The Impact of Hearing Impairment on Patient Care and Autonomy

TL;DR

Hearing loss can lead to miscommunication in healthcare, causing misdiagnosis and loss of patient autonomy, as shown in a case where a patient's wishes were overlooked until after unnecessary treatments.

Contribution

The paper highlights the importance of recognizing and addressing sensory deficits in elderly patients to preserve autonomy and avoid inappropriate medical interventions.

Findings

Hypoacusis was overlooked in a patient's care, leading to misinterpretation of mental status and inappropriate treatment decisions.

A comprehensive geriatric evaluation and sensory assessment could have prevented the loss of patient autonomy and unnecessary interventions.

The patient's true wishes for pain control and hospice care were only recognized after significant medical interventions.

Abstract

Sensory deficits, including hypoacusis, can cause a barrier to communication between healthcare providers and patients, which in turn can lead to misdiagnosis and loss of patient autonomy. Such deficits are frequently overlooked in clinical encounters. We present a 92-year-old Spanish-speaking female who presented twice to the Emergency Department for complications of a diabetic foot infection. Limited evaluation, documentation, and accommodations regarding the patient’s hypoacusis led to a misinterpretation of her mental status and a transfer of decision-making to surrogates. A two-toe amputation, mechanical intubation, and intensive care unit stay were followed. It was only after these events that the caregivers realized the patient's hypoacusis and learned about her different wishes focused on pain control and hospice care rather than surgical intervention. Available geriatric tools, a consultation with a geriatrician, a thorough evaluation of sensory deficits, and a multidimensional and comprehensive approach could have prevented the loss of autonomy and unexpected care.