Introduction

Presbycusis or age related hearing loss is a common problem in older people and has major influences on their quality of life as well as on their health¹. The Kingdom of Saudi Arabia is also experiencing the increasing rate of the elderly population hence increased prevalence of hearing loss². This condition does not only impede the capacity to speak but also to interact socially, have a mental stability, and even perform certain tasks in this life³. In a context where the Saudi Arabia healthcare system is gradually developing to cater for the aged population, proper care for age related hearing impairments through from nursing interventions have become important aspects ignored by most⁴.

The elderly Saudi Arabia especially women before the arrival of the modernization period lived with their families hence it is important to ensure they are always connected and engaged⁵. However, it has social consequences such as isolation, depression, and cognitive impairment because of the prejudice surrounding the utilization of hearing aids and other associated equipment’s. In this regard, the nurses are not only responsible for addressing the technicalities of the hearing impairment but also for the education and the behavioral interventions which will enable the patients and their families to have a way forward through the new challenge of communication breakdown that they are presented with⁶.

Saudi Arabia is making progressive changes in delivering care in the health care sector, and among the changes is the attention given to sensory losses like the hearing impaired⁷. Due to the development in audio-logical services as well as in the proper hearing aid devices, it is well focused on early diagnosis and treatment of hearing impaired elderly⁸. Nurses as the professional who are primary care givers play an important role in the implementation of these interventions that include assessment of the need for an audio-logical service, arranging for audio-logical services and support of hearing aid and other devices usage⁹. It is worth to mention that this integrative approach helps not only to enhance the hearing abilities of the elderly patients but also an overall health condition¹⁰.

The study focuses on the importance of culturally sensitive nursing care for older adults with hearing impairment in the Kingdom of Saudi Arabia as the cases of hearing impairment continue to rise due to ageing¹¹. Specifically, the cultural relevant factors such as culture, family and expectation of the elderly patients and their families should be taken into account while developing important nursing interventions¹². Incorporating all these factors in their profession, the nurses will have the ability of reducing the effects of hearing loss, improve on the overall health of elderly people, and enable the elderly in KSA to live a normal productive life despite this devastating disease that is brought about by aging¹³.

Problem Statement

The rapidly ageing population in the Kingdom of Saudi Arabia also lingers with age-related hearing loss, a condition that apart from affecting communication ability results in loneliness, depression and accelerated cognitive deterioration¹⁴. Although the further evolved audio-logical services do exist within the KSA, the application of the effective nursing interventions in treating the patients still lacks coherent integration concerning the aspects of the culture and social life of the Saudi community. Some of these challenges include the absence of protocols and variation in care plans for handling hearing impairment among the elderly thus leads to the conclusion that there is scope for more formalized patterns of care for elderly patients with hearing impairment in nursing.

Significance of the Study

The importance of this study is to contribute towards increasing the quality of life of older people in Saudi Arabia by providing better nursing care with an emphasis on the nature of age-related hearing loss¹⁵. Since communication is considered as an essential aspect in human lives and especially for those with interpersonal relationships, social contacts, and overall well-being, proper nursing care would help in the avoidance of these impacts of hearing loss, the avoidance of these psychological complications, and enhanced indigency of the senior citizens. Through culturally appropriate and patient centered approach, this paper seeks to add to the knowledge and practice of geriatrics within Saudi Arabia’s healthcare sector.

Aim of the Study

This research is now designed to assess and enhance nursing practices and administrative approaches for ameliorating age related hearing impairment in elderly patients within Kingdom of Saudi Arabia¹⁶. The purpose of the study is to understand the best practices of evaluation, training and caregiver management of the elderly patients and families to address the cultural specifics of Saudi Arabia health system. It is through this research that a guideline for the nursing practices that are generic and can be implemented in different facilities to improve health status and the quality of well-being among the elderly with hearing loss in Saudi Arabia will be set..

Methods

Research Question (PICOT Question)

In the elderly patients 65 and above in the Kingdom of Saudi Arabia(P), to what extent the nursing interventions and management strategies (I) developed in this study improves on hearing related quality of life, communication efficacy and social interactions (O) as compared to conventional practice (C) at six months follow up(T)?

Search Strategy

In this context, the approach adopted for the identification of literature for nursing interventions and management of Age-Related Hearing Impairment in elderly patients in KSA was as under. The strategy began with defining the key concepts: hearing impairment and age, nursing interventions in hearing impairment, management approaches, geriatric patients and Saudi Arabia setting. These keywords and phrases were searched by using Boolean operators to make sure that a word-wise search is done across all the database sources. The articles were only published between the years 2019 and 2024 only due to the fact that this research will only consider recent articles and because some cultures may not accept female genital mutilation even though they practice it.

