The percentage of Americans 65 years and older is expected to increase rapidly, with the fastest growing age group being individuals 85 years and older (U.S. Department of Health and Human Services, 2003). The predicted increase in the next few decades in the number of older adults, many of whom will have significant hearing impairments, will undoubtedly have a pronounced impact on the profession of audiology and its service delivery models. It has been well documented in recent years that untreated hearing loss in elders may severely compromise their quality of life (Bagai, Thavendiranathan, and Detsky, 2006; National Council on the Aging, 1999). Audiologists have an important role to play in ensuring the highest quality of life for those in their "golden ages", and it is critical that audiologists understand this population and its special hearing healthcare needs. Older adults typically have characteristics, needs, and predicaments that are quite different from younger populations, and audiologists need to prepare to address their unique needs. Challenges faced by older adults with hearing loss and the audiologists who serve them include: pre-fitting concerns (lack of problem awareness and readiness for hearing aids), personal characteristics during fitting (increased likelihood of cognitive and psychoacoustic auditory processing components to the listening difficulties), manual dexterity compromises, and sensory difficulties beyond hearing loss (touch and vision), and special issues in adjusting to hearing loss and hearing aids. A comprehensive model of audiologic management is needed, one designed to help older adults deal more effectively with their hearing difficulties. Topics in this article include pre-fitting considerations the audiologist may take into account, decisional factors for fitting amplification and other assistive technology, and post-fitting audiologic rehabilitation programming such as clear speech training, control of the listening environment, and auditory training.
Pre-Fitting Considerations for the Older Adults
In recent years, practitioners in allied health disciplines have discovered that it is better for older adults to collaborate with health professionals, rather than assume a passive, compliant role (Haber, 2003). Many audiologists were educated in a traditional medical model, with the professional serving as the "expert", providing one-way information to patients, and outlining a plan of intervention with little input from the patient or family. However, the current trend in health care is for professionals to be health educators, not just rehabilitators, so that the health component of hearing care is emphasized. In this model, the audiologist collaborates with older adults in the management of their hearing losses. Thus far, as a field, we have a less than stellar record of success in attracting older adults to avail themselves of our services, and in helping them manage their hearing difficulties. According to MarkeTrak VII data, less than half of the 65+ age group who could benefit from hearing aids actually purchase them (Kochkin, 2005). Further, market research has shown that almost 20% of older adults who actually do purchase hearing aids discontinue their use as they relegate their hearing aids to the dresser drawer (Kochkin, 2000).
One explanation for the high return rate for hearing aids may be that we are not tuned in to the older adult's degree of problem awareness and level of readiness for hearing aids and other rehabilitation options. The author has frequently heard audiologists lament the denial of hearing loss by older adults. Although research by Smith and Kricos (2003) provided evidence that older adults with hearing loss usually do acknowledge their hearing losses, many of them downplay the negative effects that their hearing losses have on them and their frequent communication partners. Similar findings were reported for a survey on effects of untreated hearing loss on older adults conducted by the National Council on Aging (1999). Two-thirds of the respondents who reported hearing loss but who did not use hearing aids stated that their hearing losses were not "bad enough to get a hearing aid".
