Application of the ICF in Rehabilitation of Older People with Hearing Impairment

1
Application of the ICF in Rehabilitation of Older
People with Hearing Impairment

• Louise Hickson
• Communication Disability in Ageing Research Centre

2
Overview

• Examples of studies applying the ICF in this
  context
• Activity and participation of older people with
  hearing impairment living in the community and in
  aged care
• Relationships between impairment, activity and
  participation
• Impact of rehabilitation on activity and
  participation
• Issues in current use of the ICF in audiology

3
History

• WHO ICIDH terminology has been used in
  rehabilitative audiology since 1980
• The framework and not the coding system
• Applied in research initially and then in
  clinical practice (assessment outcomes)

4
1. Studies of Activity and Participation

• Focus has been on older people because hearing
  impairment is most prevalent in this population
• Studies of the nature of the Activity Limitations
  and Participation Restrictions
• Studies of the extent of the Activity Limitations
  and Participation Restrictions
• Self-report measures used

5
Nature of Disability

• Most common Activity Limitations
• Difficulty hearing speech especially in adverse
  listening conditions (e.g., noise, at a distance)
• Difficulty hearing TV/radio
• Most common Participation Restrictions
• Withdrawal from social interactions
• Avoidance of difficult listening situations
• (Stumer, Hickson Worrall, 1996 Morgan, Hickson
  Worrall, 2002 Stark Hickson, 2004)

6
Extent of Disability
(Stumer, Hickson Worrall, 1996)
7
Why the difference?

• Impairment is higher in those in
  aged care because of co-morbidity these older
  people have other health conditions that
  adversely effect hearing.
• Activity Limitations and Participation
  Restrictions are less in those in aged care
  because of
• personal factors (other health conditions, lack
  of motivation to communicate)
• environmental factors (few opportunities to
  communicate, limited topics of conversation,
  staff modify communication)

8
2. Studies of Relationships between Impairment,
Activity and Participation

• Correlations vary and are moderate at best
• Impairment is measured by objective tests of
  hearing function
• Supports the fact that these are different
  aspects of disability
• Effect of age on relationships - as people age
  they report fewer Activity Limitations and
  Participation Restrictions for the same level of
  HI (Gatehouse, 1990).

9
3. Studies of Impact of Rehabilitation on
Activity and Participation

• Different forms of rehabilitation hearing aid,
  assistive devices, communication programs
• Hearing aid fitting reduces Activity Limitations
  and Participation Restrictions and improvements
  are maintained for one year (Newman Weinstein,
  1988 Malinoff Weinstein,1989 Mulrow et al,
  1990)

10
Activity and Participation change with hearing
aids

• Areas of improvement (person with impairment)
• Less frustration when talking to family
• TV/radio
• Party
• Areas of improvement (significant other)
• TV/radio
• Less frustration in general
• More relaxed conversation

(Stark Hickson, 2004)
11
Activity and Participation change with
communication program

• Group program for older people and their
  significant others
• Significant improvements immediately
  post-program, maintained at 6 month follow-up
• Improvements greater with hearing aids than
  communication program
• Other dimensions of outcome were better for the
  communication program - satisfaction, reducing
  impact on others

(Hickson, Worrall Donaldson, 2004)
12
Issues in current use of the ICF in audiology

• Some of the effects of hearing impairment that
  were captured by the previous model as handicap
  are not included in activity and participation
  (e.g., stress, depression, fatigue)
• Growing interest in contextual factors and how
  rehabilitation focused on these may be crucial to
  improve function and reduce disability (e.g.,
  aged care environments, attitudes of others,
  communication ability of spouses).

13
For example

• Traditional focus in audiology is on the
  individual and his or her hearing impairment,
  activity limitations and participation
  restrictions
• However, this has been unsuccessful for some
  people most noticeably those in aged care.

14

• Programs for older people living in residential
  care need to focus on the broader communication
  environment of the facility as well as the
  individuals within it.

Physical environment
Social environment
Resident
15
Summary

• ICF is being applied in the context of
  rehabilitation of older people with hearing
  impairment and its application is evolving

16

• Thank you!
• l.hickson_at_uq.edu.au