ࡱ> ih$K( / 0LDTimes New Roman(0(z[ 0 o@ .  @n?" dd@  @@`` `+x'     !"#$  '& 0AA@ʚ;ʚ;g43d3d@z[ 0ppp@ <4!d!dl 0 <4ddddl 0  <4ddddl< 02.0___PPT10 ppN___PPT90(? %E%Geriatric Population and Hearing Loss%h Assist. Prof. Songl AKSOY (PhD) Hacettepe University ENT - Audiology and Speech Pathology Department 1st INTERNATIONAL DEAF ASSOCIATION CONFERENCE 7-12 September 2004 0stanbul XgLi IOTable 1: Percentage of Population Age 65+ in Selected Countries (1990 and 2025)PP OCountry 1990 2025 Sweden 17.9% 23.7% United Kingdom 15.6 21.9 Germany 15.0 24.4 Italy 14.7 25.1 France 14.1 21.8 United States 12.6 20.0 Japan 11.8 26.3 Canada 11.5 21.8 Turkey 8.05(2003) $ZMemory and Aging(Stage of memory Effect of aging on storage Sensory Memory Unchanged by aging Primary Memory Unchanged by aging Secondary Memory Age-related diffences.+o)>I feel so bad for Uncle Ted, There s not much hair upon his head, And what is worse, he barely hears, There s too much hair in his ears. Bruce Lansky, 1996*) During audiometric testing the presence of a high-frequency air-bone gap, poor test-retest reliability, disagreement between pure-tone and immittance test results should alert the clinician to the potential for collapsed ear canals.  )n Hair cell loss near of the cochlea produces hearing loss in the high frequencies, which typifies presbycusis.oon 4Criteria for Classification of types of Presbyacusis55$4TSensory Neural Strial Cochlear conductive Mixed presbycusis Intermediate presbycusisT ) Of persons 65 and over, nearly one-third report having hearing impairment or heart disease making it the third most prevalent chronic condition in this age groups (Adams&Menson, 1992)<  ~Table 2 : Number and Proportion of subject in percent by Age Group Shoving Significant (>10dB) Change in PTA or PTAH over Time,s  ~Age group n PTA PTAH 58 to 63 495 13 48 64 to 69 510 17 50 70 to 75 307 20 48 76 to 81 136 33 41 Overall 1448 17.6 48 PTAH: average thresholds at 4000, 6000 and 8000 Hz. \ s /   )n Age, independent of hearing loss, is a significant variable influencing speech-recognition ability in noise. oon) Hearing loss is a major determinant of function in older persons. Increasing hearing loss is strongly associated with increased behavioral dysfunction in older adulds. Bess, Logan&Lichtenstein, 1990>BPotential Consequences of Hearing Loss Experienced by Older AdultsCC BNegatively impact on communicative behavior Alter psychosocial behavior Strain family relations Limit the enjoyment of daily activities Jeopardize physical well-being Interfere with the ability to live independently and safelyZCont.............cInterfere with long distance contact on the telephone, potentially jeopardizing safety and security Interfere with medical diagnosis, tretment, and management Interfere with compliance with pharmacologic regimens Interfere with terapeutic interventions across all disclines including social work, speech-language therapy, physical, or occupational therapydZdc) People with hearing loss are person first who are challenged to cope with a disability using adjustment processes adopted by human beings struggling with other types of chronic conditions (Schumi, 1994))^ The succsessful counselor should be supportive, facilitative, and at the same time directive.__^ITable 3 : Qualities Considered Important to a Successful Counseling StyleJJ IWarm Empathic understanding Genuine Unconditional positive regard Good listener Good interpersonal skills Caring and concerned Able to take on another person s point of view Able to respond effectively to anaother person s emotional state Understanding Z) Older adults are often unaware of the contribution of hearing loss to life satisfaction, and thus it is incumbent on audiologists to link the benefit of hearing aids to life satisfaction when counseling the elderly. 7Table 4: Factors That Influence Receptive Communication(8 / 7SPEAKER VARIABLES Mouth Movements Rate of Speech Loudness of Voice Accent Dialect Visibility of Articulators Objects in the Mouth Facial Expressions,Cont...PERSONAL VARIABLES Severity of Hearing Loss Visual Acuity Mental Status Physical Functional Status Listenning Skills Attention Span,qqCont... ENVIRONMENTAL VARIABLES Acoustic Factors Lighting Visual Distractions LINGUIST0C VARIABLES Topic Awareness Context Awareness Conversational Context Awareness Semantic Variables Syntactic Considerations`Z.ZZoZ.oTable 5 : Improving Communication with Hearing  Impaired Elderly PersonsII HThe following tips should be shared with communication partners: Obtain the person s attention before beginning a communication exchange Speak face-to-face Paraphrase if you have to repeat what has been said Speak at a normal level or slighly louder Speak slowly but not exaggerated Stand within 2 to3 feet of the listener  ADCCont... Reduce background noise Pause at the end of a sentence Avoid appearing frustrated If the person can read, write down key words Have the person with hearing impairment repeat what you have said to verify that the message was understoodZ %Aging and the Balance Control Systems&&(% I am so afraid that I am going to get dizzy and that my husbant will not hear me scream if I fall, because he refuses to hearing aids around the house. Balance Systems@Visual afferences Somatosensory afferences Vestibular afferences@) Early identification of balance system disorders, coupled with development of a preventative managment strategy, may facilitate a reduction in falls in the older adult population.) Vestibular rehabilitation programs generally include exercises designed to adress dizziness (vertigo), and/or exercises designed to improve balance function. General conditioning exercise, such as walking, may also be included.