Two-thirds of people over 70 have measurable hearing loss and barely a quarter of those use an aid. In a ward or a busy clinic, that produces a reliable and specific failure: a patient who answers the wrong question, cannot repeat the plan back, and is recorded as confused, non-compliant or lacking capacity.
The checks take under a minute and come before any assessment. Is there an aid, is it in, is it switched on, does it have a working battery - flat batteries in a hospital drawer are the single commonest cause of a resident going quiet. Then the room: face the patient, at their level, in the light so lips are visible, with one person speaking at a time and the television or the next bay's alarm dealt with first. Lower your pitch rather than raising your volume; shouting distorts consonants and helps nobody.
If that does not work, a cheap pocket amplifier with headphones - most wards that buy one never lose it - will do more for a cognitive assessment than repeating it louder. And write the plan down for the patient to take away, whatever happened in the conversation.
- Aid present, in, switched on, working battery - in that order, before anything else
- Face the patient at eye level in good light, one voice at a time, background noise off
- Lower the pitch of your voice instead of raising the volume
- Keep a pocket amplifier on the ward and use it before a cognitive assessment
- Give the plan in writing regardless of how well the conversation seemed to go
Why it matters
A hearing problem and a cognitive problem look identical across a noisy bay, and only one of them is fixed with a battery.
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