2020 Ep. 10 Mental Health & Hearing

Dale Johnson: It’s The Conversation Starts Here, on KFOR FM 103.3, 12:40 AM with Dr. Sandra Miller from Complete Hearing. Go to complete-hearing.com for a lot of information, way beyond what we have time to talk about here on the show every Saturday morning on KFOR. Dr. Miller, thank you.

Dr. Sandra Miller Au.D.: Good morning.

Dale Johnson: Thanks very much for coming in. Interesting subject today, a link between mental health and hearing and we have an expert in addition to yourself on the phone.

Dr. Sandra Miller Au.D.: We do have an expert. Today we’re going to welcome Dr. Zlomke. He actually came and spoke to our staff just to talk about mental health. And we work with a population that obviously is a little older, although we see patients of every age, our major population that we work with is age 60 to 90. And so we were so interested to hear what Dr. Zlomke had to say just about mental health in that age range, because we know how important communication is and when we talk about communication, sometimes when we have major issues with hearing, what happens is people become kind of isolated. They might be withdrawn and that might lead to depression.

Dr. Sandra Miller Au.D.: And so sometimes we wonder if that factor is really, there’s definitely something there with hearing loss. But what other implications does that have with mental health? And so what we’ve started doing in our office is we start doing a depression screen just to see if this is kind of an issue as well and is it simply just tied to the hearing part of it, but also to have somebody to partner with to refer to when we have other issues that come up. So I want to welcome Dr. Zlomke. I love when he answers the phone when you talk to him, he says, Dr. Z. So good morning Dr. Z. How are you?

Dr. Leland C. Zlomke, PHD: Good morning, Sandra and Dale. I’m fine.

Dale Johnson: Good morning, Dr. Z. Thanks for joining us.

Dr. Leland C. Zlomke, PHD: You’re welcome.

Dr. Sandra Miller Au.D.: So Dr. Z let us know that he’s traveling back, driving back from Florida coming up and so we wish him safe travels. But Dr. Z, today I want to talk to you just a little bit about some of the things you shared with us in terms of what you see in the geriatric population and just in mental health issues and kind of what you had talked to us about what you see and then also access to care. I’m really interested to have you talk about that as well.

Dr. Leland C. Zlomke, PHD: Sure. Well, one of the biggest limiting factors is that persons on medicare are not able to access mental health practitioners but only can access psychologists and master’s clinical social workers, which really limits the number of clinicians that they have ability to see.

Dr. Sandra Miller Au.D.: So medicare limits just for coverage purposes, is that correct?

Dr. Leland C. Zlomke, PHD: Yes.

Dr. Sandra Miller Au.D.: Yes. And so it puts more of, “We don’t have as many care providers that can see them because their insurance won’t even pay for the therapy.”

Dr. Leland C. Zlomke, PHD: That’s true. And why that’s put in, it’s been in for decades and just has never made a change for that. In medicine, they have changed from only physicians to PAs and APRNs, but this one limitation of providers has not been changed by the federal government at this time.

Dr. Sandra Miller Au.D.: Is that something that your profession is kind of lobbying to have changed?

Dr. Leland C. Zlomke, PHD: I think we’ve been working on it, but it just hasn’t risen to a large priority at this time by most of the professional organizations.

Dr. Sandra Miller Au.D.: Interesting. Interesting.

Dale Johnson: Dr. Z, as an outsider looking in, I would think it’d be obvious… Dr. Miller and I talk about different… I learn something every day when I sit down with Dr. Miller for these shows and it would seem to me as an outsider looking in that with technology and research and a broader breadth of knowledge these days that it would become obvious that there would be a need for more people with this expertise.

Dr. Leland C. Zlomke, PHD: Yes, there certainly is. But elderly persons, especially those that go into longterm care facilities or need to start to be more homebound and have home healthcare and suffer from depression at a very high level, but have very limited access to professionals that can help them with that far below the availability of a general population.

Dr. Sandra Miller Au.D.: I love what you said when you came to see us, you said 70 to 80% of people in longterm care are using some type of medication for anxiety and depression and only 5% of them are getting therapy.

Dr. Leland C. Zlomke, PHD: That’s true. And those numbers may not be as accurate in Nebraska and that we’re a little different than the people on the coast, generally speaking in mental health provision. But the time that I have spent in longterm care facilities, there are very common, I’d say at least half are receiving some kind of antidepressant or antianxiety medication and not receiving any mental health outpatient therapy.

Dr. Sandra Miller Au.D.: So interesting. So I was kind of wondering, why do you think that is? So what is the cause of that anxiety and depression in those patients in longterm care?

Dr. Leland C. Zlomke, PHD: Well, the research that had been done several years ago across the nation, again, has shown that when entering longterm care, most individuals lose up to 90% of all the things that they found very valuable in their life.

Dr. Sandra Miller Au.D.: Oh, wow.

Dr. Leland C. Zlomke, PHD: These would be things like just independence, close friends, access to families, being able to take care of themselves, privacy, being able to organize our own schedule, being out and about going to particular activities. And you can imagine the loss of all those things just from one day to the next gone.

