Health CommitteeWritten evidence from Action on Hearing Loss (LTC 83)

About us

Action on Hearing Loss is the new name for RNID. We’re the charity working for a world where hearing loss doesn’t limit or label people, where tinnitus is silenced—and where people value and look after their hearing.

Our response focuses on key issues that relate to people with hearing loss. Throughout this response we use the term “people with hearing loss” to refer to people with all levels of hearing loss and tinnitus, including people who are profoundly deaf. We are happy for the details of this response to be made public.

Introduction

Action on Hearing Loss welcomes the opportunity to provide written evidence on the management of long-term conditions within the NHS and social care system. Hearing loss is a long term condition affecting over 10 million people in the UK—one in six of the population.1 Our recently released evidence-based report Joining up2 showed how large cost savings and improvements to quality of life could be achieved from better provision of health and social care services to people who have hearing loss and also have other long-term conditions.

Summary

Long-term conditions are not experienced in isolation. 71% of people over 70 years have hearing loss, many of whom are likely to have one or more other long-term conditions. There are also additional associations between some conditions—for example there is strong evidence of a link between hearing loss and dementia.

Proper diagnosis and management of hearing loss can ensure proper communication with health professionals, access to services and information, and reduce the risk and improve the management of other long-term conditions.

Health professionals providing care should enquire about whether the person has a hearing loss and refer them on. Hearing checks should be carried out in a range of settings and a hearing screening campaign should be introduced, to ensure people get help for their hearing loss.

Health and social care services, health promotion campaigns and information should be provided in ways that are accessible to people with hearing loss. Staff should be trained, and communication support and assistive technologies should be provided.

Better diagnostic tools, specialist services and guidance should be developed to support people with hearing loss who also have other long term conditions.

Resources should be allocated in a cost effective way. For example, the lack of resource allocated to hearing loss within the National Dementia Strategy for England should be reviewed.

Such changes could lead to greatly improved management of long-term conditions and large cost savings, by improving communication, lowering the rate of hospital admissions and the need for specialist care, and delaying entry into residential care.

Hearing Loss and Other Long-Term Conditionsi an Ageing Population

1. Because of the high prevalence of many long term conditions in older people, the numbers of people being affected are increasing, and long term conditions are often not experienced in isolation. For example, one in 14 people aged 65 and over has some form of dementia,3 and at least one in eight has diabetes.4

2. Hearing loss is even more widespread; it affects 10 million people of all ages in the UK—one in six of the population. As our society ages this number is set to grow and by 2031 there will be more than 14.5 million people with hearing loss in the UK.5 Hearing loss has significant personal and social costs and leads to high levels of social isolation and consequent mental ill health, and it can increase the risk and impact of other long-term conditions such as dementia. In turn, effective diagnosis and management of hearing loss can minimise these impacts on peoples’ lives.

3. Age-related damage is the single biggest cause of hearing loss, which means that older people are very likely to experience hearing loss. Hearing loss is experienced by almost three quarters (71%) of all people over 70 years,6 most of whom will benefit from hearing aids and support, allowing them to communicate well and avoid social isolation, and a large number of whom will have one or more other long term conditions. Hearing loss can have particularly significant impacts on the management of other long-term conditions:

3.1Unmet communication needs, arising from unmanaged hearing loss, pose a challenge to provision of care and hence the wider management of other long term conditions.

3.2People with hearing loss experience greater difficulties in accessing health and social care services and public health information, and receive a lower standard of health service across the board.

3.3Unmanaged hearing loss can bring about challenges in terms of the management of particular conditions such as diabetes, where patients can play a large role in self-managing their condition, so effective communication with health professionals is essential.

3.4Particular psychological and behavioural challenges can result where people have unmanaged hearing loss alongside other conditions that can cause additional communication difficulties such as stroke, dementia, sight loss or Parkinson’s.

4. It is essential that the high and increasing prevalence of hearing loss and its co-occurrence with other long-term conditions are taken into account as they have implications for the diagnosis, progression and management of people with all long term conditions.

5. Despite the high prevalence of hearing loss and its significant impacts on individuals, especially where they have one or more other long-term conditions, many people who have hearing loss do not seek help. An estimated four million people have unaddressed hearing loss. It takes 10 years on average for people with hearing loss to seek help, and even when they do, 45% of GPs fail to refer them on.7 It is therefore vital that hearing loss is diagnosed and managed earlier and more effectively, and that services are improved for people with hearing loss and other long-term conditions.

Improving the Management of Multiple Conditions

6. Given the high prevalence of many long-term conditions in older groups, we would expect many of these conditions to occur alongside each other. There is also evidence of stronger associations between some of the conditions.8

7. In particular, there is now evidence that hearing loss is linked to a decline in cognitive function and dementia.9 ^, 10 ^, 11 ^, 12 People with mild hearing loss have nearly twice the chance of going on to develop dementia as people with normal hearing, and the risk increases to threefold for those with moderate and fivefold for those with severe hearing loss.13 Evidence suggests that social connectedness reduces the risk of developing dementia,14 ^, 15 ^, 16 so it may be the social isolation resulting from unaddressed hearing loss that increases the risk of dementia.

