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Coping-With-Hearing-Loss Model for Older Adults

^a Department of Psychology, Washington University, St. Louis, Missouri

Rowena G. Gomez, Department of Psychology, Box 1125, Washington University, 1 Brookings Drive, St. Louis, MO 63130 E-mail: rggomez{at}artsci.wustl.edu.

Decision Editor: Margie E. Lachman, PhD

	Abstract

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We proposed a coping-with-hearing-loss model that explains how hearing loss, psychosocial factors (i.e., attitudes about aging, personal adjustment to hearing loss, and perceived social support), and perceived strategy effectiveness affect the use of adaptive and maladaptive strategies. Adaptive strategies are behaviors that improve communication (i.e., asking others to repeat). Maladaptive strategies are coping behaviors that do not promote communication (i.e., pretending to understand the conversation). Nonaudiological variables were more important than physical hearing loss (as measured by an audiological examination) in predicting coping behaviors for hearing loss. The use of adaptive strategies was predicted by perceived strategy effectiveness. The use of maladaptive strategies was predicted by perceived effectiveness of the strategies to cope with hearing loss in daily life, poor adjustment to hearing loss, and poor social support. The results suggest that psychosocial issues may need to be addressed when older adults have difficulties coping with their hearing loss.

HEARING loss is a major concern for many older adults. About 30% of adults between the ages of 65 and 74 years and 50% of those between the ages of 75 and 79 years suffer some degree of hearing loss ( U.S. Bureau of the Census 1997). Hearing impairments can interfere with an older adult's ability to communicate effectively with others. Thus, people use compensatory strategies such as wearing hearing aids to improve communication. We examined how older adults cope with hearing loss and the reasons why they cope the way they do.

Coupland, Wiemann, and Giles 1991 concept of miscommunication provides a theoretical framework for our coping-with-hearing-loss model. These authors assume that one goal of participants is not necessarily to reach perfect communication but to avoid unpleasant outcomes due to miscommunication. For example, older adults may wish to be perceived as competent and independent at a time when health-related changes may be occurring ( Martin, Leary, and Rejeski 2000). Not all coping strategies for hearing loss promote better communication. Demorest and Erdman 1987 divided coping strategies for hearing loss into adaptive and maladaptive strategies. Adaptive strategies such as asking others to repeat are behaviors that presumably improve communication. Maladaptive strategies such as pretending to understand the conversation are behaviors that do not promote communication. These strategies, however, may help a person cope with hearing loss. These divisions are used in this study because we believe that certain predictive factors may be more pertinent to one coping strategy type than the other.

A person's objective hearing loss as measured by an audiological examination may not be the only nor the most important predictor of coping behaviors ( Andersson, Melin, Lindberg, and Scott 1996). Other nonaudiological factors may also influence how older adults cope with hearing loss. These factors include perception of one's hearing loss or subjective hearing loss ( Andersson et al. 1996), psychosocial factors such as anxiety about aging ( Brooks and Johnson 1981; Danhauer, Johnson, Kasten, and Brimacombe 1985), personal adjustment to hearing loss ( Brooks 1989), perceived social support ( Andersson et al. 1996; Brooks 1989), and perceived effectiveness of coping strategies ( Bentler, Niebuhr, Getta, and Anderson 1993).

Based on our review of the literature, we conducted a pilot study to serve as a preliminary test of our coping-with-hearing-loss model ( Gomez and Madey 1999). Perceived hearing loss, anxiety about aging, personal adjustment, and perceived social support accounted for 57% of the variance in the use of adaptive strategies and 63% of the variance in the use of maladaptive strategies. (The model for the use of maladaptive strategies did not include perceived strategy effectiveness; we did not expect maladaptive strategies to improve communication.) The predictors of coping with hearing loss were somewhat different for adaptive and maladaptive strategies. Adaptive strategies were strongly influenced by perceived strategy effectiveness. Perceived hearing loss was modestly related to the use of adaptive strategies but not to the use of maladaptive strategies. Instead, maladaptive strategies were influenced by the perceived attitudes and behaviors of others and by the person's own adjustment (or the lack thereof) to hearing loss. Perceived social support appeared to be important to the use of both types of coping strategies. Anxiety about aging did not appear to affect either strategy type.