Dr. Sandra Miller Au.D.: Right.

Dr. Leland C. Zlomke, PHD: That can lead to a lot of sadness which later can develop into depression.

Dr. Sandra Miller Au.D.: I find that so very interesting. And so I think, a lot of times when you think about people who are in that situation and we work with a population that is definitely either moving into independent care, then maybe into memory care, maybe into a longterm care facility that we think about communication being so important. So when it comes to the hearing side in regards to communication or having that somehow restoring that ability to have interaction with other people, we find a lot of times our patients if they’re not hearing well may not be engaging in activities that were, “I live in this facility but I don’t go there because I can’t hear,” or, “I’m frustrated because I can’t hear what’s happening across the table. It makes me kind of anxious because I think they’re talking about me.”

Dr. Sandra Miller Au.D.: So it’s just some of those things that develop in regards to overall health, but talking about just communication aspects of that as well. Can you tell me a little bit, Dr. Zlomke about what do you see maybe in some of those facilities or is there a way that intervention is taking place and any type of cognitive therapy at all? Can you talk a little bit about that?

Dr. Leland C. Zlomke, PHD: Well, in many high quality longterm care facilities and some of those that call themselves memory care, they may have bachelor’s level or master’s level social workers that generally are pathed with admission and family contact and organization and case management. But they also now have tried to this start having some type of supportive care to see people who are expressing a degree of sadness or withdrawal or the families are starting to talk about a change in a person’s general attitude and emotional health. So the facilities try as best they can to give a little bit of support through those social workers and sometimes the nurses as well.

Dr. Sandra Miller Au.D.: That’s wonderful. Do you find that family… Obviously, I have a mom who is suffering from dementia and I have an advocate in my sister who is very in-tuned to how things are going for her and changes she’s noticing. Can you talk a little bit about does that typically, these symptoms noticed from the family or does it come from care providers? Where does it usually come from that these issues are brought forward?

Dr. Leland C. Zlomke, PHD: It can certainly be from the care providers who see them day to day and can see that progression of dementia or emotional discomfort, but also many times families have also noticed it. And anytime there’s a referral to us that has had to go through the family as well as the facility and the person, the individual themselves has to agree for the therapy. So it’s a lot of coordination to start a case.

Dale Johnson: Maybe this is a Dr. Miller question. What role do family members play in either influencing an individual who may either be confused or their hearing has changed their personality as opposed to that person who is suffering some dementia or hearing loss? Outside help as opposed to self-help?

Dr. Sandra Miller Au.D.: Right. I think I’ll address that first if you don’t mind Dr. Zlomke and then I will let you obviously talk from your side. For us, we always, when we see our patients require, recommend you bring somebody with you because we want to know what’s happening at home and how things are interacting with loved ones, family members because it’s nice to have that extra voice there, because that person is noticing what’s happening at home. And in regards to having hearing loss and communication difficulties, if we are seeing, “Yeah, mom doesn’t like to go out anymore,” or, “My husband doesn’t want to go to social gatherings anymore,” so that’s nice to have that extra piece to understand what’s happening in their environment. So to have that communication factor of somebody communicating to us other things that the patient might not be aware of is very, very helpful.

Dr. Sandra Miller Au.D.: And we’ve talked about this before, Dale, that when we talk about getting their communication skills back to where they need to be in terms of hearing, we talk very much about what does that mean when you get home and what does that mean when you go to social events and what does that mean? And so I think from our end of things on an audiology side and getting that hearing back to where it needs to be, it’s vital that the healthcare provider number one, is involved if they are in a facility where there isn’t any type of support from family. Because a lot of times family don’t live near the people that we are seeing. So number one, it’s nice to have family involved. They are a whole part of the communication process.

Dr. Sandra Miller Au.D.: And then when we have patients who do come from, say they are doing something like Home Instead where they have a care provider that is in the home, we love to write notes and send chart notes and we love to provide information and communication strategies to say when this person gets home these are the things that are helpful. So from your end, Dr. Zlomke tell us a little bit about what does that look like from the cognitive therapy side of it?

Dr. Leland C. Zlomke, PHD: Well, it’s very common that we would have a family member, could be a spouse, could be children, could be friends that come with the patient. If it’s an outpatient setting in the Nebraska Mental Health Center‘s facility, if we’re going into the longterm care facilities, then we certainly need to coordinate care with the facility staff and professionals as well as any medical providers that are involved. But the collateral resources from family and friends who can really notice the decline or the change in emotions and provide us some kind of causation and timeframe, “They were okay until here and this is what’s changed in their life and this looks like it led to this kind of change in their functioning,” is really very important for us to be able to do.

Dale Johnson: Dr. Z, thank you very much. A link between mental health and hearing, a link between hearing and mental health, that’s our subject today. We’ll continue that conversation on The Conversation Starts Here. complete-hearing.com is the place to go to pick up on information related to complete hearing here in Lincoln, Nebraska. Every Saturday morning we talk about the importance of your hearing on The Conversation Starts Here.