About half a million elderly people live in UK residential homes and hospitals. 70% have hearing problems (1). Hearing loss increases the risk of developing dementia by up to five times. Hearing aids can help to prevent or delay dementia (2) but they require regular cleaning and their plastic tubing needs replacing every few months. Few residents can carry out these tasks despite official guidance that assumes they can do so (3).
My brother, profoundly deaf and almost totally blind, lived in care homes and hospitals in the last thirty months of his life. He was left without a working hearing-aid for long periods and slowly succumbed to dementia. On inquiry, I learned that small voluntary organisations across the country are highly critical of health and care providers for their failure to respond adequately to hearing loss among residents and patients (4).
I worked with a local medical practice training care staff to maintain hearing aids but it was difficult to interest managers. They are not uncaring but, meeting physical needs predominates in their training and in inspection regimes. Also, trainers are in short supply. Our trainer undertakes a round trip of 140 miles.
The Equality Act 2010 requires services to make “a reasonable adjustment” to avoid disabled people being placed at a “substantial disadvantage”. However, the Care Quality Commission relies on the Accessible Information Standard which is narrower in scope, requiring only that users can access health and social care information; it is silent on their need to communicate with family and friends, to make use of the telephone, radio and television or to engage in recreational activities.
Changing services is difficult. Responsibility for audiology services is fragmented between hospital and community services, between public and private providers and between health and social care. Coordinated planning and information-sharing are inhibited by internal markets, out-sourcing and separate funding systems.
Non-clinical medicine struggles to have its voice heard in the corridors of medical and political power. This explains why clinical medicine dominates the Hearing Loss Guidance Committee of the National Institute for Health and Care Excellence; it lacks adequate representation from professionals responsible for meeting the day-to-day needs of adults with hearing loss. As a consequence, its understanding and guidance is seriously flawed.
Residential care for elderly people has been in financial crisis for over twenty years and elderly people with hearing loss are at the confluence of three unglamorous and underfunded medical specialties – audiology, geriatric medicine and public health. Without a firm determination by government to improve hearing services for elderly people in homes and hospitals, some of the most vulnerable people in society will continue to receive inadequate care and needlessly slip into dementia.
- Supporting older people with hearing loss in care settings. Action on Hearing Loss.
- Hearing loss and Dementia. Action on Hearing Loss. Undated.
- Hearing loss in adults. Assessment and management guidance. NG 98 National Institute for Health and Care Excellence. 2018
- Wally Harbert When silence is no longer golden. www.hearinglossfrome.simplesite.com 2019.
Our thanks go to former OPAAL Trustee Board member Wally Harbert for this article.