognitive Status Determination, 4) Hearing Device Usage Determination, 5) Hearing Screening, 6) Accommodations, and 7) Documentation. Within the seven steps, there are six tools that may be utilized: A) Cognitive Impairment Screening, B) Hearing Loss Screening, C) Hearing Loss Management Assessment for Institutionalized Older Adults (HLMA-IOA), D) Hearing Device Care Plan for Institutionalized Older Adults (HDCP-IOA), E) Hearing Communication-Based Accommodations for Institutionalized Older Adults (HCBA-IOA), and F) Universal Communication Strategies.

Conclusion:
The HCP-IOA was designed with the specific needs and circumstances of institutionalized older adults in mind, and outlines concrete steps with ready-to-use tools to aid in the identification and management of hearing loss in the institutionalized older adult patient population. Institutionalized older adults are likely to have untreated hearing loss, and albeit common, untreated hearing loss is not a harmless condition. With the high prevalence of hearing loss in this population, the field of audiology should be seen as an integral asset in the care of institutionalized older adults. To address this widespread and insidious public health crisis, systematic hearing loss screening programs and comprehensive audiological service delivery should be implemented in institutional healthcare settings serving older adults.
Learning Objectives:
Recognize the need for systematic audiologic screening and hearing loss management in the care of institutionalized older adults.
Identify prospective workflows and tools for comprehensive audiologic screening and care delivery in healthcare settings serving institutionalized older adults.