Abstract :

Hearing Loss is generally related to senior citizens as an age-related ailment. The problem further increases when people tend to avoid the problem rather than looking for solution. In India, we have around 104 million Elderly population as par the last census of 2011.

When people are Hearing impaired, they generally tend disassociate with communication with friends, relatives. They avoid gatherings and family occasions. Many a times they provide health ailments as a reason to avoid. Deep inside thought they cherish the idea to get associated with the group. They also feel that their ideas are taken due care and are implemented. As a senior person in the home affairs, they like contribute their opinion. But long Hearing impairment does blocks them from this activity.

They become prone to introversion. They are debates which states that it is choice or by imposition. Scholars such as Krutson (1998), Gearstick (1999) have explored this concept. Hearing Aids does have come up as one of the options to remove this challenge. But this problem cannot be overcome just by using a Hearing Aid(Taneja, April 2020).

May be there are scope of future studies which reveals the joy of hearing with Hearing Aid w.r.t to senior citizens. Though there has been digital disruption creating new heights of technological innovation but it needs to be seen do Senior citizens enjoy using Hearing Aid(Clubick J, et al 2018,Jensen L 2014,Powell W 2019). But the social and psychological challenges like isolation, depression, fear to meet people, shyness are a strong in build upon the personality of this persons. It does require an active participation and words of encouragement and motivation of family and friends to overcome this road block. Future studies need to be conducted to identify how far this introversion are associated with impairment and phyco-social problems. May be statistical application of multi-variate data analysis of a large population can bring in some conclusive understandings.

Keywords :

1. Introduction

It is often said the less you hear the less you speak. We often find old people sitting calm and quite without anything to reveal. Even in large gatherings we some senior citizens completely quiet and has got nothing to reveal. Most often, we do have the notion that the concerned person might be not so interested in the discussion. Many a time we do feel that there might be some language barrier which is leading to lack of communication.

But the reality of the matter lies in the fact that the better we hear, the better we speak. The less we hear the less we speak. Hearing Impaired persons are those persons who have difficulty in Hearing . We do not call them as Deaf. But they have a partial Hearing capability.

The partial hearing does makes life complicated for them. When one discusses a long topic, its becomes difficult (Krutson et.al, 1999). Further, with different accents, fast speech and pronunciations make more difficult.

According to Population Census 2011 there are nearly 104 million elderly persons (aged 60 years or above) in India; 53 million females and 51 million males. A report released by the United Nations Population Fund and Help Age India suggests that the number of elderly persons is expected to grow to 173 million by 2026.

People do not become introvert but the situation makes them introvert. They want to reveal and express their thoughts, ideas, share jokes and love to communicate. But they become hesitant. They feel shy to communicate since they have a sense of feeling which restricts them from communication.

Objective of the Study
Old Age senior citizens does suffer from many health-related issues. They do face hearing problem as one of the barriers. Hearing Aid has come up as one of In this study we would be exploring the fact how Hearing impairment makes senior citizens more introvert. The problems if we define would be communication issues, finding difficulty to have a conversation with a group of people, understanding speech in a noisy environment etc.

There had been different studies on this aspect. Different researchers have come up with different view point. Obviously, sophistication of technology had helped in the development of new avenues to face this challenge. But the question lies can technology resolve the impairment problem. We do consider Introverts is one of the gateways which leads to depression, internal stress, demotivation, sense of inferiority and other social evils which makes life of a Hearing-impaired person hell.

Literature Review & Conceptual Background
Hearing Problem faced by senior citizens have varied magnitude. The expectation of the users is different so are the challenges. In our Literature review of 26 papers in all reviewed different scholars have tried to identify the facts on different perspective. In the works of Knutson et.al(1999)24, does explores the fact that there lies a relationship between communication problems and psychological difficulties which increases the degree of introverts.

In the works of Pamela Souza, Bevan Yeuh16(2011)in their study did considered that relationship between audibility and Hearing Aid effectiveness. Following the same pathway, we could find in the works of Benemer Pieter, Nachtegeal Jannekel9(2009)in their work where they observed that Hearing Status has a direct correlation with distress, depression and loneliness. They felt that Hearing Loss does increases the chances of depression and loneliness.

In the review of literature of various articles, we do find the use of Communication Profile for the Hearing Impaired (CPHI) Demorest & Erdman(1987). It does talk of the effective non-verbal communication strategies, which the study identifies greater anger and stress, and reported greater problem awareness and less denial associated with Hearing Loss. Though we cannot that CPHI as the only tool for evaluation of the stress on the Hearing-impaired person. But obviously it is one the strategies to evaluate the outcome of the building emotions of the Hearing-Impaired person.

Another study in this regard was conducted by Welch D., et al (Oct 2017)in his work Understanding why people enjoy loud sound. The general perspective is that when one hears less then obviously then need more sound amplification to hear. But over a time period they are at ease with the high volume of sound. He does mentions Conditioning, Adaptation& Acculturation to Lund Sound (CAALM) model which proposes they benefits associated to loud sound.

