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Marcotti A, Rivera S, Silva-Letelier C, Galaz-Mella J, Fuentes-López E. Effectiveness of the active communication education program in improving the general quality of life of older adults who use hearing aids: a randomized clinical trial. BMC Geriatr 2024; 24:828. [PMID: 39395936 PMCID: PMC11470628 DOI: 10.1186/s12877-024-05424-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 09/30/2024] [Indexed: 10/14/2024] Open
Abstract
BACKGROUND Hearing loss in older adults affects general, generic health-related and disease-specific quality of life (QoL). The conventional strategy to address it is through hearing aids, which have been shown to improve disease-specific QoL. However, the long-term results regarding general quality of life are unknown, and communication problems and stigma associated with hearing loss may persist. An effective intervention strategy to address these problems is group communication programs, most notably Active Communication Education (ACE). This program has been shown to increase communication strategies and reduce communication activity limitations and participation restrictions. These precedents allow us to hypothesize that this program could improve general QoL. METHODS A randomized clinical trial was conducted on 114 older adult hearing aid users. Fifty-four subjects composed the intervention group that received the ACE program, while 60 subjects composed the control group that received an informational-lectures type intervention. The WHOQOL-BREF questionnaire was used to measure general QoL. Measurements were taken before and right after the intervention, with follow-ups at 6 and 12 months. Multilevel linear mixed models were estimated, considering the WHOQOL-BREF dimension scores and total score as the outcomes, and an interaction term between time since intervention and group as the predictor. Within- and between-group comparisons were made. RESULTS Compared to the baseline time-point, the ACE group showed significant improvements right after the intervention, and at the 6-month and 12-month follow-ups for the dimensions of psychological health, social relationships, environment, and total score. Compared to the control group, the ACE group exhibited significantly greater improvements in the social dimension at all postintervention assessments, as well as in the environment dimension and total score at the 12-month follow-up. CONCLUSIONS The ACE program improved general QoL in terms of social relationships and environment dimensions, which lasted up to 12 months after the intervention. Therefore, ACE is positioned as an effective complement for HA users, enhancing and delivering new benefits related to broader aspects of QoL not necessarily tied to health. TRIAL REGISTRATION ISRCTN54021189 (retrospectively registered on 18/07/2023).
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Affiliation(s)
- Anthony Marcotti
- Escuela de Fonoaudiología, Facultad de Odontología y Ciencias de la Rehabilitación, Universidad San Sebastián, Santiago, Chile
| | - Sebastián Rivera
- Escuela de Fonoaudiología, Facultad de Salud, Universidad Santo Tomás -, Viña del Mar, Chile
| | - Catherine Silva-Letelier
- Programa de Magister en Epidemiología, Escuela de Salud Pública, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Javier Galaz-Mella
- Exercise and Rehabilitation Sciences Institute, School of Speech Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago, 7591538, Chile
| | - Eduardo Fuentes-López
- Departamento de Fonoaudiología, Escuela de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Vicuña Mackenna 4860, Macul, Región Metropolitana, Chile.
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Knoetze M, Manchaiah V, Oosthuizen I, Beukes E, Swanepoel DW. Perspectives on Hearing Aid Cost and Uptake for Prescription and Over-the-Counter Hearing Aid Users. Am J Audiol 2024; 33:942-952. [PMID: 39110835 DOI: 10.1044/2024_aja-23-00116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2024] Open
Abstract
PURPOSE This study explored user perspectives on the relationship between hearing aid cost and uptake, as well as cost-related recommendations for others with hearing difficulties, in a sample of prescription and over-the-counter (OTC) hearing aid users. METHOD A secondary analysis was conducted on a cross-sectional survey using qualitative content analysis to analyze responses related to the cost of hearing aids. The study included a total of 241 adult participants, comprising 179 prescription hearing aid users from the Hearing Tracker website and 62 OTC hearing aid users from the Lexie Hearing U.S. database. RESULTS Prescription users had a mean age of 66.7 years (SD = 13.2), including 62.0% males, 37.4% females, and 0.6% nonbinary individuals. OTC users had a mean age of 63.0 years (SD = 13.4), with 48.4% males and 51.6% females. Three overarching domains were identified: perceived enablers to hearing aid uptake related to the cost, perceived barriers to hearing aid uptake related to the cost, and recommendations to others with hearing difficulties related to the cost, with 14 categories recognized for prescription users and 12 for OTC users. Both groups identified the high cost of hearing aids and lack of insurance coverage as significant barriers to uptake. Many prescription users reported external support (e.g., financial support and health insurance coverage) as an enabler, while OTC users frequently mentioned the affordability of OTC devices. The most common recommendation among prescription users was to seek professional support, whereas OTC users recommended researching hearing aids before making a purchase. CONCLUSIONS Cost and insurance coverage consistently emerge as primary barriers to hearing aid adoption for both prescription and OTC users. To foster greater accessibility, initiatives should target these financial obstacles. Additional research is warranted on the relationship between hearing aid cost and uptake, especially among OTC users and those seeking financial assistance. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.26496922.
