Moderated by Terry Portis
Terry Portis introduced the Research Symposium and served as moderator. He commented that the purpose of this symposium is to look beyond the audiogram and examine the effects of hearing loss on people’s lives. And he warned people not to be alarmed by the word “psychosocial”, which they would be hearing. It doesn’t mean abnormal; it only refers to psychological and social issues.
It’s important to remember that people respond differently to hearing loss. Some people are much more affected by it than others, and you can’t predict a reaction based solely on the degree of hearing loss.
Each of the presenters will present on her area of expertise for about 30 minutes, and we should then have quite a bit of time for questions.
Pat Kricos, Ph.D
Pat’s topic was “The Influence of Non-Audiological Factors on Adjustment to Hearing Loss: What Have We Learned the Past Ten Years?”
People who are well-adjusted to hearing loss display a number of common characteristics. One is that they are aware of and acknowledge their hearing loss and the difficulties it causes. Virtually everyone in the audience today displays those characteristics, because they’re here.
A second characteristic is that they “own” the problem. They don’t blame their issues on others, but accept that their communications difficulties are due to their hearing loss.
They typically seek help to deal with their hearing loss and know some of the available coping strategies. They remain socially active, are relatively content, happy, and relaxed.
Can we predict how well people will adapt to their hearing loss by looking at their audiograms? The answer is a clear “no”.
Is the degree of hearing loss the most important factor? Many people, including many audiologists, would say, “Yes”, but the answer is, “No”. Gateway studied this question in some detail and published his results in 1994. He found that the best predictors were people’s ages and their personalities. He found that how well people adapt to hearing loss is not related AT ALL to the amount of hearing loss!
Pat chose four parameters to examine in some detail: gender, psychological factors, sociological factors, and age.
There is lots of research on the effect of gender on adaptation to hearing loss. Related medical studies have found that women are much more likely than men to be sensitive to changes in their health and to report symptoms and discomfort, so it’s no surprise that they are much more likely to seek help for hearing loss.
Women place more importance on social communications than men, and they are more likely to use non-verbal communications strategies to help them through communications breakdowns.
An interesting aside is that about 75% of people who go to an audiologist go because someone else wants them to have a hearing test!
One of the important psychological factors that affects successful adaptation to hearing loss is a person’s locus of control, whether it’s internal or external. A person with an internal locus of control is one who takes responsibility for things as appropriate; a person with an external locus of control blames external factors for things for which they should take responsibility. People with an internal locus of control tend to adjust to hearing loss better than those with an external locus of control.
Additional psychological factors include:
– People who were more anxious before acquiring hearing loss tend not to adjust as well as those who were less anxious
– extroverts tend to adjust better than introverts
– people who are prone to depression don’t adjust as well as those who aren’t
– optimists tend to adjust better than pessimists
Another important predictor is self-efficacy, which is similar to overall confidence, except that it’s task specific; people have high self-efficacy for some tasks and low self-efficacy for others. Pat’s example was that she has high self-efficacy to stand up in front of a bunch of people and talk, but low self-efficacy for bungee jumping.
A person with high self-efficacy for mechanical things might approach hearing loss with the idea that he can learn how to use a hearing aid and assistive devices, while a person with low self-efficacy may not be so confident.
If a person has low self-efficacy for a particular task, it can be raised. The key to doing so is to start off with success. This is one reason why it’s so important for audiologists to carefully instruct and nurture new hearing aid users. Pat applauded the Gallaudet Peer Mentor Program and the HLAA Academy, because their graduates are being trained to do exactly those things.
Sociological variables that affect adjustment to hearing loss include employment factors, family and social support, and educational status.
People who are working tend to adapt better, because they tend to be more active and have greater communications needs than those who are not working. They are also more likely to communicate in a variety of listening situations. These factors may contribute to higher motivation to adapt successfully.
The support of family and friends is an important factor, and those who adapt successfully tend to have a good support system. Also the majority of new hearing aid users were motivated to seek help by their significant other.
The higher a person’s educational status, the better adjusted they tend to be.
Pat admitted that the study of the effect of age on hearing loss adjustment is her favorite topic. She noted that people who are older naturally face many more issues than those who are younger, including:
– chronic disease and disability
– numerous and severe life events, such as losing spouses and friends, losing the ability to drive, moving out of their home. Note that people who use hearing aids have fewer life events than those who don’t!
– visual problems – dual sensory loss is much more significant than single
– loss of manual dexterity, which influences the ability to adjust hearing aids, for example
– cognitive changes – this doesn’t mean senility, which is an abnormal condition, but normal changes associated with aging, including reductions in processing speed, working memory, and attention. Note that these changes start at the age of 25!
Community resources are crucial to help older people adapt to hearing loss. These include medical providers, hearing loss professionals, hearing loss support organizations, including HLAA and ALDA, and peer support. Pat believes that the last two of these are the most important!