Recently, our Board President, Sarah, had the chance to sit down with Jon Suen, an audiologist and a doctoral candidate in the Johns Hopkins School of Nursing. She asked Jon about his research, which focuses on aging, loneliness, social isolation, and hearing loss. Jon shared advice for our students and clients to consider as they work to stay connected with each other during the pandemic. Their conversation has been edited for length and clarity.
Sarah: Jon, I know you as a classmate in the Johns Hopkins School of Nursing PhD program. For those who don’t know you, can you please say a little bit about your background and the focus of your research?
Jonathan J. Suen, AuD
PhD Candidate, Johns Hopkins School of Nursing & Trainee, Cochlear Center for Hearing & Public Health
Follow him on Twitter: @SuenJonathan
Jon: I have a clinical background in audiology. I have primarily worked with people who have hearing loss in urban clinical settings. I became particularly interested in exploring public health studies because I noticed a lot of people falling through cracks in the healthcare system. I realized that I needed to look at the bigger picture of an individual’s life – for example, where they live or what type of social support is available. Eventually I found my way over to a research fellowship at Johns Hopkins Medicine, where I met faculty members from the Johns Hopkins School of Nursing (JHSON) through working on a community-based project. Faculty members at JHSON take approaches to addressing health inequities that resonated deeply with me, and I decided that I wanted to continue learning from their expertise.
My research focuses on promoting healthy aging by targeting hearing loss and loneliness in the community. About two-thirds of older adults in the US have clinically significant hearing loss. As we begin to lose our hearing with age, our communication with others is inevitably affected. This can add stress to our social relationships and can eventually contribute to feeling painfully disconnected. There’s growing momentum around recognizing this sense of loneliness not as a “normal” emotional feeling, but rather as a condition that can lead to poorer health if ignored. Despite research to date about the impacts of loneliness on health, we still don’t understand this relationship well enough to know how to intervene effectively. I’m hoping my research can contribute to our understanding so that we can start doing something about it to further support people’s health and wellness.
Sarah: That work is so important, especially as more and more older people are choosing to age “in place” in their own homes. Aging in place is a wonderful option but it can put people at risk for loneliness if the right supports aren’t available to help a person stay connected to the community.
Sarah: So as an audiologist who has focused on aging, you have a lot of expertise in how we can improve communication with older adults. What are a few of the most important things our readers should know about effective communication, including with people who are experiencing hearing loss?
Jon: For hearing loss, technologies like hearing aids are helpful but they’re not the only tools that can support effective communication. Simply adjusting our communication behaviors can also make a difference.
If you’ve ever learned a foreign language, think about the times when you may have been talking with a native speaker of that language. Imagine that person talking at their normal pace and using typical words from their daily vocabulary, including slangs and idioms. What was that experience like for you? How did you feel in those moments? It’s common to feel some anxiety as you try to hone your receptive skills and go into hyperdrive focus. After a while, it can become utterly exhausting being “on” (alert). Now imagine if you were listening to a group conversation where everyone was talking over one another in a foreign language. How lost might you feel in those social situations?
This experience isn’t all that different from trying to follow conversations when you have hearing loss. You might catch the general meaning of what’s being said, but you may also miss some words here and there which could lead to embarrassing misunderstandings.
Let’s consider what a native speaker could do to make a conversation more enjoyable for a language learner. They could:
- Speak a bit slower and clearer at an adequate volume allowing the listener some time to follow along. (p.s. This doesn’t mean shouting! Shouting can actually make things harder to understand.)
- Use simpler or more common words. For example, try a word like “eat” instead of “dine” or “consume.”
- Rephrase something rather than repeat the same phrase. For example, if the person isn’t getting, “the weather was scorching,” try “it was hot out.”
- Orient the listener to the general topic of the conversation before going into details. Provide cues when changing the subject. For example, “let’s talk about your family… ok, now I’d like to learn about the types of food you enjoy…”
- Be sure to face one another when speaking. Wait to engage until you’re both able to focus on the conversation. If you’re looking at your phone or are standing in another room, it will be harder for a person to follow what you’re saying.
These are the same kinds of strategies that people can use to promote effective communication when speaking to people experiencing hearing loss.