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Affiliation(s)
- Megan Knoetze
- Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa
- Virtual Hearing Lab, University of Colorado School of Medicine, Aurora, and University of Pretoria, South Africa
| | - Vinaya Manchaiah
- Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa
- Virtual Hearing Lab, University of Colorado School of Medicine, Aurora, and University of Pretoria, South Africa
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, Aurora
- UCHealth Hearing and Balance, University of Colorado Hospital, Aurora
- Department of Speech and Hearing, School of Allied Health Sciences, Manipal Academy of Higher Education, India
| | - Ilze Oosthuizen
- Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa
- Virtual Hearing Lab, University of Colorado School of Medicine, Aurora, and University of Pretoria, South Africa
| | - Eldre Beukes
- Virtual Hearing Lab, University of Colorado School of Medicine, Aurora, and University of Pretoria, South Africa
- Vision and Hearing Sciences Research Group, Anglia Ruskin University, Cambridge, United Kingdom
| | - De Wet Swanepoel
- Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa
- Virtual Hearing Lab, University of Colorado School of Medicine, Aurora, and University of Pretoria, South Africa
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, Aurora
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Coco L, Leon K, Navarro C, Piper R, Carvajal S, Marrone N. "Close to My Community": A Qualitative Study of Community Health Worker-Supported Teleaudiology Hearing Aid Services. Ear Hear 2024; 45:1191-1201. [PMID: 38812073 PMCID: PMC11333189 DOI: 10.1097/aud.0000000000001507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
OBJECTIVES Given well-documented disparities in rural and minority communities, alternative service delivery models that help improve access to hearing care are needed. This article reports on a study of older Latino adults with hearing loss who received hearing aid services with Community Health Workers (CHWs) providing support via teleaudiology. The present study used qualitative data to explore perceptions of this novel service delivery model. DESIGN Participants completed semistructured interviews related to their experiences in the intervention approximately 17 weeks after the hearing aid fitting appointment. Two coders independently coded the data, using an iterative deductive and inductive thematic analysis approach. Inter-rater reliability was good (κ = 0.80). RESULTS Of the 28 participants, 19 were interviewed (CHW group: n = 9, 8 females; non-CHW group: n = 10, 9 females). Both groups of participants reported experiencing barriers in access to care and reported positive experiences with teleaudiology and with hearing aids as part of the trial. CHW group participants reported interactions with patient-site facilitators that were indicative of patient-centeredness. CONCLUSIONS Results demonstrate the feasibility and potential effectiveness of trained CHWs as patient-site facilitators in teleaudiology-delivered hearing aid services for adults.
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Affiliation(s)
- Laura Coco
- School of Speech, Language, and Hearing Sciences, San Diego State University, San Diego, CA
- Department of Speech, Language, and Hearing Sciences, University of Arizona, Tucson, AZ
| | - Kimberly Leon
- Department of Speech, Language, and Hearing Sciences, University of Arizona, Tucson, AZ
- Department of Psychology, University of Arizona, Tucson, AZ
| | | | - Rosie Piper
- Mariposa Community Health Center, Nogales, AZ
| | - Scott Carvajal
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ
| | - Nicole Marrone
- Department of Speech, Language, and Hearing Sciences, University of Arizona, Tucson, AZ
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Fukumasu I, Kataoka Y, Tabuchi T, Egusa K, Ando M. Exploring factors influencing the hearing test and hearing aid adoption among Japanese older adults: Implications of recognizing the hearing loss-dementia relationship. Auris Nasus Larynx 2024; 51:822-827. [PMID: 39003979 DOI: 10.1016/j.anl.2024.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 06/24/2024] [Accepted: 07/02/2024] [Indexed: 07/16/2024]
Abstract
OBJECTIVE The hearing aid adoption rate among older adults in Japan is lower than that in other developed countries. Herein, a survey was conducted to identify this bottleneck and develop countermeasures. This study aimed to examine whether raising awareness of the relationship between hearing loss and dementia is significant for hearing tests and adopting hearing aids. METHODS A questionnaire was administered to participants aged 65 or older who visited a general hospital to determine the background factors (1) for a recent history of hearing tests, (2) for the desire to visit an otolaryngologist and have a hearing test, (3) for recognizing the hearing loss-dementia relationship, and (4) for adopting hearing aids. RESULTS A total of 517 patients (mean age, 78.06; SD 6.97), representing 2.4% of the region's older-adult population, participated in the survey. A history of hearing tests within five years was significantly associated with recognizing the hearing loss-dementia relationship (adjusted OR 2.36, 95% CI 1.49-3.72). The desire to visit an otolaryngologist or have a hearing test was significantly associated with recognizing the hearing loss-dementia relationship (adjusted OR 1.70, 95% CI 1.02-2.85). Moreover, 39.3% were aware of the hearing loss-dementia relationship. The significant associated factors were being female (OR 2.50, 95% CI 1.64-3.81) and having interpersonal hobbies (OR 1.66, 95% CI 1.11-2.49). The significant background factors for adopting hearing aids were older age (OR 6.95, 95% CI 1.90-25.40), self-reported severe hearing impairment (OR 5.49, 95% CI 2.55-11.80), and living alone (OR 2.63, 95% CI 1.18-5.89). Recognizing the hearing loss-dementia relationship was not a significant factor. CONCLUSION Raising awareness of the hearing loss-dementia relationship was not associated with adopting hearing aids for self-reported hearing impairments. However, it may be associated with otolaryngology visits and hearing tests. Thus, steps like hearing screening for older adults are also essential.
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Affiliation(s)
- Ichiro Fukumasu
- Department of Otolaryngology, Head and Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan; Department of Otolaryngology, Head and Neck Surgery, Hiroshima City Hospital, Japan.
