COVID-19 Story Tip: Effectively Communicating with Older Adults Who Have Hearing Loss During COVID-19

07/14/2020

The COVID-19 pandemic has caused a variety of challenges for older adults with hearing trouble across different health care settings, including the inpatient hospital setting and nursing homes, assisted living facilities and home environments. Research from Johns Hopkins suggests that nearly half of adults over age 60 have hearing loss, which indicates a significant portion of the population may be experiencing these challenges as a result of COVID-19.

During the COVID-19 pandemic, those with hearing difficulties who are accustomed to reading lips may face challenges because they cannot read the lips of people wearing a face mask. Additionally, following the 6 foot physical distancing recommendation can make communicating by sign language more difficult. To address these communication barriers, Johns Hopkins researchers have developed a checklist for clinicians to use while treating patients with hearing loss. Published online in the June 17, 2020, issue of the Journal of the American Geriatrics Society, the checklist provides recommendations for both inpatient and telehealth visits, such as using hand-held devices and telephones that enable the older adult to see and hear the provider clearly. The checklist also includes tips for the patient’s environment, including decreasing background noise, improving lighting, and ensuring providers effectively communicate via verbal and nonverbal ways such as speaking slowly or wearing a clear mask when permissible.

Nicholas Reed, Au.D., assistant professor of audiology in the Department of Otolaryngology–Head and Neck Surgery at the Johns Hopkins University School of Medicine, and of epidemiology at the Johns Hopkins Bloomberg School of Public Health, is available for comment.

Addressing Hearing Loss Checklist

Technological Considerations

Hand-held Amplification

With simple hand-held devices such as the Pocket Talker or SuperEar (Sonic Technology Products), standard headphones easily amplify sound with volume control to improve communication.

Amplified and Captioned Telephones

These telephones, specially designed for people with hearing loss, provide increased amplification and captioned conversation.

In-room Videoconferencing

Using video technology to communicate with patients may seem like it would pose barriers. However, it allows providers to speak clearly and show their mouth for lip reading. In addition, frequencies important for speech can be amplified, and speech can be used to text to caption the video in real time. 

Speech to Text

Speech-to-test applications, such as software by Google, are increasingly available. These apps can provide live transcription of conversation to assist those with hearing loss. 

Smartphone Amplification

Apps such as Google Sound Amplifier offer high quality noise reduction algorithms and amplification for personal smartphones. These may be an option when hand-held amplifiers aren’t available.

Environmental Modifications

Lessen Background Noise

Reducing background noise by turning down the television and closing the door to noisy areas can improve communication.

Improve Room Lighting

Proper lighting helps people with hearing loss visualize the speaker to aid in lip reading, but overwhelming lighting (such as a window reflection) can be distracting.

Placards

Placards with phrases, questions and comments commonly used during a hospital stay or outpatient visit can be helpful. Using a large font with high contrast color can further help older adults.

Whiteboards or Tablets

Using whiteboards or tablets to write conversation can be cumbersome, but they are last resort options.

Communication Considerations

Ensure Attention 

Communication requires both parties to be attentive.

Communicate Face to Face 

Ensuring that the listener can see your face to lip-read is important. It also directs sound at the listener rather than in another direction. This means looking up from charts and away from computers when possible.

Make the Provider’s Mouth Visible When Possible

Covering the mouth area is a must to help prevent spread of the virus that causes COVID-19. However, any opportunity possible to use clear masks or videoconferencing without masks can help people who consciously and subconsciously lip-read.

Speak Slowly and Low

Age-related hearing loss generally occurs in higher frequencies and limits the clarity of speech. Slowing down and using a slightly lower tone can help listeners with hearing loss follow the conversation.

Do Not Shout

Most age-related hearing loss is an issue of clarity rather than volume. While some increased volume helps, shouting often further distorts information.

Give Context to Conversation 

Placing the conversation in context helps the listener decipher meaning and fill in the gaps when words are difficult to hear. This means adding supporting information such as common descriptions or actions, and being redundant.

Rephrase Rather Than Repeat

Rephrasing, and using words that are easier to hear can help the listener gain new context about the conversation. Repeating can create a frustrating negative-feedback loop.


For information from Johns Hopkins Medicine about the coronavirus pandemic, visit hopkinsmedicine.org/coronavirus. For information on the coronavirus from throughout the Johns Hopkins enterprise, including the Johns Hopkins Bloomberg School of Public Health and The Johns Hopkins University, visit coronavirus.jhu.edu.