Cochlear implant rehabilitation in older adults: literature review and proposal of a conceptual framework

Abstract

Objectives: To review studies investigating cochlear implant (CI) outcomes in older adults, and to develop a conceptual framework demonstrating important interactions between characteristics of hearing disability, aging, and the CI intervention.

Design: Review of English literature with titles containing the words "cochlear implant" and generic term referring to older adults or numerical value for age greater than 65.

Results: Hearing loss is a prevalent consequence of aging and poses special challenges for older adults. Particularly when superimposed on other age-related conditions, presbycusis (age-related hearing loss) places older adults at risk for social isolation and associated psychological and general health sequelae. The increasing cognitive demand of verbal communication and the diminished sense of social and physical connectedness can contribute to a feeling of vulnerability and poor health that worsens with advancing presbycusis. This cascade of downstream effects of hearing loss has implications for the self-assessment of health-related quality of life (HRQoL) and resulting estimates of associated costs. There is accumulating evidence of a potential role for CI in older adults with poor word understanding despite conventional hearing aid use. This review of the literature provides strong evidence of the benefits of restoring communication capacity in the deaf and hard-of-hearing geriatric population. There is, however, a lack of attention to communication performance in the real world and HRQoL outcomes, and significant gaps in knowledge regarding how CI rehabilitation interacts with changing psychosocial and functional status with aging.

Conclusion: A broader conceptual framework than is currently available for the role of CI rehabilitation in the management of severe-to-profound hearing loss in older adults is proposed. It is posited that the use of such a model in future investigations is needed to guide multidisciplinary investigations into the unique challenges of hearing loss in older adults and may open new opportunities for innovation.

Figure 1

Flow chart of report selection from the literature search strategy

Figure 2

Communicative capacity as indicated by mean speech perception scores reported in the literature prior to and 6 to 12 months following CI surgery [22, 24, 35, 38, 44, 50], is similar for older (≥65 y) and younger (<65 y) adults. CID Central Institute for the Deaf, CNC consonant–nucleus consonant, HINT Hearing in Noise Test, SP speech perception.

Figure 3

An adaptation of Wilson and Cleary’s conceptual model of patient outcomes [5] showing a continuum of the consequences of hearing loss and the intervening variables that mediate CI outcomes. Listed variables are hypothesized determinants of CI outcome in older adults. Arrows reflect prominent relationships that mediate perceived and actual impact of the intervention on communication and other functions critical to the maintenance of independence during aging, as well as HRQL. HL hearing loss, SD speech discrimination ^aDuration of HL: Pre-op Hearing; Device Integrity; Surgical Factors; Device Programming ^bHearing Acuity; Speech Perception in Quiet; Speech Perception in Noise; Attentional Burden; Emotional Response ^cCommunication; Cognition; Adaptive Behaviors; Depression; Anxiety ^dPersonality; Motivation; Values; Preferences; Mastery; Self-esteem; Expectations; Adaptability; General Health ^ePsychological Support; Economic Support; Living Arrangements; Social Support; Communication Demands