Starkey Research & Clinical Blog

You’re getting older. Are your listening demands decreasing?

Wu, Y. & Bentler, R. (2012). Do older adults have social lifestyles that place fewer demands on hearing? Journal of the American Academy of Audiology 23, 697-711.

This editorial discusses the clinical implications of an independent research study and does not represent the opinions of the original authors.

Activities and lifestyle are important considerations for potential hearing aid users because of the variability in listening environments that they may encounter. Individuals who work or have active social lives may be more likely to benefit from advanced signal processing and features like directionality and noise reduction than individuals with less social lifestyles in which a large proportion of time is spent at home or in quiet conditions.

It is often assumed that older individuals have quieter social lives and therefore fewer listening demands. This has been supported by a number of studies showing that older adults report less exposure to noisy environments and less communication demand in a variety of environments (Garstecki & Erler, 1996; Erdman & Demorest, 1998; Kricos, et al., 2007).  Despite the fact that older adults are more likely to experience hearing loss and poorer word recognition ability, older adults generally report less hearing disability and less social or emotional impact from their hearing loss than younger adults do (Gatehouse, 1990, 1994; Gordon-Salant et al., 1994; Garstecki & Erler, 1996; Uchida et al., 2003).  One explanation for this apparent contradiction is that older adults may have less demanding lifestyles than younger adults because they may encounter fewer challenging listening situations. This is assumed to be the case because older adults may participate in fewer social activities and have smaller social networks than younger adults.

The assumption that older adults are less prone to social interaction could be countered by the suggestion that retirement allows more time for social activities that could present communication challenges.  In fact, following retirement, older adults report having more time to travel, visit with family, and volunteer (Wiley et al., 2000).

The purpose of Wu and Bentler’s investigation was to compare auditory lifestyles of younger and older hearing-impaired adults and to study the relationships among age, auditory lifestyle and social lifestyle. They hypothesized that older adults would have quieter, less demanding lifestyles and that the relationship between age and auditory lifestyle would be affected by how socially active the older individuals were.

Twenty-seven hearing-impaired adults, ranging from 40 to 88 years of age, participated in the study. All subjects had symmetrical, sloping, sensorineural hearing losses. The majority of subjects were experienced hearing aid users. Auditory lifestyle, or the auditory environments encountered in typical daily activities, was measured using portable noise dosimeters, worn in a pack over the shoulder, for 7 consecutive days. The dosimeters were capable of measuring overall sound level over time. Though the dosimeters were not capable of specifically measuring signal-to-noise ratio (SNR), previous work has indicated that high overall sound level is associated with low SNR (Pearsons et al., 1976; Banerjee, 2011). Therefore, the authors assumed that the dosimeter reading were providing an indirect measurement of the SNRs encountered in the subjects’ daily lives and offered an indirect assessment of their typical daily listening demands.

Participants supplemented the dosimeter measurements with written journals describing the listening situations that they participated in during the week. They recorded their listening activities as well as the listening environments that they encountered. Listening activities were classified according to 6 categories:

1.              Conversation in small group (3 or fewer people)

2.              Conversation in large group (more than four people)

3.              Conversation on the phone

4.              Speech listening – live talker

5.              Speech listening – media

6.              Little or no conversation

There were five environment categories:

1.              Outdoors – traffic

2.              Outdoors – other than traffic

3.              Home – 10 people or fewer

4.              Indoors other than home – 10 people or fewer

5.              Crowd of people (more than 11 people)

Auditory lifestyle was evaluated with the Auditory Lifestyle and Demand Questionnaire (ALDQ; Gatehouse et al., 1999), which assesses the diversity of listening situations encountered by an individual. It is scaled according to frequency and importance of each situation and higher scores represent more diverse auditory lifestyles.

Social lifestyle was measured with three self-report questionnaires. The Social Network Index (SNI; Cohen et al., 1997) assesses the different social roles or identities held by an individual. For instance, a person could be a spouse, parent, employee or club member. Points are assigned for the various social roles assumed by the individual and higher point values indicate more active social lifestyles.

