Inkwell: Authors and Artists

    
I have no hearing loss according to my doc, but, I noticed yesterday
that when several people are carrying on conversations around me,
picking up the one I am involved in was very difficult. I noticed a
specific feeling of irritation at one point. As I don't often go out in
public with lotsa people hadn't noticed that before. Guess should add
that to list of things yo talk to doctor about next visit.
  

    
According to my friend, that is a symptom of otosclerosis.  
  

    
An undamaged (or unaged) ear can hear in a range of about 50-15,000
Hertz. As we age, that upper limit drops (at least for some of us). My
own hearing starts to fall off precipitously at about 3000 Hz, and is
pretty much gone by 5000. There are two problems with this, both of
which contribute to the familiar phenomenon of "I can't pick out
conversations in a noisy room." 

First, 3000 Hz is where we hear consonants. It's where we distinguish
"tear" from "pear". And spoken English is all about the consonants.

Second, the high end is where we get the direction the sound is coming
from. It's why it matters where you place your tweeters, but your
subwoofer can go anywhere. If you're trying to hear what George is
saying down at the other end of the table in a noisy restaurant, you're
going to need that directional sense.
  

    
You folks all know a LOT more about hearing loss than most people do,
including me.

To me, the idea that there is an additional option -- cochlear implants --
that may be helpful when you reach the limit of what hearing aids can do,
should be reassuring.  A good thing.  The data shows that even over age 70,
people can -- with considerable effort -- hear better and recognize more
speech with implants than they could relying on hearing aids. (We're talking
people with severe hearing loss). The guy I interviewed for that post was
withdrawing from social events and couldn't really use the phone, even with
assistive devices and hearing aids.  But I spoke to him for 45 minutes and
with one or two exceptions, he could understand and respond to everything I
said.

I do have some misgivings about how American medicine will use this surgery,
though.  Will people who don't have the cognitive capacity to do all the
practicing you need in order to interpret sounds with implants get them
anyway, because it's "minor" surgery and Medicare pays for it? Will people
try to skip over the hearing aid phase, because Medicare *doesn't* pay for
aids, and go directly to cochlear implants?  Will sophisticated and well-
educated people get them and less-well-informed people never know they
exist? Will smaller hospitals offer the surgery but not hire the
audiologists and rehab specialists that help patients learn to use them?
  

    

Yes, and the hearing aids my husband got have various settings that you can
switch depending on some of that directional stuff. Sitting across from
someone? Turn off the mics in the back. Listening to the kids in the back
seat of your car? (Hypothetically.) THere's a setting for that. (We opted
not to have that one since we couldn't figure out a time it would work for
us.)

But the learning to distinguish the consonants again is a biggie and
something we still need to practice with.
  

    
Are the consonants sounding different from they did before the
original hearing loss?  Or is the sound now being heard the 
same as the original, but the years of degraded sound merely
changed your recognition of the consonants?
  

    
Consonants (and speech in general) uses a big portion of what we think
of as within the normal hearing range of the human ear. Reducing the
upper portion or frequencies reduces the intelligibility of speech,
mostly because we need the broader range to sense the subtleties.
  And yes, frequencies above 7 khz are generally more useful for
directionality sense.
   The other thing that happens to older ears is what I think of as
"holes" in our hearing, frequency ranges that are reduced due to
repeatedly being subject to loud sounds in a limited range. Left ears
of truck drivers in America tend to be less sensitive because of a
typically open drivers side window while driving. Others work with
machines that emit loud noise in an upper range and the result is a
notch in the overall frequency range.
  

    
Interesting.  I have a sharp fall-off in my right ear around 5 kHz. 
In my left ear, I have a notch at 5 kHz, then my hearing recovers a bit
at 6 kHz, then rolls off again.  And in both ears (more in the right)
I have tinnitus in the form of perceived ringing at the frequencies I
can't actually hear.
  

    
I have tinnitus although I'm pretty sure its in a frequency I can still 
hear. Occasionally I notice quite a squeal in the same range but it turns 
out to be something in the environment because when I plug my ears it goes 
back to my normal ring. 

For me, there was no obvious cause. I wasn't exposed to any unusually loud 
noises right before its onset. It didn't creep up on me slowly getting 
more noticeable. Quite literally, I just noticed it day when getting off 
the treadmill. When the pounding from my heart rate went away, there was 
the ring. It's been there ever since. 

It was much worse at first. Probably no louder, just worse because I 
hadn't grown accustom to it. A few trips to the doctor ruled out anything 
serious. Nowadays, it bothers me a few times a week usually when something 
reminds me of it. Damn you!
  

    


i'm reading Paula's most recent post on the blog right now:


Predicting a Fall’s Aftermath

<http://newoldage.blogs.nytimes.com/2013/11/15/predicting-a-falls-aftermath>

i confess, it's a little discouraging! your best bet at recovery is to be
less disabled before you fall.

i guess it is more about (as the post then goes on to say) managing
expectations and being realistic about what physical therapy can do in the
case of those who were already more restricted in their mobility before the
fall. i know with my mother-in-law, who was pretty mobility impaired by her
80s, some of the trips to rehab facilities seemed more like buying a little
more time with around the clock care than really serving to rehabilitate her
physically for going home.
  

