Hearing loss is one of the most common chronic disabilities associated with aging.^1-4 In Canada, 41.1% of individuals over age 65 report that they have hearing loss.⁵ The prevalence of hearing loss is exceeded only by the prevalence of disabilities in mobility and agility. Vision loss is far less prevalent, with only 24.1% of respondents reporting this disability. The prevalence of hearing loss increases exponentially with age.^1,3,6 Because older adults are the most rapidly growing age group, with their numbers expected to double within the next 25 years,⁷ we can expect that the number of individuals with hearing loss will increase dramatically.

Hearing loss associated with aging (ie, presbycusis) is sensorineural in nature, involving a gradual decrease in hearing sensitivity. Reduction of the ability to hear high-pitched sounds, including the consonants of speech, usually precedes the loss of hearing low-pitched sounds, which include the vowels of speech and environmental sounds.^1,4,8-10 As such, speech will sound mumbled and be difficult to understand. Even individuals with only mild hearing losses will have difficulty understanding speech in suboptimal conditions of noise interference.¹¹ Older adults may have other types of hearing loss in addition to presbycusis.^1,4 They are also likely to have concomitant sensory deficits, such as vision impairment^1,12,which impact the individual’s ability to utilize speechreading as a means of supplementing the auditory signal. The more damage that has occurred within the auditory system, the more difficult it becomes to obtain benefit from the use of hearing instruments.³ Even with the use of technically advanced hearing instruments, individuals with hearing losses will not have their hearing function restored to normal levels.¹³ In addition, acceptance and usage of hearing instruments involve increased difficulty for older adults.¹

Some of the consequences of hearing loss experienced by older adults include:^1-3,9

• Difficulty communicating with others;
• Negative changes in psychosocial behavior;
• Strain on relations within the family, decreased enjoyment of daily activities;
• Difficulty living independently and safely, and
• Interference with medical diagnosis, treatment, management, and therapeutic intervention.

The significance of the handicaps resulting from hearing loss may be greater for the older adult than for younger people. Multiple disabilities are more common and the superimposition of hearing loss upon other disabilities is likely to result in a greater loss of social function.

Older adults are more likely to believe that hearing loss is primarily due to aging and are thus less likely to seek professional assistance than younger persons. Health and Welfare Canada’s 1988 report on “Acquired Hearing Impairment in the Adult”¹ stated that, in Canada, the elderly population receives suboptimal assessment and management of hearing impairment, mainly due to ageism (ie, society’s prejudice against individuals due to their advanced age). They identify the need to establish widely available and pertinent aural rehabilitation programs for older adults. The aging of the Baby Boomers will result in a more demanding, well-educated, and technologically sophisticated generation of older adults with hearing losses.¹⁴ It is important that we meet the challenge of providing accessible and appropriate rehabilitation services to this population.

The Health and Welfare Canada report stated that the lack of programs addressing the needs of older adults with hearing loss is well documented. The report suggests that services should address not only medical and communication factors, but also psychosocial dimensions and that adequate funding should be made available for comprehensive rehabilitation programs, beyond the fitting of a hearing aid. According to Health and Welfare Canada, the psychosocial component of rehabilitation can no longer be viewed as a “frill” or a privilege.

In spite of the recommendations made by this report, the majority of the services available in Canada (and in North America in general) continue to be at the level of assessment, prescription, fitting, and orientation to amplification. Additionally, in most cases, medical coverage does not provide payment for aural rehabilitation services.

The CHS/Elderhostel/YMCA Educational Program
Since 1980, group and individual aural rehabilitation programs for older adults with hearing losses and their significant others have been provided by the Canadian Hearing Society (CHS), based in Ontario. These services include five levels of “Hearing Help Classes”^15-17, a three-session program for new hearing instrument users, a 2-week summer intensive program, and a fall Elderhostel program.

The services provided were developed in consultation with consumers. CHS is able to provide these services because it receives funding from various provincial and federal government ministries, private funding agencies, and charitable donations to provide community-based services. There is a minimal charge for aural rehabilitation services, but consumers are not denied access to services if they are not able to pay for them.

In 1990, CHS joined with Elderhostel Canada to provide a week-long residential aural rehabilitation program at the YMCA Geneva Park Conference and Vacation Centre. The program, which is designed for older adults with hearing losses and their significant others, is one of only three programs I know of that is available internationally. The other programs are held at Gallaudet University in Washington, DC,^18,19 and at the University of Minnesota, Duluth.²⁰

Elderhostel is a non-profit education/travel organization in Canada that offers inexpensive, short-term academic and recreational programs hosted by a global network of educational institutions and program facilitators. Participants are typically adults who have retired (or about to retire) and are in their mid-50s and beyond.

