Evidence has been growing for many years that hearing loss has a detrimental impact on brain function. Experts suggest that even mild hearing loss could be responsible for doubling the risk of dementia, and severe hearing loss increasing the risk five-fold.
Deafness makes it harder to concentrate and think, undermining a person's working memory. Studies also indicate that hearing loss actually changes brain structure, causing shrinkage in some regions most affected by Alzheimer's.
The belief is therefore that hearing loss causes people to miss information during conversations which isolates them. This isolation makes it harder to engage fully and this becomes a vicious circle, with gradual cognitive decline the result.
This was confirmed last year by French research carried out over a 25 year period to find out if effective use of hearing aids could slow this cognitive decline in older adults with hearing loss.
Reporting their research findings in the Journal of the American Geriatrics Society, Helene Amieva, Lead Author of the study, states "This study clearly confirms that hearing loss is associated with cognitive decline in older adults" but she goes on to explain that "Using hearing aids attenuates cognitive decline in elders presenting with hearing loss."
Use of hearing aids made a huge difference to the people with hearing loss in the study, reducing their rate of decline in cognitive skills to that more like those of people without any hearing loss.
The implication is clear. Poor rates of diagnosis and under-treatment of hearing loss in elderly adults need addressing.
The NHS estimate that while 6.7 million people in the UK could benefit from wearing hearing aids, only 1.4 million (about 20%) do so. And potential cuts to hearing aid provision could erode this percentage further.
"We are concerned that Clinical Commissioning Groups in England are considering cuts to hearing aid provision, with the North Staffordshire CCG the first to ration them since the inception of the NHS.
"As a charity we have successfully campaigned to stop other CCGs from following suit and we are calling on all CCGs to continue to provide hearing aids to all those who need them, particularly in light of the priority that NHS England has placed on hearing loss through its development of a Commissioning Framework for hearing loss services which will provide guidance for CCGs and is due to be published in April 2016.
"Hearing aids offer a lifeline to many, especially older people with hearing loss who would otherwise be sat at home alone unable to communicate with the outside world. They are a highly cost-effective intervention and are accepted to be the only viable treatment for people with adult-onset hearing loss."
"We need to ensure that the public are aware of the potentially damaging consequences of hearing loss and we must ensure that the rationing of hearing aids in some areas of NHS stops now to ensure that we don't add to the number of dementia cases leading to heartache for families and additional costs to the NHS.
"We know that hearing loss is linked with dementia - and we know that today's hearing technologies are hugely beneficial in addressing hearing loss.
"We need to increase access to hearing aids early through the introduction of an adult hearing screening programme, to ensure that everyone has the opportunity to hear and possibly delay dementia."
Giving carers a taste of what it's like to live with this devastating condition is the name of the game for a mobile unit touring the country this year. The 'Virtual Dementia Tour' is aimed at improving care standards by providing carers, both professional and family members alike, with an insight into the disorientating world inhabited by people living with dementia. And by all accounts it really works.
Writing for The Guardian, Juliet Rix explains more....
Anyone who has cared for someone with dementia will recognise many of the behaviours I have just exhibited: standing still in the middle of a room, knocking things over, failing to follow instructions, not knowing what to do with an ordinary object, cowering, sitting staring into space. So why was I behaving like this?
I was inside a dementia “Tardis”; the mobile virtual dementia tour (VDT) that simulates the world of someone with mid-stage dementia. This small truck, the first of its kind in the UK and only the third in the world, will be touring the country this year, giving carers – professional and family – an insight into the world of people with dementia. The experience is intended to improve the care they give, and by all accounts, it works.
Entering the anteroom of the Tardis, I am given uncomfortable insoles that mimic the pins and needles of peripheral neuropathy. I put on gloves that blunt sensation to my fingers and make me clumsy. My glasses are taken away (“people with dementia often forget them”) and instead I have goggles that block my peripheral vision, and headphones playing normal sounds that are too loud and too uniform to fully differentiate. And I am led through a door into a darkened room. This mix of sensory deprivation and sensory overload is very quickly disorienting and distressing. The tour only lasts eight minutes and, believe me, it is long enough.
In the subsequent debrief you are told how you behaved, reminded of what was said to you (some of which you will have missed or forgotten) and told a bit about how this all connects with dementia.
The VDT was invented by a US specialist in geriatric care, PK Beville, who founded not-for-profit organisation Second Wind to change the perception of ageing. The VDT is now in use – in non-mobile form – in 17 countries. Beville started working with elderly people 30 years ago and quickly became frustrated by what she saw as the “inappropriate use of psychoactive medication and unnecessary hospitalisation” of people with dementia. Not to mention the lack of support for often untrained carers who carry the burden of looking after people with this difficult condition.
" People with dementia are not aggressive or mentally ill; they are responding to their experience as you or I would." PK Beville
Beville wanted to change the way dementia patients were cared for by helping carers understand the reasons behind their behaviour. She says she tried interactive training, role play and videos but nothing was changing. So using her own extensive observations, interviews with people with dementia and their carers, and current scientific knowledge, she created the VDT.
A study involving 146 US workers caring for elderly people found that during the VDT most became anxious and were unable to complete simple tasks. Nearly three-quarters hummed, whistled or moaned, and 51% withdrew completely. Many found the experience so overwhelming that they behaved in ways they would normally consider completely inappropriate, says Alison Clarke of Training2Care, which operates the VDT in the UK. But it is worth it, she says, for the effect it has on people’s caring. “I had one 86-year-old woman whose husband had Alzheimer’s. She was very impatient with him. She kept saying, ‘I’ve told you that’, ‘don’t do that’. When she came out of the tour … she went over to her husband, kissed him 15 times and said, ‘I’m sorry’.”
A further US study looking at carers response to the VDT five to nine months after participation revealed they remembered it vividly and reported lasting effects on their caring – including increased empathy, sensitivity, patience and an awareness of practical things like keeping noise levels down.
April Dobson, head of dementia innovation for Abbeyfield, which runs more than 500 care homes in the UK and hundreds more worldwide, says the impact of the VDT on care is “massive”. “It makes carers realise how much their actions can influence the response and behaviour of people with dementia.”
The VDT truck will be training Abbeyfield staff and families of residents with dementia, and it is hoped others, such as firefighters, shopkeepers and members of the public. The tour costs £20, although if organisations get together to form a local hub for the truck to visit, some tours could be free. With 850,000 people diagnosed with dementia in the UK (44 million worldwide) there are few who would not benefit from understanding the condition better.
If society understood, says Beville, those with dementia wouldn’t need to be drugged and shut away. Their treatment, she believes, “is the human rights issue of our time”. If we think carefully about the individual, the environment and how we communicate, she insists, the lives of those living with dementia – and their carers – could be dramatically improved. The starting point, Beville says, is simple: “People with dementia are not aggressive or mentally ill; they are responding to their experience exactly as you or I would.”
As in fact – in the VDT – we do.
The Virtual Dementia Tour is bookable at training2care.co.uk or by calling 01376 573999
First published in The Guardian 26/01/16