Effects of the “Active Communication Education” program on hearing-related quality of life in a group of Italian cochlear implant elderly users

The present study was designed to evaluate the effects of the Active Communication Education (ACE) program on the social/emotional impacts of hearing loss (HL) in a group of older adults with cochlear implant (CI). Design: prospective cohort study design with a “within-subject” control procedure. Study sample: Twenty over-65 adults post-lingually deafened CI users. All subjects were required to be native Italian speakers, to have normal cognitive levels, no significant psychiatric conditions and/or diagnosed incident dementia and at least nine months of CI experienc. Materials and Methods: 20 participants were assessed using the Hearing Handicap Inventory for the Elderly (HHIE), the Geriatric Depression Scale (GDS) and the Speech, Spatial and Qualities of Hearing Scale (SSQ) before, during and afterwards with a one and six month follow up. The evaluation of cognitive and audiological characteristics was carried out prior to commencing the ACE program. Results: The ACE program had a positive impact by reducing the social/emotional impacts of HL. Participants seemed to benefit from a rehabilitative approach aimed at improving multilevel skills - such as, comprehension of audiological and hearing dimensions, acquisition of communicative, pragmatic and problem-solving strategiesand interaction and sharing of experiences with peers. Conclusion: The ACE program, although targeting older adults with moderate HL, also seemed to be of benefit for older adults with severe/profound HL CI users. An improvement in social and emotional adaptation to hearing difficulties can in turn significantly promote optimal use of CI in older adults, thereby possibly reducing the risk of losing motivation and engagement in their use and with rehabilitation protocols. Contribution to the field The present study represents the first attempt to evaluate the benefits of a group rehabilitation program with a holistic approach to deafness adapted to a group of elderly cochlear implantees. Considering the challenge that CI users face in daily communication, this study and the existing literature underline the need for rehabilitation programs that approach both audiological and extra-audiological variables. This program supported the participants in the retrieval and acquisition of multilevel skills such as understanding the audiological and auditory dimensions, the acquisition of communication, pragmatic, and problemsolving strategies. The results of the present study show how a communicative / rehabilitation program, which uses a problem solving and interactive methodology, can also be used with severe / profoundly deaf elderly IC users who still have the resources to cope with difficulties and get back into positive social relations. Effectively, the program has improved their level of socioemotional adaptation giving rise to positive feelings of self-acceptance, responsibility, and assertiveness, ultimately improving socio-emotional reactions to hearing difficulties.