What are the recommended methods for hearing testing in clients with dementia?

Recommended Methods for Hearing Testing in Clients with Dementia

For clients with dementia, standard audiometry conducted by a qualified audiologist is the recommended first-line method for hearing testing, with adaptations made based on cognitive status and supplemented by informant reports when necessary. 1

Initial Assessment Approach

Screening for Hearing Difficulties

• Ask the person with dementia and their care partner if they have difficulty hearing in everyday life (rather than directly asking if they have hearing loss) 1
• Use simple, direct questions that require minimal cognitive processing
• Document any reported hearing difficulties as part of dementia risk assessment 1

When Hearing Loss is Suspected

1. Refer for formal audiometric testing by a qualified audiologist meeting provincial/state regulations 1

   • Pure-tone audiometry remains the gold standard but may need adaptation
   • Success rates for completing pure-tone audiometry in people with dementia range from 56-59% 2

2. Review medications for potential ototoxicity 1

   • Document and consider adjusting medications that may contribute to hearing loss

3. Conduct otoscopic examination 1

   • Rule out cerumen impaction or other treatable ear conditions

Adaptations for Audiological Testing

For Mild to Moderate Dementia

• Schedule appointments during the person's best time of day
• Allow extra time for testing procedures
• Use simplified instructions with visual cues
• Break testing into shorter sessions if needed
• Ensure testing environment is quiet and free from distractions
• Have a familiar caregiver present during testing 3

For Moderate to Severe Dementia

When standard audiometry cannot be completed:

1. Alternative Assessment Methods:

   • Whisper test (though provides limited characterization of hearing loss) 4
   • Informant questionnaires about hearing function 1
   • Observation of responses to environmental sounds
   • Otoacoustic emissions testing (requires minimal patient participation) 3

2. Rely on caregiver reports using validated tools:

   • Hearing Handicap Inventory for the Elderly-Screening (HHIE-S)
   • Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) 1

Post-Assessment Rehabilitation

If hearing loss is confirmed:

1. Recommend audiologic rehabilitation which may include:

   • Behavioral counseling techniques
   • Hearing aids or assistive listening devices when appropriate 1
   • Communication strategies training for caregivers

2. Assess effectiveness of interventions:

   • Evaluate if communication goals have been met
   • Assess improvement in hearing-related quality of life at follow-up visits 1
   • Re-test hearing at least every 3 years or when changes are reported 1

Special Considerations for Long-Term Care Settings

• Train nursing staff to perform basic hearing screening using the whisper test 4
• Implement regular hearing checks as part of routine care
• Ensure proper maintenance of hearing aids for residents
• Develop communication strategies tailored to residents with dual sensory-cognitive impairments 4, 5

Clinical Pitfalls to Avoid

• Don't assume poor performance is solely due to dementia - undiagnosed hearing loss may contribute to apparent cognitive deficits 6, 5
• Don't skip hearing assessment because of cognitive impairment - hearing loss is a modifiable risk factor for dementia progression 1
• Don't rely solely on self-report from individuals with dementia, as they may have reduced awareness of their hearing difficulties 3
• Don't use overly complex testing procedures that may frustrate the person and lead to inaccurate results 2
• Don't forget to reassess hearing as both dementia and hearing loss are progressive conditions 1

Addressing hearing loss in people with dementia can improve quality of life, reduce behavioral symptoms, and potentially slow cognitive decline, making proper assessment essential despite the challenges involved.