    
Off to read that.

(Oh great, now people can sneak up on DAvid from behind.)
  

    
re <60> That so accurate, I'm surprised it had not been documented
before. The term "use it or lose it" is quite apt. Staying active, if
one can, is very important, along with a good and determined attitude. 
   I'm thinking of my own Mom, who enjoyed being sedentary during her
last decade. Watching TV, writing letters, web surfing, and not
walking, and not getting up and doing things. When she was hit with a
fairly mild case of pneumonia, it took her nearly a year to get back to
a semblance of her former strength. She found it difficult to stand up
from sitting, and she could not pick herself up off the floor anymore,
but did not want to try to regain that essential task. She sort of
gave it up. 2 years later, a stroke knocked the stuffing out of her,
and she just did not have enough strength to regain much of anything,
and just wanted to sleep.   
  

    
I've noticed that so much. We started some years ago doing very small
exercises with weights a couple times a week. Nothing remotely
strenuous, but my stamina has increased a lot even from that small
change. I can't imagine what my strength would be like if we'd let it
fall further.

I know that as we grow older everything fades, but it only makes sense
to keep up what you can.
  

    
What prompted the research that prompted my post, was a sense that the idea
of a fall being disastrous, of a broken hip spelling the end of mobility and
independence, was too simple.  A fall can indeed put you in a wheelchair for
good.  But it can also be an injury that you can recover from. (We're
talking about a fall injury serious enough to require hospitalization.)

ANd what makes the difference -- and it seems obvious, but it wasn't a
foregone conclusion -- is your condition before the fall.  So if someone had
little to no disability beforehand, the odds of recovery are pretty high.
SOmeone who was already having trouble, they're not high.

As brady says, it's mostly about knowing what to expect.  A healthy and
active person can, with time and PT, come back from even a broken hip, which
has worse odds than other kinds of fall injuries.  But it's unrealistic to
expect someone who could walk only with difficulty beforehand to regain
independence after a fall.  Sad, but better to have realistic expectations,
I think.
  

    
Yes, I agree.
  

    
My dear friend, two years older than me (so we've been collecting
social security for a while) fell down a flight of stairs, broke her
hip, had to have major surgery. (I volunteered her for Paula's posting,
but Paula found somebody else...doesn't matter; they'd have said
exactly the same thing.)

Anyway, it's a year later, and she's traveling and minding her
grandchildren and going to Pilates a few times a week. She was already
in good shape before the fall, and while she's one of these small-boned
European women who just look like osteoporosis waiting to happen,
she's always been active, and she pushed herself after the surgery to
go back to her old activities.

In other words, stay as fit as you can.
  

    
I figure maybe 25 percent of the people whose case studies I include in the
blog come from WELL connections. Including Marjorie Keyishian...
  

    
What Brady said about some stays in rehab facilities mostly being a
way to buy more time in 24/7 care -- sometimes that's exactly what
they're for, the idea being to determine whether the person can (or is
willing to) benefit from rehab at all.
  

    
Does balance play nto the ability to avoid falls, and can that be improved?
It seems like I've read something about that on New Old Age, but it may not
have been your post. I've been telling my father that improving core
strength may help but I've realized I really don't know.
  

    
that's what they say for younger people but I don't know if it works as well
for older ones.
  

    
<http://www.nlm.nih.gov/medlineplus/news/fullstory_142015.html>

"Exercise programs meant to prevent falls in seniors may also help
prevent injuries caused by falls, according to a new review.

Fall-related injuries are common among seniors and a major cause of
long-term pain and disability. They also increase the risk of having to
go to a nursing home and have a high economic cost.

The new findings, published online Oct. 29 in the journal bmj.com,
suggest that "reducing the risk of falling and improving protective
responses during a fall may be an important and feasible means of
preventing fractures and other serious injuries in the elderly," the
study authors wrote in a journal news release."
  

    
There are balance programs for older adults, yes, often operated by physical
therapists.  And they do help, if the person actually does the recommended
exercises regularly (like standing on one foot while holding onto a chair).

Sometimes though, as a comment on the blog today points out, you don't break
something because you fall; you fall because your hip or femur broke and you
went down.
  

    
Tai chi is also great for training one's balance.
  

    
Yes, it is.  And good for older folks because of the pace and the stability.

Plus, anything done in groups has the bonus value of giving people some
social connections.  Aging can be isolating.

Today's post is about the difficulty of balancing work and caregiving. A
study points out an interesting wrinkle here: women who are caregivers are
less likely to be in the labor force.  Men: no effect.

http://newoldage.blogs.nytimes.com/2013/11/21/work-women-and-caregiving/
  

    
Great article, Paula. 

Does anyone know the status of the Social Security Caregiver Credit
Act? We need to do something.