Volume 8 Issue 3 (pdf) - Andrew John Publishing Inc
Volume 8 Issue 3 (pdf) - Andrew John Publishing Inc
Volume 8 Issue 3 (pdf) - Andrew John Publishing Inc
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If our goal is to maximize our patients’<br />
ability to communicate, we must consider<br />
the role of cognitive processing in AR. It<br />
is impossible to disentangle sensory loss<br />
from cognitive processing in older<br />
listeners, and so effective intervention<br />
must include both amplification (bottomup)<br />
and training (top-down) to improve<br />
auditory skills and teach compensatory<br />
behavioral strategies. Bottom-up strategies<br />
focus on access to a clear signal, while topdown<br />
strategies focus on functional<br />
communication (see Table 3, based on<br />
Ferre, J: Rehabilitation for Auditory<br />
Processing Difficulties in Adults, ASHA<br />
on-line seminar, 2012).<br />
“There’s more than one way to recognize<br />
a word” 13 ; through AR techniques, we can<br />
teach compensatory behavioral communication<br />
strategies to patients and<br />
caregivers, to improve top down<br />
processing and help to compensate for<br />
sensory deficits.<br />
Group AR programs not only help older<br />
adults become more effective<br />
communicators, they also foster their<br />
participation and social interaction. 22 A<br />
group gives an opportunity for repetitive<br />
practice of communication repair<br />
strategies in a meaningful context while<br />
addressing social participation needs.<br />
Social interaction is known to promote<br />
cognitive health and has been shown to<br />
have a protective effect against<br />
dementia. 5,23,24 The Hard of Hearing Club<br />
at Baycrest was designed for seniors with<br />
severe hearing loss at risk for social<br />
isolation and has successfully addressed<br />
both educational and social needs for<br />
many of its members over the 13 years<br />
that it has been running. 25<br />
There is a pressing need for audiologists<br />
to understand how cognitive impairment<br />
interacts with hearing loss so interventions<br />
can be tailored to better suit client needs.<br />
Dr. Lin is conducting another research<br />
project that will follow older adults over<br />
time to see if audiologic interventions will<br />
help delay the onset or slow the<br />
progression of cognitive decline. At<br />
Baycrest, audiologists will be working<br />
with psychologists to look at whether<br />
fitting HAs and providing AR will have a<br />
positive impact for patients with early<br />
dementia and their caregivers. If this is<br />
indeed the case, the implications are huge,<br />
and audiologists could play a critical role<br />
in providing solutions to this pressing<br />
public health concern.<br />
referenCes<br />
1. Alzheimer’s Society of Canada. Rising tide: the<br />
impact of dementia on Canadian society.<br />
Toronto: Author; 2010.<br />
2. Uhlmann RF, Larson EB, Rees TS, et al.<br />
Koepsell. Relationship of hearing impairment to<br />
dementia and cognitive dysfunction in older<br />
adults. .Journal of the American Medical<br />
Association 1989;261:1916–19.<br />
3. Lin FR. Hearing loss and cognition among older<br />
adults in the United States.Journals of<br />
Gerontology A: Biological Sciences and Medical<br />
Sciences 2011;66:1131–36.<br />
4. Gates GA, Beiser A, Rees TS, et al. Central<br />
auditory dysfunction may precede the onset of<br />
clinical dementia in people with probable<br />
Alzheimer’s disease. Journal of the American<br />
Geriatrics Society 2002;50:482–88.<br />
5. Gates GA, Anderson ML, McCurry SM, et al.<br />
Central auditory dysfunction is a harbinger of<br />
Alzheimer’s dementia. Archives of<br />
Otolaryngology-Head and Neck Surgery<br />
2011;137:390–95.<br />
6. Kricos P. Audiologic management of older<br />
