Deborah Rehmat: Gradual hearing loss – “It’s more about not being able to understand”

Posted on September 17, 2014

“It’s not really so much about not being able to hear – it’s more about not being able to understand”.

My father and I were talking on the phone when he made this remark about progressive hearing loss – something we talk about a lot these days.

He has worn hearing aids for decades and now aged 90 his loss of hearing is what he describes as ‘significant’.

My mother (at 92) has recently started to wear a hearing aid in one ear, and for the first time is experiencing for herself the unpleasant surprise of amplified sound and the ways in which a hearing aid can make things both better and worse.

“The cutlery is so loud!” she says. “It drowns out everything else!” and we laugh about it, as if the knives and forks had a life of their own, but my father has struggled with this amplification of sound for years and it’s really not funny.

Everyday background noises that most of us hardly notice – like the running tap Moira Dancer described in her post here recently – can suddenly turn into a terrifying blast of sound that can either drive you crazy or scare you witless.


'Maybe we should just use wooden spoons?'

‘Maybe we should just use wooden spoons?’

These days, everyone in our family is more conscious than ever before of what it means to lose your hearing, especially when you’re getting older.

It’s an insidious process and often steals up so slowly that it’s easier to adjust to a quieter world and not admit – or even realise – how different things have become.

By the time someone in their 70’s or 80’s with progressive hearing loss starts wearing a hearing aid, chances are that there will be other things going on that will make adjusting more difficult than it would be at a younger age.

Learning skills like lip-reading will be harder to do. Other common health issues like arthritis, heart problems, and any condition that requires regular medication with probable side effects – not to mention the general slowing down that comes with age – all make getting to grips with increasing deafness a big challenge.

Brain Overload

Ever felt exhausted after concentrating at the extreme of endurance for half an hour in order to understand what’s going on in a conversation – never mind being able to take an active part?

Anyone who is hard of hearing knows what this feels like, but imagine for a moment how it feels to elderly people, for whom the effect can be so draining that it feels like a struggle just to keep afloat and who can be left with the worrying feeling that they’re losing the plot.

My father describes how he often makes a huge effort and manages to hear the words that have been said, only to find that he can’t make any sense of the meaning.

But if this sounds ridiculous, it’s not – and it doesn’t imply creeping senility either. A scientific study at the Johns Hopkins University School of Medicine in Baltimore has explored the theory that the working memory is limited with respect to the amount of information it can hold and the operations it can perform.

Professor Frank R. Lin who led the project says:

“The job of the inner ear is to take in sounds and encode them with accurate fidelity before the signal goes to the brain for decoding, but with hearing loss the brain has a very hard time doing that. If the brain constantly has to expend more resources to decode sound, this may come at a cognitive cost.”

In other words, what happens is brain overload – if you have hearing loss, you’re working much, much harder than everyone else – simply to process sound, never mind understanding it.

No wonder it’s exhausting. You’re not going senile (though it’s easy to see why it could seem that way).

It’s all about relationships

People who don’t have hearing loss generally seem to find speaking slowly and clearly a difficult thing to do.

Add to this the fact that it’s hard, even at the best of times, to ask someone to change their behaviour – especially if that means family or close friends – and you have a recipe for deteriorating relationships and increasing isolation.

I learnt recently that another elderly member of our extended family who had been deaf for years only pointed out to her children a couple of months before she died that their shouting didn’t help her to hear, and that they’d do better to speak slowly and clearly. She simply didn’t want to seem ungrateful or to make a fuss.

Talking about it helps. Getting frustrated and keeping quiet about it only makes things worse, because irritation and frustration build up and when you do finally say something you end up snapping, shouting, feeling angry and guilty.

And if you don’t say anything, nothing’s going to change, habits are going to get settled and confirmed and be harder to break.

When communication gets difficult for whatever reason, it’s even more important to find ways to talk and to listen, even though this can be really hard.

It needs willingness, patience, negotiation and mutual understanding – all of which require quite an effort – but it’s well worth it, because even the smallest steps in the right direction can make a world of difference.

We’re all in this together – and there’s an upside

It’s quite likely that most of us will experience some hearing loss later in life; more than 70% of over 70 year-olds, and 40% of over 50 year-olds have some form of hearing loss – so most families include at least one person who is hard of hearing.

When you think about it like this, it’s obviously a communication issue that affects us all, right now – so why not make life easier for ourselves by learning to practise a few simple speaking and listening techniques – which are skills that make all communication better, in any situation – at work and at home?

Action On Hearing Loss has a very helpful leaflet called Living with someone who has gradual hearing loss full of useful tips and good advice. Asking around, I know people do devise ways to talk that suit them best and work well. A friend told me

“My mother used to make sure Jack could see her, say her first sentence, and then say “Can you hear me Jack?” He didn’t seem to find that patronising, on the contrary it seemed to give him some control and gave him time to sort of settle into hearing her.”

However, when I read Charlie Swinbourne’s interview with Bruno Kahne I gotreally excited about communication skills – because he focuses on the positive things hearing people can learn from deaf people (- and by extension, how older people who are losing their hearing can benefit by learning from younger deaf people).

Kahne gives a list of things deaf people do to help them communicate, and one of these made me really sit up and take notice. He says:

“Deaf people constantly reformulate and check understanding, saying when they don’t understand. Hearing people never ask others to repeat, and never say when they don’t understand something.”

Wow! That really hit home – because it’s understanding that’s the key. As my father said, loss of hearing is really loss of understanding.

How many of us, hearing or hard of hearing, can say we check all the time that we understand and are being understood? The world might be a very different place if we all learnt to do this, and did it all the time.

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Posted in: Deborah Rehmat