Audiologic care for clients with multiple medical comorbidities: Modifications to clinical practice and inclusion of family members and caregivers
Older adult clients seeking audiologic rehabilitation commonly present with concomitant health issues, such as visual impairment, decline in manual dexterity, and changes in cognitive status. Audiologists may modify assessment and treatment plans to accommodate these health issues, and may include family members and caregivers in their rehab planning as part of a family-centered approach to client care. Charts from 159 clients of a geriatric audiology clinic who presented for a hearing aid evaluation in 2015 were examined to determine a) how frequently audiologists indicated that their clients experienced medical comorbidities related to vision, manual dexterity, and cognition; b) specific modifications to clinical practice made by the audiologists to accommodate for these comorbidities; and c) level of involvement of family members/caregivers in the client’s audiologic rehabilitation, as noted in the chart by the audiologist. The institutional medical health records were also examined to extract any additional information about the clients' health status. The audiologists noted prevalence rates for visual, manual dexterity, and cognitive issues of approximately 50%, 35%, and 45%, respectively. Modifications to clinical practice, such as using rechargeable hearing aids for clients with poor manual dexterity, were made to accommodate these comorbidities. Although the clients were frequently accompanied by a family member or caregiver, in fewer than 20% of the cases did the audiologist explicitly note this information in the chart. Accumulating evidence suggests that the negative consequences of hearing loss, such as social isolation and reduced overall well-being, are not limited to the impaired individual. Rather, hearing loss, especially in older adults, can also have devastating effects on family members and caregivers. We will discuss potential changes to audiologic best practice that could serve to a) accommodate medical comorbidities in older clients, and b) encourage inclusion of significant others to optimize treatment success.
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