Search Syntax

("age-related hearing loss" OR "presbycusis")

AND

("nursing interventions" OR "nursing management")

AND

("elderly patients" OR "older adults")

AND

("Kingdom of Saudi Arabia" OR "Saudi Arabia")

Database Selection:

Database selection was informed by the choice of high impact, peer reviewed journals and sources that are most likely to contain the research studies needed. Four databases sources were selected initially and these included; pub med, CINAHL, Scopus and the Saudi digital library (SDL). Two databases were chosen for the richness of the information on nursing and medical works: PubMed and CINAHL, the third database Scopus for its versatility for searches in interdisciplinary fields and the fourth database SDL for access to regional material and publications that may not be indexed in international databases. These databases provide access to both, the international and regional literature required to fulfil the research question.

Selection Criteria:

The studies included in the review were considered according to relevance and quality of research and its focus. Key inclusion criteria included; focusing on nursing interventions on age related hearing loss in the elderly patients; conducted within Kingdom of Saudi Arabia or related studies; published in last 10 years. Population excluded from review includes non-elderly people, non-nursing interventions, non-Saudi Arabia based studies if not applicable to Saudi Arabia, and articles prior to 2014. Those not published in full text or in other languages but English or Arabic were also excluded from the study.

Literature Search:

The literature search consisted of using different keywords to obtain as many articles as possible and then filtering the selected articles using the specified inclusion criteria in several cycles. This led to a very substantial results list which was culled down using keywords more relevant to the Saudi context of nursing as well as focusing on the theme of ‘nursing interventions’. Sources found were at first reviewed in terms of their titles and then in terms of the articles they contained. This process helped in making a final selection of studies, which formed the strong base of understanding the status of nursing intervention and management of age related hearing impairment in elderly patients in the Kingdom of Saudi Arabia.

Study Selection Flow Chart:

The current PRISMA statement to guarantee rigorous and competent identification of the literature on nursing interventions followed the inclusion of studies and management of age-dependent hearing impaired elderly patients treated in the Kingdom of Saudi Arabia. From the database searches, 450 records were obtained, while from other sources, eight papers were obtained making a total of 458 papers. That is why 88 records were obtained as unique after identifying duplicates. These records were further refined, and out of 30 records, further consideration was given. Among them, 58 records were considered and removed according to the title and the abstract counterparts since they did not match the research topic. Based on the identified databases, the eligibility assessment for full text involved 20 articles and exclusion of such article was because of methodological limitations (n = 2), failure to answer the review questions (n = 3), being a proposal as opposed to a full study (n = 3), and being published in languages other than English (n = 4). Finally, out of 1248 articles that were retrieved from the search, only 8 were selected for the final review as per the inclusion criteria (Figure 1).

Figure 1: Flow chart.

Quality Assessment

The present study focused on reviewing research studies regarding nursing interventions and management of ageing related HL in elderly patients in the Kingdom of Saudi Arabia, the quality assessment of the included studies was conducted with the help of the standardized checklists. All of the studies under each theme were reviewed based on methodological quality check list by assessing the sample size, study design, data collection technique and the credibility, transferability, dependability and confidentiality of the data. Special emphasis was placed on the suitability of the interventions, the cultural adaptation of the procedures applied and the definition of the results. The articles with high quality on these points were granted to the higher methodological quality while the study with the following limitations in the methodical aspect as the small number of respondents, the undefined approach to the definition of the outcomes, etc. are mentioned, but considered if they revealed the interesting result. All together, the eight researches included in the review were identified as the satisfactory in terms of methodological quality, most of which provided the evidences for the effectiveness of the development of the precise and specific context tailored nursing interventions in the Saudi Arabia (Table 1).

Table 1: Quality Assessment of the Research Matrix.

A quality assessment of the selected studies on nursing interventions and management for managing age-related hearing loss in elderly patients in the Kingdom of Saudi Arabia is presented in table 2 below indicating the level of rigor and clarity of the studies. One out of five articles reviewed in this paper including one of the authors’ studies earns a fair rating since the researchers displayed some weaknesses such as failure to give adequate information on the findings or lack appropriate methodological information as in the following^17,18. These include; studies by which got a good rating on methodological quality and supported by reviews of previous literature^19-22. Were also acknowledged as good but unfortunately it does not have proper description on how the foregoing studies were selected²³. Overall, it can be stated that this matrix gives a good idea of the strengths and weaknesses of the current state of research in this field the future research in this area should adhere to very high standards regarding methodological and reporting quality.

Table 2: Research Matrix.

Data Synthesis:

An analysis on four studies that were selected on nursing interventions and management of age related hearing impairment in elderly patients in the Kingdom of Saudi Arabia revealed the following similarities and best practices. Again, most of the studies pointed to the need for culture-specific interventions that were sensitive to the social and family related system in KSA. Skills utilized by the staff involved hearing screening, patient and families teaching or counseling, and use of hearing aids and other hearing devices. The synthesis also showed that there is still insufficient randomized controlled trials in the practice of these strategies, and more formalized guidelines or algorithms for implementing these practices in daily clinical care, as well as follow-up care plans where appropriate, and suggested that of to improve and develop these areas this area warrants further research (Table 2 & 3).

