Interpersonal Relationship Implications of Hearing Loss in Persons Who Are Older

Article excerpt

Hearing impairment among older persons in the United States is pervasive (Bayles & Kasniak, 1987). It has been found to be one of the four leading chronic conditions for older persons (Aging America, 1991) and the third most common chronic condition in non-institutionalized older persons (Jack, 1981). As much as 90% of older residents of long term care facilities have been found to have hearing impairments (Bayles & Kaszniak; Chafee, 1967).

Significant heating loss has been considered to have the greatest impact upon functioning of all perceptual impairments associated with aging (Butler & Lewis, 1982). Yet, family members, care providers, medical personnel, and older persons themselves may be unaware of and uninformed about intrapersonal and interpersonal implications of heating loss. Intrapersonal effects focusing on the experience of the individual and internal aspects of hearing loss for older persons have been discussed in another paper (Kampfe & Smith, 1997). The purpose of this article is to provide information regarding late onset hearing loss and common effects of that loss upon interpersonal functioning. It is hoped that such information will result in increased sensitivity to challenges faced by older persons who experience hearing loss and by persons who interact with them.


Hearing level deteriorates with increasing age (Dayal & Nussbaum, 1971; Wax & DiPetro, 1984). The term, presbycusis, is generally used to describe the heating loss of older persons (Agnew, 1986; McFarland & Cox, 1985; Stein & Bienenfeld, 1992; Williams, 1984). Presbycusis refers to a wide range of problems associated with auditory deterioration (Hull, 1977; Stein & Bienenfeld; Williams 1984) and has been defined as the "alteration of hearing sensitivity associated with the normal aging of the auditory system" (Bayles & Kasniak, 1987, p. 150). Use of the collective term, "presbycusis" in diagnosis, however, fails to communicate much information about the actual physical condition or implications for functioning. Indeed, some authors accept the possibility of four types of presbycusis each having associated patterns of structural and functional losses (Birren & Schaie, 1985; Schuknecht, 1974).

While variability is common, overall results of research on presbycusis substantiate the belief that as deterioration associated with presbycusis advances, older persons experience increasing limitations in oral communication (Bayles & Kaszniak, 1987; Bergman, 1971; Pickett, Bergman, & Levitt, 1979; Plomp & Mimpen, 1979). Functional implications of such losses have included: lack of understanding of or distortions of verbal conversation (Davis & Silverman, 1970; Ebersole & Ness, 1994; Hallberg, Erlandsson, & Carlsson, 1992; McFarland & Cox, 1985; Pickett, Bergman, & Levitt, 1979; Thomesett & Nickerson, 1993), and misinterpretations of environmental cues resulting from misconceptions of environmental stimuli (Hull, 1977; Luey, 1980; Ramsdell, 1978). Variability in degree of or accuracy of hearing depends upon environmental conditions, stimulus frequency, and availability of other supporting interpretative cues (such as facial expressions or non-verbal movements) (Butler & Lewis, 1982). The ability to mask or differentiate competing sounds varies and is often influenced by fatigue, lighting or familiarity with the environment (Butler & Lewis). Variability in correct interpretation of speech is also influenced by placement of sounds within a phrase/sentence (i.e., whether sounds occurred in single spoken word utterances or connected speech/single sentences) (Birren & Schaie, 1985; Dorman & Marton, 1981; Hannley & Dobbins, 1981).

The hearing limitations associated with advanced age and their implications often have significant effects upon the interpersonal functioning and interpersonal relationships of the older person and others with whom she/he interacts. …