Phonak VA Hearing Aids for Veterans User Guide

Phonak VA Hearing Aids for Veterans

A Quick Guide to the Management of Cognitive Well-being in Adults with Hearing Loss This publication discusses the association between hearing loss and cognition and provides guidance to support holistic hearing management of older adults with normal cognitive aging through to dementia.

Specifications:

• Product Name: Phonak Quick Practice Guideline
• Publication Date: November 2023
• Focus: Management of cognitive well-being in adults with hearing loss

Product Information:
The Phonak Quick Practice Guideline is a publication that provides guidance on managing cognitive well-being in adults with hearing loss. It discusses the association between hearing loss and cognition, emphasizing the importance of holistic hearing management for older adults experiencing normal cognitive aging through to dementia.

Key Highlights:

• Importance of observing and recognizing cognitive changes in individuals
• Supporting older clients in adapting to changes in cognitive abilities for improved speech understanding
• Utilizing hearing technologies to support cognitive health and overall well-being
• Addressing hearing loss as a potentially modifiable risk factor for dementia
• Audibility is integral to effective communication and essential to brain health. To age well, individuals must adapt to and compensate for changes in cognitive abilities which may impact speech understanding, a critical part of communication.
• Social engagement, along with use of some form of hearing technologies may serve a protective function for cognitive health.
• The Lancet Commission identified hearing loss as the largest potentially modifiable risk factor for dementia (Livingston et al., 2017 & 2020).

Introduction

Expert guidance is provided in a new publication by experts in Sarant et al., (2023). The following quick guide summarizes key take-aways from this publication and provides useful tools to support recommendations. Cognitive aging is a natural, lifelong process that occurs in every individual. There are enormous differences between individuals in age-related cognitive changes and this variability demands a holistic client-centered approach to management.

Key messages about brain aging (GSA, 2020; adapted from Institute of Medicine, 2015).

• The brain ages just like other parts of the body.
• Cognitive aging is not a disease. It is a natural lifelong process that occurs in every individual.
• Cognitive aging is different for every individual.
• Some cognitive functions improve with age (e.g., wisdom learned from experience).
• Actions can be taken by individuals to help maintain cognitive health.

With person-centred skills and management methods, hearing care professionals can help their older clients to maintain their functional ability and support them in living an active and socially engaged life to protect their cognitive health.

Cognitive aging, cognitive impairment, and dementia
Cognitive aging involves slow cognitive changes which usually span over decades. Typical cognitive changes include:

• A general slowing in the speed of information processing.
• Reduced capacity of working memory.
• Greater effort is required to learn new information.
• Difficulties dividing or switching attention when processing parallel or interfering information.

Dementia is an umbrella term for a group of disorders, all of which affect the functioning of the brain. Different types of dementia include Alzheimer’s disease, vascular dementia, fronto-temporal lobe dementia, and Lewy-body dementia. Although dementia is common in old age, it is not part of healthy aging. Currently, more than 55 million people live with dementia worldwide, and this number is expected to triple by 2050 (Alzheimer’s Association, 2021) due to population aging. Dementia interferes with the capacity for independence in everyday activities. The changes in cognition associated with dementia involve impairment of several higher order cognitive functions such as memory, learning, language, executive function, complex attention, perceptual-motor and/or social cognition. Symptoms can also include personality changes and behavioral and emotional problems (APA, 2013).

Association between hearing loss and cognitive decline
The recent Lancet Commission reports on dementia identified hearing loss as the largest potentially modifiable risk factor for dementia (Livingston et al., 2020; Livingston et al., 2017).

Although not yet understood, there are several mechanistic theories underlying the association between hearing loss (HL) and dementia proposed:

• A common cause or pathological process for both HL and dementia affects the cochlea and auditory pathways as well as the cortex (Baltes & Lindenberger, 1997).
• Increased cognitive load due to HL causes impairment of cognitive function (Baltes & Lindenberger, 1997).
• Reduced environmental stimulation due to HL causes sensory deprivation, leading to cognitive decline (Baltes & Lindenberger, 1997).
• Altered cortical brain activity due to HL causes irreversible molecular degenerative damage. in the brain (Griffiths et al., 2020).

It is likely that no one mechanism alone accounts for the link between hearing loss and dementia (Sarant et al., 2023).

Effects of hearing interventions on cognitive outcomes for older adults

Today, there is still controversy about the effects of hearing aid use on cognition. However, systematic reviews and meta-analyses conducted by the Lancet Commission suggested hearing aid use is protective of cognition (Livingston et al., 2020, Livingston et al., 2017). The World Health Organization guidelines for risk reduction of cognitive decline and dementia still state, due to the poor quality of evidence on this topic to date, that ‘there is insufficient evidence to recommend the use of hearing aids to reduce the risk of cognitive decline and/or dementia’ (WHO, 2019).

