Physical activity among older people who are deaf and hard of hearing: perceived barriers and facilitators

INTRODUCTION

Being physically active can help to improve one’s health and wellbeing and prevent secondary medical conditions. For instance, children in kindergarten are more physically active than teenagers and young adults and seem to satisfy the criteria for health benefits [1]. With increasing age, people seem to engage less and less in physical activities. However, physically older adults are at lower risk of disease and have higher levels of physical and cognitive function, psychosocial well-being and independence than inactive older adults [2].

For individuals who are deaf or hard of hearing (D/HH), the level of physical fitness might be lower than that of people without any disability. The reasons for this difference might be due to a lack of auditive information or communication problems and a lack of auditive information during physical activity [3-7].

Regular physical activity and physical fitness are especially important in maintaining the health and well-being of people of all ages not excepting of older age population [8, 9]. It is particularly important that people who are D/HH and are usually physically inactive devote some time to physical activity since it significantly helps to improve their quality of life [10, 11]. The deaf and hard of hearing population is a heterogeneous group that includes persons who have varying degrees of hearing loss, use multiple languages and belong to different cultures. Factors that must be considered with this population include the degree of hearing loss, the age of onset of loss, the preferred language including supportive communication modes and psychological issues. Individuals who are D/HH may be disadvantaged in terms of health and participation in beneficial physical activities compared to the majority of society due to their information deficit and limited auditory perception [12-14].

The European Disability Strategy 2010–2020 [15] focuses on eliminating all barriers faced by more than 80 million Europeans that often prevent them from fully taking part in society (e.g. sports, leisure, cultural and recreational organizations, events, venues, etc.) and the economy. Rimmer et al. [16] points out that the degree of participation in physical activity among people with disabilities is affected by a multifactorial set of barriers (architectural, social, policy and attitudinal) and facilitators that are unique to this population. Despite having general awareness of the important benefits of physical activity, the rate of participation in leisure time physical activity by people with disabilities is low [17-19]. At present, there is very little understanding of the constraints on the leisure time physical activity among people who are D/HH. To promote an active and healthy lifestyle amongst individuals who are D/HH, it is necessary to understand the factors that prevent or facilitate their participation in physical activities. The purpose of this study was to investigate the ways in which participation in physical activity is either prevented or facilitated among older adults who are D/HH.

METHODS

RESULTS

The analysis revealed several themes that helped to explain why physical activity was perceived as being either prevented or facilitated among older adults who are D/HH. Each theme often captured both a barrier and facilitator to physical activity. The following themes that were identified through the analysis will be discussed in turn: communication strategies; visual and technical support; environment; physical activity participation.

Communication strategies

Participants in the study communicated using speech as well as lip reading and written texts. Both deaf individuals without cochlear implants communicated primarily through sign language; they regarded any written information as being difficult to understand. Only four of eight participants who are D/HH mentioned that they did not have difficulties in communication. Others stated that the hearing population is uninformed or indifferent.

To put this in context, audiologists categorize hearing based on pure-tone frequencies of 500 to 4000 Hz and as: no hearing loss 0–25 dB, no or very slight hearing problems, able to hear whispers; slight hearing loss 26–40 dB, able to hear and repeat words spoken in a normal voice at a distance of 1 metre; moderate hearing loss 41–60 dB, able to hear and repeat words spoken in raised voice at distances over 1 metre; severe hearing loss 61–80 dB, able to hear some words when shouted into the better ear; and profound hearing loss including deafness of 81 dB or greater, unable to hear and understand even a shouted voice [22].

Participants in this study had profound hearing loss or deafness; six of them used a hearing aid or CI (Table 1). The hearing aids users reported that the hearing aid helped him/her to communicate more easily and to control their surroundings. Users of cochlear implants also indicated that the CI helped them to better understand speech. However, problems arise when they could not have their CI (e.g. during swimming, sauna, in a storm). One of the CI users mentioned that, in such situations, he communicates using sign language that he mastered in childhood. CI users communicate in sign language with hearing as well as deaf persons in acoustically hostile environments when wanting to be sure that they understand each other well.