Elderhostel was established in the US in 1975. In 1986, Canada became part of the Elderhostel network. According to the Elderhostel calendar,²¹ in 1998-1999, Elderhostel in cooperation with some 320 institutions and organizations, offered programs to more than 68,000 Canadian households and 1 million households in the United States. Elderhostel Canada offers programs in all 10 provinces, three territories, and many overseas destinations.

The Canadian Hearing Society’s approach to educational programs for adults with hearing losses embraces the principles of self-help and consumer empowerment, developed through positive and informational opportunities for learning and change. Elderhostel offers the ideal structure and philosophy into which we have been able to realign hearing loss with images of independence and vitality. Geneva Park’s dedication to the YMCA’s principles of growth of people in spirit, mind, and body, and in a sense of responsibility to each other, the natural environment and the global community, make it an excellent partner in the program.

The goal of the program is to provide an atmosphere where participants can learn about hearing loss, share information that will enhance their understanding of their own circumstances, build social confidence, and acquire a greater awareness of self-help and advocacy in the real world. Individuals learn about strategies for maintaining and enhancing participation and have the opportunity to practice skills for enhancing the quality of their social interactions. It is an innovative program that facilitates an exchange of ideas and provides the social and psychological climate for sharing joys and new experiences leading to academic and personal growth.

The Elderhostel program is 5 days in length, beginning on Sunday afternoon and ending on Friday afternoon. Two courses specific to hearing loss are provided: “Successful Communication for Individuals with Hearing Loss” and “Improving Listening & Speechreading Skills.” These courses provide information and discussion on topics such as the impact of hearing loss on everyday life, how to enhance communication by managing the listening environment, using practical strategies and assistive devices, and principles of speechreading. Techniques used include presentations, discussion, role-play, problem-solving exercises, and speechreading exercises. A third course in line dancing is also provided. All three courses are provided on a daily basis, with each course session lasting 1 hour. The total time spent in formal sessions during the week is 18 hours. Informal sessions and laboratories are available throughout the day to encourage continued practice of the techniques that have been learned. Extracurricular activities include talent-sharing sessions, closed-caption movies, a guest speaker from the Canadian Hard of Hearing Association, a wine and cheese party, a line dancing party, informal card games, and daily fitness breaks.

All sessions are accessible to participants with hearing loss through the provision and use of assistive listening devices, overhead presentation materials, handouts, and the use of note-taking (overhead, flip-chart, or computerized note-taking).

Program Participants
Participants are 55+ years old who have a hearing loss, as well as their significant others. Significant others are encouraged to attend in advertising for the program. The maximum number of participants for the program is 40. The number of participants per year has ranged from 16 to 40, and the total number of participants from 1990 to 2000 was 289. The majority of participants have been Canadians (81%), representing four Canadian provinces; 19% have been US citizens, representing 14 states. Over half (55%) of the participants attended with a significant other.

During the first day of the program, participants are asked to fill in a “getting acquainted” questionnaire, where they are asked to provide information regarding their hearing loss, use of hearing instruments, participation in aural rehabilitation programs, reasons for attending, difficulties experienced, and expectations. The following is a summary of the information obtained from participants from 1990-2000.

Hearing loss: Four-fifths (80%) of the participants reported that they had taken a hearing test, and 81% reported that they had a hearing loss. Over half (58%) of the participants reported that the onset of their hearing loss was after age 60 and three-quarters (75%) said that the onset of their hearing loss was gradual.

Hearing instrument use: In spite of 81% of participants reporting that they had a hearing loss, only 68% reported that they used hearing instruments. The majority (62%) of the hearing instrument owners reported that they had used hearing aids for 10 years or less. Of these, 24% reported that they had used hearing aids for 5 years or less, while some participants (14%) reported that they had used hearing aids for more than 20 years.

Previous AR experiences: The majority of participants (78%) reported that they had not attended group or individual aural rehabilitation programs in the past. Almost half of the participants (47%) reported that this program was their first Elderhostel experience. The majority of participants became aware of the program through the Elderhostel Calendar (63%), with some finding out about the program through the Canadian Hearing Society (19%), friends (13%), or family members (5%).

Expectations for program: Participants reported reasons for attending the program included to gain information, to help in adjustment to hearing aid use, to help the couple communicate better, to improve the ability to speechread, to learn from others with similar problems, and a lack of programs in the community.

Participants with hearing loss reported experiencing difficulties involving listening in background noise and group situations, clarity of speech, tinnitus, beliefs and attitudes of others, telephone use, enjoyment of music, social isolation, fatigue, and frequent misinterpretations. Non-hard-of-hearing participants reported experiencing difficulties such as adjusting to the spouse’s hearing loss, frustration, and understanding problems related to hearing loss.

