**2. Presbycusis and hearing impairment**

**1. Introduction**

102 Advances in Clinical Audiology

other health challenges [11].

to this issue as early as possible [6, 13].

professional help for their hearing impairment [13, 14].

health challenges and is receiving home care [24].

of falling when hearing is impaired.

care are few.

The proportion of elderly aged ≥80 years of age (the 80+) is expected to increase dramatically over the next few decades and is projected to triple in Europe by 2060 [1]. Both the World Health Organization (WHO) and the European Union (EU) are concerned with programs on successful aging [2], and since hearing impairment is a known risk factor for functional decline, reduced social participation, withdrawal, and accidents [3–6], good functional hearing is therefore crucially important for elderly to be able to manage themselves and take care of their own lives and maybe also help their partner or spouse [7–10]. For patients in a homecare setting, hearing impairment can cause additional stress along with reduced capacity and

Hearing impairment is however a natural part of old age, and most people will experience increasingly impaired hearing as they grow older, but because this impairment can threaten functioning and well-being, communication, and quality of life, it is important to shed light on this issue and to help the elderly with this problem [7, 11, 12]. Age-related hearing impairments are sometimes possible to remedy or improve, but it is important to discover and tend

Traditionally, hearing impairments have to a large extent been an area for the elderly themselves or their relatives have been responsible for, but it seems that there is a lack of information because many elderly never check their hearing, apply for hearing aids, or seek any other

Hearing is connected to the memory function and there is evidence that hearing impairment can have an impact on the mental functioning [15–17]. Age-related hearing impairment is correlated with Alzheimer disease, and reduced hearing can contribute to falls and fractures [18], greater dependence on others, and loneliness [19–21]. For those who have ailments and chronic diseases, hearing impairments constitute an additional negative factor to the other problems and perhaps an unnecessary burden, which may lead to the latter part of life being more troublesome than necessary [11, 22]. Since age-related sensory impairments in general have been taken care by the elderly themselves, it has largely been overlooked by nurses in the home-care service and by health authorities in general [4, 23]. Knowledge and understanding about how to maintain the hearing function in old age seem to be crucial in order to manage every day activities, daily living, and participation in social activities, even if one has other

Decline in sensory abilities and their effects on physical and psychosocial capacities in older individuals have been discussed in previous studies [15–17], however, most prevalence studies of hearing impairments involve population from the general community and include people from younger age groups, so studies among older people over 80 years receiving home

Grue [11] has discussed the burden of dual sensory impairment in the elderly and also the risk

Age-related hearing impairment (presbycusis) is characterized by reduced hearing sensitivity and speech understanding in noisy environments, and an impaired ability to localize sound sources [13, 25]. Our study indicated that more than 90% of the elderly participants 80+ were living with hearing impairments that had not been checked by specialists.

The auditory system is restricted to the outer ear, middle ear, and the inner ear and is associated with the hearing center in the brain via the hearing nerve. Sound perceived by humans range from 20 to 20,000 Hz. Common speech is often in the range of 200–800 Hz and the volumes of speech vary between 30 dB (whisper) and 80 dB (shouting).

Age-related hearing loss starts from about 40 years of age when the high tones disappear. However, for many elderly it is usually not a real problem before reaching the age of maybe 75–80 years when consonants such as s, sh, f, v, t, p, and b disappear because their energy is concentrated around the frequencies 2000–8000 Hz. Thus, with increasing age, hearing ability progressively weakens, especially the ability to hear high-frequency sounds and to distinguish one sound from another.

Hearing changes for an elderly person is related to anatomical and physiological changes in the ear, in addition to elements in the surroundings and inherited factors [25–28].

It is common in Norway and other countries to simply ask elderly patients in the home-care setting about their hearing with a global question and not use any further examinations if the elderly states that the hearing is good. Our ROC curve analysis revealed that there was a discrepancy between patient self-assessments and results obtained from standardized instruments when they answered the global question, "Do you consider your hearing to be good, not so good, poor, or very poor/deaf".

The elderly often adapt to the situation so that they do not notice themselves that the hearing has been deteriorated [9, 29]. Some elderly people may also have difficulties in admitting that they have reduced hearing. It is however more common to wear glasses than a hearing aid and many elderly people are loath to admit that they have a hearing problem in fear of the social stigma it signifies [13]. Some elderly people also underestimate their hearing loss and think that they have better hearing than they actually do.

It seems however that the elderly admit having problems when they are asked more detailed questions about their hearing and communication abilities. Results from assessing hearing and communication abilities on more detailed questions indicate, for example, that the elderly find it difficult to understand speech when several other people speak simultaneously, and that they find it difficult to understand dialects or foreign accents.

Hearing impairment can also lead to misunderstandings and suspicion in addition to the social isolation [9, 30]. The sound may be difficult to locate, especially for one who has combined visual impairment and hearing loss, who has different hearing aids in the right and left ear, or one who just uses a hearing aid in one ear [31].