Product Usage Instructions:

Considerations for Practice:
Hearing care professionals should observe and recognize cognitive changes in their clients, as these changes can impact speech understanding and communication. It is essential to support older clients in adapting to changes in cognitive abilities to maintain functional ability and cognitive health.

• Hearing care professionals are in a unique position to observe and recognize cognitive as well as functional changes in their clients.
• With person-centred skills and management methods, hearing care professionals can help older clients to maintain their functional ability and support them in living an active and socially engaged life.
• Hearing interventions may facilitate improvements in communicative behaviour and quality of life.
• Including care partners/family members can provide a better picture of the client’s functional disabilities and chances of rehabilitation success.

Supporting Cognitive Health:
By providing person-centred skills and management methods, hearing care professionals can help older clients live active and socially engaged lives to protect their cognitive health. Utilizing hearing technologies may serve a protective function for cognitive health.

Cognitive Aging and Dementia:
Cognitive aging involves slow cognitive changes over time, while dementia refers to a group of disorders affecting brain function. Different types of dementia include Alzheimer’s disease, vascular dementia, frontotemporal lobe dementia, and Lewy-body dementia. It is crucial to differentiate between healthy aging and cognitive impairment associated with dementia. Two recent studies incorporated longitudinal observations, best practice audiological management, controlled hearing interventions, and comprehensive cognitive assessments to provide more insight into the causal relationship between hearing loss and cognition.

• The ACHIEVE (Aging and Cognitive Health Evaluation in Elders) randomized controlled trial found that in older adults at increased risk for cognitive decline, hearing intervention slowed down loss of thinking and memory abilities by 48% over 3 years (Lin et. al., 2023).
• The ENHANCE (Evaluation of Hearing Aids and Cognitive Effects) prospective cohort study found that comparatively, cognition at 3-year follow-up remained stable overall for hearing aid users but declined for the non-hearing aid user group (Sarant et al., 2023).

How to recognize cognitive decline that is not part of the normal aging process
With an aging population, an increasing number of clients will present with cognitive impairment. It is important to be able to recognize warning signs and early symptoms of cognitive impairment and to differentiate these from normal cognitive aging.

Recommendations include:

• Active listening and observation to identify cognitive problems that are not part of normal aging.
• Combining observations with taking notes.
• Explicitly asking about and then following up with client/family on any reported concerns (e.g., “During the past 12 months, have you experienced confusion or memory loss that is happening more often or is getting worse?”).
• Using the client’s own words to avoid misinterpretation.
• Asking for specific examples or situations.
• Providing clear and straightforward recommendations.

Proactive and person-centered hearing care including families and significant others
A proactive approach rather than a reactive approach could help to prevent many of the negative consequences of hearing loss in later life. Person- centred interventions should be aimed at optimizing functional ability, mitigating residual disability, and maximizing engagement and social participation (Clare et al., 2019). Family members or significant others should be included to provide a better picture of the client’s functional disabilities and chances of rehabilitation success. This includes educating, sharing information, instructing on technology use, asking for their opinion of a hearing problem and any other changes they have observed in their interactions with the client.

Useful tools to include family members in client care:

• Phonak Family-Centered Hearing Care Position Statement to find strategies on how to include family and be inclusive of their needs (Singh et al., 2016).
• Family-centred care counselling tools to find counselling tools for working with family. Hearing Aid Counseling Tools for Family-Centered Care
• Family-Oriented Communication Assessment and Solutions (FOCAS) to get input from both the client and their family for the goal-setting process (Crowhen & Turnbull, 2018)

Hearing management: A multifaceted approach
Communication can be cognitively demanding for older adults with sensory loss and cognitive issues, and the management of these individuals can pose challenges.

A multi-faceted approach includes:

• Social prescribing and the use of hearing technologies to contribute to cognitive reserve.
• Alternative technologic strategies or non-technology-driven alternatives to meet auditory and cognitive needs (Pichora-Fuller, Dupuis, Reed & Lemke, 2013).
• Setting realistic management goals/expectations which should include promoting safety at home (e.g., audibility of smoke alarm, doorbell).

Useful tools to incorporate a multi-faceted approach:

• Phonak technology to improve communication abilities.
  • Phonak hearing devices and solutions
  • Phonak hearing aids
  • Roger™ wireless microphones
• HearingSuccess.com portal to find online and digital auditory skills training tools to improve auditory skills through structured, repetitive listening exercises (https://hearingsuccess.com/).
• Active Communication Education (ACE) program to develop specific behavioural skills that improve the client’s communication (Hickson et al., 2007).

