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Tuning in to the ‘sound’ environment

June 1, 2008
by Susan E. Mazer, MA
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Improve quality of life, sensitize staff to hearing-impaired residents

It is now 2008. The population is not only getting older, but it is also living longer. With increased longevity comes the risk of our being subject to the ravages of aging, including lifestyle-related diseases and infirmities.

While past models of elder care dealt with a younger population for a shorter amount of time, the challenge now is assisting a population that is, for the most part, collectively dynamic in cognitive and physical capacities. Nonetheless, hearing impairment in this current and coming elder population is proving to be far more acute. A result of technologies such as headphones and higher amplification levels, the boomer generation is now the youngest generation to seek hearing assistance and will have to deal with this for many more years.

Although the symptoms of normal aging are intrinsic to the individual, the pervasive nature of hearing impairment impacts the community at large. Living institutionally, with all the care one might need, does not lessen the frustration of hearing loss, nor is the isolation any easier to bear for the family. Yet, the issue remains devoid of living examples of environments specifically designed to accommodate the needs of a hearing-impaired population.

For this reason, this article on improving the quality of life for hearing-impaired residents is being offered again, updated, and with consideration for the universality of the human aging process.

Natural progression

All of us, as we age, regardless of genes or intent, will experience a diminishing ability to hear. The capacity to easily understand casual conversation and to hear clearly when in large, noisy crowds will decline gradually until we, or others, notice it. If we swallow our pride, we may opt for one of the many hearing aids available. However, regardless of cost or technological features, we will not adapt easily. Once an aid is installed in our ears, we will hear ourselves chewing, sometimes sounding to ourselves as if we were in a cavernous tunnel, and eventually getting used to adjusting our own volume more than the one on the TV.

We will seek out telephones that have adjustable volume controls and find that watching television will be only as enjoyable as the sensitivity of its remote control. We will begin to accuse those around us of “mumbling” and get tired of asking them to improve their diction. Our greatest frustration, however, will be that some people we love dearly will speak to us as if we are 5-years-old or illiterate speaking to us loudly or s-l-o-w-l-y, as if we don't understand English.

The implication of these all too verifiable facts for the design and operation of long-term care facilities is far more significant than the industry has acknowledged. Distinguishing and respecting incremental levels of dependence in order to support relative independence, long-term care necessarily addresses more than medical factors. It involves years of attending to, caring for, and assisting, as well as developing, the kind of personal relationships that are foreign to the 2.5 interventions per day common to the acute care setting. However, even in those settings, patients or their elderly spouses are at risk for not clearly understanding the nurse or physician.

Adapting to changing needs

In the field of long-term care design, architects and designers have availed themselves of the opportunity to develop new and innovative living and caregiving spaces that respond to the diverse and changing needs of residents and staff. However, the responsibility is not only to provide physical space and service, but also to deal with the issues that confront long-term personal involvement and the profound process of facilitating graceful and dignified aging up to and through various stages of frailty.

Hidden within and among these many challenges of long-term care is the insidious factor of hearing acuity, still a stigma for the elderly, a frustration for families and spouses, an ignored risk for providers, and an equal-opportunity challenge on every level of long-term care. The long and subtle decline of a person's hearing capacity causes an equally long withdrawal from family, friends, from social gatherings, and conversation. Because hearing loss progresses in tandem with aging and other symptoms of decline, compensatory strategies tend to be developed by the elder.

Whether in a social situation where the conversation moves too fast and is too complex to comprehend or in a restaurant with blaring overhead music, the aging man or woman handles it with the same blank smile to cover up the internal isolation of impaired hearing. The resulting lack of participation, inappropriate response, or agitation brings up issues of cognition, memory, coordination, social skills and, ultimately, independence.

In long-term care facilities, because residents are living longer and quality of life is a major concern for their families, communication, conversation, activities, and social support is an ongoing need almost equal to all other levels of care. Therefore, the challenge is how to address the hearing impairment issue in the context of long-term care facility design and caregiving practice. Some points to consider:

  1. Hardwood floors and high ceilings: While each is stylish and attractive, together they create a gymnasium experience. Without enough acoustical treatment, a cavernous room can be loud, hollow, and chaotic. Sounds reverberate and interfere, and language can be unintelligible.

    In a site visit to a long-term care facility in the south, we found a delightful and bright dining room with a high open ceiling to a balcony. There was lots of light and lots of space—and lots of noise.