Hearing, Remembering, and Living Well: Paying Attention to Challenges that Older Adults Face in Noisy Environments

Conversation is crucial to many everyday activities, and most people have no difficulties engaging in one, at least not when they are young, the background is quiet and their hearing is good. However, as people get older, they can find it increasingly difficult to carry on a conversation, particularly if it is taking place in a background of noise. This is true even when they have no clinically significant hearing loss. The fact that difficulties of speech perception in noise tend to be unrelated to age-related loss in hearing sensitivity is further highlighted by the fact that hearing aids have proven rather ineffective at alleviating these particular communication challenges thus leaving older listeners at the risk of frustration and social withdrawal.
Many studies have documented age-related changes for speech perception in noise, either by reporting the percentage of older listeners who show these difficulties or by using objective measures to quantify these difficulties in older adults, compared to young adults. Moreover, work carried out by members of this group has demonstrated that noisy environments have adverse effects on communication that occur in addition to the comprehension difficulties often stated as the main problem. For instance, older adults show memory deficits for correctly perceived speech which are specific to noisy environments, and which are not being identified or appreciated by current standard audiometric or psychophysical speech perception measures. Although many studies have tried to understand why these difficulties in noise occur, and why they are, for the most part, unrelated to hearing loss treatable with hearing aids, there are currently no effective treatments available to alleviate these problems.
Most studies to date examine the question from one vantage point only, be that psychology, audiology, neuroscience or social sciences. The current project is the first of its kind that takes a broad integrative approach and combines knowledge and expertise of all of these disciplines to develop a fuller and more complete picture of the situation and its underlying causes. In the course of the project, we will be seeking answers to questions such as: Which environmental situations do older adults perceive as most disruptive to communication, and how do these situations restrict older adults' mobility and participation in society? What are useful objective measures of environmental noise sources important in the context of communication? Which voice characteristics drive the age difference in disruptiveness of background voices? How does attentional decline interact with auditory decline in aging? Do different individual trajectories of auditory and cognitive declines lead to different age-related deficits? Moreover, given our increasingly multi-cultural world in which many seniors and care-providers must function in a second-language environment, how do various native and non-native speech accents affect communication in old age?
In addition to trying to uncover potential causes for the observed difficulties, this study also aims to take the research one step further and convert our knowledge about various causes of speech comprehension difficulties into support and remediation for older adults by proposing and testing potential coping strategies that aim to alleviate the demonstrated difficulties. These strategies may include architectural recommendations to reduce noise in public places, "listening" training procedures or the active shaping of noise environments.
This project brings together expertise and knowledge of researchers from the UK, Finland, Israel and Canada in order to tackle communication difficulties faced by most older adults and to offer suggestions for coping strategies that will ultimately benefit older adults' social integration and life satisfaction.

Virtually all older adults find it challenging to communicate effectively in noisy environments. Difficulty in hearing speech or following conversations, particularly when other voices are present, is one of the most common complaints voiced by older adults. The discomfort and frustration resulting from these difficulties often prompts withdrawal or avoidance of social situations, and can severely limit the range of activities that are available to older adults, leading to a less active and satisfying life style. The goals of the proposed research are to: 1) identify the situations in which older adults experience communication difficulties; 2) develop assessment protocols capable of determining, on an individual basis, any perceptual or cognitive declines contributing to these difficulties; 3) develop individually-tailored strategies for aiding older adults with communication difficulties; 4) develop a set of standards for improving communication environments; and 5) assess the extent to which endeavors 2-4 improve the quality of life and extend the duration of an older adult's active life period.

The proposed research project aims to enhance healthy aging and increase active-life expectancy within the European Union by 2020. It will do so by identifying effective strategies that help older adults to overcome the communication difficulties they face in noisy environments. Our ultimate goal is to determine how older listeners, as a group and as individuals, can benefit from attentional strategies and training, acoustic-architectural modifications, or a mixture of these factors to remain active participants in society and achieve more engaged, confident, and fulfilling lives.

This research project has the potential for a significant economic and societal impact as it makes a particular effort to engage the general public throughout its duration, and to deliver recommendations that help older adults to maintain an effective way of communication in an often noisy environment thereby facilitating their contribution to paid and voluntary work.
In particular, we aim to 1) develop training regimens to help older adults to "listen" more efficiently in noise, 2) provide policy recommendations for the design of public spaces to minimize the intrusion of disruptive noise, and 3) raise the profile of Aging Research and increase the involvement of future scientists and care-givers in the health professions in projects aimed at understanding the dynamics of aging through the incorporation of training opportunities. We have a strong record of making this type of research a scientific and societal priority as evidenced by four members of our group being either trainees or mentors in a Strategic Training Grant on Communication and Social Interaction in Healthy Aging funded by the Canadian Institutes of Health Research (2001 and 2008).

We will use various means of engaging the general public, and particularly older adults. First, we will provide older adults with an opportunity for direct input into the challenges of environmental noise when the Finnish partner collects valuable social survey data on how older adults are affected by noisy environments according to their own appraisal. Older adults will then play an integral part in the data collection of the experimental studies and the training study that aims to implement some of the strategies developed based on the results of the first part of the project. Finally, we will seek publications not only in journals aimed at the research community, but also in journals with a broader readership that includes audiologists, ENT medical doctors, health care workers, and policy makers. We will also maintain a significant presence in older adults' community centres both for participant recruitment and for the dissemination of our findings. All of these are activities in which all partners on this grant have a long track-record.