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.
METHOD:
Subjects:
Subjects in this investigation were 80 non-institutionalized elderly (40 males and 40 females) aged 63 to 79 years (M=71.1, SD=5.8). All subjects had bilateral sensorineural hearing losses with pure-tone averages no better than 40 dB HL at 1000, 2000, and 4000 Hz in the better ear. Further, each subject had a significant handicap score (score> 18) as measured by the Hearing Handicap Inventory for the Elderly (Ventry & Weinstein, 1983). All subjects had adult onset hearing loss but were in good general health. The subjects were fitted with amplification approximately one month prior to placement in a rehabilitation group. None of the subjects had previous experience with amplification. Subjects were randomly assigned to eight groups of ten persons, each group composed of five males and five females.
Procedure:
Each subject completed the Hearing Handicap Inventory for the Elderly (HHIE) at approximately 3 weeks post fitting (first follow-up visit). The eight groups met four times for a total of six hours during the second month of hearing aid use. Each of the eight groups received audiologic rehabilitation and counseling designed to provide them with strategies for maximizing benefit of amplification. An outline of the rehabilitation program is contained in Figure 1.
Figure 1: Overview of Audiologic Rehabilitation Class for the Elderly
Prior to the beginning of the rehabilitation program, 20 males and 20 females were selected to receive additional counseling sessions (2 sessions @ 90 minutes each). The sessions were held in the week following the completion of the general rehabilitation program. Subjects were divided into 10-person male and female groups. Men received counseling related to aspects of the Social/Situational subscale of the HHIE. This component encouraged males to actively communicate with others, reinforced the importance of communication for active, healthy lives, and identified patients' concerns regarding communicating with particular family members, friends and associates. Women received counseling related to the Emotional subscale of the HHIE. They were encouraged to actively discuss their communication effectiveness with family members, friends, and associates to reduce their emotional concerns about their performance. Women were given suggestions for managing their communication effectiveness. In addition to receiving information from the audiologist, these 40 subjects communicated with one another about concerns and ideas. All 80 subjects completed the HHIE at the conclusion of their rehabilitation/counseling programs.
RESULTS:
Table 1 summarizes the means and standard deviations for subjects' HHIE scores before their participation in the rehabilitation program. Results of the t-test indicated that there were no significant differences in total HHIE scores between males and females. Significant differences were found on the subscales, however. Results of the t-test
(t78= 2.10, p t-test (t78 = 2.56, p
Table 1. Comparison of Mean Pre-Rehab HHIE Scores Of Males and Females
Table 2 contains information comparing HHIE scores of males who completed the general rehabilitation program only and males who completed both the general rehabilitation program and the program that contained gender-specific information. Male subjects who completed both the general program and the gender-specific program
(M = 10.90) had significantly lower total HHIE scores than did males (M = 12.75) who received the general rehabilitation program (t38 = 2.65, p (t38 = 2.50, p
Table 2: Comparison of Mean Post-Rehab HHIE Scores Between Male Groups
Information in Table 3 is pertinent to comparison of females who completed the general rehabilitation program only and both the general rehabilitation program and the gender-specific treatment. Female subjects who completed the gender-specific program
(M = 10.80) had significantly lower total HHIE scores than females (M = 13.25) who
only completed the general rehabilitation program (t38 = 2.85, p t38 = 2.35, p
Table 3: Comparison of Mean Post-Rehab HHIE Scores Between Female Groups
DISCUSSION:
Findings in this study compare favorably with those of Garstecki and Erler (1999) and Taylor and Jurma (1999). Males and females differ in their perception of hearing handicap. Males perceive significantly greater handicap in the social/situational areas while females perceive greater handicap in the emotional areas. One interpretation of this finding would be that males, with higher perceived handicap than females in the social/situational area and lower perceived handicap in the emotional area, feel the need to withdraw from situations requiring social interaction without great emotional concern over doing so. Females, on the other hand, with lower scores than males on social/situational items and higher scores than males on emotional items, feel the need to continue to be active in social interactions, but worry about how well they participate due to their hearing loss.
