What? I can't hear you- Hearing loss and Dementia??

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[0:00] Music

Speaker0:
[0:16] Everyone. I'm Emily.

Speaker1:
[0:17] And this is Eva.

Speaker0:
[0:18] And you're listening to Speech Talk.

Speaker1:
[0:21] We're your research book club so you can do evidence-based practice in practice.

Speaker0:
[0:25] So let's start talking.

Speaker1:
[0:27] All right. We're talking about hearing loss and dementia this week.

Speaker0:
[0:32] Oh, well, I feel like the amount that I'm actually yelling at work is ridiculous. I'll go into someone's room and automatically my voice my voice is raised like if I see that they are 80 plus I'm yelling and then my patients are like you don't have to yell and I'm like oh sorry yeah.

Speaker1:
[0:53] Man sometimes the carryover between rooms is rough like you do have to shout for three rooms and then you go in and you are still shouting and the person's like I can hear fine could you maybe not be so aggressive

Speaker0:
[1:06] And you start whispering It's okay.

Speaker0:
[1:11] But I think this just speaks to how prevalent the hearing loss is in our skilled nursing environment. We're always screaming because they can't hear us. And God forbid they actually have hearing aids. That's always my first question. Where are your hearing aids? I don't have them. I don't need them. It's like, great.

Speaker1:
[1:33] They're still at the hospital. They don't work, but they're in my pocket.

Speaker0:
[1:37] Yeah.

Speaker1:
[1:38] Like all those answers.

Speaker0:
[1:39] So we had a few articles that we wanted to review this week. We first wanted to look at, does hearing loss contribute causally to dementia?

Speaker1:
[1:49] Which it turns out a lot of other people wanted to know too.

Speaker0:
[1:52] This was a harder topic than we had originally anticipated. And we had to get through a few different articles to feel like we really had a presentable answer to share with you. So we started off with.

Speaker1:
[2:03] There is an article called Hearing Loss and Incident Dementia by Frank Lynn et al., which looked at what they called all-cause dementia, or incidents of dementia regardless of a specific cause. And this is an important caveat because the researchers can't prove that what is causing a patient's dementia. They can only assess it and determine whether or not it's getting worse.

Speaker0:
[2:28] Right. So they followed these participants over 12 years and they found that, I quote, the risk of incident all-cause dementia increased log linearly with severity of baseline hearing loss, which is to say, if your hearing loss got worse, your cognition declined as well.

Speaker1:
[2:48] Even though the research says that they can't prove that hearing loss causes cognitive impairment, the research does show that they evolved together.

Speaker1:
[2:56] So when one gets worse, the other one does.

Speaker0:
[2:58] Right. So then we looked at some informational pages from John Hopkins about hearing aids and hearing loss, and they highlighted some quotes from Dr. Lynn, one of which we wanted to share with you. Again, I quote, hearing loss contributes to social isolation. You may not want to be with people as much. And when you are, you may not want to engage in conversation as much. These factors may contribute to dementia.

Speaker1:
[3:25] I really like this quote because it shows how changes in hearing status can indirectly affect cognition. So, you know, if you are retreating into yourself because you're not engaging socially, that contributes to cognitive decline. We know that for our patients with dementia, engaging with other people, you know, doing social interactions is really important for maintaining current function. And I personally know that I have seen some crazy changes in my COG patients when they're in isolation. I had this guy who had cognitive problems and had hearing loss. And I had to go in and full PPE because he was on ISO. So I've got the mask, then the face shield, and I'm like gowned up in yellow. And we are going 12 rounds over the PGAT short form as his cognitive assessment. And at the very end, when some of the questions are, now, was the woman in the story's name Carol, Mary, or Sue? He's like, why are you calling me Sue? And I was like, I'm not. And it makes me think what you think, like, what have you thought of this whole experience? If you think I'm just like calling you women's names, like that's what you took away.

Speaker1:
[4:45] And then it turns out he did have what looked like hearing aids in. And I was like, oh, do you use hearing aids? Can I check them? And because that's me shouting. He was like, they're not hearing aids. I'm listening to the radio. I was like what is why are you listening to the radio while i'm talking to you

Speaker0:
[5:13] So oh my god that's so funny that.

Speaker1:
[5:16] Was that was a tough assessment

Speaker0:
[5:18] Have you ever done that like this is this is my naughty trick uh but i'll like take a deep breath in through my mask and then pull my mask down and shout and then my mask straight back up because like i cannot do they're like, I need to read your lips. And I'm like, I'm following precautions.

