Hearing well, living well, dying well: Hearing loss and end of life care. By Paul Breckell

Difficult Conversations National Clinical Lead, Dr Catherine Millington-Sanders and the Chief Executive of Action on Hearing Loss, Paul Breckell discuss why identifying and managing hearing loss at the end of life is so important:

Being able to communicate effectively, not only with doctors and carers but also with friends and family is arguably never more important than when nearing the end of life. Effective communication is, of course, essential to creating positive last years, months, weeks and days for individuals and meaningful, lasting memories for loved ones.

71% of people over 70 and 75% of people in care homes have hearing loss.  We know that hearing loss can make it difficult to communicate about the vital things that need to be discussed at the end of life, such as medication and choice of treatments.  When you are able to hear well it can be difficult enough to discuss decisions such as resuscitation for example, but hearing loss, if not identified by a professional, provides another hurdle.  Action on Hearing Loss found that nearly two-thirds of those with hearing loss who responded to a recent survey were unclear about the information they had been given by their GP, at least some of the time.  This is despite recent legal duties placed on health and social care professionals to comply with the  Accessible Information Standard.

We also know that hearing loss can make it difficult to have more regular conversations which are equally important at the end of life, from sharing stories with loved ones to simply what’s happening that day, what the weather’s like. Research shows that hearing loss can lead to withdrawal from social situations and emotional distress, and people with hearing loss are twice as likely to develop depression.

One significant barrier to the effective management of hearing loss at the end of life is the low diagnosis rate amongst people with hearing loss. While some think hearing loss is an inevitable consequence of ageing and don’t go for treatment, others struggle to get a referral to audiology from their GP, so for many, their hearing loss remains unmanaged during their end of life.

This is despite gold standard evidence showing that hearing aids improve communication and even improve quality of life in terms of wider determinants of health for people with hearing loss. There is also good evidence that hearing aids reduce the risk of loneliness and depression, and may even reduce the rate of cognitive decline. Health and care professionals have a crucial role to play here. If hearing aids are fitted and managed effectively it can make a huge difference and the sooner they are fitted, the more likely it is that they will be used and found of benefit.

For those already with hearing aids, a basic understanding of fitting and maintenance amongst carers - just knowing when to change the battery, for example - can transform people’s ability to communicate and their quality of life. Simple communication tips can also be adopted for those with or without hearing aids. A surprising number still think that shouting is the answer but speaking clearly and facing the person you’re speaking to can be far more effective.

Without appropriate support, people who use British Sign Language (BSL) may also be at risk of worse care at the end of life. Having access to a qualified BSL interpreter is crucial for ensuring people who use BSL are able to participate fully in discussions about their care and treatment.

This top tips guide produced by Action on Hearing Loss gives an overview of what professionals working with people at the end of life can do to identify and manage hearing loss, in line with individual choice and care needs, to help people to communicate effectively at this critical time.

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