Client-centred management goals for people with cognitive decline
Audibility is integral to effective communication, and cognitive impairment can impact the management goals of people with hearing loss.

Recommendations for client-centered management goals include:

• Monitoring hearing status regularly and revisiting hearing intervention goals as cognitive capacity changes, either with normal cognitive aging or cognitive decline as distinct from normal aging.
• Always emphasizing the interplay between psychosocial factors, individual factors, the social context, and how we communicate.
• Individualizing care focuses on the strengths, needs, and lifestyle of clients, from the perspective of the client and their significant other/partner (Dawes et al., 2021).
• Promoting effective and empathetic communication and adapting how you communicate according to the client’s needs.

For a case study that highlights the importance of recognizing and managing incipient sensory impairment and maximizing the client’s ability to function despite a potential neuro-cognitive impairment, see the full publication.

Environmental manipulation training and communication strategies
Communication skills training for clients with sensory loss and cognitive impairment and their communication partner is integral to amplification success (Hickson, Worrall & Scarinci, 2007). Examples of environmental manipulation include providing strategies to optimize the physical environment and supporting engagement in meaningful activities. Aside from environmental manipulation, communication strategies can improve communication for those with hearing loss and cognitive impairment. These strategies include:

• Minimizing environmental distractions.
• Reducing background noise
• Maintaining eye contact to promote focus of attention.
• Using actions when speaking to illustrate the meaning of spoken information.
• Using short and simple sentences.
• Being positive, flexible, and encouraging.

Conclusion
This quick practice guide provides expert guidance in providing a holistic approach in addressing hearing loss and cognition in older adults to assist with maintaining functional ability that enables well-being from mid-life through to older age.

According to the full publication, hearing care professionals should be knowledgeable in:

• Effectively communicating the association between hearing loss and cognitive decline.
• Noticing individual changes in cognition and hearing care needs over time.
• Providing individualized hearing solutions.
• Auditory rehabilitation and person-centred care.

With the rising prevalence of dementia and other age-related diseases, it is increasingly important to develop a network of inter-disciplinary professionals to refer to and with whom to collaborate on holistic client rehabilitation management.

References
2021 Alzheimer’s disease facts and figures. (2021). Alzheimer’s & Dementia: Journal of the Alzheimer’s Association, 17(3), 327–406. https://doi.org/10.1002/alz.12328 APA. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th Edition ed.). Arlington, V.A.: American Psychiatric Association. Baltes, P., & Lindenberger, U. (1997). Emergence of a powerful connection between sensory and cognitive functions across the adult life span: a new window to the study of cognitive aging? Psychology and Aging, 12(1), 12. doi: 10.1037%2F0882-7974.12.1.12 Clare, L., Kudlicka, A., Oyebode, J. R., Jones, R. W., Bayer, A., Leroi, I., . . . Pool, J. (2019). Goal-oriented cognitive rehabilitation for early-stage Alzheimer’s and related dementias: the GREAT RCT. Health Technology Assessment, 23(10). doi: 10.3310/hta23100