Speaker1:
[5:38] I'm not going to breathe in your germs. I'm only going to shout my own breath at my mask.

Speaker0:
[5:43] This is a one-way street. You have mine. I don't have yours.

Speaker1:
[5:46] Yeah. Yeah.

Speaker0:
[5:48] But I also like that the researcher points out important avenues for future research in order to more deeply understand the relationship between hearing and cognition. So whether we can use hearing loss as a marker for early stage dementia, or if we can actually modify hearing to affect dementia risk factors, that definitely needs more research. Through some of these research articles that we went through, they also talked about different types of dementia. And I don't want to go too deeply into that, but that's another area where research was like, we can't really say because there are different types of hearing loss versus different types of dementia. And there's just so many avenues that people are able to go through to say like one causes the other, but like one, I mean, do you have Lewy body dementia? You have a conductive hearing loss, a sensory neural hearing loss. So there's just so many different avenues. So that's one of the reasons it was so hard for these researchers to say one can cause the other.

Speaker1:
[6:50] Yeah, that's a really good point. A lot of times we're just grouping the question as does hearing loss cause dementia? But it's like, which type of hearing loss and which type of dementia?

Speaker1:
[6:59] And all of a sudden there's like 12 different variables you could be analyzing.

Speaker0:
[7:03] Right. But we wanted to look at another study. So we're looking at these risk factors and one study did try to figure some of that out.

Speaker1:
[7:12] Yeah. So in walks the ACHIEVE study, get ready for an acronym. ACHIEVE stands for the Aging and Cognitive Health Evaluation in Elders or the ACHIEVE study. It was a multi-center randomized trial to determine if treating hearing loss in older adults reduces the loss of thinking and memory abilities, or cognitive decline, that can occur with eating.

Speaker0:
[7:36] Their findings were pretty spectacular. Their findings state that, and I quote, I know how we did this, but I have all the quotes and I stumble on all the quotes. But I quote, in older adults at increased risk for cognitive decline, hearing intervention slowed down loss of thinking and memory abilities by 48% over three years.

Speaker1:
[8:03] That's pretty close to a 50% slowed rate over three years. That's pretty incredible. So they do know, however, that this isn't just for all cognitive decline. This was most effective for people who had a fast rate of cognitive decline. So it was harder for them to assess for people with better cognition, the effectiveness of hearing interventions. And that is partially because the study was done over three years. So for folks with slow cognitive changes, the potential intervention effects

Speaker1:
[8:38] may not have showed up in time.

Speaker0:
[8:40] So what does this mean for us? More clinical questions, obviously.

Speaker1:
[8:44] Emily, OBS, Emily, more clinical questions. So we can't for sure say that hearing loss can cause dementia or cognitive impairment, but we can like really, really comfortably state and hopefully emphatically that there is a correlation and that this is an area that needs more attention.

Speaker0:
[9:05] So we just have this chicken and egg thing going on. It's important to consider these trends when making recommendations for our patients.

Speaker1:
[9:12] So how can we help our nursing home residents?

Speaker0:
[9:16] Advocate for hearing screenings regularly.

Speaker1:
[9:19] Yeah, it's a big one. We might be the first people to see a hearing impairment

Speaker1:
[9:25] because of our knowledge and how speech relates to hearing frequencies.

Speaker0:
[9:28] That's actually exactly how I caught a hearing issue for my own kid. When he first started talking, he would lose all of his high frequency sounds. He was only speaking in both voice phonemes. And I immediately ran to an audiologist. I said, what's happening? Where are his high frequency sounds? So I was able to get tubes and sears. But if it wasn't for my knowledge as a speech therapist, that's something that I wouldn't have caught. So we do have knowledge on how hearing loss relates to our speech output and what we end up saying and what we end up hearing. Maybe some of the You notice people are missing certain sounds or certain parts of the words that, aren't in a light class. That's something that only us would know.

Speaker1:
[10:14] In particular for our older patients, we start to see that elevation in volume, that they're not just asking us to speak up, but they are speaking quite loudly themselves because they're trying to adjust to the fact that they can't hear themselves. So on that note, continuing to advocate for hearing interventions to keep our patients socially involved will also help with overall quality of life in the long run.

Speaker1:
[10:41] Preventing social isolation due to hearing loss is really big here, and we want people to stay involved and active in their day.

Speaker0:
[10:48] And we can help advise our colleagues and patient families on the relationship and the difference between hearing loss and cognitive impairment.

