The National Palliative Care Research Center

Curing suffering through palliative care research.


Margaret Wallhagen PhD, BSN, MSN


University of California, San Francisco

Grant Year
Grant Term
2 years
Grant Type
Pilot & Exploratory Project Support Grant

Project Description
Older Adult—Caregiver Dyads: Effects of Hearing Loss on Communication Related to Goals of Care in the Context of Serious Illness

This pilot addresses the NPCRC priority on improving communication by gaining an in-depth understanding of the ways hearing loss (HL) affects communication regarding care preferences and goals within the older adult patient-informal caregiver dyad in the context of serious illness. Its premise is that older adults with HL and serious illness cannot participate effectively in care discussions and are at risk of not receiving patient-centered, goal-directed care. Informal caregivers are also essential to the decision-making processes and should understand the patient’s wishes, so the impact of HL on dyadic communication must be considered. Yet almost no data are available on the impact of HL in the context of serious illness. This pilot addresses this data gap. Qualitative interviews with 10-15 dyads – older adults with HL and serious illness and their caregiver – will be conducted to:  Aim 1: Obtain in-depth descriptions that will elucidate the specific ways HL affects discussions of care, care preferences, and goals of care with a health care provider and with each other from the individual viewpoints of both the a) older adult patient and b) caregiver;  Aim 2: Obtain preliminary data on the use and usefulness of a brief educational session on HL and a pocket-talker provided at the end of the interview on subsequent communication within the dyad and with health care providers, assessed at 3 months. These data are essential for the development of a longitudinal cohort study to examine the impact of HL on communication in greater depth, over time, with a large and diverse population, and that includes the patient, caregiver, and clinician.  Data from both the Cohort study and pilot will underpin development of targeted interventions to be tested in a RCT.

Margaret Wallhagen, Ph.D., GNP-BC, is a professor in the School of Nursing, University of California San Francisco where she teaches gerontological nursing at the master’s and doctoral level. She also serves as director of the UCSF/Hartford Center of Gerontological Nursing Excellence and is Senior Nurse Scholar for the VA Quality Scholars program in SF. Her research focuses on how older individuals and their families manage chronic illnesses and changes that occur with age, and has explored issues related to informal caregiving, diabetes, and the construct of successful aging. However, for the last several decades she has focused specifically on the impact of hearing loss (HL) on older adults. Her most recent work addresses the benefits of integrating screening for HL into primary care, the impact of HL on the provision of quality palliative care, and the impact of HL on the caregiver-individual with HL dyad in the context of a serious illness.