• Crowhen, D., & Turnbull, B. (2018). FOCAS: Family Oriented Communication Assessment and Solutions. The Hearing Review. 25 (11), 20-24.
• Dawes, P., Littlejohn, J., Bott, A., Brennan, S., Burrow, S., Hopper, T., & Scanlan, E. (2021). Hearing assessment and rehabilitation for people living with dementia. Ear and Hearing. doi.org/10.1097/aud.0000000000001174
• Ferguson, M., Maidment, D., Henshaw, H., & Heffernan, E. (2019). Evidence-Based Interventions for Adult Aural Rehabilitation: That Was Then, This Is Now. Seminars in Hearing, 40(1), 68-84. https://doi.org/10.1055/s-0038-
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• Fulton, S. E., Lister, J. J., Bush, A. L. H., Edwards, J. D., & Andel, R. (2015). Mechanisms of the hearing–cognition relationship. Seminars in Hearing, 36(3), 140-149. doi: 10.1055/s-0035-1555117
• Griffiths, T. D., Lad, M., Kumar, S., Holmes, E., McMurray, B., Maguire, E. A., . . . Sedley, W. (2020). How can hearing loss cause dementia? Neuron, 108(3), 401-412. doi: https://doi.org/10.1016/j.neuron.2020.08.003
• Hickson, L., Worrall, L., & Scarinci, N. (2007). A randomized controlled trial evaluating the active communication education program for older people with hearing impairment. Ear and Hearing, 28(2), 212-230. https://doi.org/10.1097/AUD.0b013e31803126c8
• Lin, F. R., Pike, J. R., Albert, M. S., Arnold, M., Burgard, S., Chisolm, T., … Coresh, J. (2023). Hearing intervention versus health education control to reduce cognitive decline in older adults with hearing loss in the USA (ACHIEVE): a multicentre, randomised controlled trial. The Lancet. doi:10.1016/S0140-6736(23)01406-X
• Livingston, G., Huntley, J., Sommerlad, A., Ames, D., Ballard, C., Banerjee, S., . . . Mukadam, N. (2020). Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. The Lancet, 396(10248), 413-446. doi: 10.1016/S0140-6736(20)30367-6
• Livingston, G., Sommerlad, A., Orgeta, V., Costafreda, S. G., Huntley, J., Ames, D., . . . Cohen-Mansfield, J. (2017). Dementia prevention, intervention, and care. The Lancet, 2673-2734. doi: 10.1016/S0140-6736(17)31363-6
• Maslow, K., & Fortinsky, R. (2018). Nonphysician care providers can help to increase detection of cognitive impairment and encourage diagnostic evaluation for dementia in community and residential care settings. The Gerontologist, 58(suppl_1), S20-S31. https://doi.org/10.1093/geront/gnx171
• Park, D. C., Lautenschlager, G., Hedden, T., Davidson, N. S., Smith, A. D., & Smith, P. K. (2002). Models of visuospatial and verbal memory across the adult life span. Psychology and Aging, 17(2), 299. https://doi.org/10.1037/0882-7974.17.2.299
• Pichora-Fuller, M. K., Dupuis, K., Reed, M., & Lemke, U. (2013). Helping older people with cognitive decline communicate: Hearing aids as part of a broader rehabilitation approach. Paper presented at the Seminars in Hearing.
• Salthouse, T. (2019). Trajectories of normal cognitive aging. Psychology and Aging, 34(1), 17. doi: 10.1037/pag0000288
• Sarant,J., Lemke,U., Giroud,N., Scherpiet, S., & Weinstein B. (In press). Promoting hearing and cognitive health in audiologic rehabilitation for the well-being of older adults. International Journal of Audiology.
• Sarant, J., et al. (2023, July 16-20). Cognitive function in older adults with hearing loss: Outcomes for treated versus untreated groups at 3-year follow-up [Conference presentation]. AAIC 2023 Conference, Amsterdam, Netherlands.
• Saunders, G. H., Morse-Fortier, C., McDermott, D. J., Vachhani, J. J., Grush, L. D., Griest, S., & Lewis, M. S. (2018). Description, Normative Data, and Utility of the Hearing Aid Skills and Knowledge Test. Journal of the American
• Academy of Audiology, 29(3), 233. https://doi.org/10.3766/jaaa.16153
• Schaie, K. W. (2005). What Can We Learn From Longitudinal Studies of Adult Development? Research in Human Development, 2(3), 133-158. doi: 10.1207/s15427617rhd0203_4
• Singh, G., Hickson, L., English, K., Scherpiet, S., Lemke, U., Timmer, B., & Launer, S. (2016). Family-centered adult audiologic care: A Phonak position statement. Hearing Review, 23(4), 16.
• Taljaard, D. S., Olaithe, M., Brennan‐Jones, C. G., Eikelboom, R. H., & Bucks, R. S. (2016).
  • The relationship between hearing impairment and cognitive function: a meta‐analysis in adults. Clinical Otolaryngology, 41(6), 718-729.
• The Gerontological Society of America. (2020). The GSA KAER toolkit for primary care teams – Supporting conversations about brain health, timely detection of cognitive impairment, and accurate diagnosis of dementia. Retrieved from https://gsaenrich.geron.org/brain-health.
• Tsoi, K., Chan, J., Hirai, H., Wong, S., & Kwok, T. (2015).
• Cognitive tests to detect dementia: A systematic review and meta-analysis. JAMA Internal Medicine, 175(9), 1450-1458. doi:10.1001/jamainternmed.2015.2152 WHO. (2019).
• Risk reduction of cognitive decline and dementia: WHO guidelines (pp. 1-96).
• Geneva: World Health Organization.

FAQ:

Q: What are some key highlights from the publication?
A: The publication emphasizes the importance of recognizing cognitive changes, supporting older clients in adapting to cognitive abilities, utilizing hearing technologies for cognitive health, and addressing hearing loss as a modifiable risk factor for dementia.

Q: How can hearing care professionals support cognitive health in older adults?
A: Hearing care professionals can provide person-centred support, help clients maintain functional ability, promote active and socially engaged lifestyles, and utilize hearing technologies to protect cognitive health.

References

• HearingSuccess
• Redirecting
• doi.org/10.1093/geront/gnx171
• HearingSuccess

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