Speaker1:
[10:56] Yeah, I've definitely had patients who presented as cognitively impaired, but really were just hard of hearing. And same with the other way around. People are like, oh, you just really have to speak loudly at him. And I'm like, no, he has early onset dementia. He doesn't understand what you're saying. Or the other way around, they're like, oh, he's so confused. You can't really ask him anything. And it's like, no, actually, he just can't hear you. When you put in his hearing aids or you speak slowly and clearly, he does so much better. Or just try writing.

Speaker0:
[11:32] Yeah. And I've had disagreements in this too with colleagues, like respectful disagreements, but one person, this person has a lot of different issues, right? Like hearing impairment, more severe dementia, but also some psych things going on. And me and this, one of my coworkers are just going back and forth. Like, I think that they would really benefit from some hearing intervention so that they can more easily communicate. And they're like, no, they are really stuck in their head. They, if you give them more sounds, it'll kind of trigger them. It's important to advocate like both ways and try some things out. Like if you feel like maybe a hearing intervention would be helpful, get a regular amplifier. Have no reason to spend thousands of dollars on hearing aids.

Speaker0:
[12:23] Let's try an amplifier. Maybe they'll lose it. Maybe it'll help. Maybe it will drive them crazy. It's we can only test and see.

Speaker1:
[12:32] Oh man, dude, I had a patient come in and I had never seen them before. They're called pocket talkers. It's just like a pocket sized amplifier. It looks kind of like you're holding a cassette player with headphones and the hospitals will sometimes give them out. And so you talk into what looks like the cassette player and it pipes into the headphones. I'm like, obviously I sound like a technology expert here. But he was so hard of hearing. I had, I like eventually couldn't, I just realized I couldn't treat this guy because I was shouting into the amplifier and he would just look at me and go, huh? I was like, do you have difficulty chewing? He's like, yeah. I was like, did you eat the sandwich? My daughter's coming. It was just a completely disjointed conversation. And I was like, I don't know what to do. I don't know what to do. and it turns out writing writing was fine like i don't know why it took me like four sessions before i tried writing i felt like such a dumb dumb because the man can read fine that's

Speaker0:
[13:53] But that's always something that i'm like back and forth on trying because you never know like, where their cognitive status has taken them, like, or where their cognitive baseline is, can they read and write themselves? But I did, I had one person where that worked really well. And I was like, I actually, this was frustrating for me because this person could read and write perfectly fine. They were like almost completely deaf. So I had the facility. I said, this person needs a whiteboard and a dry erase marker. And they're like, well, that counts as office supplies. So you have to buy that. I was like, no, this is a receptive language device at this point. Buy the man a whiteboard. Why are we going back and forth about $5? He needs this. Or go do a billion pieces of paper and kill trees. I don't know. This is obnoxious.

Speaker1:
[14:47] Yeah. Well, and that's a great zoom out moment because when you think about people's quality of care in their skilled nursing facilities, if nursing staff can't carry around like sheafs of paper for a patient to communicate with them, then what ends up happening is people start just, you know, getting their meds administered to them. They just start doing things for the patients, like, you know, changing their clothes, doing whatever it is that nursing does, which are all very important, but the patient doesn't really have as much context for it. It just feels like people are just coming in, shoving things in their face, grabbing their clothes. There's no communication around it, which is just kind of a rough and disorienting process. And I can only imagine what they are taking in for their, you know, how they're perceiving their medical advice from their doctors. You're going into an office, someone is telling you really important information, and you just have no idea.

Speaker0:
[15:51] Yeah, how are you supposed to get actually resident consent to do all of these things and buy in and avoid the agitation and make sure that they're feeling comfortable if we're just kind of pushing through their hearing impairment and not addressing how to properly care for these people.

Speaker1:
[16:10] Yeah, we recently had a woman who couldn't do the BIMs, like couldn't answer questions about the day month year and she was kind of behaviorally doing some strange stuff like you'd go in to talk with her and she just like pulled the sheet up to her nose and i was like yeah man this woman is i you know i was very concerned about her ability to get consent for things whether she should be her own poa And the next time I went to see her, she was up in her chair. She was not in a loud environment. And we had a regular conversation. And I was like, oh, my God, this is like night and day. It was so crazy.

Speaker0:
[16:53] She was a little overstimulated.

Speaker1:
[16:55] Yeah, she did still have a little bit of cognitive impairment, but it did not present nearly as bad as it did on evaluation. And it had a lot to do with the interaction of her cognitive status with her severe hearing loss. It was really interesting to see.

