Care of the resident with hearing impairment, long-term care
听障居民的护理、长期护理Revised: February 20, 2024
Introduction
介绍
An estimated 25% of people ages 65 to 74 and 50% of people ages 75 and older have disabling hearing loss.1 Hearing impairment is most common in older white males and can lead to social isolation, decreased mobility, reduced cognitive functioning, and altered quality of life. People with hearing loss may appear uninterested in social activities, frustrated, angry, or ambivalent. Among adults with sensory impairments that include vision and hearing alterations, those who have hearing alterations are much less likely to seek out medical consultation (76.3%) compared with those who have vision disturbances (98.8%). Although the use of glasses is commonplace for vision alterations (93%), the use of hearing aids is much less common (30%).12
据估计，25% 的 65 至 74 岁人群和 50% 的 75 岁及以上人群患有残疾性听力损失。1 听力障碍在老年白人男性中最为常见，可导致社交孤立、行动不便、认知功能下降和生活质量改变。听力损失的人可能看起来对社交活动不感兴趣、沮丧、愤怒或矛盾。在患有感觉障碍（包括视力和听力改变）的成年人中，与视力障碍者 （98.8%） 相比，有听力改变的人寻求医疗咨询的可能性要小得多 （76.3%）。虽然使用眼镜对视力改变很常见 （93%），但使用助听器的情况要少得多 （30%）。12
Due to the high incidence of hearing loss in older adults, all people ages 65 and older should be screened for hearing loss on admission to a long-term care facility and regularly thereafter. Although the U.S. Preventive Services Task Force doesn't recommend routine hearing screening for asymptomatic adults older than age 50, it does support screening and intervention strategies for adults who present with perceived hearing problems or cognitive or affective symptoms that are commonly related to hearing loss.3 Hearing screening can be performed using several methods, including the whisper test, finger rub, watch tick test (if you have a watch that audibly ticks), single-question test, and screening questionnaires.3 Handheld audiometric devices can also be used as a means to assess hearing acuity.4
由于老年人听力损失的发病率很高，因此所有 65 岁及以上的人在入住长期护理机构时都应接受听力损失筛查，此后应定期接受筛查。尽管美国预防服务工作组不建议对 50 岁以上的无症状成年人进行常规听力筛查，但它确实支持对出现感知到的听力问题或通常与听力损失相关的认知或情感症状的成年人进行筛查和干预策略。3 听力筛查可以使用多种方法进行，包括耳语测试、手指摩擦、手表滴答测试（如果您的手表可以听到滴答声）、单题测试和筛查问卷。3 手持式测听设备也可用作评估听力敏锐度的手段。4
Communicating with residents who are hearing impaired presents challenges in long-term care facilities as staff members strive to assess residents' needs and facilitate effective communication. Age-related hearing loss (presbycusis) is the most prevalent type of hearing loss among older adults. Presbycusis most commonly results from gradual changes in the middle ear and involves high-pitched sounds (for example, s, sh, f, and ph sounds). Because this hearing loss develops gradually, many affected individuals are unaware of it; however, others around them may notice the decline in functioning hearing. This type of hearing loss, known as sensorineural loss, results from a defect in the middle ear or auditory nerve. It commonly includes impaired speech discrimination.5
与听力受损的住户沟通给长期护理机构带来了挑战，因为工作人员会努力评估住户的需求并促进有效的沟通。年龄相关性听力损失（老年性耳聋）是老年人中最普遍的听力损失类型。老年性聋最常见的原因是中耳的逐渐变化，涉及高音调的声音（例如，s、sh、f 和 ph 音）。因为这种听力损失是逐渐发展的，所以许多受影响的人没有意识到它;然而，他们周围的其他人可能会注意到听力功能的下降。这种类型的听力损失，称为感音神经性减退，是由中耳或听觉神经缺陷引起的。它通常包括言语辨别能力受损。5
Optimal treatment of hearing loss usually involves an evaluation for amplification in the form of hearing aids. Although some residents can benefit from cochlear implants, most older adults are treated with hearing aid devices. Common barriers to obtaining hearing aids include comfort, cost, and resident acceptance of the need for a hearing aid.5 As hearing aid devices have advanced with modern digital technology, the costs have also increased and often aren't covered by private insurance carriers or Medicare.5 In addition to cost issues, some residents may be reluctant to use hearing aids due to dissatisfaction with their performance in certain settings. The need for effective communication strategies is particularly important for residents who have hearing impairment but choose not to use hearing aids or can't afford them.