| | - Yuko Kataoka
- Department of Otolaryngology, Head and Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Takahiro Tabuchi
- Division of Epidemiology, School of Public Health, Graduate School of Medicine, Tohoku University, Japan
| | - Kentaro Egusa
- Department of Otolaryngology, Head and Neck Surgery, Hiroshima City Hospital, Japan
| | - Mizuo Ando
- Department of Otolaryngology, Head and Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
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McKee MM, Zhang J, Akobirshoev I, McKee K, Mitra M. Antenatal Hospital Use among Deaf and Hard of Hearing Women. Am J Perinatol 2024; 41:e1560-e1569. [PMID: 36918163 PMCID: PMC11459527 DOI: 10.1055/a-2053-7439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
OBJECTIVE Hearing loss is increasingly prevalent among younger adults, impacting health and health care use. Deaf and hard of hearing (DHH) women have a higher risk of chronic diseases, pregnancy complications, and adverse birth outcomes compared with hearing women. Health care utilization patterns during the perinatal period remain not well understood. The objective of this study was to examine differences in antenatal emergency department and inpatient utilization among DHH and non-DHH women. STUDY DESIGN We conducted a retrospective cohort study design to analyze 2002 to 2013 Massachusetts Pregnancy to Early Life Longitudinal data to compare antenatal inpatient and emergency department use between DHH (N = 925) and hearing (N = 2,895) women with singleton deliveries. Matching was done based on delivery year, age at delivery, and birth parity in 1:3 case-control ratio. Demographic, socioeconomic, clinical, and hospital characteristics were first compared for DHH mothers and the matched control group using chi-squared tests and t-tests. Multivariable models were adjusted for sociodemographic and clinical characteristics. RESULTS Among DHH women (N = 925), 49% had at least one emergency department visit, 19% had an observational stay, and 14% had a nondelivery hospital stay compared with 26, 14, and 6%, respectively, among hearing women (N = 28,95) during the antenatal period (all ps < 0.001). The risk of nondelivery emergency department visits (risk ratio [RR] 1.58; p < 0.001) and inpatient stays (RR = 1.89; p < 0.001) remained higher among DHH women compared with hearing women even after adjustment. Having four or more antenatal emergency department visits (7 vs. 2%) and two or more nondelivery hospital stays (4 vs. 0.4%) were more common among pregnant DHH women compared with their controls (all p-values < 0.001). CONCLUSION The findings demonstrate that DHH women use emergency departments and inpatient services at a significantly higher rate than their hearing controls during the antenatal period. A systematic investigation of the mechanisms for these findings are needed. KEY POINTS · Antenatal emergency department use is significantly higher among deaf and hard of hearing women.. · Antenatal hospitalizations are significantly higher among deaf and hard of hearing women.. · Hearing loss screening may identify those at risk for adverse pregnancy and birth outcomes..
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Affiliation(s)
- Michael M. McKee
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Jianying Zhang
- The Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Ilhom Akobirshoev
- The Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Kimberly McKee
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Monika Mitra
- The Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
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Engdahl B, Aarhus L. Prevalence and predictors of self-reported hearing aid use and benefit in Norway: the HUNT study. BMC Public Health 2024; 24:474. [PMID: 38355451 PMCID: PMC10867996 DOI: 10.1186/s12889-024-17852-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 01/23/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Knowledge on hearing aid use and benefit is important to ensure appropriate and effective treatment. We aimed to assess prevalence and predictors of hearing aid use and benefit in Norway, as well as possible birth cohort changes. METHODS We analyzed two large cross-sectional, population-based hearing surveys of 63,182 adults in 1996-1998 and 2017-2019 (the HUNT study). We used multivariable regression models to examine independent predictors of hearing aid use and benefit, including demography, hearing-related variables, known risk factors for hearing loss and birth cohort. RESULTS The nationally weighted hearing aid use in the adult population increased from 4.2% in 1997 to 5.8% in 2018. The use among individuals with disabling hearing loss (≥ 35 dB HL) increased from 46.3% to 64.4%. Most users reported some (47%) or great (48%) help from their hearing aids. In addition to the level of hearing loss and birth cohort, factors associated with hearing aid use included lower age, tinnitus, childhood-onset hearing loss, higher education, marriage, having children, being exposed to occupational noise or impulse noise, recurrent ear infections, and head injury. In addition to the level of hearing loss, factors related to hearing aid benefit included younger age, female gender, and higher income. Being bothered by tinnitus reduced the benefit. CONCLUSION Our study shows an increase in self-reported hearing aid usage over time in Norway, with lower adoption rates and perceived benefits observed among the elderly. The results suggest that having a spouse and children positively influences the adoption of hearing aids. These findings emphasize the necessity of customized strategies to address demographic disparities and the need for innovative enhancements in hearing rehabilitation programs.
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Affiliation(s)
- Bo Engdahl
- Department of Physical Health and Ageing, Norwegian Institute of Public Health, Postbox 4404 Nydalen, N-0403, Oslo, Norway.
| | - Lisa Aarhus
- Department of Occupational Medicine and Epidemiology, National Institute of Occupational Health, Oslo, Norway
- Department of Internal Medicine, Diakonhjemmet Hospital, Oslo, Norway
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Anthony T, Assi S, Garcia Morales EE, Jiang K, Powell D, Martinez-Amezcua P, Oh ES, Deal JA, Reed NS. Hearing Loss, Hearing Aids, and Satisfaction With Health Care in the National Health Interview Survey. Otolaryngol Head Neck Surg 2024; 170:414-421. [PMID: 37746921 PMCID: PMC10844895 DOI: 10.1002/ohn.533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/31/2023] [Accepted: 09/02/2023] [Indexed: 09/26/2023]
Abstract
OBJECTIVE Hearing loss may negatively impact satisfaction with health care via patient-provider communication barriers and may be amenable to hearing care treatment. STUDY DESIGN Cross-sectional. SETTING National Health Interview Survey, a nationally representative survey of noninstitutionalized US residents, 2013 to 2018 pooled cycles. METHODS Participants described satisfaction with health care in the past year, categorized as optimal (very satisfied) versus suboptimal (satisfied, dissatisfied, very dissatisfied) satisfaction. Self-report hearing without hearing aids (excellent, good, a little trouble, moderate trouble, a lot of trouble) and hearing aid use (yes, no) were collected. Weighted Poisson regression models adjusted for sociodemographic and health covariates were used to estimate prevalence rate ratios (PRRs) of satisfaction with care by hearing loss and hearing aid use. RESULTS Among 137,216 participants (mean age 50.9 years, 56% female, 12% black), representing 77.2 million Americans in the weighted model, 19% reported trouble hearing. Those with good (PRR = 1.20, 95% confidence interval [CI]: 1.18-1.23), a little trouble (PRR = 1.27, 95% CI, 1.23-1.31), moderate trouble (PRR = 1.29, 95% CI, 1.24-1.35), and a lot of trouble hearing (PRR = 1.26, 95% CI, 1.18-1.33) had a higher prevalence rate of suboptimal satisfaction with care relative to those with excellent hearing. Among all participants with trouble hearing, hearing aid users had a 17% decrease in the prevalence rate of suboptimal satisfaction with care (PRR = 0.83, 95% CI, 0.78-0.88) compared to nonusers. CONCLUSION Hearing loss decreases patient satisfaction with health care, which is tied to Medicare hospital reimbursement models. Hearing aid use may improve patient-provider communication and patient satisfaction, although prospective studies are warranted to truly establish their protective effect.