Speaker0:
[17:13] So our evidence tells us that we just have more clinical questions.

Speaker1:
[17:20] But for now, we can say that there is evidence that supports cognitive decline and hearing loss being related and that maybe these are just patients that we need to keep a closer eye on as they age to ensure that they're still living their highest quality of life.

Speaker0:
[17:35] So speaking of like getting devices for patients, I did have one family who was able to get an amplifier for my patient. And it was just, they're really reluctant to get it. The thing was like $30 and they're like, well, we're just worry that it'll end up being lost. And I'm like, well, put her name on it.

Speaker1:
[17:59] We could try.

Speaker0:
[18:01] Things happen. And wouldn't you know it, the damn thing got lost.

Speaker1:
[18:08] Oh, man. Oh, my God. No.

Speaker0:
[18:10] Because I was talking with them and I was like, so I haven't seen it. They're like, we left it here. We did that. We wanted her to have it. And I was just like, ah you know we'll look for it I mean it never it did never turn up she went home without it but it was just like one of those things where it's like you know you wish you could have like I don't know maybe done something more had your recommendation turn out to be something better, but even I mean even though we know that these hearing things are helpful sometimes like, the cognition of it and like implementing a hearing device for our people who may have extrasensory needs, like putting something in their ear or, uh, you know, just keeping track of things like that's just too much for them to handle on the late stages. And that's, yeah.

Speaker1:
[19:06] I've come up with a really great idea. We're going to get him amplified. We're going to see what happens. The only problem is he has no idea where he keeps putting his amplifier. Yeah. Which sometimes is on the patient and sometimes I think is on the building. Like I have found hearing aids and dentures in some weird places and I'm like, who did this? Who did this? Was it the patient or the person making the bed? I don't know.

Speaker0:
[19:30] I know. And that's, that sucks too. Cause it's like, you don't, we can't like take responsibility for everything that happens in the facility.

Speaker0:
[19:39] And I kind of, I'll edge that with patients and families too. Like, I really think that this would be helpful. And like, are you going to take responsibility for it if it gets lost? Like, no, I'm not. No, straight up, I will not. That is not my job to make sure these $7,000 hearing aids don't get lost. I don't know what to tell you about that. Maybe you can get like extra insurance on that B because that is not – that is not – I don't have that. I am a lowly speech therapist.

Speaker1:
[20:14] Yeah. That's unfortunate.

Speaker0:
[20:16] Maybe an AirTag to help. I don't know. That would only help with the charging unit. I don't know.

Speaker1:
[20:24] I have this patient. She's no longer actually my patient. but I get tons of evals in her room, shared room, two beds. And for some reason I have had a string of hard of hearing patients in her room and she hates it. First of all, she hates my voice. She's made it very clear that I have a grating and horrible voice and I have to elevate it so that her roommates can understand me when I'm doing my sessions with them. And she will like get on the phone with family members and stuff and be like, this woman keeps coming into my room. She's such an a-hole, is not respectful, and will just go off on me to somebody else in the room on the phone while we're in the room together. And meanwhile, I'm just like really trying to tune that out while I'm focusing on my patient and like appropriately administering evaluations or treatment therapy or whatever it is. While there's just this constant stream of somebody with very good hearing just railing on me. It's very hard to balance, I've got to say.

Speaker0:
[21:41] Oh my God, that's so funny. That reminds me, I had this, I had one email like that. It was two. It was like that double room situation. I had an eval in bed A and B. And I started with the one bed. And I was like, how am I going to do my B cat? Because I don't want them to get extra answers. So I just try to be quiet. And then I go over to bed B. And they're like, what? And I was like, man, I didn't even have to be quiet.

Speaker1:
[22:16] That's so good. That's so good. Yeah. Yeah. And a lot of this makes me think about, you know, auditory comprehension and receptive language. You know, where is that in the mix for all you researchers out there? Like I have a patient who I'm pretty sure hears perfectly fine. He has terrible auditory comprehension, but at a cognitive level seems fairly intact. So what if it's not the hearing loss or the cognition? What if it's auditory processing or receptive language impairments? Man, someone's got to get in there and sort out all these details.

Speaker0:
[22:50] Yeah, but I think that's actually you, like, you pick up that patient and you decide.

Speaker1:
[22:58] I'm going with auditory processing and cognitive impairment. Yeah, like when, if you shout at him, I think he'd be like, oh, what? Why are you yelling? So I think the hearing loss, it's not hearing loss, you know?

Speaker0:
[23:12] Here's like very specific auditory comp tasks.

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