听力损失的最佳治疗通常包括以助听器的形式评估放大。尽管一些居民可以从人工耳蜗中受益，但大多数老年人都接受助听器设备治疗。获得助听器的常见障碍包括舒适度、成本和居民对助听器需求的接受度。5 随着助听器设备随着现代数字技术的进步，成本也随之增加，而且私人保险公司或 Medicare 通常无法承保。5 除了成本问题外，一些居民可能由于对助听器在某些环境中的性能不满意而不愿意使用助听器。对于有听力障碍但选择不使用助听器或买不起助听器的居民来说，需要有效的沟通策略尤为重要。
To ensure that residents receive proper treatment and assistive devices to maintain hearing, federal regulations state that a long-term care facility must help residents, if necessary, make appointments with professionals who specialize in hearing assistive devices as well as arrange for transportation to and from those appointments.6 The facility should also provide hearing amplifiers, communication boards, and interpreters for residents, as necessary.7
为了确保居民得到适当的治疗和辅助设备以保持听力，联邦法规规定，如有必要，长期护理机构必须帮助居民与专门从事听力辅助设备的专业人员预约，并安排往返这些预约的交通。6 必要时，该设施还应为住户提供助听器、通信板和口译员。7
Equipment
设备
Light source 光源
Optional: hearing aid, hearing aid battery or battery charger
可选：助听器、助听器电池或电池充电器
Preparation of Equipment
设备准备
Inspect all equipment and supplies. If a product is expired, is defective, or has compromised integrity, remove it from patient use, label it as expired or defective, and report the expiration or defect as directed by your facility.
检查所有设备和用品。如果商品已过期、有缺陷或完整性受损，请将其从患者使用中移除，将其标记为已过期或有缺陷，并按照您的设施的指示报告过期或缺陷。
Prepare the hearing aid for use according to the manufacturer's instructions. Hearing aids may need regular battery replacement or daily charging. Assist the resident, as necessary.
根据制造商的说明准备助听器以供使用。助听器可能需要定期更换电池或每天充电。必要时协助住户。
Implementation
实现
Perform hand hygiene.8910
保持手部卫生。8910Assist the resident with using a hearing aid, if applicable. (See the "Hearing aid care" procedure.)
