الفهرس 
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Abstract
Hearing impairment is a wide spread health problem affecting over 50% of persons age 65 and older and its prevalence increase with age. It had a significant effect on all aspects of life of older adults, it affects sense of safety, relationships with family and friends, communication, causes social isolation, depression, anxiety, low self-esteem, inability to perform in instrumental activities of daily living and decrease cognitive function.
This study aimed to identify relation between hearing impairment and cognitive, functional and psychosocial status of community dwelling older adults.
Research tools and method:
Design: a descriptive correlational research design
Setting: The study was conducted in the Ear, Nose and Throat (E.N.T) Outpatient clinic of Damanhur National Medical Institute El-Behaira Governorate, Egypt.
Subjects: The study subjects consisted of 200 older adults attending the previously mentioned setting aged 60 years and above, free from neurological disorders such as stroke or Parkinson’s disease, not using hearing aids and free from fracture that hinder functional abilities of older adults. They divided into two equal groups selected randomly by using matching method in age and sex. Study group (n=100) who diagnosed with hearing impairment and control group (n=100) who diagnosed with disorders other than hearing impairment.
Tools of the study: In order to collect the necessary data, six tools were used.
Tool (I): Socio-demographic data and clinical data of the older adults with hearing impairment structured interview schedule.
This tool was developed by the researcher and includes three parts:
Part 1: Socio-demographic characteristics of the elders such as age, sex, marital status and level of education.
Part 2: Health profile of the elders which includes questions related to hearing impairment and health history.
Part3: Social activities such as (visits and phone call to relatives).
Tool II: ”The Mini-Mental State Examination (MMS)”
It was used to assess cognitive function of the subjects. It includes questions related to orientation, registration, attention, calculation, recall and language. The MMS scale score is 30 point.
Tool III: ”Barthel Index Scale (BI)”
It was developed by Barthel et al (1965) .This tool was used to assess elder’s activities of daily living. It consists of 10 items namely feeding, dressing, bathing, toileting, controlling bladder, controlling bowel, moving from chair to bed and return, getting on and off toilet, walking on level surface, ascend and descend stairs. The total score of the scale is 20 point.
Tool IV: Instrumental Activities of Daily Living ”Lawton and Brody scale”
Lawton and Brody scale 1969 was used to assess instrumental activities of daily living. It includes eight items; the ability to use telephone, shopping, food preparation, house-keeping, laundry, transportation, responsibility for own medication and ability to handle finances. The range of score of the scale is from 8-24.
Tool V: The General Well-Being Schedule:
It was developed by (Dupuy1977). It was used to measure feelings of psychological well-being and distress of older adults in community. It includes 18 items measuring six dimensions namely positive well-being, self-control, vitality, anxiety, depression and general health. A total score running from 0 to 110 classified as follow:-
• Scores of 0 to 60 reflect severe distress.
• Scores of 61 to 72 reflect moderate distress.
• Scores of 73 to 110 reflect positive well-being.
Tool VI: ”UCLA Loneliness Scale (version 3)”
It was developed by Russell et al (1987). It was used to assess feeling loneliness in middle-aged and older adults. It included 34 statements. The total score is adjusted from 1 to 136 classified as follow:-
• Not lonely (equal to34)
• Mild loneliness (ranging from 35 to 67)
• Moderate feeling of loneliness (range from 68 to 101)
• Severe loneliness (ranging from 102 to 135)
• Extreme loneliness (equal to136).
Each older adult who fulfilled the inclusion criteria and his relative were interviewed after explaining the purpose of the study by the researcher in the E.N.T outpatient clinic to collect necessary data. The interview time ranged from 30 to 45 minutes to complete the study tools according to the level of understanding and cooperation of the study subjects. Data was collected during a period of 4 months started from the beginning of March till the end of June 2016.The statistical package for social science (SPSS) was utilized for data analysis and tabulation. The level of significance selected for this study was “P” equal or less than 0.05.
