5Ms of Working with Older Adults: Implications for Hearing Health Care

The American Geriatrics Society recently updated the minimum geriatrics competencies for graduating medical students, which was created to ensure that graduates of U.S. medical schools are prepared to provide high-quality interdisciplinary care for people as they age.1 The 27 competencies bring together recent concepts which have emerged in the field of geriatrics, ranging from person-centered care and falls risk screening/management to cognitive well-being. Framed around five key areas, the 5Ms listed in Table 1 represent the skills, knowledge, and abilities deemed essential to the delivery of quality care to older adults. Hearing status and access to spoken communication are directly relevant to the 5Ms. Hearing health care stakeholders should leverage available evidence and address how the management of hearing health can help medical professionals realize these minimal competencies. Multi-disciplinary collaboration by both hearing health care and primary care professionals must include some form of informal screening to identify persons at high risk for hearing loss along with efforts to increase access to hearing interventions which can help to optimize well-being throughout prolonged life spans.2,3Shutterstock/thodonal88, audiology, health care, public health.Table 1: Minimum Competencies in Geriatrics Medical School Graduates Must be Able to Demonstrate2Table 2: Questions to Determine When to Refer a Patient to a Hearing Health Care Professional (adapted from SAC Speech-Language & Audiology Canada)Table 3: Age-Related Hearing Loss and the Five “Ms”5MS & HEARING HEALTH CARE The competencies listed in Table 1 are of relevance to primary care doctors who work with older adults with hearing loss whose hearing capacity remains undervalued, underappreciated, and undertreated. As champions of hearing health care, we have an obligation to underscore for our medical colleagues that hearing is the sense older adults rely upon to communicate and engage with others.4 Physicians must understand that when hearing loss is unaddressed and spoken communication needs unsupported, the downstream impacts are dramatic, especially for persons with multimorbidity. We must stress the fact that the trajectory will depend in large part on whether or not hearing loss is addressed.4 We must begin by emphasizing the following facts: (1) close to, 91% of adults with hearing loss are aged 50 years and older; (2) nearly 25 percent of persons aged 65 to 74 and 50 percent of those who are 75 and older have disabling hearing loss; (3). about 28.8 million U.S. adults could benefit from using hearing aids; and, (4) the rate of hearing aid use is very low among older adults even though most hearing aid users are older.3-6 In my view hearing status and the fifth “M,” namely what matters most dovetails well with the first “M” the mind and hearing status intersects with both. The fifth “M” relates to health outcomes, care preferences, transitions in care, and the import of effective communication. Patient-provider communication is an essential component of this “M and hearing status of course is at the heart of the delivery of appropriate and effective communication in clinical settings.7 For persons with cognitive or functional impairments, techniques must be adapted to avoid misunderstandings. Primary care physicians must come to understand the relevance of hearing status to quality of life and safety of care offered to older adults especially for persons with co-existing functional impairments such as mobility limitations or low vision. We must provide specific tips about how to recognize or detect when hearing status may be compromised, potentially impacting health outcomes and treatment adherence.8 These tips are especially important as doctors are unlikely to take/have the time to routinely conduct a formal hearing screen because “throughput” is such an essential part of the current health care delivery model. As an alternative to a formal hearing screen, some of the questions shown in Table 2 should be shared with our medical colleagues as a basis for referrals for hearing health care. It is imperative that we connect hearing status with the What Matters Most “M” to the Mind “M” and the Mobility “M, as well.” Emphasizing that the impacts of unrecognized/untreated hearing loss are not benign and are not solely sensory can help ignite readiness to change the mindsets of medical professionals. The compelling evidence regarding the impacts of age-related hearing loss is shown in Table 3 where I relate each M to selected hearing-related impacts. The latter evidence combined with data supporting the availability and efficacy of a wide variety of cost-effective interventions to address the burden of ARHL should be detailed to help convince stakeholders of the importance of collaborating with hearing health care professionals to help optimize care delivery and well-being. The burden and costs of ARHL are both misunderstood and undervalued. After low back pain and migraine, ARHL was ranked third as the largest cause of global YLD in 2019. Notably, it was ranked first among sensory disorders.3 Given, the strong associations between hearing loss, age, and increasing life expectancy it is abundantly clear that if people live long enough they will, at some point, experience hearing loss with at least 50% having moderate-to-complete hearing loss requiring intervention.3 Since the consequences of ARHL are both far-reaching and increasingly gaining acceptance, we must, as a profession, work together to change the mindsets of stakeholders who question the “game-changing and varied interventions available and effective at different stages across the life course.4 In short, age is no longer a barrier, to hearing rehabilitation, be it the use of digital hearing aid technology, cochlear implantation, or self-fitting hearing aids. We have a pressing obligation to educate primary care professionals who work with older adults about how the variety of available hearing health care interventions intersect with the 5Ms to help optimize both physical and mental capacity.6

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