by Neil Bauman, Ph.D.
A concerned daughter wrote,
My step-dad has been hard of hearing since the 1990s due to being a gunner in Vietnam. Only in the last 8 years has he decided to not wear his hearing aids even though he got some updated ones just 3 years ago. I have seen the effects this has had on my entire family, especially my mother. He has basically ostracized himself and becomes very defensive when we ask him to put in his hearing aids because they are “uncomfortable.” If he does decide to put them in after we beg him he will only put one of the two in. He has several grandkids and just a couple of us kids who hate to see him go down this path of depression.
Just recently he took his computer in to get it repaired and when he got it back he discovered all the Microsoft programs were no longer on it. He refuses to go back and complain. The only conclusion my mom and I can come to about this is he gets frustrated extremely easily because he has a difficult time communicating with them. This example is just one of several others where he would much rather not deal with things than actually see a positive outcome.
I miss conversing with him. We all do. While he has a couple other health issues right now, his hearing it what has directly affected all of us for years. It pains us to see him spiraling down this path of depression. Do you have any words of advice that would assist me and my family? It might require another intervention (1st intervention was 3 years ago when we finally convinced him to buy more hearing aids).
What you are describing is not uncommon among elderly people, especially men. You want your dad to wear his hearing aids, and for some reasons (which we’ll look into), he doesn’t want to.
You want to force him to wear them as you believe they will really benefit him. You may be correct, however, the old adage, “You can lead a horse to water, but you can’t make him drink” not only applies to horses, but also to your father.
All is not lost however. The adage says you cannot make a horse drink—that is true—but you can do things to make the horse want to drink.
It all comes down to “benefits” vs. “costs”. When the horse gets thirsty enough (a cost) the need to slake his thirst (a benefit) will be powerful enough to overcome his stubbornness not to drink. Now here is the key. There is a simple way to make a horse want to drink—make him really thirsty by salting his oats!
Your dad looks at wearing hearing aids as a cost, not a benefit. You need to demonstrate to him that the benefits of wearing hearing aids (or other assistive listening devices) greatly outweigh the cost of not wearing them. Then, like the horse, he will be willing to satiate his need. In your father’s case it will be doing what is necessary in order to hear better.
At present, your dad doesn’t see any benefits to wearing his hearing aids, just costs. Thus he doesn’t wear them. I am the same way. Unless there is a very real and perceived benefit, my hearing aids stay in my pocket (where they are right now) because whenever I wear my hearing aids there are costs to me. Thus, in situations where I don’t perceive that the benefit to me is greater than the cost of not wearing them, I leave them off (or take them out). However, when I perceive that the benefit of wearing them outweighs the cost to me, I put them on. Your dad may view things the same way, whether he can articulate it clearly or not.
Let’s see how we can apply this benefit vs. cost analysis to your father and his hearing aids. First, I don’t believe interventions are the way to go. Notice the results of your last intervention. Yes, you all intervened. Yes, you “forced” him to get new hearing aids—the combined force of all your “nagging” (a cost) temporarily increased the benefit of doing what you all wanted (getting new hearing aids), so he acquiesced in order to get you all off his back.
However, look at the results. Now that he has you off his back (a benefit), he won’t wear his fancy new hearing aids, or he grudgingly wears just one when you really press him (to get you off his back again), because he doesn’t see any real benefits—or more importantly, any perceived benefits—that greatly outnumber the cost to him of wearing them. This reveals that the intervention was ultimately not a success and just wasted a lot of dollars on new hearing aids that live in the dresser drawer, not on his ears.
Having another intervention will probably prove just as futile because you are not addressing the real, underlying problem—his lack of perceived benefit to wearing hearing aids vs. the perceived and real costs to him of wearing his hearing aids.
In this analysis, it is the perceived benefits and perceived costs that are important, not the real benefits and real costs, because we, as humans, typically act on what we perceive to be case—whether we are right or not.