The main results obtained were as follows:
The mean age of the study group was70.58±8.264 years while for the control group was 69.29±8.260. Males were more prevalent than females; they constituted 57%, while females constituted 43% for both groups. 53% and 62% respectively for both the study and control groups were married. There is no significant difference between both groups regarding age, sex and marital status.
59% and 58% of both the study and control groups were illiterate, 19% could just read and write, 12% were primary or preparatory education, while 10% received either secondary or university education for the study group while the corresponding percentage for the control group were 10%, 19% and 13% respectively. The mean monthly income of both the study and control groups was 516.88±292.80 and 599.94±299.49 respectively. There is no significant difference between both groups regarding education but a significant difference was found between both groups regarding income.
As regard to the history of hearing impairment, the duration of having hearing impairment ranged from one to fifty-five years with a mean of 8.36 ± 6.25 years. More than two third (69%) of the study group had sensorineural hearing impairment, while the rest had either (29%) conductive hearing impairment or (2%) mixed hearing impairment. Regarding affected ear, it was noticed that 60% of the study group suffering from bilateral hearing impairment, 23% suffering from hearing impairment in left ear and the rest (17%) in right ear.
Concerning the medical diseases the present study showed that 53% and 44% respectively of both the study and the control group suffering from cardiovascular disease followed by ophthalmological diseases (32% and 38%), diabetes mellitus (20% and 35%), GIT & hepatic diseases(12% and 13%) and respiratory diseases (10% and 4%) respectively of both the study and the control groups. No significant difference was found between both groups for medical diseases except diabetes mellitus.
Regarding consumption of medication, it was noticed that 47% and 42% of both the study and the control groups respectively consumed cardiovascular drugs followed by diabetic drugs (19%, 33%), GIT & hepatic drugs (12% and 13%), respiratory drug (10%, 13%) for both groups. no significant difference was found between both groups for all drugs except respiratory and diabetic drugs.
It was observed that (31% and 14%) of both the study and control groups respectively had family history of hearing impairment. A significant difference was found between both groups.
There is significant difference between both groups concerning participation in social activities such as visiting outside home, phone call, sitting alone, practicing recreational activities, exchanging talking with people during sitting with them and feeling embarrassed when talking with people for the first time. The main cause of non-participation in social activities for the study group was hearing impairment.
It was found that 39% and 17% of both the study and the control groups had mild cognitive function impairment, 7% and 3% of both groups had severe cognitive function impairment, and 54% and 80% of both the study and the control groups had normal cognitive function.
95% and 94% of both the study and the control groups were independent in performing activities of daily living, 4% and 6% of both groups need assistance and 1% of the study group and non of the control group were totally dependent. While concerning instrumental activities of daily living 44% and 36% of both the study and the control groups were unable to perform instrumental activities of daily living, 41% and 35% of both groups need assistance and 15% and 29% of both the study and the control groups performed activities unaided.
Concerning psychological status, 42% and 9% of both the study and the control groups had severe distress, 25% and 18% of both groups had moderate distress and 33% and 73% of both the study and the control groups had positive well-being. Concerning social status, 60% and 23% of both the study and the control groups had moderate loneliness, 22% and 1% of both groups had severe loneliness, 14% and 74% of both the study and the control groups had mild loneliness, 3% of the study group and non of the control group had extreme loneliness, and 1% and 2% of both the groups were not lonely.
There is a statistical significant difference between both groups concerning cognitive, performance of IADLs and psychosocial status while no significant difference was found between both groups concerning performance of ADLs.
Conclusion:
It can be concluded from the present study that hearing impairment has significant effect on cognitive, instrumental activities of daily living and psychosocial status of older adults. Older adults suffering from hearing impairment had mild cognitive impairment, severe psychological disturbance, suffered from moderate loneliness and were unable to perform IADLs in contrary to ADLs.
The main recommendations are:
1. Older adults should be instructed about use and care of available assistive devices such as hearing aid and assistive listening devices.
2. Encouragement older adults with hearing impairment to do annual ear examination.
3. Inservice education program for nurses about normal age related changes affecting ear, consequences of hearing impairment, available health resources and appropriate intervention for older adults suffering from hearing impairment such as communication techniques and use of hearing aid.