Smith and Kricos (2003) speculated that there may be three broad levels of acknowledgement of hearing difficulties in the older adult population: complete acknowledgement, partial acknowledgement, and non-acknowledgement, with different interventions depending on the level of problem awareness shown by the older individual. For the non-acknowledger and partial acknowledger, an intervention might be designed to help the patient become aware of everyday communication difficulties. If they are fit with hearing aids before realizing the degree of difficulties caused by the hearing loss, the probability of the hearing aids being returned or relegated to the dresser drawer is likely to be significantly increased. Consider the evidence provided by Kochkin (2002) via the MarkeTrak VI data: close to 30% of individuals who discontinued use of hearing aids attributed their non-use to poor benefit. It is possible that lack of perceived benefit may have occurred for many of these new hearing aid users because they were fit before fully acknowledging the degree of difficulty their hearing losses were causing them. Further, consider that Kochkin's (1998) MarkeTrak IV results demonstrated that more than half of all new hearing aid users reported that family members had motivated them to obtain hearing aids. Thus, it is likely that many of the patients who come to our audiology clinics may acknowledge that their hearing abilities have worsened, but do not accept that their hearing losses are causing them significant problems in their everyday lives. The risk entailed by fitting non-acknowledgers and partial acknowledgers with hearing aids before they are aware of the effects that their hearing losses are having on them, as well as on their families, friends, and coworkers, is that they do not appreciate how much the hearing aids are helping them. One way to identify older individuals who are not fully acknowledging their hearing difficulties is simply to ask them if they think they have a hearing loss. The non-acknowledger will state that they do not have a hearing loss and may make comments that most audiologists have heard over and over, such as "I can hear when I want to," or "Folks just don't speak clearly anymore." The partial acknowledger may say "I know I have a hearing loss, but it's not causing any problems."
Babeu, Kricos, and Lesner (2004) outline a number of options for effective audiologic management of patients who do not acknowledge their listening difficulties. First, provide them with information about hearing loss and its effects so that they become aware of the many symptoms and effects of hearing loss besides communication breakdowns. For example, they may not realize that the reason they feel tense lately, or become tired so easily, may be due to the stress and strain of trying to understand their communication partners. Some sources of information for patients who do not fully acknowledge their problems are presented in the Appendix. From the author's personal experience in offering community "Living with Hearing Loss" programs, the booklet by Trychin (2003) that is listed in the Appendix is particularly helpful for non-acknowledgers. In this booklet, Trychin, a well-known psychologist with a hearing loss himself, provides a candid description of
- the signs and symptoms of hearing loss,
- problem situations reported by individuals who are hard of hearing,
- physical, behavioral, emotional, and cognitive reactions to hearing loss,, and
- mental health risks associated with hearing loss.
Another option for helping non- or partial acknowledgers is to ask them to return to the dispensing clinic in 3 to 6 months, but in the meantime, to monitor their hearing abilities in a number of situations so that they may become more aware of how their hearing losses are affecting them and their families. Figures 1, 2, and 3 are sample "self-awareness" materials that may be used to raise the realization that they may be experiencing hearing difficulties.
Obviously the well-meaning family members or friends who cajoled the non- or partial acknowledger into having a hearing test may be disappointed when the audiologist suggests a return to the clinic at a later date. Thus, the audiologist should explain why hearing aids are not being dispensed at this time. The family members should be advised to be patient, to gently explain how the hearing loss is affecting them, and above all, not to nag the person.
Figure 1. Awareness of "tuning out" when listening is difficult.
Figure 2. Awareness of difficulties in noisy conditions and when it is difficult to see the person's lips.
Figure 3. Awareness of how hearing loss may affect family members.
For older adults who fully acknowledge their hearing loss and its effects, it is essential to obtain the older adults' perspectives on communication problems. When evaluating older patients, it may not be enough to consider pure-tone and speech thresholds, and speech recognition measured via word lists presented in quiet. Facets of communication that are actually encountered in everyday communication also need to be addressed. Several questions that may be addressed include:
- What type of situations does the patient find most troubling?,
- Does the patient have difficulties separating out and attending to voices from multiple talkers?
- How much effort is required in difficult versus easy listening conditions, and what effect does this have on the patient?
- Does the patient seem to have difficulties attending to the talker, or switching attention between talkers?
- Does the patient think that his hearing loss is affecting him psychosocially?
