People Hearing Better welcomes Dr. Claudia Dewane, DEd, LCSW. Dr. Dewane has agreed to allow People Hearing Better to reprint experts from her article in Social Work Today, Hearing Loss in Older Adults — Its Effect on Mental Health. In her article, Dr. Dewane discusses the transition into hearing loss for late deafened or hard of hearing adults. Difficulties arise with everyday communication and awareness of the difficulties faced can help family and friends to better understand and communicate with a loved one who has hearing loss.
If there were no need to communicate every day, older adults with hearing loss would have no problem.
Helen Keller is credited with noting that blindness cuts us off from things, but deafness cuts us off from people. The significant impact of hearing loss on communication and interaction with others sometimes goes unrecognized by healthcare practitioners. Coping with hearing loss is different from other disabilities in that it is an invisible handicap. The reactions or behaviors associated with hearing loss may not be apparent, and even the sight of a hearing aid doesn’t guarantee recognition of a disability.
Individuals with normal hearing often assume that simply saying something louder or turning up the volume will enable a hard-of-hearing elder to hear. Volume is not necessarily the issue; difficulties with sound and word discrimination may be involved. The need to repeat or experiencing non sequitur responses adds to negative perceptions of older adults with hearing loss as being slow. Internalizing these stereotypes and the resultant negative self-perception certainly contributes to emotional sequelae of hearing loss.
Hearing loss and the difficulties with everyday communication plays a role in how older adults experience and react to environmental stressors. For example, losing a job is difficult for anyone. Is it harder for a hard-of-hearing individual? Knowing that certain jobs may be more difficult to pursue, accommodations need to be requested and limitations may need to be acknowledged. Such adaptations influence perception of a crisis in a way that’s different from an individual with normal hearing.
Adults who have early-onset hearing loss report that while there are negative aspects of hearing loss, they’ve incorporated them into their personalities. They develop ways to cope with and manage hearing loss in their daily lives. It may be somewhat different for older adults who experience identity crisis, and reactive depression may occur.
There is a cultural continuum of hearing loss. A sense of belonging is important to mental health, yet individuals who are hard of hearing don’t belong entirely in the hearing world or in the deaf culture. A significant cultural difference exists between older adults who are somewhat deaf and those who are Deaf, that is, totally without hearing. (The distinction is noted by lowercase and uppercase of the letter D.)
Hearing loss can create a psychological solitary confinement. Yet many older adults with hearing loss deny the disability or the impact it exerts on everyday communication and their quality of life. The average delay in seeking help following a diagnosis of hearing loss is five to seven years. Thus, a practitioner working with older adults experiencing hearing loss may need to ascertain the individual’s stage of acceptance. Family members who attribute hearing loss to normal aging and physician descriptors of hearing loss as mild or moderate inadvertently bolster individuals’ denial.
Older adults who are hard of hearing often report that when their hearing loss causes everyday communication problems, it can result in difficulty thinking or concentrating. This results in inattentiveness, distraction, and boredom. The most serious consequence is withdrawal or abandoning participation. The resultant self-talk is predictable: “I can’t participate, so I might as well pack it in. I can’t contribute, so what good am I?”
Psychological Implications of Hearing Loss
Sometimes hearing loss exerts a direct impact on mental health. Depression and adjustment disorder can occur as a natural response to hearing loss and its subsequent impact on the quality of life and everyday communication. It can be highly embarrassing to be unable to behave according to applicable social rules. The feeling of shame linked to hearing loss stems from older adults inadvertently reacting in inappropriate and socially unacceptable ways, such as responding to a misunderstood question in an inaccurate fashion. Older adults may think “How stupid I must look!” “How embarrassing!” or “What will others think?”
The stress of living with hearing loss can put people at risk for many reactions, including distrust, chronic sadness or depression, nervousness, anger or irritability, isolation, and poor self-image.
A sense of guilt frequently accompanies hearing impairment in older adults. Many elders with hearing loss assume responsibility for unsuccessful communication and blame themselves for misunderstandings caused by the hearing loss. Many feel apologetic about repeatedly asking for others’ help to understand what is being said or when they’re unable to participate in social events.
Some elders who are hard of hearing feel isolated or lonely within their own families. They miss the side conversations or easy banter during family outings or conversations.
Family members may feel just as lonely, as though they’ve lost a comfortable relationship because of the hearing loss. Hearing loss affects everyone in the family—not just those who are unable to hear and communicate with ease. With this invisible disability, others tend to forget hearing difficulties and minimize the extent to which hearing impairment may result in misunderstandings.
A Significant Loss
Depression is a common emotional reaction to any loss, and hearing impairment can involve a number of losses. The primary one is the reduced ability to hear and communicate successfully or on equal terms, resulting in interpersonal difficulties. Second, status and career possibilities may suffer from the perception that elders’ skills are affected by the loss. Many adults shy away from the idea that they have hearing loss thus denying themselves help from available technologies that could help with everyday communication.
If an individual has not been diagnosed with a hearing loss but it is obvious that there’s a hearing deficit, referral to a qualified audiologist may be in order. It’s helpful to know the capabilities and differences between a hearing aid dealer or dispenser and an audiologist.
Coping with hearing loss involves an adjustment process. It isn’t just an ancillary factor helping someone achieve optimal functioning in later life. It may, in fact, be the most important factor. It’s critical for an older adult to come to terms with the impact of hearing loss on his or her identity.
Thank you, Dr. Dewane! We truly appreciate you allowing us to reprint excerpts from your article, so that it might benefit our community. Dr. Dewane's most recent article, Environmentalism and Social Work is now available on Social Work Today
Dr. Dewane has been a clinical social worker for 30 years and specializes in trauma work. She is an associate professor of social work at Temple University, has a profound bilateral hearing loss, and is a hearing loss support specialist certified through the Hearing Loss Association of America.
**Our sincerest thanks to Social Work Today for allowing us to reprint Dr. Dewane's informative and helpful article. It is a great benefit to our community to share essential ideas about hearing loss and coping with hearing loss.
Dewane Claudia, DEd, LCSW, Hearing Loss in Older Adults — Its Effect on Mental Health
Social Work Today July/August 2010 Issue, Vol. 10 No. 4 P. 18 taken on: Jan 01, 2011