adults with hearing loss and compromised<br />
cognitive/psychoacoustic auditory processing<br />
capabilities. Trends in Amplification<br />
2006;10(1):1–28.<br />
7. Pichora-Fuller MK. Effects of age on auditory<br />
and cognitive processing: implications for<br />
hearing aid fitting and audiologic rehabilitation,<br />
Trends in Amplification 2006;10(1) 29–59.<br />
8. Lunner T. Memory systems in relation to<br />
hearing aid use. Cognition, Audition and<br />
Amplification, AAA Conference, Boston; 2012.<br />
9. Musiek F. Assessment of central auditory<br />
dysfunction: The Dichotic Digit Test revisited.<br />
Ear and Hearing 1983;4:79–83.<br />
10. Idrizbegovic E, Hederstierna C, Dahlquist M, et<br />
al.Central auditory function in early Alzheimer's<br />
disease and in mild cognitive impairment.Age<br />
and Ageing 2011;40:249–54.<br />
11. Lin FR, Metter EJ, O’Brien RJ, et al. Hearing loss<br />
and incident dementia.Archives of Neurology<br />
2011;68:214–20.<br />
12. Kricos P. Providing hearing rehabilitation to<br />
people with dementia presents unique<br />
challenges. The Hearing Journal<br />
2009;62(11):39–43.<br />
13. Pichora-Fuller MK. Perceptual effort and<br />
apparent cognitive decline: Implications for<br />
audiologic rehabilitation. Seminars in Hearing<br />
2006;27:4.<br />
14. Kiessling J, Pichora-Fuller MK, Gatehouse S, et<br />
al. Candidature for and delivery of audiological<br />
services: Special needs of older people.<br />
International Journal of Audiology<br />
2003;42(Suppl 2):2S92–101.<br />
15. Pichora-Fuller MK. Audition and cognition:<br />
Where the lab meets clinic. ASHA Leader<br />
2008;13(10):14–17.<br />
16. Humes LE. Modeling and predicting hearingaid<br />
outcome. Trends in Amplification<br />
2003;7(2):41–75.<br />
17. Gatehouse S, Naylor G, and Elberling C. Linear<br />
and non-linear hearing aid fittings – 2. Patterns<br />
of candidature. International Journal of<br />
Audiology 2006;45:153–71.<br />
18. Lunner T and Sundewall-Thorén E. Interactions<br />
between cognition, compression, and listening<br />
conditions: Effects on speech-in-noise<br />
performance in a two-channel hearing aid.<br />
Journal of the American Academy of Audiology<br />
2007;18:604–17.<br />
19. Walden TC and Walden BE. Unilateral versus<br />
bilateral amplification for adults with impaired<br />
hearing. Journal of the American Academy of<br />
Audiology 2005;16(8):574–84.<br />
20. Kobler S, Lindblad AC, Olofsson A, and<br />
Hagerman B. Successful and unsuccessful users<br />
of bilateral amplification: differences and<br />
similarities in binaural performance.<br />
International Journal of Audiology<br />
2010;49(9):613–27.<br />
21. Sweetow RW, Sabes JH. The need for and<br />
development of an adaptive Listening and<br />
Communication Enhancement (LACE)<br />
Program. Journal of the American Academy of<br />
Audiology 2006;17(8):538–58.<br />
22. Worrall L and Hickson L. Communication<br />
disability in aging: From prevention to<br />
intervention. Clifton Park, NY: Delmar<br />
Learning; 2003.<br />
23. Fratiglioni L, Paillard-Borg S, Winblad B. An<br />
active and socially integrated lifestyle in late life<br />
might protect against dementia. Lancet Neurol<br />
2004;3(6):343–53.<br />
24. Hultsch DF, Hertzog C, Small BJ, and Dixon RA.<br />
(1999). Use it or lose it: Engaged lifestyle as a<br />
buffer of cognitive decline in aging Psychology<br />
and Aging 1999;14:245–63.<br />
25. Reed M. The Hard of Hearing Club: A social<br />
framework for audiologic rehabilitation for<br />
seniors with severe hearing difficulties. In L.<br />
Hickson (Ed), Hearing care for adults: The<br />
challenge of aging. Phonak: Stäfa, Switzerland;<br />
2009<br />
Canadian Hearing Report 2012;8(3):42-45.<br />
REVUE CANADIENNE D’AUDITION | CANADIAN HEARING REPORT 45