Given these findings, we expanded the model to include physical hearing loss as measured by an audiological examination. We also included the perceived effectiveness of strategies to apply to both adaptive and maladaptive strategies in terms of coping with hearing loss in daily life. Although maladaptive strategies do not improve communication, they may enable a person to cope with their hearing problems psychologically and socially.

	Methods

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Participants
Thirty-three men and 28 women from a mailing list maintained at a local hearing clinic agreed to be in our study. The participants' mean age was 75.52 years (SD = 6.95; range = 61–85). The participants generally rated their health as good (M = 2.25; SD = 0.90) on a 5-point Likert scale ranging from 1 (excellent) to 5 (poor).

Measures
Compensatory strategies for hearing loss
The overall use of adaptive and maladaptive strategies from the Communication Profile for the Hearing Impaired (CPHI; Demorest and Erdman 1987) served as dependent variables to test the model. We measured adaptive coping strategies by two subscales, verbal strategies and nonverbal strategies, which had a correlation of .69 (p < .01); therefore, we averaged the subscales to form a composite. We measured maladaptive strategies by the Maladaptive Behaviors subscale of the CPHI.

Perceived effectiveness of coping strategies
We rated the perceived effectiveness of nine adaptive and six maladaptive strategies on 5-point Likert scales ranging from 1 (not effective) to 5 (very effective) in response to the question "How effective is this strategy in helping you cope with hearing loss in your daily life?" The adaptive strategies were hearing aids, facing the person, asking others to repeat, situating oneself to hear the speaker better, asking others to talk louder, amplification devices, asking others to talk slower, asking others to face you, and asking others to get your attention before speaking. The maladaptive strategies were pretending to understand conversations, interrupting conversations, avoiding talking to strangers, avoiding social situations, dominating conversations, and ignoring the speaker. We formed separate total scores for adaptive and maladaptive strategies by summing the ratings in each category.

Physical hearing loss
We assessed physical hearing loss with an auditory examination. The measure was the average hearing loss for the better ear for pure-tone air-conduction thresholds at the following frequencies: 250, 500, 1000, 2000, and 4000 Hz.

Perceived hearing loss variables
We asked the participants to rate how well they could hear on a 5-point Likert scale ranging from 1 (no problems) to 5 (severe problems).

Psychosocial variables
We measured anxiety about aging with the Anxiety About Aging Scale ( Lasher and Faulkender 1993). We assessed personal adjustment to hearing loss with the Social and Emotional Impact Scale and the Lack of Acceptance and Adjustment Scale from the Attitude Toward Loss of Hearing Questionnaire (ATLHQ; Saunders and Cienkowski 1996) and the Personal Adjustment Scale from the CPHI ( Demorest and Erdman 1987). We measured perceived social support with the Perceived Absence of Support Scale from the ATLHQ ( Saunders and Cienkowski 1996) and the Attitude of Others and the Behavior of Others subscales from the CPHI ( Demorest and Erdman 1987).

Procedure
We conducted the experiment in individual sessions at Washington University, St. Louis, Missouri. The participants took approximately 50 min to complete the questionnaires.

	Results

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Table 1 shows the correlations of the frequency of the use of adaptive and maladaptive strategies with the predictors of the model. Examination of the zero-order rs reveals a pattern similar to our pilot study: The psychosocial variables were more strongly correlated with the use of maladaptive strategies than with the use of adaptive ones.

