The Role of Hearing Loss Self-Management in Older Adults

Summary of Research Conducted by Elizabeth Convery, MSC, Carly Meyer, Ph.D., Gitte Keidser, Ph.D., and Louise Hickson, Ph.D.

Permanent hearing loss is a chronic condition that affects the whole person: their communication, psychosocial wellbeing and health-related quality of life are among the key factors influenced by age-related hearing loss.

Adults with hearing loss can manage these effects through an active process called hearing loss self-management (HLSM). Recent research suggests that hearing health care tends to follow an acute rather than chronic model of care: biomedical focus, device-centric practice, clinician-led decision-making. As a result, adults with hearing loss are not always afforded the opportunity to develop HLSM knowledge and skills.

Many audiologists think of “hearing loss self-management” as synonymous with “hearing aid self-management” and believe that if a patient has acquired hearing aids and wears them long-term, their job is essentially done. Gaining an understanding of the multidimensional nature of hearing loss self-management could enable audiologists to start thinking more holistically and begin those oft-difficult conversations with patients about the problems they’re experiencing that aren’t necessarily directly related to hearing aid use. Further, understanding the multiple dimensions of hearing loss might help audiologists identify interventions and strategies that address the non-device-related needs, such as more fruitful spontaneous conversations with their family and friends or more effectively coping with conversations in a noisy listening situation.

The objective of this clinical research was to examine the use of a Hearing Loss Self-Management (HLSM) program with a group of older Australian adults as a means of improving outcomes in this population. It is believed that HLSM could be a stand-alone, fee-for-service opportunity offered by clinics to adults who purchase hearing aids elsewhere. Additionally, HLSM skills could be offered to patients purchasing their hearing aids from the clinic as part of a larger professional service package.
Key Questions of this Research
  1. Can clinicians assess HLSM skills using the Partners in Health scale and the Cue and Response interview? These are two complementary tools that have been developed for other chronic conditions.
  2. What do the results of the assessment tell us about the individual patient? What do they tell us about current clinical practice more generally?
What Are the Partners in Health Scale and the Cue and Response Interview?
Validated pair of clinical tools for collaboratively assessing chronic condition self-management –now modified for audiology use

Assessments of a patient’s participation in shared decision-making, ability to monitor/respond to functional changes, HL and treatment knowledge, access to services, psychosocial coping strategies
From the Flinders Chronic Condition Management Program™ (Battersby et al. 2003)

Method and Results
Data was collected at the University of Queensland in Australia. Thirty adults (aged 51-85) with mild to moderately severe hearing loss participated in this study. All study participants were recipients of hearing health care from either the public (n =16) or private (n=14) Australian healthcare system.

Both individual and group results analyzed. Group results were examined for three themes pre-selected from the existing literature: (1) clinician minimization of the psychosocial impact of hearing loss, (2) lack of patient knowledge about non-technological interventions, and (3) audiologist-led versus shared clinical decision-making.

Clinical audiologists completed routine assessments on each participant. The dialogue between the audiologist and participants was recorded and provided a picture of the whole patient in their own words. The recorded assessments were used to identify specific HLSM strengths and weaknesses (e.g. consistent hearing aid user, but not coping emotionally.)

There were three overarching themes identified in the data.
  1. Clinician minimization of the psychosocial impact of HL
    Patients reported social isolation; reduced value from the social events they continued to attend; and feelings of anger, anxiety, and frustration when communicating with others. Few of these issues had been raised in past audiology appointments.

  1. Lack of patient knowledge about non-technological interventions
    As a group, patients demonstrated a high level of knowledge about the characteristics of their HL. However, their knowledge of strategies for treating and managing HL was limited to hearing aids and other technology-based interventions.

  1. Audiologist-led versus shared clinical decision-making
    There was considerable variation in the extent to which patients reported taking part in shared decision-making with their audiologist. Some described a highly paternalistic, clinician-led style of practice, while others described their relationship with their audiologist as a partnership.

What Can Clinical Audiologists Learn From This Hearing Loss Self-Management Research?
Patients who participated in this study indicated the need for audiologists to focus more on the psychosocial consequences of hearing loss, offer interventions beyond technology, and engage in shared decision-making. Discussing these three components allows patients to become actively involved in their own hearing care treatment goals and plans.

The Partners in Health scale and the Cue and Response interview could help audiologists have more effective dialogue with patients:
  1. Assess and address hearing loss more holistically. During the communication assessment appointment, audiologists would gain a deeper understanding of the emotional and social consequences of hearing loss by using these two tools.
  2. Tailor interventions to the unique needs of each patient. These interventions could stand alone from the delivery of a device. Thus, HLSM has the potential to be a service that audiologists offer patients. Those patients may opt to buy HLSM skills training as part of a larger comprehensive service package, or ala carte after they have purchased hearing devices elsewhere.

This pictogram is based on a poster session by the authors at the HEARING CRC meeting in Melbourne, Australia. Contact: