2. PRIMER ON AGE RELATED HEARING LOSS

3. AUDIOGRAM OF “TYPICAL PATIENT” WITH AGE RELATED HEARING LOSS

4. HOW BIG A PROBLEM IS AGE RELATED HEARING LOSS IN THE UNITED STATES?

5. ADEQUATE HEARING IS A LINK BETWEEN PERSON-CENTERED COMMUNICATION AND OPTIMAL HEALTH OUTCOMES (MODIFIED FROM LEVINSON, LESSER & EPSTEIN, 2010) PERSON CENTERED COMMUNICATION IMPROVED PATIENT CENTERED COMMUNICATION DURING THE PATIENT ENCOUNTER INCREASED PATIENT KNOWLEDGE, BETTER INFORMED DECISION MAKING, INCREASED ADHERENCE IMPROVED QUALITY OF LIFE AND WELL BEING ADEQUATE HEARING

6. FEATURES OF AGE RELATED HEARING LOSS InvisibleImpacting Insidious Interfering

7. How Can I Tell If My Patient May Have A Hearing Loss?  Does your patient consistently ask “what” when you are taking a history?  Does the patient offer incorrect responses to simple questions?  Does your patient appear confused at times because of misunderstanding?  Does caregiver or spouse frequently answer questions for the patient?  Does your patient turn his/her head toward you to better understand?

8.  Smoking  Noise Exposure  Male Sex  Ototoxic Medication  Noise Exposure  Dementia  Age  Hypertension  Cardiovascular disease  Diabetes What are Risk Factors for Hearing Loss?

9.  Increased odds of falls  Increased odds of developing dementia  Higher likelihood of experiencing functionally disability  Increased risk of repeat hospitalizations  Increased risk of experiencing emotional distress and social engagement restrictions  Poorer self rated health  Impaired Patient Centered Communication  Compromised transition in care What are Some Consequences of Untreated Hearing Loss?

10. Hearing Loss and Multimorbidity (BHI)

11. Mortality Risk Senile Dementia Social Isolation Falls Poor Self Rated Health Which Functional Problems are Age Related Hearing Loss Linked To?

12.  Improved Health Related Quality Of Life  Reduced Depressive Symptoms  Increased Functional Independence  Reduction in Caregiver Burden Health Benefits That Hearing Impaired Who Use Hearing Aids Can Anticipate

13.  To Promote Improved Physician Patient Communication  To Optimize Person Centered Care  To Identify If Persons At High Risk for Falls Have a Concomitant Hearing Loss  To Improve Quality of Health Care Delivery  To Improve Patient Safety  To Promote More effective Transitions in Care Why Should Clinicians Screen For Hearing Loss?

14.  Little evidence for one method over another  Choose a method that fits your population, practice setting, personal preference  A Three Tiered Screening Should Include  Otoscopy  Objective Impairment Screen  Self Report of Hearing Problems What are the Recommended Methods for Screening for Hearing Loss?

15.  An Audiologist: a doctor of audiology who has specialized training in diagnosing, measuring degree and type of hearing loss and treating non medical causes of hearing loss  An Otolaryngologist: a medical doctor who specializes in diagnosing and treating diseases of the ear, nose, throat and neck To Whom Should I Refer?

16.  Persons who Perceive Themselves to Have Difficulty Hearing and Understanding  Persons Who Are Actively Engaged and Take Responsibility for Managing Their Care  Persons Who Are Motivated or Activated to Maintain Function and Prevent Further Decline Who Has the Greatest Potential To Benefit From Treatment?

17.  Pre-Contemplation  “I do not have difficulty hearing/understanding others  Contemplation  “I am concerned about my hearing, but am not ready to do any thing about it  Preparation  “I am ready to have my hearing tested and inquire about treatment options”  Action  “I am ready to purchase hearing aids; I am ready to consider a cochlear implant”  Maintenance  “I go to the audiologist for a tuning of my hearing aids every six months” Readiness for Hearing Loss Treatments: Stages of Change

18.  Encourage Patient to Think of R elevance of Knowing How Well They Can Hear  Assist Patient to R ecognize the R isk of Not Treating Their Hearing Loss  Assist patient to R ecognize R ewards of Treating Their Hearing Loss  Discuss R oadblocks to Having Hearing Tested and Hearing Loss Treated Five R’s To Motivate Patients To Have Their Hearing Tested ( Modified from ACP)

19. Counseling Based Audiologic Rehabilitation Individual or Group Web Based/Virtual Audiologic Rehabilitation (LACE) Hearing Aids, Hearing Assistive Technology Hearing Assistive Technology, PSAPS, Communication Strategies Training Interventions for Hearing Loss (Modified from Weinstein, 2012; Abrams & Chisolm, 2013)

20.  Make sure face and mouth are visible when speaking to the patient  Make sure to keep distractions (auditory/visual) to a minimum when speaking  Make sure to be within three to six feet of the patient  If patient owns a hearing aid, make sure h/she is wearing it and it is turned on  If the patient appears to be having difficulty understanding, use a commercially available hand held amplifier (e.g. Pocket Talker) to make it easier to communicate What Behavioral Interventions Are Helpful for Communicating with the Hearing Impaired

21.  Minimize background noise  Know patient’s literacy level  Use plain language and visual aids especially if patient shows signs of hearing loss  Speak slowly and face the patient with lips at same level as patient  Make sure the room in which you are speaking has good lighting  Verify listener comprehension through teach-back  Paraphrase what you have said if patient did not appear to understand Practice Improvement - Tips for Avoiding Poor Patient/Physician Communication (Krupa, 2012)