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Affiliation(s)
- Teresa Anthony
- College of Public Health, University of South Florida,
Tampa, FL
- Department of Communication Sciences and Disorders, College
of Behavioral and Community Sciences, University of South Florida, Tampa, FL
| | - Sahar Assi
- Cochlear Center for Hearing and Public Health, Johns
Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins University
Bloomberg School of Public Health, Baltimore, Maryland
| | - Emmanuel E. Garcia Morales
- Cochlear Center for Hearing and Public Health, Johns
Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins University
Bloomberg School of Public Health, Baltimore, Maryland
| | - Kening Jiang
- Cochlear Center for Hearing and Public Health, Johns
Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins University
Bloomberg School of Public Health, Baltimore, Maryland
| | - Danielle Powell
- Cochlear Center for Hearing and Public Health, Johns
Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
- Department of Health Policy and Management, Johns Hopkins
University Bloomberg School of Public Health, Baltimore, Maryland
| | - Pablo Martinez-Amezcua
- Cochlear Center for Hearing and Public Health, Johns
Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins University
Bloomberg School of Public Health, Baltimore, Maryland
| | - Esther S. Oh
- Cochlear Center for Hearing and Public Health, Johns
Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
- Department of Medicine, Johns Hopkins University School of
Medicine, Baltimore, Maryland
| | - Jennifer A. Deal
- Cochlear Center for Hearing and Public Health, Johns
Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins University
Bloomberg School of Public Health, Baltimore, Maryland
| | - Nicholas S. Reed
- Cochlear Center for Hearing and Public Health, Johns
Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins University
Bloomberg School of Public Health, Baltimore, Maryland
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Powell DS, Garcia Morales EE, Oh E, Deal JA, Samus QM, Wolff JL, Reed NS. Dementia and Hearing Aid Use and Cessation: A National Study. Am J Audiol 2023; 32:898-907. [PMID: 37713529 PMCID: PMC11001429 DOI: 10.1044/2023_aja-23-00038] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 06/12/2023] [Accepted: 07/25/2023] [Indexed: 09/17/2023] Open
Abstract
PURPOSE The current standard for management of hearing loss in the United States involves the use of a hearing aid. Anecdotal evidence suggests that the use of a hearing aid may be less effective in the context of dementia, though national data on use and cessation are not described. METHOD This longitudinal analysis of the National Health and Aging Trends Study followed participants who self-reported hearing aid use to estimate risk of hearing aid cessation over 9 years. We examine whether hearing aid cessation differs by dementia status using generalized estimating equations logistic regression accounting for loss to follow-up. Supplemental analyses were undertaken to examine the contribution of caregiving and environmental factors on hearing aid cessation. RESULTS Of 1,310 older adults who reported hearing loss (25% 80-84 years, 51% women, 74% White), 22% with dementia and 57% baseline hearing aid use. Dementia increased likelihood of ceasing hearing aid use during the first year after adoption (OR = 2.07, 95% CI [1.33, 3.23], p interaction = .11). In later years, older adults with either a previous or recent diagnosis of dementia had a 95% higher odds of hearing aid cessation (OR = 1.95, 95% CI [1.31, 2.90]), a decrease in odds with respect to the first year after adoption, when compared to participants without dementia, after adjusting for demographic, health, and economic factors. Economic and social factors that may influence care demands (more caregivers, income-to-poverty ratio, and additional insurance) increased likelihood for cessation for those with dementia. CONCLUSIONS Older adults with (vs. without) dementia are more likely to cease hearing aid use over time, most notably during the first year after adoption. Strategies to support hearing ability, such as self-management or care partner education, may improve communication for those living with co-occurring hearing loss and dementia.
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Affiliation(s)
- Danielle S. Powell
- Department of Hearing and Speech Sciences, University of Maryland, College Park
| | - Emmanuel E. Garcia Morales
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Esther Oh
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jennifer A. Deal
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Quincy M. Samus
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD
| | - Jennifer L. Wolff
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Nicholas S. Reed
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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9
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James TG, Sullivan MK, McKee MM, Rotoli J, Maruca D, Stachowiak R, Cheong J, Varnes JR. Emergency department patient-centred care perspectives from deaf and hard-of-hearing patients. Health Expect 2023; 26:2374-2386. [PMID: 37555478 PMCID: PMC10632638 DOI: 10.1111/hex.13842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 06/20/2023] [Accepted: 07/30/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Deaf and hard-of-hearing (DHH) patients are a priority population for emergency medicine health services research. DHH patients are at higher risk than non-DHH patients of using the emergency department (ED), have longer lengths of stay in the ED and report poor patient-provider communication. This qualitative study aimed to describe ED care-seeking and patient-centred care perspectives among DHH patients. METHODS This qualitative study is the second phase of a mixed-methods study. The goal of this study was to further explain quantitative findings related to ED outcomes among DHH and non-DHH patients. We conducted semistructured interviews with 4 DHH American Sign Language (ASL)-users and 6 DHH English speakers from North Central Florida. Interviews were transcribed and analysed using a descriptive qualitative approach. RESULTS Two themes were developed: (1) DHH patients engage in a complex decision-making process to determine ED utilization and (2) patient-centred ED care differs between DHH ASL-users and DHH English speakers. The first theme describes the social-behavioural processes through which DHH patients assess their need to use the ED. The second theme focuses on the social environment within the ED: patients feeling stereotyped, involvement in the care process, pain communication, receipt of accommodations and discharge processes. CONCLUSIONS This study underscores the importance of better understanding, and intervening in, DHH patient ED care-seeking and care delivery to improve patient outcomes. Like other studies, this study also finds that DHH patients are not a monolithic group and language status is an equity-relevant indicator. We also discuss recommendations for emergency medicine. PATIENT OR PUBLIC CONTRIBUTION This study convened a community advisory group made up of four DHH people to assist in developing research questions, data collection tools and validation of the analysis and interpretation of data. Community advisory group members who were interested in co-authorship are listed in the byline, with others in the acknowledgements. In addition, several academic-based co-authors are also deaf or hard of hearing.
