Report: new research shows the extent to which hearing loss can lead to problems at doctors' clinics and hospital casualty departments and miscommunication between the patient and the healthcare professional
By Patrick Henn, Colm Ó Tuathaigh & Simon D Smith, UCC School of Medicine
Thanks to advances in medical science, we now have the safest and most effective medical care in history. At the same time, we are also seeing a difference in those seeking regular medical care. Patients are older and often have several chronic illnesses requiring multiple medications and frequent visits to health care service providers.
Unfortunately, older patients often experience problems with their medication and medical treatment. This could involve missing or confusing dosages which could lead to a visit to the casualty department and hospital admission.
What causes these problems? As we age, we often anticipate that memory begins to fade and medical research shows that this is indeed the case, though fortunately only a minority of us progress to diagnosed dementia. With older patients and their GPs frequently having to manage several medical conditions and often multiple medications, can memory loss alone explain the problems older people encounter with medical care?
Another aspect to consider is hearing loss. Our hearing declines as a result of the natural ageing of the hearing process and is called Presbycusis, or age related hearing impairment (ARHI). It occurs gradually, initially affecting our ability to hear higher frequency sounds and, over time, our ability to clearly hear sounds at gradually lower frequencies.
Approximately 30 to 40 percent of people over the age of 65 are affected by this problem. Conversational speech may sound unclear and indistinct to the listener. This can lead to confusion, for example not being able to tell the difference between words such as 50 and 15 or soot and foot. It impairs our ability to understand conversations, particularly in noisy environments like cafés, restaurants and bars. In such everyday social situations, it may seem a nuisance or lead to embarrassment.
But in a hospital, doctor’s clinic, dental surgery, or health centre, a hearing difficulty may have more profound consequences. Many older adults may mishear important medical information from their healthcare providers which leaves them vulnerable to unintended medical error that results in poorer medical health care.
At University College Cork School of Medicine, we have conducted new research to further understand this problem and improve patient safety. Previous research focused on memory impairment rather than hearing loss as the main contributor to this problem so in our first study, we set out to separate hearing from memory problems.
Working with Darrelle Keegan at the Disability Services at UCC, we emailed questionnaires to disability support services in universities and other third level institutions in Ireland and UK. These were then distributed to students registered as hearing impaired at these institutions.
We found that some of the students reported difficulty in using healthcare, including misunderstanding diagnoses and the names and dosages of medication. 59 percent of our respondents indicated "yes" to mishearing a doctor or nurse in a hospital or GP setting. Approximately 60 percent identified this in relation to consultation content; 33 percent mishearing; and 21 percent misinterpreting what was said, including diagnosis, guidelines and advice, and matters relating to medications.
In a further study, we surveyed 100 adults aged 60 years and over without memory impairment attending the outpatients’ department of Cork University Hospital. Over half of the participants reported some degree of hearing loss, a greater rate amongst those aged 80 years and over. Some of the participants reported mishearing the doctors’ or nurses’ explanation of their condition or medication instructions. Others found it difficult to distinguish the doctors’ or nurses’ words from the background noise of the hospital.
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Bearing this problem in mind, patients and health professionals can make healthcare safer. For patients, it is helpful to let your doctor know at the beginning of the consultation that you have hearing problems. At the end, repeat back what you have heard and understood, especially medication names, dosages, how often to take them and how to take them. Does your doctor want you to stop taking any of your current medicines or does your doctor want you to take more of or less of any of your current medicines?
We train our doctors to be good communicators and they all want to be safe clinicians, so letting them know about your hearing problems or putting what you understand into your own words allows them to correct any errors or write things down.
Our work highlights that healthcare providers need to know if their patients have hearing loss, especially to alleviate the medical errors and costs associated with hearing impairment. Our research will continue to seek to examine and find methods to deliver effective communication to improve patient safety and to deliver high-quality patient-centred health care.