Muffled sounds, drum beat and dementia

Last night I watched the 2019 movie, Sound of Metal.

The film explores the experiences of Ruben Stone a heavy metal drummer who develops profound hearing loss.

Riz Ahmed of 4 Lions is Ruben.

A few weeks ago I was involved in one of our ‘Conversations about Covid’ in which audiologists from Manchester and Sheffield discussed some of their work.

You see, hearing matters.

I asked the question which I am sure others were thinking, ‘Of all the senses, I imagine if I had to lose one, I would chose hearing.’

This question was naïve.

It reflected little understanding of what it is to be deaf or what it means to have sensory impairment; it is akin to suggesting which organ you could or could not do without, a form of anatomical one-upmanship, ‘the brain’ ‘the heart’ ‘the kidney’ – I see the imagine neurologists, cardiologists and nephrologists proclaiming their organ to be the most important.

No, I had underestimated hearing.

The movie does a good job.

It emphasises that hearing loss is not just the functional inability to hear sounds, it is more, far deeper. The psychology or an individual’s mental approach to the loss is as important.

And, when you start to look more deeply, you realise that sound is not just conversation or telly, it is ambient noise, birds in the trees, the wind, passing cars. My dog licking her paw behind me, my breath.

Sound is music, it is a connection to others, it is an internal link to the past.

Inside my head are stored the shadows of every sound I have ever heard, every song, every voice; etched-out in faint outline, ready to rise again should there be a need.

I can’t hear my mum’s voice although if she were to speak now I would immediately recognise her, the same with my dad, my grandpa, people I haven’t seen or spoken with in decades.

And so too with music.

That hit from 1977 is embedded somewhere inside of me.

Back in the day when I used to have inpatients and work on a hospital ward, I would play the Beatles. This was the sound of my ward rounds. This is the sound that would echo as I chatted with patients.

Norwegian Wood

Yesterday

Michelle

Penny Lane

All resonating, taking me back and creating an atmosphere.

From the Conversation we discussed research which shows that even mild hearing loss can increase an individual’s risk of dementia by two, significant loss by a factor of five.

Hearing is more than noise or sound.

Hearing is communication.

Opticians are on every street corner, we wear sunglasses for fun; hearing aids have yet to become fashionable.

I am often frustrated when I visit a nursing home and the rooms are filled with 40 watt light bulbs. A false economy. The owners save money on electricity at the cost of residents falling over.

Even those enlightened places that have invested in Phillips day-lighting often miss the importance of hearing.

Hearing aid batteries are flat, they are lost, wax accumulates and no one checks.

The confused old lady does not have dementia, she has lost her glasses and her hearing aids were thrown-out with the laundry.

We don’t respect hearing.

Whenever I think of hearing and music I always consider Beethoven.

beethoven-600x600jpg

He was deaf. He seemed to get on OK.

How little I know.

In Scotland and Wales, all national broadcasts from the government are accompanied by people signing. Not so in England.

sign

This doesn’t surprise me.

In essence, I feel that no one cares.

Or, if they care, they don’t think.

If it is something that can be measured, say, amount a person drinks, the presence or absence of pressure ulcers, falling weight, even satisfaction scores, attention is paid.

Yet, the silent world inside our heads is forgotten. Overlooked.

Every so often a fuss is made when a translator can’t be found to help with a clinical encounter where the patient doesn’t speak English.

How often is a fuss made when the patient can’t hear?

It is a moral offence to label someone as ‘being demented’ unless you have proof they can hear what you are saying.

I saw a patient the other week at his home.

His daughter insisted she be there when I visited.

Upon my arrival I had to wait a few minutes until she cleaned-out his hearing aids.

In the end, he could hear some of what I said.

‘He usually says ‘yes’ when he can’t hear.’

What can we do?

My patients sometimes experience delirium.

There are two kinds – hyperactive and hypoactive.

In the former, people tend to have broken sleep, they can be distressed, agitated, restless; with the latter, passivity reigns.

Passivity and deafness seem to be linked.

Those people who experience the hypoactive form of delirium have a much higher risk of dying.

What does deafness do to your chances of survival?

How do we up-end this situation?

In my medical student lectures I always emphasise the importance of making sure the patient can hear you and if they have hearing aids, to check they are working, the batteries are in place and have power.

We need more.

Part of this is design or technology, to make either trendy hearing aids or ones that work, yet more important, by an order of magnitude is to raise awareness.

Awareness that when someone says ‘yes’ this could be part of their conditioning rather than an agreement, when a person is passive, doesn’t appear to engage or seems to not understand your direction, consider that they may be struggling to hear you.

It is the mantra I have been carrying for years – don’t assume the patient is bad or stupid or lazy, don’t foist your prejudices or pre-judgements upon them, engage in a spirit of openness, without baggage.

Check and check-in.

Sensitivity.

Is their response appropriate?

Imagination.

Use a pen and paper, your phone, a laptop – open Word and write big.

Check the hearing aid batteries.

Look into the patient’s ears – admittedly this requires an otoscope, all GPs have them.

If your accent is too thick, your voice too quiet, ask for someone to translate, English to Yorkshire or whatever.

Take it slowly.

Repeat.

Patience.

Eye contact once you have established the person can see.

You might even have to lower your mask.

Don’t shout, this usually just creates muffles noise that doesn’t convey your message.

Speak to an audiologist.

Watch the movie.

Subtitles are optional.

expression

If you want to join my next Covid Conversation – follow this link at 4pm on Wednesday the 5th of May via Teams (check you have it downloaded first).

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