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Affiliation(s)
- Tyler G. James
- Department of Family MedicineUniversity of MichiganAnn ArborMichiganUSA
- Department of Health Education and BehaviorUniversity of FloridaGainesvilleFloridaUSA
| | | | - Michael M. McKee
- Department of Family MedicineUniversity of MichiganAnn ArborMichiganUSA
| | - Jason Rotoli
- Department of Emergency MedicineUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | | | | | - JeeWon Cheong
- Department of Health Education and BehaviorUniversity of FloridaGainesvilleFloridaUSA
| | - Julia R. Varnes
- Department of Health Services Research, Management, and PolicyUniversity of FloridaGainesvilleFloridaUSA
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Amlani AM. Effect of Determinants of Health on the Hearing Care Framework: An Economic Perspective. Semin Hear 2023; 44:232-260. [PMID: 37484988 PMCID: PMC10361793 DOI: 10.1055/s-0043-1769611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023] Open
Abstract
Hearing care is expanding accessibility to consumers through new service delivery channels and methods of technology distribution (see Brice et al, this issue). This diversification has the potential to overcome longstanding consumer disparities (e.g., health, socioeconomic, psychological, environmental) in receiving care and provider constraints (e.g., accessibility, geography, direct access) to delivering care that adversely impacts quality of life (e.g., social isolation, depression, anxiety, self-esteem). In this article, the reader is provided with an overview of health outcomes factors (i.e., determinants of health)-in the context of an economic framework (i.e., supply, demand)-and their effect on consumer behavior and provider preferences toward hearing healthcare services. This overview also affords readers with strategic business insights to assess and integrate future hearing care services and technology to consumers in their local markets.
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Ratakonda S, Lin P, Kamdar N, Meade M, McKee M, Mahmoudi E. Potentially Preventable Hospitalization Among Adults with Hearing, Vision, and Dual Sensory Loss: A Case and Control Study. Mayo Clin Proc Innov Qual Outcomes 2023; 7:327-336. [PMID: 37533599 PMCID: PMC10391598 DOI: 10.1016/j.mayocpiqo.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2023] Open
Abstract
Objective To evaluate the risk of potentially preventable hospitalizations (PPHs) among adults with sensory loss. We hypothesized a greater PPH risk among people with a sensory loss (hearing, vision, and dual) compared with controls. Patients and Methods Using 2007-2016 Medicare fee-for-service claims, this retrospective, case-control study examined the risk of PPH among adults aged 65 years and older with hearing, vision, and dual sensory loss compared with their corresponding counterparts without sensory loss (between June 1, 2022, and February 1, 2023). We ran 3 step-in regression models for the 3 case and control cohorts examining PPH risk. Our generalized linear regression models controlled for age, sex, race, Elixhauser comorbidity count, rurality, neighborhood characteristics, and the number of primary care physicians and hospitals at the county level. Results People with vision (adjusted odds ratio [aOR], 1.21; 95% CI, 0.84-0.87) and dual sensory loss (aOR, 1.26; 95% CI, 1.14-1.40) showed a higher PPH risks than their corresponding controls. For people with hearing loss, our unadjusted models showed a higher PPH risk (OR, 1.40; 95% CI, 1.38-1.43) but after adjustment, hearing loss showed a protective association against PPH risk (OR, 0.85; 95% CI, 0.84-0.87). Moreover, in all models, annual wellness visits reduced the PPH risk by about half (eg, aOR, 0.54; 95% CI, 0.52-0.55), whereas living in disadvantaged neighborhood increased the PPH risk (eg, aOR, 1.13; 95% CI, 1.10-1.15) for cases and controls. Conclusion People with vision and dual sensory loss were at greater PPH risk. This study has important health policy implications in reducing PPH and is indicative of a need for more incentivized and systematic approaches to facilitating the use of preventive care, particularly among older adults living in a disadvantaged neighborhood.
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Affiliation(s)
| | - Paul Lin
- Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - Neil Kamdar
- Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - Michelle Meade
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - Michael McKee
- Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI
- Department of Family Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - Elham Mahmoudi
- Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI
- Department of Family Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI
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Ye X, Zhu D, Wang Y, Chen S, Gao J, Du Y, Wang J, Zuo H, Shi X, He P. Impacts of the hearing aid intervention on healthcare utilization and costs among middle-aged and older adults: results from a randomized controlled trial in rural China. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 31:100594. [PMID: 36879779 PMCID: PMC9985011 DOI: 10.1016/j.lanwpc.2022.100594] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
BACKGROUND Hearing impairment has become a major global health issue. To reduce the burden of hearing impairment, we explored impacts of the hearing aid intervention on healthcare utilization and costs. METHODS In this randomized controlled trial, participants aged 45+ were allocated with a ratio of 1:1.5 (intervention: control). Neither the investigators nor the assessors were blinded to the allocation status. Those in the intervention group were fitted with hearing aids, and those in the control group received no care. We applied the difference-in-difference (DID) approach to examine the impacts on healthcare utilization and costs. Given that social network and age can be significant variables affecting effectiveness of the intervention, subgroup analyses by social network and age were used to explore the heterogeneity. FINDINGS 395 subjects were successfully recruited and randomized. 10 subjects did not meet the inclusion criteria and therefore, 385 eligible subjects (150 in the treatment group and 235 in the control group) were analyzed. The intervention significantly reduced their total healthcare costs (average treatment effect (ATE) = -1.26, 95% CI = -2.39, -0.14, p = 0.028) and total out-of-pocket (OOP) healthcare costs (ATE = -1.29, 95% CI = -2.37, -0.20, p = 0.021) in the 20-month follow-up. To be exact, it reduced self-medication costs (ATE = -0.82, 95% CI = -1.49, -0.15, p = 0.016) and OOP self-medication costs (ATE = -0.84, 95% CI = -1.46, -0.21, p = 0.009). Subgroup analysis showed that the impacts on self-medication costs and OOP self-medication costs varied by social network (ATE for self-medication costs = -0.26, 95% CI = -0.50, -0.01, p = 0.041; ATE for OOP self-medication costs = -0.27, 95% CI = -0.52, -0.01, p = 0.038). The impacts also varied by age groups (ATE for self-medication costs = -0.22, 95% CI = -0.40, -0.04, p = 0.019; ATE for OOP self-medication costs = -0.17, 95% CI = -0.29, -0.04, p = 0.010). There were no adverse events or side effects during the trial. INTERPRETATION Hearing aid use significantly lowered self-medication costs and total healthcare costs, but had no impacts on inpatient or outpatient services utilization or costs. The impacts were manifested among people with active social network or younger age. It can be speculated that the intervention may be adapted to other similar settings in developing countries to reduce healthcare costs. FUNDING P.H. reports grants from National Natural Science Foundation of China (No. 71874005) and Major Project of the National Social Science Fund of China (No. 21&ZD187). TRIAL REGISTRATION Chinese Clinical Trial Registry: ChiCTR1900024739.