The second questionnaire, The Welin Activity Scale (WAS; Welin et al., 1992) measures the frequency of 32 activities, divided into three categories: home (e.g., reading), outside home (e.g., dining at restaurant) and social activities (e.g., visiting with friends). Subjects indicate how often they participate in each activity on a 3-point scale.  The sum of points for all activities and for activities outside the home are scored, and higher scores indicate more active lifestyles.

The third scale that was used to measure social lifestyle was the Social Convoy Questionnaire (SCQ; Kahn & Antonucci, 1980; Antonucci, 1986; Lang & Carstensen, 1994).  This questionnaire requires respondents to assign social partners to one of three concentric circles. The ratio of  inner circle partners to those in the outer two circles represents the closeness of social partners. Previous research has shown that younger adults have more peripheral partners than older adults, yielding lower SCQ scores than older adults in general (Lang & Carstensen, 1994).

Journal entries provided information about the proportion of time that subjects spent in speech-related activities, in quiet and noisy conditions. Participants in both age groups spent the highest proportion of time listening to media at home, followed by small-group conversations at home and small-group conversations away from home. The proportion of time spent in phone conversations or outdoors was relatively small for both groups. There were no significant differences between young and old subject groups for the percentages of time spent in any of the activity categories.

Analysis of the dosimetry measurements was conducted to determine the proportion of time participants spent in noisy conditions and the intensity of the sound they encountered.  The sound levels encountered by both groups had a spread of approximately 30dB and not surprisingly, the highest levels occurred in crowds and traffic and the lowest levels occurred at home.  The measured sound levels were higher for younger listeners than older listeners for most of the frequently encountered listening events though age-related differences reached significance for only two events: small group conversation in traffic and media listening in traffic.

ALDQ scores assessed the listeners’ auditory lifestyles and although older subjects had lower scores, suggesting that older listeners experienced less demanding auditory lifestyles, there were no significant differences between the two groups. Social lifestyle was measured with the SNI, WAS and SCQ scales. The only scale to yield a significant age-related difference was the SNI scale, in which younger listeners had higher scores than older listeners. This difference is in keeping with previous reports and indicates that older listeners in this study had less diverse and smaller social networks than younger subjects.

Prior to any further analysis, journal entries and dosimetry information were examined to come up with an indicator of listening demand, which was labeled LD-65. This score represents the amount of time a subject spent in speech-related conditions in which the sound levels were 65dBA or higher. Listeners had indicated that levels of 65dBA were “somewhat noisy”, so levels above this point were assumed to be “noisy”. Therefore, LD-65 was used as a measure of listening demand because higher LD-65 scores indicate that listeners were participating in more speech-related activities in conditions that were likely to be noisy.

Significant correlations were found for age versus SNI as well as age versus LD-65, indicating that older subjects had smaller social networks and were also likely to experience fewer listening demands than younger subjects. Additional analyses were required to determine that the effects of age on listening demand were mediated by social lifestyle. In other words, age did not affect listening demand on its own as much as it did when social lifestyle was also considered.

The results of this study indicate that younger and older adults have similar auditory lifestyles, in terms of the proportion of time they spend in speech-related activities, in quiet and noisy conditions. But whether or not older individuals experience fewer listening demands is a more complicated issue.

Depending upon the analysis, the results of this study may suggest little age-related difference between groups, while contrasting analyses suggest younger adults encountered higher sound levels than older adults did in comparable listening situations. This difference may relate to behavioral as well as situational differences. For instance, younger adults might drive faster, listen to louder music, or drive on the highway more often than older adults, which would have the effect of increasing sound level measurements in these conditions. Similarly, if some of the noisy situations encountered by younger adults were in bars or clubs, they would yield higher sound level measurements than moderately noisy restaurants. Although the age difference for the dosimeter measurements was significant, the difference in mean levels was only 2.8dB. The authors question whether this difference is truly noticeable and appropriately point out that there were not strict controls on placement of the dosimeter packs, so variability in placement could have affected the measurements somewhat.