8. Services must become better at treating hearing loss and dementia when they are experienced together. Not only is hearing loss often undiagnosed, but hearing loss may be misdiagnosed as dementia or make the symptoms of dementia appear worse, or dementia may be underdiagnosed because of hearing loss or deafness.17 ^, 18 Where both conditions are present, their diagnosis, impact and management can be complicated. For example, where unaddressed hearing loss causes communication problems in people with dementia, this can lead to behavioural and psychological problems which could have been avoided by better diagnosis and management. Both hearing loss and dementia need to be addressed early19 and when they are diagnosed and treated they should take into account each other’s challenges. For example, one study found that only 5% of care home residents, many of whom had dementia, were able to complete a full audiometric assessment.20 Specialist diagnostic tools as well as improved management (such as through well-maintained hearing aids and support) are needed.21

9. Cardiovascular disease, diabetes and hypertension are all correlated, and there is some evidence that there may be a link between these conditions and hearing loss.22 This may be due to a lack of access to prevention services and public health information among people with hearing loss and deaf people,23 ^, 24 ^, 25 suggesting that these services and information should take account of hearing loss and be made more accessible.26

10. Where other conditions such as stroke, Parkinson’s and sight loss themselves affect communication, they can compound communication issues in people who also have hearing loss or who are deaf, requiring very specialised diagnostic tools and management.27 ^, 28 ^, 29 ^, 30 ^, 31 ^, 32 ^, 33 Sudden hearing loss can increase the risk of stroke, and stroke itself can cause hearing impairment, meaning these two conditions are likely to occur together.34 ^, 35 ^, 36 There is also evidence of correlation between diabetes and hearing loss, and particular implications for the management of diabetes, as patients with diabetes can play a large role in self-managing their condition, so effective communication with health professionals is essential.37 Given the high levels of co-occurrence, it is crucial that services for cardiovascular disease, stroke, Parkinson’s, sight loss and diabetes take account of hearing loss.38

Designing Integrated Services for People with Long-Term Conditions

11. Despite the evidence that people often experience long-term conditions together, they are often addressed separately. Government plans have emphasised better management of services for people with long-term conditions,39 ^, 40 ^, 41 ^, 42 ^, 43 but they have tended to treat long-term conditions in isolation. For example, the National Dementia Strategy for England44 does not acknowledge the need to manage hearing loss in people with dementia. The planning of services, diagnosis and management for each long-term condition needs to take the others into account.

12. In the case of hearing loss, relatively low cost interventions such as hearing aids can improve communication, quality of life and social relationships.45 Hearing aids allow individuals to communicate better with health professionals and ensure that other long-term conditions can be managed effectively. Hearing aids may also particularly help people at risk of or who have dementia, as they may improve cognitive function46 ^, 47 or slow down the deterioration in cognitive function.48

13. There are a number of steps that are not currently being taken that can allow for the effective management of other long-term conditions among people with hearing loss, improve quality of life, and save money.49

13.1GPs and all health professionals should be aware of the high prevalence of hearing loss and links between hearing loss and other long-term conditions. They should enquire about whether the person has a hearing loss, cross-refer and cooperate with other professionals.

13.2Opportunistic and targeted hearing checks should be integrated into other services and settings, such as in pharmacies, care homes, consultations for other conditions, and alongside other health checks at GPs. An adult hearing screening programme for 65 year olds would ensure people manage their hearing loss when they are most able to adapt.

13.3All health and care providers should ensure that staff are trained in deaf awareness and communication tactics, that proper processes are in place for booking communication support, that assistive technologies are used and that services are accessible to people with hearing loss and deafness.50

13.4Information, guidance and health promotion campaigns around other long-term conditions should be provided for people with hearing loss and deaf people who use British Sign Language (BSL) in a format that they can access.

13.5.Develop better diagnostic tools, specialist services and guidance to support people with hearing loss who also have other long term conditions, and make sure these are used. For example, audiological assessments for people with dementia have been developed which simplify instructions,51 and some audiology departments have adapted their testing procedures so that they meet the needs of people with dementia.

13.6Ensure that resources are allocated in a cost effective way by properly managing hearing loss in people with other long term conditions. For example, the lack of resource allocated to hearing loss within the National Dementia Strategy for England should be reviewed.

14. These changes could enable significant cost savings—if they resulted in increased awareness, earlier diagnosis, more effective diagnosis, more integrated and personalised care, and better access to services, this could lead to greatly improved management of long-term conditions, lowering the rate of hospital admissions and the need for specialist care, and delaying entry into residential care.52

15. People with dementia and unmanaged hearing loss are at a high risk of requiring a high cost intervention at an early stage. Cost savings could therefore be made through better management of hearing loss, providing services that are accessible to people with hearing loss or deafness, and ensuring that the diagnosis and management of dementia takes a person’s hearing loss into account. Our Joining Up53 report estimates that ensuing reductions in the need for residential care would save at least £28 million per year in England. Further savings would be made through reducing hospital admissions and the need for specialist care, avoiding delayed or incorrect diagnoses and more effective management and re-ablement.54

16. These cost savings could also be replicated across services managing other long-term conditions, such as diabetes, sight loss and cardiovascular disease.

9 May 2013