When it’s safer to meet in-person again, facemasks and/or physical distancing may still be recommended. If that’s the case, consider using a clear facemask that allows your listener to see your face when you speak. There are several in-store/online and homemade DIY options that you can explore. If appropriate, you can also use a voice-to-text smartphone or tablet app to provide live captions for your conversation partner to read along. Some good ones include Ava and Google Live Transcribe (Androids only). You can either hold your phone by your face and the person can read the transcribed texts as you speak, or they can download the app themselves and read the captions on their own phone while you speak from a safe distance.
Sarah: Those tips are so helpful and I love the analogy – that’s something many of us can relate to. During the pandemic, our student volunteers are primarily communicating with our clients through virtual methods. What advice do you have for communicating effectively over the phone? What about via video calls or other technology?
Jon: The phone can be challenging for some people with hearing loss since they can’t also see your facial cues and body language. When I’m speaking with someone over the phone who I know has trouble hearing, I’m particularly mindful about practicing the communication strategies I described above. I might also have the person repeat-back vital details so I know that they heard what I said. If the person is having trouble following our conversation, I might suggest that they listen via speaker phone so that they can use both ears.
It is also helpful to send important details in writing before or after a phone conversation. Be sure to let the person know if you plan to do that. You might say, “I’m going to go over some things with you today, but don’t worry about getting all the details right now because I’m also going to mail this information to you after we talk. For now, just relax, listen, and feel free to ask me any questions.”
Video calls have some advantages over traditional phone calls since people can also read your body language. As with any calls, be sure there’s limited background noise (e.g., turn off the TV, close the window) and make sure you have a light source in front of you rather than behind so that your face is properly lit.
Sarah: That’s great information. I want to also touch a bit more on your work related to loneliness and isolation. You mentioned that there is some research demonstrating that loneliness is associated with poor health outcomes. What do we know about that?
Jon: There’s a nuanced difference between loneliness and social isolation. Loneliness describes a subjective distress from feeling socially disconnected, and isolation refers to an objective measure of decreased social network size. A person can realistically be socially isolated and lonely, socially isolated but satisfied, or socially integrated and still lonely. However, both loneliness and isolation are linked with poorer health outcomes like heart disease and lower immune function.
A well-respected expert in the field has proposed that loneliness is actually an evolutionary advantage we developed for survival. Humans are social species whose chances of survival are drastically improved when we work together and develop a community. According to this framework, loneliness is a biofeedback symptom that alerts us to an unmet social need. Much like how hunger alerts us to the need for food or how pain from a cut alerts us of an injury, loneliness is our body’s way of telling us about a need for social relationships. Ignoring hunger and pain from an injury would obviously have negative effects. Similarly, according to this theory, ignoring feelings of loneliness time and time again would also eventually impact our health.
Sarah: What should our readers know about how COVID may be impacting our community, including both our clients and students, in terms of loneliness and isolation?
Jon: Public health guidelines focused on limiting physical/in-person social contacts are necessary. However, loneliness and social isolation are definitely concerning side effects. I believe the pandemic is increasing our collective consciousness about just how important our social connections really are for health and wellness. Those of us who probably didn’t think about it before may now have a more personal and intimate awareness of the pains of loneliness and isolation. However, for some people, these are chronic experiences that existed before and will persist long after the pandemic. This may be true for some Lori’s Hands clients if they lack access to transportation or other resources that affect social contact. I like to think that people will have developed greater empathy for these issues as a result of the pandemic and will prioritize addressing them.
Sarah: Do you have any ideas or advice for how our students and clients can stay connected with each other during this isolating time?
Jon: If one of our goals is to minimize loneliness and isolation, we first need to understand the expressed needs and desires of those in our lives – ask them, don’t assume. Then we need to consider what we can safely do that also promotes a sense of trust and dependability, which likely looks different for different people. Some people are great with technologies, while for another the process of trying to learn them can be frustrating and make the situation worse. Some people just want someone to listen to them (emotional support), while others may want help with something practical (instrumental support). And don’t forget that someone can be isolated and perfectly satisfied, while another person may be surrounded by people and still feel lonely.
Sarah: This year has challenged our entire Lori’s Hands community, as it has so many around the world. I’m continuously impressed by how our students and clients are finding creative ways to stay connected during the pandemic. This information will be so helpful for our team, especially as we enter the winter months. Thank you for your time and insight, Jon!
Thank you for taking the time to talk with me, Jon! Always great to connect and to learn about your work. – Sarah