Cochlear implants for older adults with cognitive impairment: Professionals' perspectives

Age-related hearing loss and cognitive impairment (for example dementia caused by Alzheimer’s disease, vascular dementia or Mild Cognitive Impairment), both increase in prevalence with age. Therefore, a large proportion of older adults with cognitive impairment are likely to have hearing loss too. Unidentified and untreated hearing loss can cause problems in people with cognitive impairment, such as confusion and disorientation, depression, social isolation and worsened dementia-related behavioural problems. Effective hearing care provides an opportunity to optimise wellbeing for older adults with cognitive impairment and hearing loss (Atef et al., 2023; Cross et al., 2022; Dawes et al., 2019). For those with severe-to-profound hearing loss who receive limited or no benefit from hearing aids, cochlear implants can be a suitable treatment option. Cochlear implants are surgically implanted devices that provide hearing to people with severe hearing loss and allow people to be better aware of their surroundings and engage in conversations. Previous research suggests that older adults with cognitive impairment and severe-to-profound hearing loss can benefit from cochlear implants, in terms of performance on cognitive tests and speech recognition (Dawes et al., 2024). However, after a cochlear implant has been fitted, there is a period of rehabilitation and adjustment to both the routine of wearing and managing a cochlear implant, and also the brain’s adaptation to the new way of receiving and processing auditory information. Considerations of the risks and benefits of cochlear implants for older adults with cognitive impairment is essential, however, little is known about the referral rates, candidacy assessment, consent process, fitting, rehabilitation and overall support for this cohort. In this study, for the first time, we will explore whether older adults with severe-to-profound hearing loss and cognitive impairment are referred and fitted with cochlear implants, why/why not they are referred and fitted, whether clinical teams are knowledgeable about this population, what their attitudes towards referring and fitting this population are, and what practices look like in clinics. Our results will contribute to the evidence base for cochlear implants for older adults with cognitive impairment.