Effects of Group Composition in Audiologic Rehabilitation Programs for Hearing Impaired Elderly

Abstract
This study investigated the effect of rehabilitation group composition on self-perception of handicap and satisfaction with the audiologist in hearing impaired elderly. Group compositions included subjects only, subjects and a support spouse, and subjects and a support peer. Results indicated that the participation of support members made a significant difference in HHIE and ACES-E scores.

Introduction

Elderly patients present unique challenges when they undergo audiologic evaluation and rehabilitation. An individual's response to audiologic rehabilitation programs is affected by a variety of factors, including personality, general health, age and gender, financial capabilities, motivation, social activities, and reactions by family and friends (Taylor & Jurma, 1997; Garstecki & Erler, 1999; Barry & McCarthy, 2001; Barry & Barry, 2002). In short, elderly populations can face difficulties with rehabilitation programs both related and unrelated to degree of measured hearing loss. Implementing effective counseling methods into the rehabilitative process is critical to success, particularly with the elderly. It has been established that rehabilitation/counseling programs are beneficial in promoting successful use of amplification with elderly patients (Kricos & Holmes, 1996; McCarthy, 1996). Further, rehabilitation and counseling programs have been shown to be helpful in reducing self-perception of handicap (Malinoff & Weinstein, 1989). Taylor and Jurma (1999) reported that group rehabilitation programs were effective in reducing self-perceived handicap when used with the elderly. Integrating social contacts with traditional rehabilitation strategies can increase patients' personal involvement in their rehabilitation programs and motivation to seek help in dealing with their hearing loss. Such an environment provides a cooperative climate for patient growth through the assimilation and application of information regarding strategies for coping with hearing loss.

Two indicators of the relative effectiveness of group audiologic rehabilitation programs are patient perception of handicap and patient perception of audiologist effectiveness. To that end, the use of self-assessment data to document positive outcomes as a result of amplification and rehabilitation has become both a clinical practice and a research priority.

The inventory that has been used extensively in self-perceived handicap is the Hearing Handicap Inventory for the Elderly (HHIE) developed by Ventry and Weinstein (1983). The HHIE uses a self-report methodology with a series of statements probing social and emotional responses to hearing impairment using a yes/no/sometimes format. The paradigm used to measure hearing benefit and/or perceived degree of handicap in most of these studies involved administration of the HHIE on a pre- and post-hearing aid fitting/pre- and post rehabilitation program basis. Outcome is measured by comparing the degree of handicap assessed in each administration of the questionnaire. Positive outcome is defined as a reduction in self-perceived hearing handicap as a result of amplification and/or rehabilitation. The Audiologist Counseling Effectiveness Scale for the Elderly (ACES-E) developed by Taylor (1993b) is designed to assess satisfaction of elderly patients with the counseling they receive from their audiologists. The ACES-E is composed of 26 items that assess patients' perception of audiologists' counseling and service provision in the emotional and informational domains. Patients react to statements by indicating their degree of agreement using a 5-point scale anchored by (1) not at all and (5) strongly agree. The ACES-E can be used in conjunction with other indices like the HHIE to interpret patients' reactions to audiologic rehabilitation programs and to tailor treatment protocols to the needs of particular patients.