Factors Affecting the Provision of Hearing Assistive Technology to Older Adults
There are a number of factors to consider when providing hearing assistive technology to older patients. Manual dexterity may be a problem for many older adults, especially given that arthritis is the most common chronic condition experienced by this population. Other sources of dexterity problems include Parkinson's Disease, secondary effects of strokes, and other neurological problems. Thus, it is essential to assess dexterity of the fingers, hands, and wrists, as well as the ability to raise the arms to the ears. The Purdue Nine Hole Peg Board (Mathiowetz and Weber, 1985; Sharpless, 1976; Tiffin and Asher, 1948) can be used by audiologists to ascertain the patient's degree of dexterity, although many audiologists use a more informal evaluation, such as asking the patient to pick up a sample hearing aid, turn the controls, and lift the aid to the ear. Souza (2004) suggests that if physical dexterity is a problem, the audiologist may want to consider automatic directional hearing aids because a toggle switch or push button may be difficult to manipulate. Likewise, she suggests that hearing aids with automatic telecoils and hearing aids that automatically select the electroacoustic program for different listening situations might be considered for those with dexterity compromises.
In addition to dexterity issues, older adults may also have reduced tactile sensation that may interfere with their abilities to manipulate hearing aid controls, insert hearing aid batteries, and position the hearing aids in their ears. The Semmes-Weinstein Monofilaments test (Bell-Krotoski and Tomancik, 1987; Weinstein, 1993) is an easily administered test of the patient's cutaneous sensory perception, although as with manual dexterity, the audiologist may use informal tactics to determine patient issues with handling the hearing aids.
Another area to consider when fitting older adults with hearing aids is whether they have other sensory deficits. Vision deficits in particular must be addressed when relevant. When the older patient has a dual sensory loss involving poor audition and vision, care in selection of appropriate hearing aids must be taken. Again, hearing aids with automatic features and raised volume controls may be helpful. Other negative effects of visual deficits in elderly patients may be alleviated through the use of modified written materials and magnification devices as suggested by Smith and Kricos (2002). Audiologists who work with older adults need to design written materials with a larger font (e.g., 14 point), dark print on a light background, an uncluttered design, and materials that are printed on non-glossy paper. The sense of touch may also be reduced in many older adults, which may affect the type of hearing aids that are chosen, and the ease with which hearing aids are inserted and removed.
Depending on the patient's word recognition abilities and input, it may be advisable to assess the contributions of the central auditory system to the patient's listening difficulties. If the patient's pure tone thresholds and word recognition in quiet appear to be fairly good, but the patient complains of having hearing difficulties, it is advisable to assess word recognition in noise. Because auditory processing disorders (APD) typically result in difficulties understanding speech in noisy settings, speech-in-noise tests such as the Quick SIN (Etymotic Research, 2001) may be useful, both as pre- and post-intervention measures. Strouse and Wilson (2000) suggest a number of advantages for using dichotic digit materials to determine auditory processing disorders in older adults, including the relative immunity of the digit stimuli to the effects of cochlear hearing impairment, high inter-test reliability, and stimuli that are familiar to most listeners. A potential problem in the average dispensing clinic, of course, is the time demands to administer audiologic tests beyond the standard protocol of immittance, pure tone audiomery, and word recognition testing. However, Strecker and Dancer (2005) argue that an APD screening should be included as part of the routine audiologic evaluation for older adults. They point out that patients will benefit from more appropriate recommendations and more realistic expectations for assistance from hearing aids, and thus be more satisfied with their hearing aids and with our professional services as audiologists.
Recently there has been increasing interest in the potential contributions of cognitive processing to the listening difficulties of older adults. Pichora-Fuller and Singh (2006) and Kricos (2006) have described how normal age-related changes in cognition, such as working memory, attention, and speed of processing, may contribute to everyday listening challenges of older adults. Particularly when listening in acoustically hostile environments, auditory information may be adversely affected due to central cognitive resources being reallocated to support auditory processing. In a reciprocal fashion, this reallocation could lessen the availability of cognitive resources for storage and retrieval functions of working memory (Tun, O'Kane, and Wingfield, 2002; Larsby, Hällgren, Lyxell, and Arlinger, 2005). When trying to understand a talker while also trying to ignore a nearby competing voice, the older adult may experience an increased load on attentional control, due to divided attention at the cognitive level (Tun et al, 2002). In turn, this may place a substantial demand on executive function, the working memory component responsible for scheduling, organizing, and allocating resources for attending to ongoing activities. Given the greater speech recognition problems, slower speed of processing, as well as other normal age-related cognitive abilities, it is not surprising that many older adults report feeling tired after communicating in noisy settings such as church halls or restaurants.