Older adults who are D/HH try to resolve failures of the auditory analyzer through an agreement in advance and thus avoid misunderstandings in communication. All of them assume a specific attitude with regard to their communication skills and the skills of the counterparties with whom they communicate. Users of hearing aids or CI eliminate common problems with comprehension in noisy environments in various ways: “After years of living with hearing loss and possible communication pitfalls, I already know what to do. Usually, I tell the person in advance what I need for smooth communication, or I resolve the situation at the first sign of trouble” (P3, 56 years old).

Table 1. Participants characteristic

Participants P1 P2 P3 P4 P5 P6 P7 P8

Age 52 67 56 64 64 58 72 64

Gender

Female – + + – – – + +

Male + – – + + + – –

Onset of hearing loss

Years of age FB FB 5 13 2 5 18 36

Type of hearing loss

Sensorineural + + + + + + + +

Degree of hearing loss

Deafness + + – – – – + +

Profound hearing loss – – + + – – – –

Moderate hearing loss – – – – + + – –

Use of hearing aid or CI

Yes – + + – + + CI CI

No + – – + – – – –

Primary mode of communication

Czech sign language + + – – – – – +

Czech language (spoken speech) – + + + + + + +

Difficulties in communicating

I have no problem – – – – + + + +

Uninformed + + – – – – – –

Indifferent + – + + + + – –

Hearing state of parents

Both parents hearing + + + + + + + +

Hearing state of siblings

Hearing siblings + + + + + + + +

Education

Regular school – – – + + + + +

Leaving examination – + + + + + + +

University degree – – + – – + + + Note. FB = from birth; CI = cochlear implant

DISCUSION

A targeted support of communication and a mutual collaborative environment where physical activities are provided may alleviate or eliminate any possible feelings of social exclusion among those who are D/HH. On the contrary, an example of an inappropriate approach taken by professionals is the situation where they verbally explain everything in great detail to the hearing persons, but very often provide only rather simple instructions to individuals who are D/HH, or who rely primarily on gestures when communicating with people who are D/HH. Similar findings have been published in other studies that were focused on the special needs of people who are D/HH [3, 5]. Drawbacks in communication may, for people with varying degrees of hearing loss, result in insufficient development of their verbal or sign vocabulary. Consequently, they are often not afforded enough opportunities during physical activities to engage in social interaction with mainstream society, and through it, to develop new skills and interpersonal relationships.

The main factors impeding the involvement of people who are D/HH in leisure time physical activities include a feeling of indifference or uncertainty from the majority of society, as well as a lack of available information [24]. Appropriate physical activities can help to reduce personal and family stress and facilitate bringing about new long-term friendships into their lives, as well as help the individuals to take their minds off the hectic course of life. It also helps them to overcome critical periods in their lives. Those findings have also been confirmed in the other studies [25, 26].

Therefore, if we want to offer appropriate physical activities, we must take into account the specific conditions foe persons who are D/HH: (a) the general needs of people who are D/HH (the basic needs of persons); (b) the special needs of given individuals based on their skills and abilities. We agree with Reich & Lavay [27], Schultz et al. [28] and Zaccagnini [29], who stated that there are numerous physical activities that individuals who are D/HH could take part in, although they must have the opportunity and know how to access them. Professionals delivering these services need to have appropriate training, including knowledge and skills related to the special needs of people who are D/HH, especially appropriate communication skills and practical experience with that group.

CONCLUSION

In the present study, older adults who are D/HH were interviewed so that they could describe their participation in leisure time physical activities. By using qualitative methods, ways that prevented or facilitated physical activity participation among older adults who are D/HH were investigated.

Physical activity providers or other professionals delivering these services could benefit from training how to best facilitate physical activity for older people who are D/HH. Also, opportunities to participate in different forms and levels of physical activity that include provisions for a smooth transition between responsible parties when they leave are essential. Information and guidelines are needed that inform people how, why, where, and when to be physically active with respect to their special needs. As a part of this, promoting positive messages that incorporate the multiple reasons for being physically active, such as physical, mental, and emotional rewards, is required. Close cooperation between relevant service providers and local organisations for people who are D/HH is the best choice to build connections with existing mainstream community activities.