To get at the root of the problem you have to keep asking the question, “Why?” Why does he not wear his hearing aids? Why is he tuning out and giving up? Why is he depressed?
Once you know the real answers, then you can address them—sometimes head on, and other times by being a bit sneaky and “salting his oats”.
Here are some of the reasons why a hard of hearing person like your father may seldom wear his hearing aids.
1. They do not significantly help him hear better.
In spite of all the hype spouted by the hearing aid manufacturers, and the well meaning intentions of audiologists and family members, there are still a good number of situations where wearing hearing aids does not give significant help. Noisy places or when you are at a distance from the speaker are the two main ones.
For example, the one place where you especially want him to hear—at family gatherings—is one place where hearing aids do not help numbers of hard of hearing people. I am one of them. In fact, I have never heard and understood what was being said at any family gatherings when wearing my hearing aids. I say this after having worn hearing aids for more than 60 years. For some of us hard of hearing people, hearing aids alone in such situations are not the answer.
We wonder, “Where is the benefit”? Since we still can’t follow much of what is being said no matter how much we strain to hear, there is little or no benefit to wearing hearing aids in such situations. However, there are a number of costs from our point of view. One cost is that all the straining to hear leaves us exhausted. Another cost is that all the meaningless racket leaves us tense and often results in headaches. Yet another cost is we often feel totally frustrated at not being able to follow a conversation. You see, we want to hear, yet just can’t understand what people are saying. Thus when you compare the benefits to the costs, the costs win out hands down. In such situations it is much more peaceful and easier on us to put our hearing aids in our pockets (so the racket doesn’t bother us) and tune out or leave the room.
Initially, we go with high hopes of being able to hear with our new hearing aids, but our hopes are quickly dashed when we realize they don’t help us hear (understand) much more than our old ones did. Eventually, we realize we’re never going to hear much and thus refuse to wear our hearing aids in such situations. The costs of wearing them are just too high. Basically, we give up because we know hearing aids aren’t going to work in that situation. I wouldn’t be at all surprised if your dad finds himself in the same situation.
Many of these costs are the family’s fault. You see, you want your dad to change and be hearing again—to hear and act like a person with normal hearing. This just isn’t going to happen.
Rather, the family members need to be willing to change and meet the hard of hearing person’s hearing needs. Unfortunately, few family members are willing, and dad gets left out—again.
Few hearing people understand the limitations of hearing aids. I’ve been in meetings where the leader is going to show a video and mentions the poor quality of the sound track. Then he says to us hard of hearing people—”Turn up your hearing aids and listen harder”. What he doesn’t realize is that first, we are listening as hard as we can—unlike hearing people who can hear with ease. Second, if all we needed to do is turn up our hearing aids, don’t you think we would have done that years ago? In most cases, turning up the volume on hearing aids just lets you hear louder gibberish. It doesn’t change gibberish into English!
What family members need to do is speak so dad (or any hard of hearing person present) can hear. This means speaking one at a time, speaking slowly and clearly, facing the hard of hearing person so he can speechread (even though the remarks are made to another family member), having adequate light on all faces for ease of speechreading (which may destroy the ambience you are trying to create), cut out any background sounds (shut doors or windows, have the kids play in another room, turn off the TV or background stereo music, etc.).
Unfortunately, few families are willing to do this—and thus dad (or mom) sits in the corner alone and zoned out. The good news is that it doesn’t have to be this way if the family members really wanted to meet his hearing needs.
One solution is for your dad to move to a separate, quiet room and have one family member at a time come and chat with him. He may do wonderfully well one-to-one—but tune out if he is part of the whole family gathering where he hears nothing but gibberish.
Note: doing this requires special effort by each family member. It has been my experience that family members all want to be together so they won’t miss anything. They want dad to be there too (included), but they don’t realize that dad is totally “out of it” in such situations and may feel deliberately excluded.
It’s the hearing people that need to be willing to change—dad can’t change his ears— but the hearing family members can change their habits and deliberately leave the family setting to chat with dad one-to-one.