协助住户使用助听器（如果适用）。（参见 “助听器护理” 程序。Face forward and look into the resident's face when speaking. A forward-facing position enables the resident to view your face and is associated with more-effective communication exchanges.11
说话时面朝前方并看着住户的脸。前向位置使居民能够看到您的面部，并与更有效的沟通交流相关联。11Be respectful when speaking to the resident. Avoid appearing frustrated or rushed because these actions may be perceived negatively by the resident and can deter future interactions due to shame, embarrassment, or guilt.12
与居民交谈时要尊重。避免显得沮丧或匆忙，因为这些行为可能会被居民负面看待，并且可能会因羞耻、尴尬或内疚而阻止未来的互动。12Ensure that the lighting is adequate during conversation and that it's positioned in a way that allows maximum visualization of the speaker's face. (For example, place the light in front of you.) Providing adequate lighting enables the resident to observe facial expressions, gestures, and lip and body movements that provide communication cues.12
确保在通话期间光线充足，并且其位置可以最大限度地看到说话者的面部。（例如，将灯放在您面前。提供足够的照明使居民能够观察提供交流线索的面部表情、手势以及嘴唇和身体运动。12When engaging in conversation, decrease environmental sounds by turning off radios and televisions and closing doors, as necessary. External environmental noise increases the possibility that the resident won't be able to specifically discriminate your voice and decreases effective communication and the resident's ability to hear the conversation clearly.5
交谈时，必要时关掉收音机和电视并关上门，以减少环境声音。外部环境噪音会增加住户无法专门区分您的声音的可能性，并降低有效沟通和住户清晰听到对话的能力。5During conversation, don't chew gum, eat, drink, or cover your mouth while speaking. Eating and other activities can distort speaking, making it more difficult for someone with a hearing impairment to understand what's being said. Unintentionally covering your mouth with hand gestures can also negatively affect communication effectiveness.5
交谈时，不要嚼口香糖、吃东西、喝水或说话时捂住嘴巴。进食和其他活动会扭曲说话，使听力障碍者更难理解所说的内容。无意中用手势捂住嘴也会对沟通效率产生负面影响。5Speak slightly louder than normal, but don't shout. Shouting inadvertently distorts normal speech, making comprehension more difficult.4
说话的声音比平时稍微大一些，但不要大声喊叫。大喊大叫会无意中扭曲正常言语，使理解更加困难。4Speak clearly at a normal rate without exaggerating sounds. Exaggerating sounds distorts the normal speech pattern, making comprehension more difficult.4
以正常的语速清晰地说话，不要夸大声音。夸张的声音会扭曲正常的语音模式，使理解更加困难。4Provide clues about the topic of conversation, whenever possible, to help the resident follow the conversation.12
尽可能提供有关对话主题的线索，以帮助住户跟踪对话。12Observe the resident for cues that comprehension is occurring. If the resident appears to have difficulty with the conversation, use shorter, simpler, more direct sentences, which are easier to understand than long, complex sentences.12
观察居民以寻找正在发生理解的线索。如果住户似乎在对话中遇到困难，请使用更短、更简单、更直接的句子，这些句子比长而复杂的句子更容易理解。12When engaging a resident in conversation, try to relocate the interaction to a quiet location with little background noise and extraneous conversations. Crowded locations make communication more difficult for a resident with a hearing impairment because external noises distort the noises being perceived.
在与住户交谈时，尝试将互动转移到一个安静的地方，没有背景噪音和无关的对话。拥挤的地方使听力障碍的居民更难进行交流，因为外部噪音会扭曲感知到的噪音。Perform hand hygiene.8910
保持手部卫生。8910Document the procedure.13
记录过程。13
Special Considerations
特别注意事项
Older adults should have their ears examined. If cerumen is present, remove it because cerumen impaction can reduce hearing.14 Don't insert cotton-tipped swabs into the ear canal because they push cerumen deeper into the ear and may worsen impaction or traumatize the ear canal.15
老年人应该检查他们的耳朵。如果存在耵聍，请将其切除，因为耵聍嵌塞会降低听力。14 不要将棉签插入耳道，因为它们会将耵聍推入耳朵更深处，并可能加重嵌塞或使耳道受到创伤。15Older residents who are frail, those with other health-related conditions, and those who have limited mobility may have difficulty with proper positioning and with implementing other interventions for effective communication. For these residents, consider using assistive communication devices, such as hearing amplifiers.14
体弱的老年居民、患有其他健康相关疾病的人以及行动不便的居民可能难以正确定位和实施其他干预措施以进行有效沟通。对于这些居民，请考虑使用辅助通信设备，例如助听器。14
Resident Teaching
驻地教学
When assistive communication devices are required, teach the resident and family (if applicable) how to use them effectively. Have them teach back the information provided to ensure their understanding.
