Dyadic partner perspectives of ageing with hearing handicap in the audible world : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Psychology at Massey University, Palmerston North
Grounded in Green and Kreuter's (1991) flexible research framework (the PRECEDE model), the prime purpose of this doctoral research agenda has been to enhance our understanding of the frequently obscure psychosocial implications of ageing with hearing handicap (HH) in the audible world, by focusing on the dyadic perspectives of older New Zealand (NZ) ex-service personnel and their spouses. Glass and Balfour's (2003) Ecological Model of Ageing guided the multidisciplinary literature review, in order to accommodate the functional implications of age-related losses which could potentially exacerbate the social and emotional sequelae of ageing with HH and tinnitus. In addition, Cohen's (1992) Transactional Model of Stress (which integrates three social support constructs with Lazarus and Folkman's  model describing adaptations to stressful events), illustrates how on-going social and emotional adjustments to hearing losses could potentially affect older adults' health-related quality of life (H-QoL). Infused by these transdisciplinary ecological perspectives, a composite model of Ageing with Hearing Handicap was proposed to explore older dyadic partner perspectives of NZ veterans' adjustment to ageing with hearing handicap; and to identify which factors exerted the most influence over the veterans' self-reported perceptions of HH and H-QoL. Methods: A purposive pilot study sample (N=51 veterans) initially guided the appropriate selection of ecologically relevant biopsychosocial variables and data collection methods (self-report mail out booklets) for two subsequent studies: (i) The main 'parent' study (referred to as the Hearing Aid Research Project [HARP]), which examined the predictors of hearing aid use in veterans aged 50 year and older; and (ii) The doctoral study, which explored dyadic perspectives of ageing with HH. The doctoral study's dyadic partner sample (N=671 dyads) comprised a subset of the 1249 HARP veterans. This subset met the doctoral study's inclusion criteria of male veterans aged 65 years plus, who had responded with a female partner/spouse residing in the same household. Only dyads with reasonably complete mail out survey response sets were selected. The dyadic partner response sets included social demographic details and responses to a number of constructs relevant to the doctoral research context including: aural rehabilitation, HH, H-QoL, emotional wellbeing, social support and memory in everyday life. Results: The results describe significantly different aural rehabilitation coping trajectories between the self-identified 'first time' and more experienced hearing aid users; and dyadic partner comparisons which highlight that the female partners were more acutely aware of the stigmatising impact of hearing losses on the veterans' social and emotional agency. Analyses of the intersecting structural and functional features of social support illustrated that increasing levels of the veterans' hearing handicap (HH) exacerbated both partners' social isolation. Wenger's (1994) support network typology illustrated how both partners' depressive symptoms and the veterans' frequency of forgetting increased significantly across a socially integrated to isolated support network continuum. The composite model of Ageing with Hearing Handicap accounted for 71.5% of the variation in the veterans' self-reported HH; 62.6% of their physical and 37.3% of their mental H-QoL. The multivariate analyses also demonstrated that HH produced a direct and negative impact on the veterans' mental H-QoL, by constraining their social and emotional agency; but only indirectly on their physical H-QoL, through reducing their energy levels and constraining their social participation. Conclusions: These transdisciplinary perspectives provide cross-sectional insights about the social and emotional wellbeing of veterans ageing with HH and their spouses, and suggest downstream links that affect their H-QoL. These findings highlight the importance of hearing health policy agendas and the communication contexts of health service delivery across all age groups. Moreover, by resolving the complex methodological and conceptual challenges inherent in focussing on older dyadic partners' everyday experiences, targets have become apparent for further investigation, to enhance and refine our understandings of engaging ecological perspectives when conducting health research.