Male patients need to realize they can be effective communicators even though they have significant hearing loss. Further, they need to understand that others (family members, friends, etc.) are interested in their participation in communication activities. Males need to be encouraged to find ways to participate in activities rather than withdrawing from them. They might also benefit from encouragement to be active in the development and administration of their treatment protocols. Female patients need to find ways to alleviate the stress and emotional upset caused by difficulty in communicating. Information concerning environmental controls, such as where to sit in restaurants, church, etc., are among the types of information that would help them alleviate stress is specific situations. Encouraging them to openly acknowledge and discuss their communication difficulties with family members, friends, and associates might also reduce the emotional stress that they feel. These are illustrations of the types of information that were included in the gender-specific sessions provided in the current study.
This investigation is unique in its effort to study the effects of gender-specific counseling during audiologic rehabilitation programs. Males who received gender-specific counseling showed significant reduction in scores on both the total HHIE score and on the Social/Situational subscale. These reductions were greater than reductions of male subjects who participated in the general rehabilitation program only. Females who received gender-specific counseling in addition to general rehabilitation content scored significantly lower on the total HHIE and on the Emotional subscale than female subjects who participated in the general rehabilitation sessions only. In other words, males and females received additional benefit from gender-specific counseling. That benefit is reflected in the lower perceived handicap as evidenced by the scores.
CONCLUSIONS:
The findings of this study have implications for audiologic rehabilitation, in regard to programmatic considerations as well as to counseling strategies. The conclusions of the study are as follows:
- Results from this study support earlier findings (Garstecki & Erler, 1999; Taylor & Jurma, 1999). Males and females differ in the way their
hearing impairment is perceived and/or experienced. - Gender-specific counseling programs can be effective in reducing self-perceived handicap in elderly individuals.
- Results from this study support the need to further evaluate gender differences in perception of hearing loss, and to further evaluate how counseling and audiologic rehabilitation programs can influence these perceptions and experiences.
REFERENCES:
Abrams, H. B., Hnath-Chisholm, T., Guerreiro, S. M., & Ritterman, S. I. (1992). The effects of intervention strategy on self-perception of hearing handicap. Ear and Hearing, 13, 371-377.
Demorest, M. E., & Erdman, S. A. (1987). Development of the communication profile for the hearing impaired. Journal of Speech and Hearing Disorders, 54, 180-188.
Garstecki, D. C., & Erler, S. F. (1999). Older adult performance on the communication profile for the hearing impaired: Gender differences. Journal of Speech, Language, and Hearing Research, 42, 785-796.
Moore, B. C. J. (2002). Hearing loss in the elderly and its compensation with hearing aids. Gerontechnology, 1, 140-152.
Mulrow, C. D., Aguilar, C., Endicott, J. E., Velez, R., Tuley, M. R., Charlip, W. S., & Hill, J. A. (1990). Association between hearing impairment and the quality of life of elderly individuals. Journal of the American Geriatrics Society, 38, 45-50.
Newman, C. W., Jacobson, G. P., Hug, G. A., Weinstein, B. E., & Malinoff, R. L. (1991). Practical method for quantifying hearing aid benefit in older adults. Ear and Hearing, 9,
81-85.
Taylor, K. S. (1993). Self-perceived and audiometric evaluations of hearing aid benefit in the elderly. Ear and Hearing, 14, 390-394.
Taylor, K. S., & Jurma, W. E. (1999a). Study suggests that group rehabilitation increases benefit of hearing aid fittings. Hearing Journal, 52, 48-54.
Taylor, K. S., & Jurma, W. E. (1999b). Effects of age and gender on self-perception of hearing handicap in the elderly. Presented at the American Speech-Language-Hearing Association, San Francisco, CA.
Ventry, I. M., & Weinstein, B. E. (1982). The hearing handicap inventory for the elderly: A new tool. Ear and Hearing 3,128-134.