当需要辅助通信设备时，教住户和家人（如果适用）如何有效地使用它们。让他们把提供的信息传授给他们，以确保他们理解。
Complications
并发症
Complications associated with hearing impairment care may include:
与听力障碍护理相关的并发症可能包括：
psychological effects 心理影响
embarrassment 困窘
guilt 内疚
shame 羞耻
social isolation 社交孤立
safety issues 安全问题
inability to adequately hear announcements, instructions from caregivers, fire alarms, and other safety-oriented instructions.2
无法充分听到公告、护理人员的指示、火警和其他以安全为导向的指示。阿拉伯数字
Documentation
文档
Documentation associated with hearing impairment care includes:
与听力障碍护理相关的文件包括：
specific communication strategies used to ensure proper communication and adequate understanding (for example, recording that you gave directions in the resident's room with the door closed and the radio and television off)
用于确保正确沟通和充分理解的具体沟通策略（例如，录制您在住户房间关门、收音机和电视关闭的情况下给出指示）teaching provided to the resident and family (if applicable)
为住户和家庭提供的教学（如适用）understanding of that teaching
对该教义的理解follow-up teaching needed.
需要后续教学。
Related Procedures
相关程序
Hearing aid care 助听器护理
References
引用
(Rating System for the Hierarchy of Evidence for Intervention/Treatment Questions)
（干预/治疗问题证据层次结构的评级系统）
National Institute on Deafness and Other Communication Disorders. (2021). Quick statistics about hearing. Retrieved January 2024 from https://www.nidcd.nih.gov/health/statistics/quick-statistics-hearing
国家耳聋和其他沟通障碍研究所。（2021）. 关于听力的快速统计。2024 年 1 月从 https://www.nidcd.nih.gov/health/statistics/quick-statistics-hearing 检索Cox, R. M., et al. (2014). Impact of advanced hearing aid technology on speech understanding for older listeners with mild to moderate, adult-onset, sensorineural hearing loss. Gerontology, 60(6), 557–568. Retrieved January 2024 from https://doi.org/10.1159/000362547 (Level VI)
Cox， RM 等人（2014 年）。先进的助听器技术对患有轻度至中度成人发病的感音神经性听力损失的老年听众的语音理解的影响。老年学，60（6），557-568。2024 年 1 月从 https://doi.org/10.1159/000362547 检索（VI 级）Abstract 抽象 | Complete Reference
|完整参考| Full Text |全文 U.S. Preventive Services Task Force. (2021). Screening for hearing loss in older adults: U.S. Preventive Services Task Force recommendation statement. Journal of the American Medical Association, 325(12), 1196–1201. Retrieved January 2024 from https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/hearing-loss-in-older-adults-screening (Level VII)
美国预防服务工作组。（2021）. 老年人听力损失筛查：美国预防服务工作组推荐声明。美国医学会杂志，325（12），1196-1201。2024 年 1 月从 https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/hearing-loss-in-older-adults-screening 检索（VII 级）Chou, R., et al. (2011). Screening for hearing loss in adults ages 50 years and older: A review of the evidence for the U.S. Preventive Services Task Force (AHRQ Publication No. 11-05153-EF-1). Agency for Healthcare Research and Quality. Retrieved January 2024 from https://www.ncbi.nlm.nih.gov/books/NBK53864/ (Level VII)
Chou， R. 等人（2011 年）。筛查 50 岁及以上成年人的听力损失：美国预防服务工作组的证据回顾（AHRQ 出版物编号 11-05153-EF-1）。医疗保健研究和质量局。2024 年 1 月从 https://www.ncbi.nlm.nih.gov/books/NBK53864/ 检索（VII 级）Pacala, J. T., & Yueh, B. (2012). Hearing deficits in the older patient: "I didn't notice anything." Journal of the American Medical Association, 307(11), 1185–1194. Retrieved January 2024 from https://doi.org/10.1001/jama.2012.305
帕卡拉，J. T.，& Yueh，B. （2012）。老年患者的听力缺陷：“我什么都没注意到。美国医学会杂志，307（11），1185-1194。2024 年 1 月从 https://doi.org/10.1001/jama.2012.305 检索