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Affiliation(s)
- Xin Ye
- Institute for Global Public Policy, Fudan University, 220 Handan Road, Yangpu District, Shanghai 200433, China
- LSE-Fudan Research Centre for Global Public Policy, Fudan University, 220 Handan Road, Yangpu District, Shanghai 200433, China
- China Center for Health Development Studies, Peking University, 38 Xue Yuan Road, Haidian District, Beijing 100191, China
| | - Dawei Zhu
- China Center for Health Development Studies, Peking University, 38 Xue Yuan Road, Haidian District, Beijing 100191, China
| | - Yanshang Wang
- China Center for Health Development Studies, Peking University, 38 Xue Yuan Road, Haidian District, Beijing 100191, China
| | - Siyuan Chen
- China Center for Health Development Studies, Peking University, 38 Xue Yuan Road, Haidian District, Beijing 100191, China
| | - Jiamin Gao
- School of Social Development and Public Policy, Beijing Normal University, Beijing 100875, China
| | - Yali Du
- Peking University Third Hospital, Beijing 100191, China
| | - Juncheng Wang
- Linyi Center For Disease Control And Prevention, Linyi City 276007, Shandong, China
| | - Huibin Zuo
- Linyi Center For Disease Control And Prevention, Linyi City 276007, Shandong, China
| | - Xuefeng Shi
- School of Management, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Ping He
- China Center for Health Development Studies, Peking University, 38 Xue Yuan Road, Haidian District, Beijing 100191, China
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The Financing of Hearing Care: What We Can Learn from MarkeTrak 2022. Semin Hear 2022; 43:339-347. [PMCID: PMC9715306 DOI: 10.1055/s-0042-1758400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
The “cost” of hearing aids has been a perceived key driver of the uptake, or lack thereof, of hearing aids. The MarkeTrak 2022 survey included questions that focused on the cost of the hearing test and amplification devices, out-of-pocket expenses, third-party coverage, and the perceived value of the devices. The hearing test itself was perceived as a barrier for some as the expense of the visit or the lack of third-party coverage was often cited as a reason for not following through on a recommendation to get a test. For those persons who received a hearing test, financial constraints were noted to be the most significant reason for not following through on a recommendation for a hearing aid, particularly for those over the age of 65 years. Higher income levels or some third-party coverage for devices was related to higher adoption rates. For persons who did choose to purchase amplification devices, financial considerations were not among the most important factors in reaching that decision. A clear majority of persons who made the decision to purchase amplification were satisfied with the out-of-pocket expenses associated with the purchase. The MarkeTrak 2022 Survey also included questions designed to assess the price sensitivity of individuals to various scenarios regarding the cost (e.g., $1000/pair, $2000/pair, or $4000/pair) or the amount of third-party coverage (e.g., $1000/pair, $2000/pair, or Total Cost). Results indicate increased amounts of third-party coverage were a bigger motivator than simply lowered cost. The MarkeTrak Survey indicates perceived cost factors continue to play a role in decisions to pursue hearing care and/or amplification devices.
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James TG, Miller MD, McKee MM, Sullivan MK, Rotoli J, Pearson TA, Mahmoudi E, Varnes JR, Cheong JW. Emergency department condition acuity, length of stay, and revisits among deaf and hard-of-hearing patients: A retrospective chart review. Acad Emerg Med 2022; 29:1290-1300. [PMID: 35904003 PMCID: PMC9671827 DOI: 10.1111/acem.14573] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/12/2022] [Accepted: 07/26/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Deaf and hard-of-hearing (DHH) patients are understudied in emergency medicine health services research. Theory and limited evidence suggest that DHH patients are at higher risk of emergency department (ED) utilization and poorer quality of care. This study assessed ED condition acuity, length of stay (LOS), and acute ED revisits among DHH patients. We hypothesized that DHH patients would experience poorer ED care outcomes. METHODS We conducted a retrospective chart review of a single health care system using data from a large academic medical center in the southeast United States. Data were received from the medical center's data office, and we sampled patients and encounters from between June 2011 and April 2020. We compared DHH American Sign Language (ASL) users (n = 108), DHH English speakers (n = 358), and non-DHH English speakers (n = 302). We used multilevel modeling to assess the differences among patient segments in outcomes related to ED use and care. RESULTS As hypothesized, DHH ASL users had longer ED LOS than non-DHH English speakers, on average 30 min longer. Differences in ED condition acuity, measured through Emergency Severity Index and triage pain scale, were not statistically significant. DHH English speakers represented a majority (61%) of acute ED revisit encounters. CONCLUSIONS Our study identified that DHH ASL users have longer ED LOS than non-DHH English speakers. Additional research is needed to further explain the association between DHH status and ED care outcomes (including ED LOS and acute revisit), which may be used to identify intervention targets to improve health equity.
