November 5, 2018
Challenges for the Oldest Older Adults
Dubno (2015) summarized three presentations from the special session at the 2014 Hearing Across the Lifespan (HEAL) conference (June 2014) in Como, Italy. Dubno reports that the oldest older adults refers to those 85 years and older. This group is the fastest growing segment of the population and they have complex needs including co-morbidities that impact communication, cognition, use of technology, dexterity, frailty, physical disabilities, and more. Dubno reports that the oldest older adults are less likely to be employed, are community dwellers, and often have their communication partners as caregivers—often leading to loneliness, social isolation, lower self-rated health, and a lower quality of life. 

Barbara Weinstein focused on auditory changes and the increased need to maintain communication ability, to use hearing aid amplification, and to attend to person-centered care. Marie Oberg spoke of services beyond the audiology clinic, such as primary care and the individual’s capacity for health behavior change and “development of innovative interventions for improved communication skills.” Kathy Pichora-Fuller focused her presentation on the dual loss of hearing and cognition in the oldest old. 

Dubno reports that, “taken together, it is clear…the auditory, cognitive, social, emotional, and lifestyle factors that affect hearing health of the oldest older adult population are highly integrated and cannot be managed in isolation….”

For More Information, References, and Recommendations
Dubno JR. (2015) Research Forum on Challenges in Hearing Health Care for the Oldest Older Adults.  American Journal of Audiology  24(6):98-99.
Ears and Brain
A recent Morning Edition on NPR highlighted the role of hearing aids in slowing the rate of cognitive decline in older adults. The feature highlighted the work of Maharani et al (2018) that examined the relationship. Drawing data from the Health and Retirement Study (HSR), Maharani and colleagues showed that cognitive function based on episodic memory (word recall) was associated with hearing aid use and that decline in episodic memory was mitigated by reported use of hearing aids. The authors reported the rate of decline was reduced by 75 percent. Though interesting findings, the study has numerous limitations. 

First, the episodic memory test is presented orally, thus the presence of hearing loss may compromise the ability to hear the words required for recall. Second, the use of hearing aids was self-reported and did not include information on frequency of hearing aid use. Finally, word recall is not by itself a measure of cognitive function, rather cognitive function and cognitive decline require a battery of testing that address the various domains of cognition. For more information check out the segment on NPR .

Reference
Maharani et al. (2018) Longitudinal relationship between hearing aid use and cognitive function in older americans, J. Am Geriatrics Soc .
National Academies Workshop on The Role of Nonpharmacological Approaches to Pain Management 
Pain is a leading cause of disability in the United States. Given the complexity and biobehavioral nature of pain, the 2011 Institute of Medicine report on Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research advocated for multifaceted approaches for pain management comprised of both pharmacological and nonpharmacological therapies. In 2017, the National Academies of Sciences, Engineering, and Medicine's report on Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use reviewed the status of available evidence on nonpharmacological therapies for managing chronic pain. For example, cognitive behavioral therapy, a type of psychotherapy focused on restructuring negative thoughts and experiences with positive expectations, has been shown to be effective in reducing pain intensity and other psychological effects caused by pain for low back pain, headaches, arthritis, orofacial pain, and fibromyalgia.

As a result of this national push toward the use of nonpharmacological therapies for chronic pain, increased health professionals' education and training will be needed to encourage the adoption and appropriate use of the evidence-based approaches. In addition, addressing policy barriers, such as those related to reimbursement for these treatments will be important to enable broader use and dissemination. Given the changing landscape for pain management, the Forum on Neuroscience and Nervous System Disorders and the Global Forum on Innovation in Health Professional Education  will host a public workshop on December 4–5, 2018, bringing together key stakeholders, to discuss these treatments and integrative health models for pain management. 

For more information, including the public agenda, please c lick here .