As audiologists and hearing scientists have started identifying the unique challenges faced by many older adults with cognitive components to their hearing difficulties, the hearing aid industry has responded by offering hearing aid signal processing strategies for older adults with hearing loss and cognitive and auditory processing disorders (Souza, 2004). One promising strategy appears to be use of a slower speech-processing algorithm (Cienkowski, 2003). There is some research evidence that older listeners with reduced cognitive abilities may obtain greater benefits from hearing aids when slow-acting compression is used (Gatehouse, Naylor, and Elberling, 2003).
When the older adult exhibits pronounced difficulties in speech recognition in noise, the audiologist needs to be proactive in recommending assistive devices beyond hearing aids. Although many older adults reject the use of FM devices (Boothryd, 2004; Chisolm, McArdle, Abrams, and Noe, 2004), they should still be made aware of the options available to help them understand speech in noisy settings.
Post-Fitting Interventions: Increasing the Likelihood of Successful Hearing Healthcare
There are a number of post-fitting interventions available to help ensure successful hearing aid use and maximum communication abilities for older adults. The importance of post-fitting counseling and support for older adults and their significant others cannot be emphasized enough, given the complexities and challenges experienced by many older adults with hearing loss, as noted above. A collaborative problem-solving approach to helping older adults cope with their listening difficulties is likely to be far more successful than a monologue on the part of the audiologist, in which a one-size-fits-all approach to audiologic management is used (Abrahamson, 2000; Kricos, 1997). Hearing care professionals and patients can identify the everyday listening challenges that are experienced, and then work together to find solutions. There are a number of advantages for offering a collaborative problem-solving approach via group programs that are attended by patients and their frequent communication partners. New hearing aid users realize that other people have problems similar to theirs and receive support from them as well as from the group facilitator. Spouses, and other frequent communication partners obtain a more realistic appreciation of the new hearing aid user's communication problems and they learn strategies for reducing communication breakdowns. Regardless of whether the post-fitting support program is offered in a group format or via individual counseling, or even through recommendations of reading materials or referral to websites such as HealthyHearing.com, the important point is to educate patients about how to manage their hearing losses. Hearing aids alone are probably not going to be enough, especially with this population. Ideally the audiologist will provide communication tips and strategies such as identifying the sources of everyday communication difficulties, suggestions for controlling the communication environment to reduce listening difficulties, and positive and effective ways of repairing communication breakdowns.
Other treatment options include formal listening training, attention to the patient's self-efficacy for managing communication challenges, and clear speech training for frequent communication partners. A formal listening training program was recently developed that seems promising for use with older adults. The Listening and Communication Enhancement (LACE; Sweetow, 2005; Sweetow and Henderson-Sabes , 2004) program is described by its developers as a cost-effective, home-based program to teach listening strategies, build self-efficacy about communication, and address some of the cognitive changes that may detrimentally affect the listening abilities of many older adults. Using interactive and adaptive tasks, the LACE program provides exercises for listening to degraded speech such as rapid time-compressed speech and speech in noise. To improve conversational fluency, the LACE program includes adaptive training activities for cognitive tasks such as auditory memory and speed of processing as well as interactive communication strategies. This training approach seems promising in meeting some of the unique listening challenges of older adults (Sweetow, 2005).
