6 The effects of aging may also include some emotional sequelae, such as feelings of depression, helplessness, and frustration. The effects of aging on the brain are complex in that they manifest gradually and in varying degrees. Unfortunately, this population has a high incidence of hearing loss and comorbidities that include cognitive decline and multisensory deficits. According to United Nations’ data, there are over 9 million people in the United States aged 80+ years, and the worldwide average annual growth rate of the age 80+ population (3.8%) is twice as high as the growth rate of the 60+ age group (1.9%). The age 80+ population is growing in numbers and living longer. The healthy younger patients do not display the comorbid conditions more common in older patients, and therefore do not need to learn some of the compensatory communication strategies taught in AR classes. Younger hearing-impaired patients generally may not perceive value in attending AR classes because they tend to be more satisfied with hearing aids. 5 However, the guidelines fail to define the ages of each group. The American Speech-Language-Hearing Association (ASHA) endorses hearing screenings for people over age 50, and proposes best-practice guidelines and policies for AR programs for children and adults. A detailed review of AR and AT clinical study designs on PubMed failed to find a single study using entirely older people. The adult AR studies universally include subjects 50 years and older, and many do not include patients over 75 years of age. The mixed findings of AR program outcomes reviewed in clinical studies may be partly due to the heterogeneous group of subjects in the programs. In this paper, older patients are defined as those 80 years and older. It is the opinion of the authors that AR programs are better suited for older patients than younger patients due to multifactorial events exclusive to this age group. Thus, it seems apparent that AR and AT training methods have advantages, disadvantages, and challenges. In general, self-study programs do not address the learning needs of the significant others (SO), and many older patients are not comfortable using new technologies. 4 However, there are limitations to self-study programs that conflict with survey results exploring the reasons why some patients want to participate in classroom training. There have been attempts to develop computer-guided online AR, smartphone AR applications, and self-directed AR and AT programs to embrace new technology and address some of the problems associated with classroom training. Apparently, more rigorous evidence is necessary to guide clinical decision-making regarding how AR programs provide value. It was concluded that, with the combined body of evidence, there is little support to draw any firm conclusions that AR classroom programs are beneficial. In a recent review, 3 386 articles on aural rehabilitation for adults were cross-referenced and 8 met the inclusion criteria to assess benefit. A plethora of studies on aural rehabilitation (AR) and auditory training programs describe comprehensive curriculums that result in many hours of trainings, some lasting for weeks. However, as Dr Jerger noted, what followed were several decades largely characterized by hearing care professionals paying “lip service to the importance of auditory training.” 1Īmong the reasons for a lack of professional acceptance are that aural rehabilitation programs are time-consuming, outcomes are mixed, and there is little or no reimbursement. Some auditory training programs, including those at Walter Reed Hospital described by Mark Ross, PhD, 2 and others in Europe described by Geoff Plant in this issue of The Hearing Review(see p 18), were exemplary (and arguably overkill). Subsequently, Carhart developed a comprehensive program to improve the listening skills of the young veterans and called it auditory training(AT). Prior to 1942, Carhart had learned from a colleague at Northwestern that there had to be training for maximal benefit. James Jerger, PhD, wrote in a JAAA editorial 1 that, when the military asked Captain Raymond Carhart, the “Father of Audiology,” to dispense hearing aids to veterans returning from WWII, Carhart said that issuing hearing aids was not enough. Future studies on AR and auditory training should focus upon this important population. By Oscar Armero, AuD, and Charissa Hicks Emerging evidence points to increased importance of AR for older adultsįrom our experience as clinicians who serve the age-80+ population and the emerging scientific evidence about this patient group, it is older patients who are most likely to benefit from aural rehabilitation (AR) programs, and therefore, more eager to attend AR classes.
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