The model explained much more (65%) of the variance in the use of maladaptive strategies, F(10,50) = 9.23, p < .0001. Perceived strategy effectiveness in coping with daily life made a unique contribution (ß = .34). Other significant ßs were for the Social and Emotional Impact Scale and the Personal Adjustment Scale. Poorer adjustment to hearing loss was associated with greater use of maladaptive strategies. Although they were substantially correlated with the use of maladaptive strategies at the zero-order level, many of the other predictors were not statistically significant in the simultaneous regression analysis because of their substantial multicolinearity. Physical and perceived hearing loss did not make a unique contribution.

	Discussion

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Nonaudiological variables were more important than physical hearing loss in predicting coping behaviors of older adults with hearing impairment. For both adaptive and maladaptive strategies, the perceived effectiveness of the strategy to help them cope with their hearing loss is an important predictor of the use of these strategies. People tend to use strategies more frequently if they perceive the strategy to be effective even if the strategy does not enhance communication. Thus the maladaptive strategies thought to be helpful in coping may not be perceived as maladaptive by those who use them. Our study suggests that poor adjustment to hearing loss and poor perceived social support are also associated with greater use of maladaptive coping strategies. It is difficult to say if poor adjustment and poor perceived social support lead to the use of maladaptive coping strategies, or vice versa, because of the study's correlational nature. This study, however, does suggest that information obtained from audiological examinations may not be sufficient to help older adults cope with their hearing problems. Psychosocial issues may need to be addressed as well.

	Acknowledgments

 
This study was supported by Training Grant AG0030 from the National Institute on Aging. We give special thanks to Martha Storandt and Mitch Sommers for guidance and support in the conduct of this study and the preparation of the original manuscript. Dr. Madey is currently at the Department of Psychology, Shippensburg University, Pennsylvania.

Received for publication February 16, 2000. Accepted for publication December 4, 2000.

	References

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• Andersson G., Melin L., Lindberg P., Scott B., 1996. Elderly hearing-impaired persons' coping behavior. International Journal of Behavioral Medicine 4:303-320.
• Bentler R. A., Niebuhr D. P., Getta J. P., Anderson C. V., 1993. Longitudinal study of hearing aid effectiveness. II: Subjective measures. Journal of Speech and Hearing Research 36:820-831.
• Brooks D. N., 1989. The effect of attitude on benefit obtained from hearing aids. British Journal of Audiology 23:3-11. [Medline]
• Brooks D. N., Johnson D. I., 1981. Pre-issue assessment and counselling as a component of hearing aid provision. British Journal of Audiology 15:13-19. [Medline]
• Coupland N., Wiemann J. M., Giles H., 1991. Talk as "problem" and communication as "miscommunication": An integrative analysis. Coupland N., Giles H., Wiemann J. M., , ed."Miscommunication" and problem talk 1-17. Sage, Newbury Park.
• Danhauer J. L., Johnson C. E., Kasten R. N., Brimacombe J. A., 1985. The hearing aid effect. Hearing Journal 38:12-14.
• Demorest M. E., Erdman S. A., 1987. Development of the Communication Profile for the Hearing Impaired. Journal of Speech and Hearing Disorders 52:129-143. [Abstract/Free Full Text]
• Gomez, R., & Madey, S. F. (1999, November). Psychosocial factors that affect how older adults cope with hearing loss. Paper presented at the 52nd Annual Scientific Meeting of The Gerontological Society of America, San Francisco, California.
• Lasher K. P., Faulkender P. J., 1993. Measurement of aging anxiety: Development of the Anxiety About Aging Scale. International Journal of Aging and Human Development 37:247-259. [Medline]
• Martin K. A., Leary M. R., Rejeski W. J., 2000. Self-presentational concerns in older adults: Implications for health and well-being. Basic and Applied Social Psychology 22:169-179.
• Saunders G. H., Cienkowski K. M., 1996. Refinement and psychometric evaluation of the Attitude Toward Loss of Hearing Questionnaire. Ear & Hearing 17:505-519.
• U.S. Bureau of the Census1997. Statistical abstract of the United States 1996 U.S. Government Printing Office, Washington, DC.

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