Self-efficacy is another consideration for the older adult who has just received hearing aids. Self-efficacy, as defined by Bandura (1986, 1989), is the domain-specific belief that one can successfully complete a task. Although an older adult may appear to be confident in many areas, such as social interaction, ability to golf, and self-independence, she may not feel confident in her ability to learn how to use hearing aids. Perhaps this is why audiologists frequently hear comments from new hearing aid users such as, "I can't figure out how to tell the right hearing aid from the left," or "I can't remember which program to use when I'm in church." These negative affirmations regarding the ability to learn how to use hearing aids successfully can sabotage the best of hearing aid fittings. According to Bandura (1989), one of the best ways to avoid low self-efficacy is to avoid failure when learning a new task. In the case of the new hearing aid user, that means minimizing problems in handling the hearing aids and learning how to use and care for them. Thus, we see the need for post-fitting support in the form of education and counseling. Bandura (1986, 1989) also encourages vicarious learning such as observing successful role models Therefore, audiologists may want to refer patients with low self-efficacy to venues where they could interact with highly self-assured and positive hearing aid users in the community such as active members of the local Hearing Loss Association of America chapter www.hearingloss.org.
Clear speech training for significant others is another promising tool for helping individuals with hearing loss. In general, studies of clear speech have indicated an approximately 17 to 20% increase in speech intelligibility when speakers were asked to change from use of conversational speech to clear speech. (Helfer, 1998).
The first published study to document benefits of clear speech training was conducted by Caissie et al. (2005). These investigators compared a spouse who received approximately 45 minutes of clear speech instruction to a spouse who was simply asked to speak clearly. The talkers were recorded as they produced sentences in conversational speech conditions, at 1-week post-intervention (intervention being provided for only one of the talkers), and at 1-month post-intervention. The recorded samples were then played back for identification by research participants, half of whom were hearing impaired and half of whom were normal hearing. Interestingly, for the listeners who were hearing impaired, results for the talker who was asked to use clear speech but who received no training showed improvements of 33% and 18% respectively in the 1-wk and 1-mo post-intervention, auditory-only sentence perception testing results. The results with the trained talker were even more impressive. The trained talker's intelligibility improved by 42% and 40% respectively in the post-intervention 1-wk and 1-mo auditory-only testing for the listeners with hearing impairment. These numbers are at least double the improvement in percentage of correct sentences recognized when a speaker attempts, without training, to produce clear speech. In view of normal, age-related changes in speed of processing, it is understandable why the use of slightly slower speech with meaningful pauses is helpful for older adults.
These interventions may significantly alleviate difficulties of older adults with hearing loss as well as those encountered by their families and friends. The author acknowledges that the pre-fitting, fitting, and post-fitting considerations for working with older adults require considerable time, something many audiologists in busy clinics do not have. To streamline the process, the reader may find the tool developed recently by Sandridge and Newman (2006) to be helpful. The nine-item instrument known as the Characteristics of Amplification Tool (COAT) is designed to help the dispensing audiologist consider important audiological and non-audiological pre-fitting issues, choose the best hearing aid fitting, and counsel the patient, in one hour or less. The COAT can be completed in 10 minutes or less, is easy to administer and interpret, and helps the audiologist obtain the important non-audiologic information to determine the patient's technology needs. An attractive feature of the COAT for time-pressed audiologists is that the results provide a guide for realistic counseling during the hearing aid selection appointment.
As a result of increases in active life expectancy, changes in the work force, and changes in the family life course, gerontologists have described a new period of the lifespan referred to as the "Third Age" (Weiss & Bass, 2002). The conception of this cycle of life is that individuals in the Third Age are retired from their lifetime occupations and have fulfilled their primary responsibilities with regard to family formation and childrearing (Weiss & Bass, 2002). Consequently, they are viewed as having new opportunities of how they can live their lives and how they can give meaning and purpose to their remaining years (Weiss & Bass, 2002). As indicated earlier in this article, untreated hearing loss can potentially threaten the active lifestyle pursued by "Third Agers". The emphasis in this article has been on helping older adults live life to the fullest by provision of a comprehensive treatment program to help them overcome their hearing difficulties.