Another thing that can work quite well at family gatherings is for dad to use assistive listening devices along with his hearing aids (or by themselves if he won’t wear his hearing aids). Again, these will only be successful if the other family members cooperate.
For example, a (wireless) FM system can really help your dad hear what is going on. All the family members need to do is speak into the remote FM microphone. The person speaking holds or wears the wireless microphone and dad switches his hearing aids to t-coil mode (or RF mode if he has fancy hearing aids with RF receivers built in). In t-coil mode he won’t hear anything except what comes through the FM microphone (which effectively cuts out most of the background noise). When the person wearing the microphone is talking, his voice will be ever so much louder than the background noise (since the mic is close to the speaker’s lips) and your dad will hear him clearly.
The problem is that when someone else says something, if dad is going to hear it, they must pass the microphone to the other person before they speak. However, this typically breaks down because people jump in with “one liners” without waiting for the microphone to be passed to them. So again, dad is left out.
A compromise is for only one person to wear the microphone. At least dad will then hear that one person. Here are some good choices for determining who should wear the microphone.
— Ask dad who he particularly wants to hear. Maybe it’s his brother whom he hasn’t seen for 10 years.
— Give the microphone to the “life of the party” since that person is going to be doing most of the talking anyway. That way he’ll miss the least (and hear lots of jokes, etc.).
— Give the microphone to the “wise one”—the person who may not have much to say, but whenever he says something it is worth hearing.
— Give the microphone to the person whom dad hears the best. Some people are easy to hear and others are very difficult to understand whether they are using a microphone or not.
You can see a quality FM system here.
2. Wearing his hearing aids hurts or is uncomfortable
Some people have sensitive ears and wearing hearing aids irritates their skin and is very uncomfortable or hurts. I have this problem as my skin is sensitive, and both my hearing aids and glasses hurt (burn) when I wear them for a few hours. It’s not that the ear molds are uncomfortable, or that I’m allergic to the materials in them (I use hypoallergenic molds), it’s just that the ear mold and hearing aid touching my skin hurts after a while. When the pain gets too much, I just take my hearing aids off. Thus, for me, wearing hearing aids always has a painful cost involved.
It’s not fair. My wife can put in her hearing aids and forget she has them on. No irritation or pain at all. I wish my ears would do the same, but they don’t.
I balance my desire to hear against the pain of wearing my hearing aids. At first my desire to hear wins out, but when the pain gets too much, then my desire to get rid of the pain wins out. My compromise is to wear my hearing aids when people are directly talking to me. The rest of the time I put them in my pocket ready for the next conversation. Maybe something like this is what your dad needs to try if that is his basic problem.
Another cause of pain is if the ear molds do not fit properly. This is easy to remedy. Either have the ear molds remade, or the sore spots filed off so they are comfortable. The idea is to reduce the cost to him of wearing his hearing aids, thus causing the cost/benefit ratio to swing in favor of the benefits of wearing hearing aids.
3. Amplified sounds “recruit” and hurt
Unless hearing aids are adjusted correctly (and the worse your hearing loss, the less likely they are adjusted correctly), certain sounds will “recruit”—that is, you perceive them as being much to loud. These sounds hurt and you wince. For example, I was out driving with my adult daughter yesterday, and when she took her seat belt off, the sound of the belt buckle hitting the door frame as it retracted “hurt” my ears. She has good hearing and is quite sensitive to sounds, yet the seat belt buckle noise didn’t bother her in the least. That is what recruitment is like. Other sounds that commonly recruit for numbers of people are cutlery clanking, dishes clunking, dogs barking and even the loud parts of words seeming to be much too loud.
Now here’s the problem. I can have my hearing aids adjusted to stop these loud (recruiting) sounds, but when the hearing aid fitter does that, it reduces my speech comprehension. The result is that speech sounds won’t recruit, but I can’t understand much of what a person is saying either. Therefore, in adjusting hearing aids, there is a fine line between speech intelligibility (comprehension) and sounds recruiting. You try to get as close to this fine line as you can, but it is still a compromise.
