Cochlear Implant Rehabilitation in Older Adults: Literature Review and Proposal of a Conceptual Framework

Abstract

Hearing loss is a prevalent consequence of aging and also poses special challenges for older adults. Particularly when superimposed on other age-related conditions, presbycusis (age-related hearing loss) places the older adult at risk for social isolation and associated psychological and general health sequelae. The increasing cognitive demand of verbal communication, as well as the diminished sense of social and physical connectedness, can furthermore contribute to a feeling of vulnerability and poor health that worsens with advancing presbycusis. This cascade of downstream effects of hearing loss has implications for the self-assessment of health related quality of life (HRQL) and resulting estimates of associated costs. There is accumulating evidence of a potential role for cochlear implants (CI) in older adults with poor word understanding despite conventional hearing aid (HA) usage. In our review of the literature we identify strong evidence for the restoration of communication capacity in the deaf and hard of hearing geriatric population, little published work on communication performance in the real world and HRQL, and significant gaps of knowledge regarding how CI rehabilitation interacts with changing psychosocial and functional status. We therefore propose a broader conceptual framework than is currently available for the role of CI rehabilitation in the management of severe-to-profound hearing loss in older adults. We posit that the use of such a model in future investigations is needed to guide multidisciplinary investigations into the unique challenges of hearing loss in older adults as well as open new opportunities for innovation.

Stationäre Rehabilitationsmaßnahmen bei erwachsenen CI-Trägern

“…Clark et al zeigten in einer Übersichts-arbeit zur CI-Versorgung hochgradig hörgeschädigter geriatrischer Patienten, dass selbst diese Patientengruppe von der CI-Versorgung profitiert [6]. Andererseits besteht derzeit noch weiterer Forschungsbedarf hinsichtlich der rehabilitativen Nachbetreuung dieser Patientengruppe und der Anpassung der Therapiemaßnahmen an die besonderen Bedürfnisse und Voraussetzungen älterer Patienten [5,6].…”

“…Andererseits besteht derzeit noch weiterer Forschungsbedarf hinsichtlich der rehabilitativen Nachbetreuung dieser Patientengruppe und der Anpassung der Therapiemaßnahmen an die besonderen Bedürfnisse und Voraussetzungen älterer Patienten [5,6]. Grundsätzlich bestehen aufgrund verbesserter und schonenderer Operationsverfahren keine besonderen Risiken bei der Implantatversorgung älterer Patienten ohne zusätzliche gesundheitliche Einschränkungen [7].…”

“…Verbesserung kommunikativer Kompetenzen konnten ältere Patienten einen deutlichen Zugewinn an Lebensqualität erlangen [6,15,16]. Hinsichtlich der Steigerung der Sprachwahrnehmung und -verarbeitung mit einem CI bestehen jedoch bei älteren Patienten signifikante Unterschiede zu jüngeren Altersgruppen [9].…”

Cochlear Implants (CIs) and Plasticity of the Auditory System

“…These variability's is related to several factors such as age at onset of hearing loss (before or after language acquisition) (Galey, 1984), duration of hearing loss, status of survival neurons, duration of CI use and speech processing strategies in the device itself. Moreover, temporal and spectral processing capabilities of the patients should be also considered [12,13].…”

“…cases with a severe or profound sensorineural hearing loss that constitute about [11][12][13].5% of the hearing-impaired population. Cochlear implants (CIs) represent important choice in such cases.…”