*Many people here need hearing aids which help to stave off dementia, but few use them*
https://www.straitstimes.com/singapore/many-people-here-need-hearing-aids-which-help-to-stave-off-dementia-but-few-use-them
2024-08-11
SINGAPORE - If you think that hearing loss is part and parcel of ageing, and is something seniors have to learn to live with, think again.
More studies are showing that uncorrected hearing loss is the single most important risk factor in causing dementia.
The 2024 Lancet Commission report on dementia prevention, intervention, and care released on July 31 estimates that treating hearing loss could cut the number of people with dementia by 7 per cent.
Ear, nose and throat (ENT) specialists in Singapore agree that treatment or correction is vital.
“Studies have shown that hearing loss is associated with a higher risk of cognitive decline and dementia. Treating hearing loss with amplification may reduce the likelihood of developing dementia,” said Dr Kimberley Lau, an associate consultant in otolaryngology (ENT) at Khoo Teck Puat Hospital.
This is because hearing loss often not only results in social isolation and depression, but also impacts the brain.
Britain’s Alzheimer’s Society explained that with hearing loss, the parts of the brain for sounds and speech have to work harder.
“This additional effort may lead to changes in the brain that affect our memory and thinking abilities,” it said.
Aside from that, doctors here said that uncorrected hearing loss also increases a person’s risk of depression, accelerated loss of brain tissue, and poorer physical and mental health, leading to higher risks of falls and hospitalisation.
Many who need hearing aids are not using them.
Hearing loss is extremely common among older people, said Dr Ng Jia Hui, a consultant in the Department of Otorhinolaryngology-Head and Neck Surgery at Singapore General Hospital (SGH).
She said about 88 per cent of people aged 60 years and older suffer from age-related hearing loss, or presbycusis, adding that this is expected to increase as the population ages.
Screening for hearing is relatively new in Singapore, said Associate Professor Jenny Loo, a senior principal audiologist at the National University Hospital (NUH).
Proper equipment for hearing tests was introduced here only in 2000 for children, and screening for seniors began in 2018 under Project Silver Screen, a preventive health initiative by the Ministry of Health and Temasek Foundation Cares.
“Before that, we would hold a tuning fork behind the patient’s ear, or get nurses to bang files on the table to check their hearing,” Prof Loo said.
Studies carried out here indicate that less than 10 per cent of people who could be helped with hearing aids wear them, said Dr Kenneth Chua, president of the Society for Audiology Professionals Singapore.
Experts cite lack of knowledge and embarrassment over using hearing aids as possible reasons for the low uptake.
Dr Chua added that other barriers include lack of accessibility and affordability, and people thinking their hearing loss is not severe enough.
Hearing aids cost between $1,000 and $9,000 per piece – twice that for a pair. They generally last four to five years.
The Agency for Integrated Care (AIC) provides a 90 per cent subsidy – up to $2,700 for a pair of hearing aids – for those who qualify through means testing.
Mr Kelvin Lim, AIC’s chief of grants division, said the number of seniors who received the agency’s subsidies for hearing aids went up from 3,000 in 2019 to more than 5,000 in 2023, an increase of close to 70 per cent. For the first half of 2024, almost 2,700 seniors received subsidies for hearing aids.
Start using aids at early stage of hearing loss
The experts The Straits Times spoke to say that people should not wait till their hearing loss is very severe before getting hearing aids. Getting the aids at the early stages helps a person adapt better to the use of amplification.
“Many people realise they have a hearing problem only when it reaches moderate level, at which point it starts to significantly affect speech understanding and communication,” said Prof Loo.
The longer hearing loss goes untreated, “the harder (it is) for the patients to adapt to the sound amplified by hearing aids”, she added.
Then there are those who have hearing aids, but give up on them, complaining that they get loud sound blasts, do not sound natural, or are not comfortable to use.
Audiologists say it takes time for the brain to adjust to hearing aids.
“Hearing loss tends to occur gradually. Learning to hear sounds again with hearing aids is also a gradual process – at first, sound from the hearing aid may seem unnatural,” Dr Lau said, adding that “hearing aids help to improve hearing, but they do not restore normal hearing”.
Prof Loo explained that the issue is the brain’s ability to adapt to hearing aids, rather than the quality of the devices. A proper fitting by an audiologist is necessary for people to reap the full benefits of hearing aids, she added.
Unlike spectacles, hearing aids are dynamic and have to be tuned and adjusted, said Dr Paul Lock, an ENT consultant at Tan Tock Seng Hospital. This might need to be done annually as patients age.
He added that it generally takes about three months for people to get used to hearing aids.
It takes time to get hearing aids
In the public sector, it could take between several months and a year, or more, for a person to get his hearing tested by a doctor and then see an audiologist to get fitted with hearing aids.
Mr Gopal Krishna Sarepaka, a senior principal audiologist at SGH, said a patient typically has to wait around 10 months to see an audiologist, after a doctor says hearing aids are needed. But those who need the hearing aids more urgently are attended to sooner, he added.
“The reason for the longer wait time is an increasing demand for hearing aid services from ageing seniors,” he said.
The hospital gets over 2,000 hearing referrals a year. It was 1,132 for the first six months of this year, against 2,028 for the whole of 2022 – an increase of about 6 per cent.
In the private sector, the whole process can be done within a day.
Dr Barrie Tan, who has a ENT clinic at Gleneagles Medical Centre, said: “Our resident in-house audiologist is able to immediately programme and fit on loaner hearing aids for a take-home trial by the patient on the same day.”
Patients at his clinic are given loan sets to try for a fortnight. If they feel comfortable with them, they can be fitted with a new pair when they return with the trial pair.
The public health clusters have set up community clinics run by audiologists, where patients can be seen more quickly. Those who need to see a doctor will be referred accordingly.
Mr Gopal said patients at the community clinics are often seen within three months. “They undergo diagnostic hearing testing and continue with hearing aid trial if required,” he said.
Most of them are referred to the community clinics by Project Silver Screen, which aims to screen 30,000 seniors a year.
Associate Professor Loh Woei Shyang, who heads ENT at NUH, said: “Many of these senior adults would not have sought help for hearing loss before community hearing screening was initiated.”
He said seven in 10 people screened have hearing issues, with half of them needing to be referred for further care.
Said Mr Gopal: “Ageing gracefully is about having a good quality of life with good hearing through hearing aids.”
Dr Lock agreed, saying: “Being in contact and communication with the world around us ensures that we are continually engaged and can continue contributing to our community. This in turn will reduce the incidence of dementia.”
Mr Eric Lee, 77, is a long-time user of hearing aids. His advice to people new to the devices is to use them all the time, to let the brain adjust to, and dismiss, the background noise.
Friends of his who wear their hearing aids only when they need them continue to find such noise irritating.
He is a staunch advocate for the aids, without which he said he would not be able to participate in conversations, “not even when the person is near me”.
“Without them, I live in a world of silence.”
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