Abrahamson J. (2000). Group audiologic rehabilitation. Seminars in Hearing, 21, 227-235.
Babeu, L., Kricos, P., Lesner, S. (2004). Applications of the Stages-of-Change Model in audiology. Journal of the Academy of Rehabilitative Audiology, 37.
Bagai, A., Thavendiranathan, P., & Detsky, A. (2006). Does this patient have a hearing impairment? Journal of the American Medical Association, 295, 416-428.
Bandura, A. (1986). Self-efficacy. In A. Bandura (Ed.), Social foundations of thought and action: A social cognitive theory (pp. 390-453). Englewood Cliffs, NJ: Prentice-Hall.
Bandura, A. (1989). Regulation of cognitive processes through perceived self-efficacy. Developmental Psychology, 25, 729-735.
Bell-Krotoski, J., & Tomancik, E. (1987). The repeatability of testing with Semmes-Weinstein Monofilaments. The Journal of Hand Surgery, 12A, 155-161.
Boothroyd A. (2004). Hearing aid accessories for adults: The remote FM microphone. Ear and Hearing, 25, 22-33.
Caissie, R., Campbell, M., Frenette, W., Scott, L., Howell, I.., & Roy, A. (2005). Clear speech for adults with a hearing loss: Does intervention with communication partners make a difference? Journal of the American Academy of Audiology, 16, 129-139.
Chisolm TH, McArdle R, Abrams, H, Noe, CM. (2004, November). Goals and outcomes of FM use by adults. The Hearing Journal, (57(11):28-35.
Cienkowski, K. (2003, May/June). Auditory aging: A look at hearing loss in older adults. Hearing Loss: The Journal of Self Help for Hard of Hearing People, 12-15.
Etymotic Research (2001). Quick SIN version 1.3 manual. Accessed 06/23/06 from
Gatehouse S., Naylor G., & Elberling C. (2003). Benefits from hearing aids in relation to the interaction between the user and the environment. International Journal of Audiology, 42, 1S77-1S86.
Haber, D. (2003). Health promotion and aging: Practical applications for health professionals (Third Edition). NY: Springer Publishing.
Helfer K. (1998). Auditory and auditory-visual recognition of clear and conversational speech by older adults. Journal of the American Academy of Audiology, 9, 234-243.
Kochkin, S. (1998). MarkeTrak IV: Correlates of hearing aid purchase intent. The Hearing Journal, 51(1), 30-38.
Kochkin, S. (2000). MarkeTrak V: Why my hearing aids are in the drawer: The consumer's perspective. The Hearing Journal, 53(2), 34-42.
Kochkin, S. (2002). MarkeTrak VI: Ten-year customer satisfaction trends in US hearing instrument market. The Hearing Review. 9(10), 14 18-20, 22-25, 46.
Kochkin S. (2005). MarkeTrak VII: Hearing loss population tops 31 million people. The Hearing Review. 12(7), 16-29.
Kricos PB. (1997). Audiologic rehabilitation for the elderly: A collaborative approach. The Hearing Journal, 1997, 50(2), 10-19.
Kricos, P. (2006). Audiologic management of older adults with hearing loss and compromised cognitive/psychoacoustic auditory processing capabilities. Trends in Amplification, 10(1), 1-28.
Larsby, B., Hällgren, M., Lyxell, B., & Arlinger, S. (2005). Cognitive performance and perceived effort in speech processing tasks: effects of different noise backgrounds in normal-hearing and hearing-impaired subjects. International Journal of Audiology, 44, 131-143.
Mathiowetz, V., & Weber, K. (1985) Adult norms for the 9-hole peg test of finger dexterity. Occupational Therapy Journal of Research, 5, 24-38.
National Council on Aging. (1999). The consequences of untreated hearing loss in older persons. Retrieved June 30, 2006, from www.ncoa.org/content.cfm?sectionID=105&detail=46
Pichora-Fuller, K., & Singh, G. (2006). Effects of age on auditory and cognitive processing: Implications for hearing aid fitting and audiological rehabilitation. Trends in Amplification, 10(1), 28-59.