Participants with hearing loss reported that by attending the program they expected:

• To obtain information on new devices/hearing aids;
• To learn how to get the most out of the hearing aid;
• To decide if a hearing aid will be helpful;
• To gain information for alternatives for the next hearing aid;
• To prepare for further deterioration of hearing;
• To learn methods of coping; to learn techniques for dealing with difficult listening situations, and
• To be with others in the “same boat.”

Non hard-of-hearing participants reported that by attending the program they expected:

• To learn how to better communicate with hard-of-hearing people;
• To gain understanding and skills;
• To gain a greater understanding of the problem;
• To learn alternative techniques for communicating in difficult situations, and
• To learn how to encourage the hard-of-hearing spouse.

Program Feedback
During the final day of the program, participants were asked to complete a program evaluation questionnaire, which asked participants to provide feedback regarding the program, their experiences, the program facilitators, and to provide suggestions for changes to the program.

Generally, all sessions were rated as valuable and meeting the expectations of the participants. The majority of participants (98%) reported that meeting with others in like-circumstances was valuable. All participants reported that they received useful information and that they would recommend the program to others. The majority of participants (96%) reported that they would be interested in attending a similar course in the future.

Some of the suggestions for changes to the program included more time for individual consultation, more speechreading practice, more role-play of real-life situations, more time for assistive devices orientation, more relaxation exercises, including a “hearing ear dog” demonstration, and having the course in the spring or summer.

One section of the program evaluation questionnaire encouraged the participants to provide written comments regarding the program and their experiences. A review of the comments from 1990 to 2000 illuminated some general themes. There was a reported increased awareness on the part of both the hard-of-hearing person and the non-hard-of-hearing spouse. For example, one participant wrote:
“It is as if I have been immersed in an area I have given very little thought to. I am aware now of how many people have hearing loss and how to cope and to make others aware of your loss and to be patient with their loss.”

One of the hard-of-hearing participants, describing her spouse’s increased awareness, wrote:
“The more information the hearing partners receive, the more interested and involved they become in my experience. My husband learned more from the Unfair Hearing Test than any course yet!”

Participants also described their experiences specific to Elderhostel. For those who had not participated in Elderhostel before, the program encouraged future participation:
“This was my first experience with Elderhostel and I would love to repeat this one and hope to attend others.”

Those participants who had attended an Elderhostel program in the past compared the present program to others:
“It is one of the most special Elderhostel’s I have attended, perhaps because we are all aware of our handicap.”

Although many comments attributed the success of the program to the instructors, it was apparent that meeting others who are coping with hearing loss was also important:
“This has been a great help to my life to hear other people’s problems and their solutions.”

“Having a hearing-impaired roommate was helpful to both of us. We didn’t know each other until we met here. As I learned what to do to help she benefited along with me...I learned that I am not the only one with a problem,” and

“It was a revelation to meet with so many others with hearing difficulties. It certainly was a most helpful experience that will bear fruit in our family relations and in meeting with close friends who are hard of hearing–or anyone else we meet.”

Participants gained more confidence in themselves and in dealing with issues related to their hearing losses:
“I do not feel so shut off from the world—I feel that I can educate my friends.”

“I learned that I must let others know about my hearing loss and how they can help.”

“[It] raised my self-esteem to be made aware it’s ok to be hard of hearing and not something to ignore or disguise, that it’s not necessarily synonymous with aging!”

Participants were positive about the importance of the aural rehabilitation Elderhostel:
“This course is most necessary for hard of hearing people and their significant others.” and

“I would like to see every person with a hearing problem take these courses.”

Conclusion
The Elderhostel program has been an important component of the Canadian Hearing Society’s aural rehabilitation programs since 1990. The program has provided services to adults with hearing losses and their significant others from across Canada and the United States. It is evident that individuals are willing to travel great distances in order to participate in aural rehabilitation programs. Positive feedback regarding the Elderhostel aural rehabilitation program and the expressed necessity of such services should encourage us to increase the number of aural rehabilitation programs available internationally.

Correspondence can be addressed to HR or Mary Beth Jennings, MCISc, National Centre for Audiology, Room 2262, Elborn College, the University of Western Ontario, London, Ontario, Canada, N6G 1H1; email: jennings@nca.uwo.ca.   If you would like to obtain a copy of the conference proceedings, or find out more about the next conference (to be held in May 2003), contact: Geoff Plant, the Hearing Rehabilitation Foundation, 35 Medford Street, Somerville, MA 02143; email: HeaRF@aol.com; Web site www.hearf.org.

References
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