The findings of this study suggest that assumptions about age should not wholly dictate clinical decisions in structuring a treatment plan so much as social activities and lifestyle should. Certainly, individuals of any age with diverse social activities will experience more listening demands than those with quieter lifestyles. Still, the experiences of employed individuals in the workplace may present more complicated listening demands for reasons other than overall sound levels and duration of exposure.  Employed hearing aid users may experience stress related to their communication ability when interacting with co-workers, managers, and supervisors that is not comparable to the listening demand experienced in purely social situations with similar sound levels. Because the selection of hearing aids can be affected by all of these variables, self-report inventories and detailed clinical histories that illuminate each individual’s social and auditory lifestyle will help to arrive at decisions appropriate for the patient.

 

References

Antonucci, T. (1986). Hierarchical mapping technique. Generations 10 (4), 10-12.

Banerjee, S. (2011). Hearing aids in the real world: typical automatic behavior of expansion, directionality and noise management. Journal of the American Academy of Audiology 22 (1), 34-48.

Cohen, S., Doyle, W., Skoner, D., Rabin, B. & Gwaltney, J. (1997). Social ties and susceptibility to the common cold. Journal of the American Medical Association 277 (24), 1940-1944.

Erdman, S. & Demorest, M. (1998). Adjustment to hearing impairment II: audiological and demographic correlates. Journal of Speech, Language and Hearing Research 41 (1), 123-136.

Garstecki, D. & Erler, S. (1996). Older adult performance on the communication profile for the hearing impaired. Journal of Speech and Hearing Research 39 (1), 28-42.

Gatehouse, S. (1990). The role of non-auditory factors in measured and self-reported disability. Acta Otolaryngologica Supplement 476, 249-256.

Gatehouse, S. (1994). Components and determinants of hearing aid benefit. Ear and Hearing 15 (1), 30-49.

Gatehouse, S., Elberling, C. & Naylor, G. (1999). Aspects of auditory ecology and psychoacoustic function as determinants of benefits from and candidature for non-linear processing hearing aids. In: Rasmussen, A.N., Osterhammel, P.A., Andersen, T., Poulsen, T., eds. Auditory Models and Non-Linear Hearing Instruments. Denmark: The Danavox Jubilee Foundation, 221-233.

Gordon-Salant, S., Lantz, J. & Fitzgibbons, P.J. (1994).  Age effects on measures of hearing disability. Ear and Hearing 15 (3), 262-265.

Kahn, R. & Antonucci, T. (1980). Convoys over the life course: attachment, roles and social support. In: Baltes, P.B., Brim, O.G., eds. Life-span Development and Behavior. San Diego, CA: Academic Press.

Kricos, P., Erdman, S., Bratt, G. & Williams, D. (2007). Psychosocial correlates of hearing aid adjustment. Journal of the American Academy of Audiology 18 (4), 304-322.

Lang, F. & Carstensen, L. (1994). Close emotional relationships in late life: further support for proactive aging in the social domain. Psychology of Aging 9 (2), 315-324.

Pearsons, K., Bennett, R. & Fidell, S. (1976). Speech Levels in Various Environments: Report to the Office of Resources and Development, Environmental Protection Agency. BBN Report #3281. Cambridge: Bolt, Beranek and Newman.

Uchida, Y., Nakashima, T., Ando, F., Niino, N. & Shimokata, H. (2003). Prevalence of self-perceived auditory problems and their relation to audiometric thresholds in a middle-aged to elderly population. Acta Otolaryngologica 123 (5), 618-626.

Welin, L., Larsson, B., Svardsudd, K., Tibblin, B. & Tibblin, G. (1992). Social network and activities in relation to mortality from cardiovascular diseases, cancer and other causes: a 12-year follow up of the study of men born in 1913 and 1923. Journal of Epidemiology and Community Health 46 (2), 127-132.

Wiley, T., Cruickshanks, K., Nondahl, D. & Tweed, S. (2000). Self-reported hearing handicap and audiometric measures in older adults. Journal of the American Academy of Audiology 11 (2), 67-75.

Wu, Y. & Bentler, R. (2012). Do older adults have social lifestyles that place fewer demands on hearing? Journal of the American Academy of Audiology 23, 697-711.

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