**3. Hearing impairment in community health care**

The 80+ often have serious health issues in addition to hearing impairments that may significantly impact their independence and functioning in daily life. It is therefore necessary to have accurate information about sensory functioning in this population. Researchers in a Norwegian study initially used a checklist method to ask the participants about their hearing [32] and then used the obtained results to apply further tests and follow-up to those who described their hearing as impaired. A major problem with that study is that it did not determine objectively whether the subjects who did not rate their hearing as impaired actually had normal hearing.

We know that there is a discrepancy between patient self-assessment and results obtained from standardized tests such as pure-tone audiometry test in the 80+ [33]. In addition, there seems to be little knowledge about whether the 80+ have sufficient information to even seek help in the first place, and whether they do receive the help that is available to compensate for their impairments [34]. Communication and access to information are considered to be especially important for the 80+, since many remain at home most of the time and have limited contact with others [35]. Therefore, we cannot just hand over this responsibility to the elderly.

Studies have shown that home-care nurses appear to pay limited attention to hearing losses [11, 13], possibly resulting in the problems and difficulties related to age-related hearing loss being overlooked and underestimated. The everyday life of a nurse is busy and involves many tasks, and focusing on the senses require a little more time and consideration for the nurses than they usually spend with the patient. The nursing procedures used in home care for identifying hearing impairment among the 80+ appear to be deficient, or at best, variable so developing good procedures for detecting and tending to the elderly's hearing impairments is crucial.

In addition to risk factors for social withdrawal that can have a serious impact on a person's quality of life and result in many elderly living at home feeling lonely [35], several studies have demonstrated that hearing impairments significantly influence especially the instrumental activities of daily living (IADL), referring to activities such as using the phone, managing money, housework, and shopping [6].

Since a majority of the 80+ have severe sensory impairments [11, 13, 36], but seem to not notice it themselves [33], the most likely interpretation of this inconsistency could be that they have adapted to the situation and do not find it worth mentioning as causing difficulties in their daily life. Alternatively, they may simply be resigned to and have accepted their impairments as part of the aging process, or they may think, due to a lack of appropriate knowledge, that it is not possible to correct their hearing [36]. The acceptance of an impairment situation and the willingness to report a hearing loss are associated with greater knowledge, education, and income [13].

elderly find it difficult to understand speech when several other people speak simultaneously,

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

The 80+ often have serious health issues in addition to hearing impairments that may significantly impact their independence and functioning in daily life. It is therefore necessary to have accurate information about sensory functioning in this population. Researchers in a Norwegian study initially used a checklist method to ask the participants about their hearing [32] and then used the obtained results to apply further tests and follow-up to those who described their hearing as impaired. A major problem with that study is that it did not determine objectively whether the subjects who did not rate their hearing as impaired actually had

We know that there is a discrepancy between patient self-assessment and results obtained from standardized tests such as pure-tone audiometry test in the 80+ [33]. In addition, there seems to be little knowledge about whether the 80+ have sufficient information to even seek help in the first place, and whether they do receive the help that is available to compensate for their impairments [34]. Communication and access to information are considered to be especially important for the 80+, since many remain at home most of the time and have limited contact with others [35]. Therefore, we cannot just hand over this responsibility to the elderly. Studies have shown that home-care nurses appear to pay limited attention to hearing losses [11, 13], possibly resulting in the problems and difficulties related to age-related hearing loss being overlooked and underestimated. The everyday life of a nurse is busy and involves many tasks, and focusing on the senses require a little more time and consideration for the nurses than they usually spend with the patient. The nursing procedures used in home care for identifying hearing impairment among the 80+ appear to be deficient, or at best, variable so developing good procedures for detecting and tending to the elderly's hearing impair-

In addition to risk factors for social withdrawal that can have a serious impact on a person's quality of life and result in many elderly living at home feeling lonely [35], several studies have demonstrated that hearing impairments significantly influence especially the instrumental activities of daily living (IADL), referring to activities such as using the phone,

Since a majority of the 80+ have severe sensory impairments [11, 13, 36], but seem to not notice it themselves [33], the most likely interpretation of this inconsistency could be that they have adapted to the situation and do not find it worth mentioning as causing difficulties in their daily life. Alternatively, they may simply be resigned to and have accepted their impairments as part

and that they find it difficult to understand dialects or foreign accents.

ear, or one who just uses a hearing aid in one ear [31].

normal hearing.

104 Advances in Clinical Audiology

ments is crucial.

managing money, housework, and shopping [6].

**3. Hearing impairment in community health care**

Multimorbidity, increased risk of diseases in the sensory organs, and age-related changes in the eyes and ears not only lead to reduced hearing and vision but also make the 80+ living in a home-care setting a vulnerable group [34].

The 80+ may not have adequate information about sensory loss in old age and where to get help, treatment, and rehabilitation. It is therefore vital that health-care providers offer this information and help, particularly when the elderly person is already receiving home care. Such information may encourage the elderly to take actions to improve their situation or ask for help and support. It is likely that practical and emotional support can help the 80+ in dealing with sensory impairments.

From both preventive and health-promoting perspectives, home-care nurses can play a particularly important role by incorporating simple hearing tests in their regular procedures [34]. Examination with an otoscope to detect ear wax and check the eardrum and an examination with a portable audiometer are simple procedures that can be done by the home-care nurse.

Elderly people today might have experienced economic hardship during their childhood and upbringing, since they grew up during the recession in the 1930s and during the World War II. If they have to spend money to improve their hearing, this might affect their budget, and therefore they may not prioritize it [34]. Thus, recommendations would be to set clear goals and to closely and carefully help the elderly in every way possible to optimize their hearing function until the goals are reached [14].

It is important that nurses who work with the elderly have knowledge of age-related changes, and most importantly understand the consequences of hearing loss on certain factors of daily life: ADL/IADL, falls, loneliness, and the quality of life. It is also important that healthcare providers are aware of what can be improved, with regard to hearing impairments and are able to explain this to the elderly. When using a hearing aid, it is not the same hearing as the hearing of a 20-year-old, but it is after all much better than not hearing.

When we talk to someone who is not hearing, it is important to consider the following:

