Supporting People with Hearing Loss at End of Life

A blog written by Dr Katie Ekberg, Senior Lecturer, College of Nursing and Health Sciences, Flinders University

Communication underpins all our social connections, supporting our participation and engagement with all facets of society. Hearing loss has a fundamental impact on an adult’s ability to communicate and, in turn, socially connect with others. Hearing ability declines with age from about 50 years [1] and 70-75% of Australians over the age of 70 experience some form of hearing loss. [2] This rises to 80% for those over 80 years old. So, most people at end of life in aged care will experience some level of hearing loss.

Older adults with hearing loss can start to withdraw from social situations, participate less in conversations, and become more socially isolated and lonely. Adults with hearing loss are 1½ times more likely to experience depression than their peers with normal hearing. [3] Hearing loss is also associated with cognitive decline (including dementia). [3-6] Hearing loss, and the social disconnection it causes, can therefore have a significant impact on a person’s overall well-being.

In our recent research, healthcare settings were surprisingly reported by adults with hearing loss as one of the least supportive environments for supporting hearing. [7] In interviews, adults with hearing loss reported being treated negatively by healthcare professionals and healthcare receptionists due to their hearing loss. Reported behaviours included talking too fast, speaking quietly, not speaking face-to-face, and even showing anger when being asked to adapt their communication.

To deliver holistic and person-centred care for older people with palliative care needs at end of life, we must support their hearing and communication needs. Together, family/friends, aged care services, care workers, and health professionals should ensure that they are communicating in a way that supports the person to hear and be included in all conversations in healthcare environments and in daily life.

What can clinicians do?

A greater awareness about hearing loss and inclusive communication can help tackle the impact of hearing loss on older adults’ quality of life. Here are some simple ways clinicians can be more inclusive of people with hearing loss:

• Speak face-to-face as much as possible. This allows for lip-reading so that people are not just reliant on their hearing. If you know someone has difficulty hearing, move closer to them and talk clearly and slightly more slowly.
• Think about the environment you are in – how noisy is it? When possible, choose settings that are quieter.
• Turn down background noise if you can (for example, radio, music, TVs).
• Arrange seating in a way that allows everyone to face each other. Round tables are best.
• Give people the opportunity to choose where they are seated around a table or in a room. Adults with hearing loss may position themselves in the middle of a table or next to specific people they need to hear.
• If you notice a person not joining in the conversation you could ask them if they can hear OK and, if not, what you can do to help.
• If the adult with hearing loss wears a hearing aid and they are in your care, monitor that batteries are charged/replaced and that the hearing aid is working daily.
• In hospital settings, check if the patient is recorded as wearing a hearing aid and if they need it on before starting conversations.

How can audiologists help?

We know that allied health professionals are vital team members in aged care to help older people stay independent in their lives and support them as their health declines. However, we don’t always include audiologists in a team of allied health professionals. Audiologists can provide hearing support to older adults in many ways including ongoing hearing checks, fitting and adjusting hearing devices to personalised needs, providing information and counselling on hearing in everyday life, and offering communication programs for adults with hearing loss and their family members.

You can find out more about the role of audiologists through the Audiology Australia website.

 

Communication is core to palliative and end-of-life care. Supporting older adults with their hearing needs is an essential component of care at home, in hospital, and in aged care.

The ELDAC Allied Health Toolkit offers additional tools for ‘Having Confident End-of-Life Conversations’, including links to resources for talking with families and diverse populations.

 

References:

1. Moore, D. R. et al. (2014). Relation between Speech-in-Noise Threshold, Hearing Loss and Cognition from 40–69 Years of Age. PloS One 9, e107720.
2. HCIA. (2017). The social and economic cost of hearing loss in Australia. (The Hearing Care Industry Association, Canberra, ACT).
3. Lawrence, B. J. et al. (2019). Hearing loss and depression in older adults: A systematic review and meta-analysis. The Gerontologist, 1-18.
4. Mick, P. & Pichora-Fuller, M. K. Is hearing loss associated with poorer health in older adults who might benefit from hearing screening? Ear and Hearing 37, e194-e201, (2016).
5. Strawbridge, W. J., Wallhagen, M. I., Shema, S. J. & Kaplan, G. A. (2000). Negative consequences of hearing impairment in old age: A longitudinal analysis. The Gerontologist 40, 320-326.
6. Lin, F. R. & Albert, M. (2014). Hearing loss and dementia–who is listening? Aging & Mental Health 18, 671-673.
7. Nickbakht, M., Ekberg, K., Waite, M., Scarinci, N., Timmer, B., Meyer, C., & Hickson, L. (2025). The experience of stigma related to hearing loss and hearing aids: Perspectives of adults with hearing loss, their families, and hearing care professionals. International Journal of Audiology, 64(sup1), S12–S19. https://doi.org/10.1080/14992027.2024.2353862

 

Dr Katie Ekberg, Senior Lecturer, College of Nursing and Health Sciences
Flinders University.