For example, I have to put up with a certain amount of recruitment in order to talk with my older daughter. That’s just the way her voice is for my ears. If the pain of recruitment becomes too much, then I take my hearing aids off because the cost/benefit ratio has now swung decidedly in favor of costs, not benefits. Unfortunately, the result is I can’t hear/understand what she then says.
That is why I like to converse one-to-one with people in quiet places—so there are no outside recruitment sources. When I do that, I typically hear quite well.
It could be that your dad has a problem with recruitment when wearing his hearing aids so the cost of wearing them is always greater than the benefits of chatting with family members.
I’d definitely investigate this. Audiologists want to set hearing aids so you can hear “normally” and for numbers of people this makes various sounds recruit. He needs his aids set so sounds don’t recruit. This will greatly reduce the perceived cost to him of wearing hearing aids, and thus the cost/benefit ratio may swing to the benefit side (which is what you really want).
Therefore, have his hearing aids tweaked up the best they can be, having regard for recruitment. This may take several tries to get it as good as possible.
4. He is not in the acceptance stage in the grieving process
An often-overlooked aspect of being willing to wear hearing aids is determined by where you are in the process of grieving for your hearing loss.
Typically, people who lose hearing go through the classic 5 steps of the grieving process—denial, anger, bargaining, depression and finally acceptance. It is only in the acceptance stage that hard of hearing people are willing to wear hearing aids. Here is why.
In the denial stage (which can last a considerable time), you “know” you don’t have a hearing loss so therefore, obviously you don’t need to wear hearing aids. Thus you refuse to consider the idea.
In the anger stage (which is typically of much shorter duration) you are mad at everyone and everything connected to your hearing loss. At this stage, you are too busy venting your anger to worry about getting and wearing hearing aids.
In the bargaining stage, you are bargaining with God or doctors to get your hearing back. Since at this point you feel your loss is going to be temporary, there is no point in wasting money buying hearing aids.
Finally, one day you realize that your hearing loss is here to stay—that denial, anger and bargaining didn’t work. So you conclude that nothing works. Thus you give up and slip into deep, dark depression.
Your dad may be stuck in the depression stage. (Some people get stuck here for years.) This is where you reach rock bottom. People in this stage will not (willingly) wear hearing aids because they are depressed—they just don’t care. “Nothing works—so hearing aids won’t work either”.
The good news is that he just has to progress one more step and he will move into the acceptance stage. It is only in this stage that he will be willing to do what he can do to help himself hear better. He will start with baby steps—so it is very important that these baby steps be successful.
A good “baby step” is to get close to him and talk with him face to face in a quiet room while he wears his hearing aids. When he realizes how well he can converse that way, it gives him hope that his hearing aids will work in other places too. Thus he will be encouraged to wear them more (and more) as he realizes that the benefits of his hearing aids now outweigh the costs of wearing them.
If he is still working through grieving for his hearing loss, you (and he) would do well to read my short book, “Grieving for Your Hearing Loss—the Rocky Road from Denial to Acceptance“. It has helped many.
Both you and your dad have to realize that hearing aids are not perfect by any means—so don’t expect them to be. Your dad needs to go back and have his hearing aids adjusted and tweaked a number of times to find the “fine line” compromise that will work the best for him. Then he needs to learn how to successfully cope in various situations rather than giving up.
He needs to take it slowly and realize that he can hear well in certain situations. Then, you can work with him to show him how he can hear well in other situations. Slowly he will be back into circulation again.
In this whole process, always remember the cost/benefit ratio. Work to reduce any perceived costs, and at the same time work to increase any perceived benefits. As the cost/benefit ratio swings to the benefit side, you’ll notice that he will willingly wear his hearing aids (and/or assistive devices) in situations where the benefits are much greater than the costs of not wearing them. And, as an additional benefit, you’ll be happier too!