Hearing loss and dementia are, unfortunately, connected. Because trouble communicating is an important symptom of both problems, it can be difficult to tell if someone with Alzheimer’s disease, or a related dementia, is losing the ability to hear. Difficulty speaking and understanding could be a sign of the brain cell damage that makes thinking so hard for someone with dementia, but it could also be a matter of simply not being able to hear.
Hearing loss can make it seem like someone is in the later stages of dementia when they are actually in the middle, or even earlier, stages. In other words, your loved one’s cognitive (thinking) problems may not be as bad as they appear. It can be easy to assume that difficulties are due to dementia when the problem is that it’s simply too hard to hear. Also, listening and communicating stimulate the brain. If it’s too hard to hear, someone with dementia may check out rather than work mentally to engage. Checking out makes focus and memory worse, whereas being able to hear improves the ability to concentrate and, in turn, strengthens the brain and slows the decline of focus and memory.
Testing the hearing of someone with dementia is important, and remember that audiology / hearing tests can be adapted for people with dementia (see below).
Communication is incredibly important for someone with dementia, which means caretakers must stay diligent about monitoring hearing issues. Someone who can’t hear well will become more socially isolated and, at the same time, less independent. This means your loved one needs more help but is less likely to ask for it. Being heard and communicating well is also a strategy for managing caregiver stress, which impacts the person with dementia as well.
Hearing loss is linked to dementia, meaning studies have found that people who have difficulty hearing are statistically more likely to develop dementia. The opposite is not true, that dementia affects one’s ability to hear. However, as stated above, the symptoms are so similar that it can seem like someone with dementia is also rapidly losing the ability to hear. It is also very possible for an older person to have both problems.
The fact is that many elderly folks, about one-third of people between 65 and 75, and almost half of people over 75, (study) suffer some loss of hearing, and Alzheimer’s is a disease that similarly affects people as they age. Between 27 percent (men) and 36 percent (women) of people over 70, in fact, develop Alzheimer’s disease or another dementia. The problems often overlap, which means caregivers should manage the difficult symptoms of dementia, and also take into account the loss of hearing that naturally occurs.
Hearing loss can result from the use of other common medicines that you might give your loved one to deal with pain issues or depression. Naproxen and ibuprofen, for example, have been shown to cause hearing loss for some people, especially men. Depression is a common symptom of dementia. Antidepressants such as Prozac, Zoloft, or another may be part of your loved one’s drug regime, and you should know that these may also cause problems with hearing.
Some antibiotics, usually a group called aminoglycosides used to treat kidney and urinary tract infections, have been shown to affect hearing. Diuretics for lowering blood pressure also list hearing loss as a side effect. If your loved one is taking any of these drugs, be sure to speak with your doctor about their side effects, and try to closely monitor whether hearing is becoming more difficult.
Age-related hearing loss usually happens in both ears equally. The tiny hairs in an ear canal that turn vibrations into nerve signals (read by the brain as sounds) become damaged and die, and these tiny hairs do not regrow. People who listened to a lot of loud noise (say, by attending several rock concerts as a youth) are more prone to lose hearing, or genes can also play a role. Smoking has been shown to make a person more likely to lose hearing. Illnesses including diabetes are also linked to ear problems.
To put it technically, conversations are normally between 45 and 60 decibels (the unit for measuring volume), and we typically lose about one decibel annually after the age of 60. Over time, this makes communication and functional ability harder. Someone who struggles with hearing might be embarrassed when meeting a new person, for instance, and have a hard time at work or with friends and family. Normal activities, like going to a restaurant or seeing a movie, become trying. It can feel restricting. Hearing loss, not surprisingly, has been associated with depression. Dementia is similar.
If your loved one is having difficulty hearing, as well as the cognitive problems associated with Alzheimer’s or another dementia, communication can seem daunting. There are, however, several steps you can take to help improve communication and keep these issues as manageable as possible.
Regular Hearing Checks
Hearing tests are common and necessary for all older people, even those without dementia, but some audiology departments have people who specialize in testing people with dementia. Ask your doctor how to find them. While there are free online hearing tests, these are largely designed as hearing aid marketing tools and are not intended or designed for persons with dementia.
Ear wax can be a problem for older adults, and is often ignored until it obstructs hearing or causes pain and even sickness. Once-a-year cleanings should be good enough. If buildup occurs a doctor can use irrigation or suction to clean the ear canal. Bone growth within the ear canal (exostosis) can further contribute to sound obstruction and further the buildup of wax.
Quiet the Room
Reduce background noise and distractions. Common noise makers that may affect your loved one’s ability to hear include fans, phones, and loud appliances. Turn them down, especially when you’re trying to talk.
Keep rooms well-lit. This will make it easier to understand sounds.
When speaking to your loved one, use gestures and be expressive. Speak face-to-face, from relatively close.
If you’re having trouble, don’t get discouraged. Don’t say something like, “Whatever, it doesn’t matter anyway.” Your loved one can read your frustration.
Do not repeat yourself too many times if the conversation goes poorly, and avoid exaggerated mouth movements that will make your lips harder to read.
Hearing aids take time and practice for anyone to get used to, and are especially difficult for someone with dementia. They are, however, a powerful tool to help someone having trouble hearing, and may directly benefit people with dementia by stimulating the brain and improving function.
If a doctor determines that a hearing aid could help your loved one with dementia, try these tips:
– Take the process slowly, and don’t get frustrated.
– When the aid is brand-new, try it in places that are quieter, where your loved one is especially comfortable.
– Fine tuning a hearing aid can take multiple doctor visits, to adjust the fit and audio settings, so be prepared to go back repeatedly.
– Read the instructions carefully. These are complicated little devices!
– Keep the hearing aid clean of ear wax and dirt.
– Have at least one replacement ready. Hearing aids get lost all the time, and someone with dementia is obviously even more likely to misplace one.
– Have a storage mantra that’s easy to remember, and keep reminding your loved one. Something like: “In the ear or in the case.”
– There are easily worn clips that connect a hearing aid to lanyards or clothing and let them hang when they’re removed.
– Know where to get a malfunctioning hearing aid fixed. This may be a local hearing healthcare professional or even a specialized hearing aid repair service. Talk to the doctor when the hearing aid is new about where to go if it breaks.
– Know how to change batteries.
Personal Sound Amplification Systems
There are other options besides hearing aids that you may want to consider. Pocket talkers amplify sounds into headphones that can be worn comfortably, and can filter out background noise. These are also called personal sound amplification systems (PSAS), and can be much cheaper than a hearing aid (about $300 compared to more than $1,000 for a hearing aid). Be sure to check with your doctor about whether the device is appropriate for your loved one.