Steps to better understanding resistant behaviours in hospitalised patients with dementia

The paper to which this summary (Print edition 8 November 2019) refers could be important, as it points out many deficiencies in current practice of the care of people with dementia and suggests ways to improve. However, it has one very important failing; there is no mention of hearing loss or deafness.

How can I follow instructions if I can’t hear what you are saying? In the original paper, resistant behaviour is discussed as though it is a failure on the part of the patient. In my experience the failure is often that the professional (carer, nurse or doctor) has not checked that the patient can hear. Without hearing it is no surprise that the patient cannot understand what has been asked of them.

The original paper talks at length about problems with communication, but almost always as if the fault lies with the patient. Communication is a two-way process. When a patient has difficulty communicating it is the duty of the professional to work out why, to ensure the necessary environment and equipment are optimised, and to convert ‘communication’ into ‘conversation’.

In the 80-84 year old age group around 11% have late-onset dementia (Alzheimer’s Society, 2014) (1). Nearly all of these will have hearing difficulty as 94% of people age 80 and over can be expected to have significant hearing loss (≥25dB HL in better ear) (2).

Obstructing ear wax must always be excluded, then simple measures such as facing the patient, lowering the pitch of the voice and avoiding shouting might enable conversations and improve communication.

All those involved in helping people with memory loss should be taught how to help their patients use and maintain their hearing aids. Action on Hearing Loss have produced a summary of key points (3).

Listening devices such as the Stetoclip (4) can help those who cannot use hearing aids, but perhaps the best preventive answer is to ensure all adults take up and use hearing aids as soon as hearing loss is identified. Regular use should mean patients are more accustomed to their aid and likely to continue with it as their mental ability deteriorates. Hearing aid use is also associated with reduced incidence of dementia, and hearing loss can also be easily mistaken for the condition.

1. Prince M, Knapp M, Guerchet M, McCrone P, Prina M, Comas-Herrera A, Wittenberg R, Adelaja B, Hu B, King D, Rehill A and Salimkumar D. (2014) Dementia UK: Update. Alzheimer's Society
2. Commissioning Services for People with Hearing Loss: A Framework for Clinical Commissioning Groups, NHS England (2016)
3. Communicating well with residents who have hearing loss. Action on Hearing Loss information sheets A1422 et seq. https://www.actiononhearingloss.org.uk/-/media/ahl/how-we-help/health-ca...
4. Stetoclip Communicator amplifier for hard of hearing people, Connevans Ltd., Merstham, Surrey https://www.connevans.co.uk/product/8088186/91ACOM3/Communicator-amplifi...