The health and social outcomes of people with acquired hearing loss

Anthony HoganNational Centre for Epidemiology & Population Health

Overview

• The social position of people with acquired hearing loss•The health and social impacts of hearing loss• Barriers to providing assistance• A comprehensive treatment model

The social position of people with acquired hearing loss

People with hearing loss have endured stigmatisationDeafness in ancient Greece

• a curse• an absence of intelligence• an inability to reason• dull wittedness • excluded from participation in community life

People with hearing loss have endured stigmatisationDeafness in Biblical times

• Stubbornness of heart, the refusal to listen, co-operate and obey.

• People with hearing loss and disabilities generally in biblical times, were poor outcasts, dependent on the charity of others for survival.

• Deafness = dumb = stupid

People with hearing loss have endured stigmatisationDeafness in medieval times

• An absence of reason• People with disability seen as fools• A person unable to speak was not allowed to inherit the family

fortune• Not allowed to receive the sacraments of the Church, which

reflected one of the primary elements of full participation in community life

• Speech associated with citizenship rights

People with hearing loss have endured stigmatisationDeafness during the industrial revolution

• Lost traditional work on the land

Unemployment soared as communication was central to work in cities

• Social revolutions – ‘society’ feared for its safety• People with disability were institutionalised in large numbers –

work houses• Bell and the remaking of deaf people as hearing people

Still stigmatistised today

Labels BHA members say people apply to them:• Deaf, heedless, snobbish, inattentive, stupid,

idiot, not with it, dumb, ignorant, useless, retarded, boring, arrogant, stubborn, slow, vague and psycho

Still stigmatistised today

And labels some BHA members applied to themselves:

• I’m a nuisance, I’m hard to include • I don’t matter, I don’t fit in• I feel depressed, isolated, I’m difficult• I feel less of a person, I am invisible• I feel left out.

Has society consistently considered having hearing problems as being an inherently bad thing!

How would you feel about going to a BBQ where you didn’t know many people?

Fireplace

Stereo Lounge

Front Door

Lounge

Stereo

DECK

FAMILY ROOM

BATHROOM

KITCHEN

BBQ

BAR

Stereo

Spotlight

Spotlight

LOUNGEROOM

The health and social impacts position of people with acquired hearing loss

Health impacts of hearing loss

• elevated unadjusted male six year mortality rate among older males for those with uncorrected loss• male elevated risk rates for diabetes• high blood pressure• a higher incidence of stroke • increased rates of heart attack • higher use of prescribed medications.

Health impacts

• Higher use of prescribed medications• Those with moderate to severe hearing loss are

• three times more likely to see their doctor than members of the general population

• up to seven times more likely to require assistance in the home

• 15 times more likely to need assistance in activities of daily living.

Lots of HIPs present with reduced HRQoL

AQOl at baseline

1.00

.94

.88

.81

.75

.69

.63

.56

.50

.44

.38

.31

.25

.19

.13

.06

0.00

-.06

30

20

10

0

Std. Dev = .28

Mean = .52

N = 239.00

Median .55

Health impacts

0

10

20

30

40

50

60

No communicationlimitation

Mild Moderate Severe Profound

Physical (Population) Physical (HI) Mental (Population) Mental

The Relationship Between Stress and SWB

Dominant Source of SWB Control

SWB

Stress

High

Low

Threshold

DISTRESSHomeostasis

No stress High stress

75

Level of environmental challenge

Socio-economic impacts of hearing loss

•Less likely to be in paid work by a minimum of at least two percentage points for adults of working age• With this rate potentially being much higher in harder economic times where people with disabilities are more vulnerable to the impacts of economic downturns • More likely to be on lower income than the population.

Social impacts of hearing loss

• Increased effort and fatigue • Stress and anxiety • Difficulties in family relations• Social isolation • Negative self image

Workplace impacts for HIP people

• Lost of confidence• Working twice as hard• Varied frustrations• Hanging on• Job hunting• Innovating• Skills development• Looking for accommodations

Next steps

Fireplace

Stereo Lounge

Front Door

Lounge

Stereo

DECK

FAMILY ROOM

BATHROOM

KITCHEN

BBQ

BAR

Stereo

Spotlight

Spotlight

LOUNGEROOM

Do we need to learn to be affected?

Sometimes aids and devices aren’t enough

We may need to change• But at the population level the evidence shows that

technology alone is not enough

For individuals we need psycho-social rehabilitation

But society needs to change too

1 in 6 really?

We need change at a societal level• Accessible communication venues• Captions• Acceptance and support for new ways of talking with

each other• Community education

It’s no longer just a man’s world• Nor is it just a hearing world either!

Psycho-social barriers to action

• Mis-perceive affects of hearing loss• Reluctant to acknowledge hearing loss• Fear of being stigmatised (stupid or old)

• Need for an engagement strategy

Rehabilitation Overview

Patient Decision Making & Case Conference

Technology based

Rehabilitation

CommunicationStrategies

Therapies &Group Work

Referrals

Closure

Audiology

Engagement

ENT