Studies does reflect the fact that Hearing Aids are one of the solutions to overcome the Hearing Impairment. Authors like Speaks C. et al ( 1966), article on investigating the performance of Hearing Aids with different levels of Hearing Loss does Clubick J, et al (Nov 2018), Jensen L (Nov 2014), Souza et.al ( Oct 2011), Taniguchi M (July,2004), Powell W,et.al (April 2019) does mentions the fact that in their work Hearing Aid comes has one of the alternatives for Hearing impairment. They further, state the fact that it has an impact on the emotional part of the persons. The communication level also does gets changed. Statistical tools have been applied to draw inferences of the fact that how far they are useful.

But the literature review we undertook did not provided us a clear solution to the fact how hearing-impaired persons can overcome the challenge of Introverts. The studies do suggest to the fact that there is a physical challenge which can be overcome by Assistive listening device as well as there is a psychological portion which we mention as motional blockage to communication. How far each of them is applicable is a question which needs further studies and probe.

Research Methodology
In the Literature study we have seen scholars in their work have seek the use of qualitative as well as quantitative techniques to assess the impact of senior citizen. Some of them used questionnaire format while others have taken data analysis through hearing threshold measurement. In our study we are doing a conceptual study of the scholars whom we have in defied related the work. We have assessed their work and tried to identify the areas of work or scope of further study. During the conceptual study we have tried to consider the variables which were mainly independent and dependent in nature. Hearing Loss and Performance of the Hearing Aid were the primary variables in which the most of the studies revealed.

Statement of Problem/Research Problem
Time study of the different research papers conducted by various authors and researchers have revealed that Senior citizens does face some form Hearing disabilities at their age. Studies have indicated that some try to conceal their problems while others show the interest but at a very late period. Hearing Aid has come up as a solution to the impairment problem. It is mostly used to bridge the communication gap faced by the senior citizens.

Though we are trying to derive a relationship between Hearing Impairment and Introverts. In needs to be noted that there are people with normal hearing as well are prone to introvert. Probably we seek to understand the impact of Hearing Impairment to Introverts in our article.

Studies have suggested that Introverts leads to shyness, depression, isolation and other artificial stigma. Though Hearing Aids and other assistive listening devices does come up as a solution to Hearing Impairment to a great extent. But do they overcome the challenge of Introverts.

Research Gap
The Literature review does indicate that Senior citizens suffer from chronic diseases as well as Hearing ailments. The studies have indicated that hearing aids does impact varying level of hearing loss. But the gap which was explored during the literature review was that Senior citizen do have numerous reasons which are beyond the Hearing impairment and communication skills problems. We term them as phyco-social stigma where we have seen many authors have mentioned quite a few variables which does impact the introverts. But the combination of all the factors as well the proportion of each factors contributing the introverts is a gap which needs further exploration.

Quality of Life – Senior Citizens
The term quality of life refers to the fact that how much fit, comfortable and ability to involve himself/herself in part and parcel of life. 10We do have good and bad days; life does test how mentally strong we are to face the challenges.

Actually, the term Quality of Life (QOL) is quite ambiguous since it refers to the experience of an individual one has of his own and also relating to the living conditions in which the individuals does finds themselves.17

Introversion
Introversion is a personality trait characterized by a focus on internal feelings and prejudices. Introverts and Extroverts are often viewed in terms of two extreme opposites, but the truth is but generally people line in between the two.

Studies have shown that introverts make up an estimated 25 to 40 percent of the population. But there are still many misconceptions about this personality type. It should be noted that introversion is not the same thing as social anxiety or shyness.

Can we identify introvert and who isn't? we generally associate them as shy persons who prefers to stay home alone instead of socializing. But there are wide variety of introvert we can come across.

On Physiological level we can state, a network of neurons located in the brain-stem which is defined as Reticular Activating System (RAS) is responsible for regulating the movement. When confronted by likely threats in the environment, the RAS will adjust your arousal levels in order to make us alert and be ready to deal with the danger. The psychologist Hans Eysenck suggested that these arousal levels could be thought of as a continuum. According to Eysenck's theory, introverts are those that have naturally high levels of arousal. The reasons being introverts tend to experience chronically high arousal levels. Moreover, they tend to seek activities and environments where they can escape from overstimulation. Since they are naturally high arousal levels, they are more alert and take in more information from the environment.

Hearing Impairment and its Impact on Senior Citizens
Hearing Impairment is challenge for senior citizens. Often this impairment is termed as Presbycusis which relates to Auditory nerve and cochlea malfunctioning. Similar to eyes where nerve deafness can be taken care either by spectacles or contact lenses 14. In case of Hearing deafness when the problem relates to Senso-neural Deafness (SN HL) Hearing Aids or Cochlear Implant (CI) are the solutions one has.

