Gender-Specific Audiologic Rehabilitation Programs and Self-Perception of Handicap in the Elderly

Abstract:
This study investigated whether gender-specific counseling strategies (designed differently for male and female hearing-impaired elderly) would reduce self-perceived hearing handicaps. Results indicated significant decreases in HHIE scores on the Social/Situational subscale for males and on the Emotional subscale for females when gender-specific counseling occurred. These findings have implications for the counseling component of audiologic rehabilitation programs.

Introduction:

The elderly are the fastest growing segment of the population. It is estimated that the elderly segment of the USA will exceed 75 million by the year 2040 (Weinstein, 2000). Hearing loss is common in the elderly, and the degree of hearing loss tends to increase with increasing age. By 70 years of age, the majority of people have hearing loss sufficient to cause communication problems in everyday life (Moore, 2002). Such findings and projections indicate the potential for hearing loss to have a substantial negative impact on the quality of life for elderly citizens.

Assessment scales measuring self-perceived handicaps are recognized as effective instruments for quantifying the effects of hearing loss and the efficacy of rehabilitation efforts (Taylor & Jurma, 1999; Taylor, 1993; Abrams et al., 1992; Newman et al., 1991). The widespread use of such scales stems from the fact that audiometric data fall short of describing the effects of impairment on everyday function. Self-assessment data provide insights about an individual's response to hearing impairment that cannot be gleaned from audiometric data alone.

The Hearing Handicap Inventory for the Elderly (HHIE, by Ventry & Weinstein, 1982) provides a handicap assessment measure designed specifically for the elderly. It is designed to quantify the emotional and social/situational effects of hearing impairment in the non-institutionalized elderly. In addition to analyzing the impact of measured hearing loss, audiologists must take into account various personal, attitudinal, and situational factors, which may fluctuate over time.

While investigations have considered audiometric differences between men and women, only a few studies have examined the effects of gender on self-perception of hearing handicap. Mulrow et al. (1990) concluded that male veterans associated significant social, emotional, and communication difficulties with hearing loss. Further, subjects with only mild to moderate loss of hearing reported difficulty hearing adversely affected their quality of life. Garstecki and Erler (1999) investigated the adjustment of elderly male and female subjects to hearing loss using the Communication Profile for the Hearing Impaired (CPHI, by Demorest & Erdman, 1987). Results indicated that women assigned greater importance to social communication, were more likely to use nonverbal communication strategies, perceived greater anger and stress and reported greater problem awareness and less denial associated with hearing loss than men. Taylor and Jurma (1999) reported significant differences between males and females on the Social and Emotional subscales of the HHIE. Males perceived greater handicap in the social areas while females perceived greater handicap in the emotional areas. These results suggest that women experience and adapt to hearing loss in a different manner than men.

This study was designed to investigate whether gender-specific counseling strategies incorporated into an audiologic rehabilitation program would reduce self-perception of handicap, as compared to participation in traditional rehabilitation programs. Audiologists have the responsibility to determine how best to promote quality of life for their patients. Intuitively, if elderly males and females have different perceptions of their hearing handicap, the differences between genders should be taken into account in the development of appropriate treatment and rehabilitative protocols.