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Affiliation(s)
- Tyler G. James
- Department of Family MedicineUniversity of MichiganAnn ArborMichiganUSA
- Department of Health Education and BehaviorUniversity of FloridaGainesvilleFloridaUSA
| | - M. David Miller
- School of Human Development and Organizational Studies in EducationUniversity of FloridaGainesvilleFloridaUSA
| | - Michael M. McKee
- Department of Family MedicineUniversity of MichiganAnn ArborMichiganUSA
| | | | - Jason Rotoli
- Department of Emergency MedicineUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Thomas A. Pearson
- Department of EpidemiologyUniversity of FloridaGainesvilleFloridaUSA
| | - Elham Mahmoudi
- Department of Family MedicineUniversity of MichiganAnn ArborMichiganUSA
| | - Julia R. Varnes
- Department of Health Services Research Management and PolicyUniversity of FloridaGainesvilleFloridaUSA
| | - Jee Won Cheong
- Department of Health Education and BehaviorUniversity of FloridaGainesvilleFloridaUSA
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Thai A, Khan SI, Choi J, Ma Y, Megwalu UC. Associations of Hearing Loss Severity and Hearing Aid Use With Hospitalization Among Older US Adults. JAMA Otolaryngol Head Neck Surg 2022; 148:1005-1012. [PMID: 36048464 PMCID: PMC9437822 DOI: 10.1001/jamaoto.2022.2399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 06/29/2022] [Indexed: 12/13/2022]
Abstract
Importance Hearing loss is associated with higher hospitalization risk among older adults. However, evidence on whether hearing aid use is associated with fewer hospitalizations among individuals with hearing loss remains limited. Objective To assess the association between audiometric hearing loss severity and hearing aid use and hospitalization. Design, Setting, and Participants This population-based cross-sectional study used audiometric and health care utilization data for respondents aged 65 years or older from 4 cycles of the National Health and Nutrition Examination Survey from 2005 to 2016. Data were analyzed from February 23, 2021, to March 22, 2022. Exposures Audiometric hearing loss severity and participant-reported hearing aid use. Main Outcomes and Measures The main outcome was respondent-reported hospitalization in the past 12 months. Multivariable logistic regression was performed to assess the association of hearing loss severity with hospitalization. To assess the association of hearing aid use with hospitalization, propensity score matching was performed with 2:1 nearest neighbor matching without replacement. Results Of 2060 respondents (mean [SD] age, 73.9 [5.9] years; 1045 [50.7%] male), 875 (42.5%) had normal hearing, 653 (31.7%) had mild hearing loss, 435 (21.1%) had moderate hearing loss, and 97 (4.7%) had severe to profound hearing loss. On multivariable analysis, moderate and severe hearing loss were associated with hospitalization (moderate hearing loss: odds ratio [OR], 1.50; 95% CI, 1.01-2.24; severe hearing loss: OR, 1.71; 95% CI, 1.03-2.84). Of 1185 respondents with at least mild hearing loss, 200 (16.9%) reported using a hearing aid. Propensity score-matched analysis showed that hearing aid use was not associated with hospitalization (OR, 1.17; 95% CI, 0.74-1.84), including among respondents with moderate or severe hearing loss (OR, 1.17; 95% CI, 0.71-1.92). Conclusions and Relevance In this cross-sectional study, hearing loss was associated with higher risk of hospitalization, but hearing aid use was not associated with a reduction in hospitalization risk in the population with hearing loss. The association of hearing aid use with hospitalization should be evaluated in larger prospective studies with reliable data on the frequency of hearing aid use.
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Affiliation(s)
- Anthony Thai
- Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Suleman I. Khan
- Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Jeff Choi
- Department of Surgery, Stanford University, Stanford, California
| | - Yifei Ma
- Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Uchechukwu C. Megwalu
- Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
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The trend in adoption of hearing aids following changes in provision policy in South Korea. Sci Rep 2022; 12:13389. [PMID: 35927560 PMCID: PMC9352758 DOI: 10.1038/s41598-022-17459-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 07/26/2022] [Indexed: 12/04/2022] Open
Abstract
The Korean government started to cover part of the price of hearing aids ($200) for individuals with hearing disabilities in 1997, and the reimbursement for a hearing aid increased in 2005 ($300) and again in 2015 ($1000). The aim of this study was to evaluate the annual trend of newly-registered individuals with hearing disability according to the changes of the hearing aid provision scheme. Subjects with newly-registered hearing disabilities were assessed using Korean National Health Insurance Service (KNHIS) data from January 1, 2004, to December 31, 2018. A total of 271,742 individuals were newly registered during the index period. Records of hearing aid prescriptions and hearing aid subsidies were used to assess the adoption of hearing aids. This study also assessed the intervals between registration of hearing disability and the adoption of hearing aids, as well as the number of hearing aid subsidies provided. From 2004 to 2009 there was a slight increase in the number of individuals newly registered with hearing disabilities, and from 2011 to 2015, the number showed a tendency to decrease. Then, from 2015, the number of individuals with hearing disabilities increased abruptly, and the proportion of subjects receiving hearing aid subsidies also increased. Between 2004 and 2018, the time interval from hearing disability registration to hearing aid adoption showed a decreasing trend. We conclude that the annual number of individuals with newly-registered hearing disabilities is affected by the level of the hearing aid subsidy, and there is much unregistered or unaddressed hearing loss prior to the introduction of realistic hearing aid provision.