Before we proceed further, we need to understand how far nerve deafness impacts one’s normal activity. There are quite a few questions which arises at this point which needs more clarity.

• What problems senior citizen when they are heard of hearing ?
• Do they realize that they are having a challenge in Hearing?
• DO they have to compromise due to their hearing in ability?
• Do they feel handicapped due to this challenge?
• What solutions do they have in hand to overcome?
• How far these solutions are appropriate enough to overcome the challenge

Compared with visual impairment when people are readily accepting the fact that they have a problem. In case of Hearing Impairment people generally do not accept the fact that they have a problem. There are quite a few misconceptions in the minds of people which requires rigorous counselling before this view’s changes.9 Many a people are of the view that Hearing Aid are used by persons who are deaf. Further, Hearing Aid use decorates the hearing capability of a person. The truth actually is, that Hearing Aid are worn by persons who have Hearing challenge similar to the fact that Spectacles are worn by persons who have Visual challenges.

Challenges faced by Hearing Impaired persons
Hearing Impaired persons do face quite a few challenges. The challenge is to understand and communicate. A senior citizen generally tends to spend most of their time at home. They need to communicate with his fellow family members.

Occasionally when he travels to Bank, Post Offices, Clubs, Family Gathering etc. were quite a few people are speaking at the same time along with background noise. He finds really awkward to manage as the ability to understand and communicate further dents. Even though he wants to participate he tends to remain silent and introvert. The happiness to communicate, the charm of sharing ideas, thoughts, memories become really restricted.5Hearing the FM radio, listening to classical music or watching the television though intended does not provide that charm of listening. Many a times when he sees his friends in the park or club, he tends to provide some excuses to avoid the embracement.

According to WHO (2018) data, the prevalence of hearing impairment (HI) in India is around 6.3% (63 million people suffering from significant auditory loss). The estimated prevalence of adult-onset deafness in India is 7.6% and childhood-onset deafness is 2%.iv

Impact on Hearing Impairment on Introversion
Obviously at the onset it needs to be stated that hearing loss is not restricted to senior citizens only. But it can happen to any person at any age. The neonatal babies might have the congenital Hearing Problems.

If we compare the life of a hearing impaired senior citizen to a black and white photograph, hearing aid is a colored photograph which resorts back the benefit of ones lost charm in life. Studies does suggest that Hearing impairment further makes people introvert. Probably its not by choice by situation which puts them in this position. The Psychological stigma, fear of unknown facts, shyness all bundles up to increase the index of Introverts.

The introvert in true sense does feels to be involved in discussion. He also wants to communicate with people via phone, video conferences, tries to listen music, watch movies, news and sop serials. But the challenges do restrict them from doing so.

Discussion & Findings
Obviously, the problem that is there cannot be substituted with an artificial solution. But obviously it helps to overcome many a challenge which one come across. The inherent question lies does every Senior citizen Hearing impaired person wants to communicate, socialize. Do all of them possess the same feeling that it positively affects their quality of life. If still the answer is yes, then what is the price for this solution.

Actually, we have to balance our needs, requirements, availability, place and time. Assistive listening devices does provide some form of solution to help communication.

Recommendation
Senior citizens do possess quite a few challenges which is further amplified when then are introvert. This stops them to communicate their feelings, thoughts and put their ideas into practice. People around him do not get to know what are the requirements. Kipping this factor in mind providing a good assistive listening device would not serve the purpose. But there are some natural habitats which does needs to be overcome. Easier said than done, the age old practices require genie intention from the impaired person as well as their fellow members be it their family, friends and close aides who need to be supportive and come forward to provide a comfortable environment to make introvert to a normalized speaker. Even the best practices might not provide a fruitful result. The results might vary from case to case basis. But we need to stick to the main principles to make things happen.

Scope of the Study
Since we have conducted a literature review of limited journals and published papers our finding has been quite restricted. A questionnaire based survey including people of different income group and areas would provide a better perspective of the work. Obviously, there are research gaps which have been mentioned earlier in the paper which can be considered as a full-fledged thesis for further research work.

Conclusion
Senior citizens do undergo quite a few Health challenges. Hearing impairment is one of the challenges which makes a negative impact on the personality. People tends to be introvert and try to avoid conversation. They remain mum or speechless in a discussion. The happiness and enjoyment in listening music, watching television, speaking with friends and relatives in cellphones vanishes. They really struggle when they are in public place due to their hearing incapability.

They tend to feel comfortable when they are alone. They try to avoid the discussion and share their thoughts. But obviously it’s been ageing the practice has been continued. Further the impairment has increased it many folds effect. Effective Assistive listening device like Hearing Aid, Counseling, cooperation of family, friends and close aids can help to overcome this problem. Actually, the society has to change the mind set and rather than considering them as introvert now its time we consider the pain which makes them be behave in this manner.
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