Sandridge, S.A., & Newman, C.W. (2006). Improving the efficiency and accountability of the hearing aid selection process. Accessed 06/21/06 www.audiologyonline.com/articles/article_detail.asp?article_id=1541
Sharpless, J. (1976). The nine-hole peg test of finger-hand coordination for the hemiplegic patient. In P. Mossman (Ed.), A problem-oriented approach to stroke to stroke rehabilitation (pp. 428-431). New York, NY: Thomas.
Smith, S., & Kricos, P. B. (2002). Rehab for the elderly patient. Advance for Audiologists, 4, 35-37.
Smith, S., & Kricos, P. (2003). Acknowledgement of hearing loss by older adults. Journal of the Academy of Rehabilitative Audiology, 36, 19-28.
Souza, P. (2004). New hearing aids for older listeners. The Hearing Journal, 57(3), 10-17.
Strecker, N., & Dancer, J. (2005). Routine APD screenings needed. Advance for Audiologists, 7, Accessed June 23, 2006 from audiology.advanceweb.com/common/Editorial/PrintFriendly.aspx?CC=50535
Strouse, A., & Wilson, R. (2000). The effect of filtering and inter-digit interval on the recognition of dichotic digits. Journal of Rehabilitation Research and Development, 37, 599-606.
Sweetow, R. W. (2005). Training the adult brain to listen. The Hearing Journal, 58(6), 10-16.
Sweetow, R. W., Henderson-Sabes, J. (2004). The case for LACE (Listening and Communication Enhancement). The Hearing Journal, 57(3), 32-40.
Tiffin, J., & Asher, E. (1948). The Purdue Pegboard: Normative studies of reliability and validity. Journal of Applied Psychology, 32, 234-247.
Tun, P., O'Kane G., & Wingfield, A. (2002). Distraction by competing speech in young and older adult listeners. Psychology and Aging, 17, 453-467.
U.S. Department of Health and Human Services. (2003). A profile of older Americans: 2003. Accessed July 7, 2005, from www.aoa.gov/prof/Statistics/profile/2003/4.asp
Ventry, I., & Weinstein, B. (1982). The Hearing Handicap Inventory for the Elderly: A new tool. Ear and Hearing, 3, 128-133.
Weinstein, S. (1993). Fifty years of somatosensory research: From the Semmes-Weinstein Monofilaments to the Weinstein Enhanced Sensory Test. Journal of Hand Therapy, 6(1), 11-22.
Weiss, R. S., & Bass, S. A. (2002). Challenges of the third age: Meaning and purpose in later life. New York: Oxford University Press.
The author would like to acknowledge the assistance of Shari Kwon, 3rd-year AuD student at the University of Florida, for her assistance with design of Figures 1, 2, and 3.
Sources of Educational Materials for Non-Acknowledgers and Partial Acknowledgers
Organizations and Support Groups
American Academy of Audiology
8300 Greensboro Drive, Suite 750
McLean VA 22102-3611
Hearing Loss Association of America (formerly known as Self Help for Hard of Hearing People, Inc.)
7901 Woodmont Ave, Suite 1200
Bethesda, MD 20914
Say What Club
Dugan, M. (1997). Keys to living with hearing loss. Bethesda, MD: SHHH Publications.
Pope, A. (1997). Hear: Solutions, skills and sources for people with hearing loss. Bethesda, MD: SHHH Publications.
Self Help for Hard of Hearing People, Inc. (2002, March/April). Position statement on hearing aids for people with hearing loss. Hearing Loss.
Trychin, S. (2003). Living with hearing loss workbook. Can be ordered from Sam Trychin, 212 Cambridge Rd., Erie PA 16511. (814) 897-1194.
Wayner, D. S. (1998). Hear what you've been missing: How to cope with hearing loss. New York: John Wiley Publishing.