Transcript Document

The health and social outcomes of
people with acquired hearing loss
Anthony Hogan
National Centre for Epidemiology & Population Health
Overview
• The social position of people with acquired hearing loss
•The health and social impacts of hearing loss
• Barriers to providing assistance
• A comprehensive treatment model
The social position of people with acquired
hearing loss
People with hearing loss have endured
stigmatisation
Deafness in ancient Greece
• a curse
• an absence of intelligence
• an inability to reason
• dull wittedness
• excluded from participation in community life
People with hearing loss have endured
stigmatisation
Deafness in Biblical times
• Stubbornness of heart, the refusal to listen, co-operate
and obey.
• People with hearing loss and disabilities generally in
biblical times, were poor outcasts, dependent on the
charity of others for survival.
• Deafness = dumb = stupid
People with hearing loss have endured
stigmatisation
Deafness in medieval times
• An absence of reason
• People with disability seen as fools
• A person unable to speak was not allowed to inherit the family
fortune
• Not allowed to receive the sacraments of the Church, which
reflected one of the primary elements of full participation in
community life
• Speech associated with citizenship rights
People with hearing loss have endured
stigmatisation
Deafness during the industrial revolution
• Lost traditional work on the land
Unemployment soared as communication was central to work in
cities
• Social revolutions – ‘society’ feared for its safety
• People with disability were institutionalised in large numbers –
work houses
• Bell and the remaking of deaf people as hearing people
Still stigmatistised today
Labels BHA members say people apply to them:
• Deaf, heedless, snobbish, inattentive, stupid,
idiot, not with it, dumb, ignorant, useless,
retarded, boring, arrogant, stubborn, slow,
vague and psycho
Still stigmatistised today
And labels some BHA members applied
themselves:
• I’m a nuisance, I’m hard to include
• I don’t matter, I don’t fit in
• I feel depressed, isolated, I’m difficult
• I feel less of a person, I am invisible
• I feel left out.
to
Has society consistently considered
having hearing problems as being an
inherently bad thing!
How would you feel about going to a BBQ where
you didn’t know many people?
Front Door
Fireplace
Stereo
Lounge
BATHROOM
LOUNGEROOM
KITCHEN
Lounge
FAMILY ROOM
Stereo
Spotlight
DECK
Stereo
BAR
Spotlight
BBQ
The health and social impacts position
of people with acquired hearing loss
Health impacts of hearing loss
• elevated unadjusted male six year mortality rate among
older males for those with uncorrected loss
• male elevated risk rates for diabetes
• high blood pressure
• a higher incidence of stroke
• increased rates of heart attack
• higher use of prescribed medications.
Health impacts
• Higher use of prescribed medications
• Those with moderate to severe hearing loss are
• three times more likely to see their doctor than
members of the general population
• up to seven times more likely to require assistance in
the home
• 15 times more likely to need assistance in activities of
daily living.
Lots of HIPs present with reduced HRQoL
30
20
10
Std. Dev = .28
Mean = .52
N = 239.00
0
-.06
.06
0.00
.19
.13
.31
.25
.44
.38
Median
AQOl at baseline
.56
.50
.55
.69
.63
.81
.75
.94
.88
1.00
Health impacts
Physical (Population)
Physical (HI)
Mental (Population)
Mental
Severe
Profound
60
50
40
30
20
10
0
No communication
limitation
Mild
Moderate
The Relationship Between Stress and
SWB
Dominant Source of SWB Control
Homeostasis
DISTRESS
High
75
SWB
Threshold
Low
No stress
High stress
Stress
Level of environmental challenge
Socio-economic impacts of hearing loss
•Less likely to be in paid work by a minimum of at least two
percentage points for adults of working age
• With this rate potentially being much higher in harder
economic times where people with disabilities are more
vulnerable to the impacts of economic downturns
• More likely to be on lower income than the population.
Social impacts of hearing loss
• Increased effort and fatigue
• Stress and anxiety
• Difficulties in family relations
• Social isolation
• Negative self image
Workplace impacts for HIP people
• Lost of confidence
• Working twice as hard
• Varied frustrations
• Hanging on
• Job hunting
• Innovating
• Skills development
• Looking for accommodations
Next steps
Front Door
Do we
need to
learn to be
affected?
Fireplace
Stereo
Lounge
BATHROOM
LOUNGEROOM
KITCHEN
Lounge
FAMILY ROOM
Stereo
Spotlight
DECK
Stereo
BAR
Spotlight
BBQ
Sometimes aids and devices aren’t enough
We may need to change
• But at the population level the evidence shows that
technology alone is not enough
For individuals we need psycho-social rehabilitation
But society needs to change too
1 in 6 really?
We need change at a societal level
• Accessible communication venues
• Captions
• Acceptance and support for new ways of talking with
each other
• Community education
It’s no longer just a man’s world
• Nor is it just a hearing world either!
Psycho-social barriers to action
• Mis-perceive affects of hearing loss
• Reluctant to acknowledge hearing loss
• Fear of being stigmatised (stupid or old)
• Need for an engagement strategy
Rehabilitation Overview
Engagement
Audiology
Patient Decision Making & Case Conference
ENT
Technology
based
Rehabilitation
Communication
Strategies
Therapies &
Group Work
Referrals
Closure