(%%Table 6 : Fall Prevention Instruction&&$%~1. Use prescribed walking aid at all times 2. Move though positional transitions slowly to avoid imbalance 3. Use elevators instead of stairs or ramps, if possible 4. Use handrails whenever possible if stairs or ramps must be used 5. Avoid sitting in low, overstuffed chairs if you have difficulty standing up. When standing up, scoot your hips to edge of the chair prior to rising Z~)&Cont...$6. Wear low-heeled laced shoes with a firm sole (no slippers) 7. Home modifications: Always keep a ligt on. Turn a light on prior to entering any dark room Keep electrical cords and small objects out of walking paths Remove throw rugs (UU*'Cont... *Keep frequently used items in the kitchen and bathroom within easy reach, preferably on eye-level shelves Use nonstik decals or rubber mat in the bathtub and shower 0nstall grab bars in the bathtub and shower, if needed 8. If rabit head movements cause imbalance, do not drive "Z:Z%"fShakespeare, Hall, and Mueller on What s in a Name?3 What s in a name? That which we call a rose By any other name would smeel as sweet. William Shakespeare (1564-1616) Romeo and Juliet, Act II  What s in a name? That which we call tinnitus By any other name whould sound as unpleasant James Wilbur Hall III (1948- ) and Gustav Hermann Mueller III (1947- ) Audiologist s Desk Reference Volume IINfU=_seTinnitus and Hearing Impairment (Tinnitus, the perception of sound in the absence of an external acoustical stimulus, is usually associated with sensorineural hearing loss.. The prevalence of hearing impairment and tinnitus increases with age. !)jSmoking: Experimental work on animal showed that nicotine can have degenerative effects on the cochlear strucres. The direct correlation between smoking and tinnitus. Coffee: Very little is written the effect of coffee on auditory system. Alcohol: Quaranta (1996) found that alcohol is a significant risk factor for tinnitus if it is consumed on a daily basis.NkZBr."Teacher of the deaf and pediatricians accepted that  deaf children do not get tinnitus Why? ^^ ]Children might consider tinnitus as  normal if it present since early in life. Children are less prone to the anxiety suffered by adults regarding the medikal implications. Their compliants might be ignored by adulds." # )It is clear that tinnitus can be a common and serious problem in children. Age was found to be strongly related to the prevalence of tinnitus. Approximately 30% of person above the age of 65 years have tinnitus.$!Tinnitus and Sleep(About 40 to 50 % of the tinnitus population experiences some difficulty with sleeping. Sleep deprivation in turn can be related to: Reduced attention Reduced concentration Emotional instability DepressionFW-JW-I ETinnitus Treatment (none are effective in all patients with tinnitus),F$$3EjAcupuncture Drugs Directive counseling Electrical stimulation Allergy control Vitamin therapy Herb therapykkk+(Cont... Diet control Biofeedback Hypnotherapy Alteration in air pressure Maskers or  instruments Low-level noise generators vu$t'#)#Thank you songulaksoy@hotmail.com8  ,#0  ` ` ̙33` 333MMM` ff3333f` f` f` 3>?" dd@,|?" dd@   " @ ` n?" dd@   @@``PR    @ ` ` p>> jb(    6 9 "P  T Click to edit Master title style! !$  04; "  RClick to edit Master text styles Second level Third level Fourth level Fifth level!     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Slide 14 Slide 15JTable 3 : Qualities Considered Important to a Successful Counseling Style Slide 178Table 4: Factors That Influence Receptive CommunicationCont...Cont...ITable 5 : Improving Communication with Hearing Impaired Elderly PersonsCont...&Aging and the Balance Control SystemsBalance Systems Slide 25 Slide 26&Table 6 : Fall Prevention InstructionCont...Cont...4Shakespeare, Hall, and Mueller on Whats in a Name? Tinnitus and Hearing Impairment Slide 32^Teacher of the deaf and pediatricians accepted that deaf children do not get tinnitus Why? Slide 34Tinnitus and SleepFTinnitus Treatment (none are effective in all patients with tinnitus)Cont... Slide 38  Fonts UsedDesign Template Slide Titles&_:noroozinoroozi  !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOQRSTUVWYZ[\]^_abcdefgjRoot EntrydO)Current User`SummaryInformation(PPowerPoint Document(^DocumentSummaryInformation8X