2021 Summer GAPNA Newsletter Volume 40 Number 2

Clinical Pearl: Hearing Loss

Elderly clients with hearing loss who present in primary care pose unique challenges in history taking, assessment, and patient education.

Even with clients who are known to the practitioner, hearing loss remains a challenge during the clinical encounter.

Here are a few clinical practice tips:

  • If the patient is known to have a hearing aid, make sure it is turned on and working.
  • Always cue the patient when speaking to them to gain their attention; many patients which chronic hearing loss tune out other’s speech unless it is important because it is fatiguing to be constantly vigilant to hear what people say.
  • Do your best to face the patient and let them see your mouth when you are talking; most patients with hearing loss have learned to lip read although they are often not aware of it.
  • Slow down your speech and keep sentences short. One subject and one verb per sentence are good; these patients often cannot understand run-on sentences. Answer questions with the “yes” or the “no” at the very beginning of the sentence; don’t make them listen to the end of a long sentence.
  • Speaking a little more loudly may be indicated but in most instances the important thing is to lower the pitch of the voice because presbycusis (the common form of hearing loss in older adults) is the loss of high-frequency sounds. The lower pitch brings the words within range.
  • Use patient education materials so that if the patient cannot easily hear your instructions, they can see or read them.
  • Take the time to smile and soften your facial features every few minutes. When working with someone with hearing loss, as you strain to talk more loudly and monitor your speech, your face may show impatience or anger. We know from the facial coding literature that facial muscles displaying anger, besides being seen by the patient, send a message to your brain that you don’t like what you’re doing.
  • Finally, at this time of COVID, if wearing a mask in the clinical encounter, consider masks with a clear plastic mouth section or use a clear visor.