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Gaeta L, Azzarello J, Baldwin J, Ciro C, Hudson MA, Johnson CE, John AB. The Impact of Amplification on Cognitive Screening Test Scores. J Gerontol Nurs 2022; 48:31-37. [PMID: 35771067 DOI: 10.3928/00989134-20220606-05] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Hearing loss is associated with cognitive decline in older adults. Research has shown that hearing loss negatively affects cognitive screening test measures as patients may mishear verbally administered questions. The purpose of the current study was to investigate the impact of amplification on performance on a commonly used cognitive screening test. Thirty older adults with hearing loss underwent testing with the Mini-Mental State Examination (MMSE) in three conditions: without hearing aids, with hearing aids, and with a personal listening device (PLD). Performance on the MMSE significantly improved with the use of hearing aids or a PLD. Amplification and the use of communication strategies should be considered when administering cognitive screening measures to older adults. Failure to account for hearing status may lead to invalid results and can increase the likelihood of over-referral for further assessment. [Journal of Gerontological Nursing, 48(7), 31-37.].
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Emergency Department Utilization Among Deaf and Hard-of-Hearing Patients: A Retrospective Chart Review. Disabil Health J 2022; 15:101327. [DOI: 10.1016/j.dhjo.2022.101327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 03/31/2022] [Accepted: 04/01/2022] [Indexed: 11/23/2022]
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Willink A, Assi L, Nieman C, McMahon C, Lin FR, Reed NS. Alternative Pathways for Hearing Care May Address Disparities in Access. Front Digit Health 2021; 3:740323. [PMID: 34901925 PMCID: PMC8655113 DOI: 10.3389/fdgth.2021.740323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 10/19/2021] [Indexed: 11/13/2022] Open
Abstract
Background/Objectives: Low-uptake of hearing aids among older adults has long dogged the hearing care system in the U.S. and other countries. The introduction of over-the-counter hearing aids is set to disrupt the predominantly high-cost, specialty clinic-based delivery model of hearing care with the hope of increasing accessibility and affordability of hearing care. However, the current model of hearing care delivery may not be reaching everyone with hearing loss who have yet to use hearing aids. In this study, we examine the group of people who do not use hearing aids and describe their characteristics and health care utilization patterns. We also consider what other healthcare pathways may be utilized to increase access to hearing treatment. Design: Cross-sectional, the 2017 Medicare Current Beneficiary Survey. Setting: Non-institutionalized adults enrolled in Medicare, the U.S. public health insurance program for older adults (65 years and older) and those with qualifying medical conditions and disabilities. Participants: A nationally representative sample of 7,361 Medicare beneficiaries with self-reported trouble hearing and/or hearing aid use. Measurements: Survey-weighted proportions described the population characteristics and health care utilization of those with hearing loss by hearing aid use, and the characteristics of those with untreated hearing loss by health care service type utilized. Results: Women, racial/ethnic minorities, and low-income Medicare beneficiaries with self-reported hearing trouble were less likely to report using hearing aids than their peers. Among those who do not use hearing aids, the most commonly used health care services were obtaining prescription drugs (64%) and seeing a medical provider (50%). Only 20% did not access either service in the past year. These individuals were more likely to be young and to have higher educational attainment and income. Conclusion: Alternative models of care delivered through pharmacies and general medical practices may facilitate access to currently underserved populations as they are particularly high touch-points for Medicare beneficiaries with untreated hearing trouble. As care needs will vary across a spectrum of hearing loss, alternative models of hearing care should look to complement not substitute for existing access pathways to hearing care.
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Affiliation(s)
- Amber Willink
- Menzies Centre for Health Policy, University of Sydney, Sydney, NSW, Australia.,Cochlear Center for Hearing and Public Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Lama Assi
- Cochlear Center for Hearing and Public Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Carrie Nieman
- Cochlear Center for Hearing and Public Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States.,Department of Otolaryngology, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Catherine McMahon
- Department of Linguistics, Macquarie University, Sydney, NSW, Australia
| | - Frank R Lin
- Cochlear Center for Hearing and Public Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States.,Department of Otolaryngology, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Nicholas S Reed
- Cochlear Center for Hearing and Public Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States.,Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
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Desjardins JL, Sotelo LR. Self-Reported Reasons for the Non-Use of Hearing Aids Among Hispanic Adults With Hearing Loss. Am J Audiol 2021; 30:709-716. [PMID: 34314258 DOI: 10.1044/2021_aja-21-00043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Purpose To examine the self-reported reasons for the non-use of hearing aids among Mexican-American Hispanic adults who have hearing loss. Method A total of 122 Hispanic adults with hearing loss, who did not currently or previously use a hearing aid, participated in this study. Participants completed a comprehensive hearing health questionnaire and the Hearing Handicap Inventory Screening Questionnaire to examine the possible reasons for the non-use of hearing aids. Results Self-reported hearing loss, hearing handicap score, and health insurance status were the best predictors of an individual's willingness to use hearing aids to treat their hearing loss. The primary reasons cited for the non-use of hearing aids among Hispanics with hearing loss was the belief that their hearing impairment was not severe enough to warrant using a hearing aid and that hearing aids were unaffordable. Conclusions Greater public health education regarding the deleterious effects of untreated hearing loss and the positive impact of amplification on cognitive, social, and psychological health may be warranted to improve the usage rates of hearing aids in Hispanic adults.
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Affiliation(s)
| | - Loren R. Sotelo
- Department of Rehabilitation Sciences, The University of Texas at El Paso, TX
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Abstract
Ideally, public health policies are formulated from scientific data; however, policy-specific data are often unavailable. Big data can generate ecologically-valid, high-quality scientific evidence, and therefore has the potential to change how public health policies are formulated. Here, we discuss the use of big data for developing evidence-based hearing health policies, using data collected and analyzed with a research prototype of a data repository known as EVOTION (EVidence-based management of hearing impairments: public health pOlicy-making based on fusing big data analytics and simulaTION), to illustrate our points. Data in the repository consist of audiometric clinical data, prospective real-world data collected from hearing aids and an app, and responses to questionnaires collected for research purposes. To date, we have used the platform and a synthetic dataset to model the estimated risk of noise-induced hearing loss and have shown novel evidence of ways in which external factors influence hearing aid usage patterns. We contend that this research prototype data repository illustrates the value of using big data for policy-making by providing high-quality evidence that could be used to formulate and evaluate the impact of hearing health care policies.
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Wells TS, