ISOLATION AND LONELINESS
Isolation can sometimes lead to loneliness, both of which have been associated with poorer health outcomes. Previous virus outbreaks (e.g. SARS in 2003) saw a rise in mental health and psychosocial issues during the outbreak that persisted for many years after.
GPs and allied health professionals are working with the physical and mental health impacts of the acute response phase to COVID-19 now, and will continue to do so during the recovery phase and beyond.
One group particularly susceptible to the negative impacts of forced isolation are those with hearing loss, particularly older adults. Hearing loss is highly prevalent among older adults, affecting over 50 per cent of those in their 70s and over 80 per cent over 80.3 As an ‘at-risk’ group for COVID-19, older Australians are also very likely to be adhering to self-isolation recommendations.
HEARING LOSS AS A CONTRIBUTOR TO MENTAL HEALTH ISSUES
The relationship between hearing loss, and emotional and mental health in older adults is a longstanding research interest of the Ear Science Institute Australia. Emotional distress caused by hearing loss can include feelings of frustration, anger, embarrassment, inferiority, shame, stigmatisation, loss of identity, isolation, and loneliness. Hearing loss is thus considered to be a major contributor to the development of late-life mental health issues, such as anxiety and depression.
During this period of self-isolation, socialising may look different, but the risks posed by social isolation remain the same. It has been recommended that we use creative methods, including digital technology to stay connected with loved ones, continue our jobs and to access medical and allied health services in a safer way.
However, the platforms required to achieve this can be a challenge for those with hearing loss, and they may be at risk of missing out.
HOW GPs CAN PROVIDE ADDITIONAL SUPPORT TO PATIENTS WITH HEARING LOSS DURING COVID-19
Explore potential psychosocial and mental health impacts
GPs play a key role in early identification and timely referral for hearing concerns, representing the first point of contact for many of those seeking help for hearing issues. They also play the same instrumental role for mental health. For this reason, it is important that GPs keep hearing and its relationship with social and mental wellbeing top of mind.
For older adults exhibiting signs of hearing loss, GPs should be mindful to enquire about psychosocial and mental wellbeing in this population, especially now with forced isolation.
Is a telehealth appointment accessible?
Many GP practices are utilising telehealth to continue service delivery to patients in need. One key aspect to keep in mind when delivering telehealth is a person’s communication needs. Some questions to consider include:
- Can the client hear well enough on the phone, or do they require a video conferencing application that provides additional face-to-face and visual cues?
- During video conferencing, should a software platform with live captioning be employed (such as Skype or Microsoft Teams)?
- Can the patient with hearing loss request a well-hearing support person to be present to ensure that information is received correctly?
- Can verbal information and directions be supplemented with written information and directions?
Consider flexible hearing services
Audiologists remain open as an essential service throughout the COVID-19 restrictions, and many practices will also be increasing their phone and video options. This will allow those with hearing difficulties to access advice and interventions that will help them during this time. For those with a more severe hearing loss who may have difficulty accessing phone services, live captioning on video or an in-person visit is key.
Are patients with hearing loss getting additional support?
There are times when people may need to leave their home and communicate with others during COVID-19, for example to buy groceries or attend essential appointments. With the increased use of face masks by the general public, people with hearing loss may have increased difficulty communicating, as they are deprived of vital facial cues. It is important that we consider the additional difficulty that widespread use of facemasks will have on the hearing impaired.
Hearing aids can greatly assist communication and can reduce the negative impacts of social isolation.14 They are designed to improve hearing in certain situations, or to meet listening goals that are most important to a patient. These goals may have changed in light of COVID-19 restrictions, for example a patient who visited family daily may now rely on the phone to communicate with them. It is recommended that they get in touch with their audiologist so they can adjust their hearing aids to meet their current needs.
At times, patients with hearing aids may not be hearing well because their hearing aids need a service or a repair. This may be possible to perform without the patient present. Patients with hearing aids may also consider proactively having their hearing aids cleaned and serviced now, to ensure optimal functioning, in the event of potential tightening of lockdowns.
In both cases, audiological referral can assist. It is recommended that patients call ahead to determine the best way to receive service as there are cases where tele-audiology may be possible.
References available upon request.