Table 3: Finding indicates themes, sub-themes, Trends, Study support, Explanation and potential recommendation.

Discussion

Age-related hearing loss in elderly patients in KSA can only be handled through developing a package care that involves nursing care and management. As discussed in the current literature, this paper focuses on the issues of educational programs for nurses, the practice of routine auditory assessments, holistic care delivery and addressing the issues of comorbidity related to elderly patients.

Continuing education programs for nurses have a central role in improving the performance of managing geriatric hearing impairment. According to the study done by it showed that educational interventions could positively enhance the performance and communication of nurses with patients who have hearing impaired. This finding corresponds with the study done by17 where more emphasis was given the poor knowledge among the healthcare professions, hearing loss, and its management in KSA21. Education integration into practice provides a way of guaranteeing that the nursing profession is fully prepared to handle various factors relating to age-related hearing loss hence embracing the desired outcomes for the patients.

Early hearing screening is paramount in the identification and management of hearing loss, and thus regular auditory tests are very important have also stressed the need to implement routine early-auditory screening to be able to identify hearing impaired children to intervene as early as possible16,21. When it comes to KSA where hearing loss is quite common May help in setting up routine hearing tests that can easily give way to proper diagnosis and better management practices. Retrospectively, the primary care practitioners may schedule the above assessments as parts of patients’ routine care to identify hearing loss problems and improve their quality of life in older-age groups.

Curtis (2002) suggested that development of complexnursing care plan that incorporates approaches to the care of age-related hearing-impaired patients is important. As 16,18 pointed out, it is evident that early and comprehensive inpatient care increases the quality of life of elderly patients with hearing loss and includes rehabilitation and psychology. In KSA, implementing and embracing a holistic approach towards the nursing care can provide solutions to different aspects in the patients’ health and the amplification of hearing loss treatment. This approach entails not only an attempt to treat the hearing impairment but also factors such as stress and anxiety associated with the whole problem of hearing loss – and these elements significantly increase the quality of the patient’s life.

Polypharmacy, associated disorders, and other related health issues, require proper management for proper management of age related hearing loss. In recent studies 19,20,22 mentioned that polypharmacy is common among elderly patients in KSA and its adverse effects. Both medical and pharmacological factors such as polypharmacy that can worsen hearing loss and or lead to complications should be managed adequately. The issues mentioned above concerning comorbid conditions should be well understood by the healthcare providers and add strategies to deal with comorbid conditions while dealing with hearing loss in elderly patients and improve their overall healthcare.

Hence, there is the need to establish an intricate approach to addressing age-related hearing loss in elderly patients in KSA based on the identified nursing performance indicators that are educational programs for nurses, auditory assessments, comprehensive nursing interventions, and comorbidity management. The applicability of these strategies in the practice of health care means that it is possible to enhance the quality of life of elderly patients and successfully manage the problems relating to hearing impaired patients. Further studies should be conducted in these areas and suggestions should be made with reference to the available literature to improve the management of Age related hearing impairment in Saudi Arabia.

Conclusion

Altogether, the evidence-based audit found that the best approach to the management of age-related hearing loss in elderly patients within Saudi Arabia is by constant education of healthcare practitioners about the signs and symptoms of hearing loss, periodic auditory screening, and comprehensive nursing care. Thus, the elaboration of such approaches, as well as the mitigation of the impact of the comorbidities, can enhance the quality of the elder’s life with hearing loss. Thus, the Saudi Arabian health care systems can help in catering the needs of its increasing aging population and improve overall health of the respective societies through the identified settings.

Limitation

Thus, one of the methodological limitations of this study is the unequal quality and the range of studies included into the final sample. For example, some of the research gives detailed information on nursing interventions and management approaches to the elderly while others may be limited by small sample sizes or recruited only from specific regions in Saudi Arabia thus the generalization of the results may be off. Furthermore, the arbitrary approach to the choice of study methodology and the variability of the outcomes contributing to a single measure introduce difficulties in the comparison of results from one setting to another or between different populations.

Recommendation

In order to improve the current situation with age-related hearing loss in elderly Saudi Arabian patients, it is proposed to carry out an improved training on this topic for healthcare professionals, with the required information on effective interventions and methods of hearing disorders management at present. In addition, creating a schedule of regular check-ups that would include auditory tests for elderly patients should be given high priorities in order to detect the problem in the early stage. Taking into consideration the patient with multiple disorders and other diseases, it will also help to enhance the patient survival rate, satisfaction, and quality of life due to the integrated approach to patient management and psychological assistance offered to the clients.