The Challenge of Older People Living in Aged Care Environments

hearing loss occurs in 80 to 90% of ACF residents (Worrall, Hickson & Dodd, 1993; Jee et al., 1995), compared to approximately 40 to 50% of older adults living in the community. In addition, those in ACFs are more complex in terms of audiological management as they have other serious co-occurring health conditions that complicate the rehabilitation process. The major relevant health conditions are dementia and vision impairment (e.g., Worrall et al., 1993; Erber & Scherer, 1999; Jee et al., 2005). Secondly, although older people living independently in the community require assistance from others at times, such assistance is essential for ACF residents, and staff in the facilities are the main providers of such assistance. Therefore, education of staff is essential for successful outcomes of any rehabilitation offered, whether it be hearing aid fitting, assistive device fitting, or communication strategy training. However, the education of staff in ACFs is difficult as staff have generally high workload demands and there is a high rate of staff turnover. Burnip and Erber (1996) report that it is common for staff to underestimate the extent of hearing problems in the residents and others have documented that staff have limited knowledge about hearing and focus on physical care with little time to talk to residents (e.g., Kato, Hickson & Worrall, 1996; Garahan et al., 1992). Education of staff is therefore critical for the success of hearing health care in ACFs and it needs to be ongoing to account for the high rate of staff turn-over. Thirdly, the ACF environment itself is problematic for effective audiological management that will enhance hearing and communication function. The nature of the physical and social environment in ACFs hinders effective and satisfying communication exchanges, thus, special care needs to be taken to provide hearing services that address these issues. The physical environment is problematic because of a lack of privacy, high reverber-