1. Widner-Kolberg, By Margaret MA, BSN, RN, CPN


Those with this often invisible disability get little standardized help from our health care system.


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Our society's perceptions of people who have disabilities are changing for the better. Today, people with disabilities are much more visible in everyday places. They successfully work in many different fields.

Figure. Mary Narayan... - Click to enlarge in new windowFigure. Mary Narayan

Most people are unaware that hearing loss is not only a disability but also the third most prevalent chronic health condition among older Americans. Reasons for the high numbers of people with hearing loss include an aging U.S. population, louder environmental noise levels (the Centers for Disease Control and Prevention estimates that up to 12.5% of children and adolescents already have some permanent noise-induced hearing loss), and hundreds of thousands of U.S. veterans returning home with noise-induced hearing loss.


According to a recent study by researchers at Johns Hopkins Medicine, up to 48 million American adults report hearing loss in at least one ear. Hearing loss crosses all ages, diseases, cultures, and races. Yet it is in many cases an invisible disability, one that often goes unrecognized and undertreated. Hearing loss affects patient safety as well as all-important activities of daily living. By impeding communication, hearing loss also contributes to feelings of loneliness, depression, and isolation.


There is much confusion about the difference between people who identify as deaf and those who identify as hard of hearing. These two groups are often linked together, but their methods of communicating are very different. Members of deaf culture mostly communicate using American Sign Language and are proud of their culture. People who consider themselves hard of hearing may be deaf or have less severe hearing loss, but they do not consider themselves part of deaf culture, rarely use sign language, and mostly live in the hearing world. In addition, there are many people with hearing loss who do not even consider themselves hard of hearing, despite their difficulty in understanding conversations.


Health care has methods in place to communicate with those who are deaf. Sign language interpreters are often on staff in hospitals, and some hospitals also use a video interpreter to help ongoing communication. Special phones are in place for the patient and family to use.


But for people who are hard of hearing, there are few written standards of care or assistive devices-often there is no more than a sign placed in a patient's room. Health care personnel are usually not trained in reliable ways of communicating with this population. Although closed captioning is now available on updated television sets, it is still not included in instructional videos.


This is why all health care disciplines should be taught-through standardized programs, policies, and procedures-about helping people who are hard of hearing. Developing such resources need not be costly but should be done with the help of people who are knowledgeable about this disability.


Without an effective means of standardized communication for people with hearing loss, we are left with a serious disconnect regarding important information sharing. This not only reduces the quality of care but can also raise liability issues when it places patients in danger. Applying the correct rules of communication is an acquired skill. An understanding of how people who are hard of hearing hear words will empower professionals to give them the safe care they are entitled to.


In addition, we need more research into how we can best help people in health care settings who are hard of hearing. This is a multifaceted problem that won't be solved by simply speaking louder. I started to lose my hearing as a young nurse and now hear with the help of bilateral cochlear implants. I have worked in nursing for 38 years and still enjoy the job. As my hearing deteriorated, I learned how to advocate for myself so I could stay in the profession I'd chosen. And multiple hospitalizations, not all of them related to hearing loss, taught me what it is like being a patient with hearing loss. It's time for a change-let's start by teaching this public health problem in our nursing schools.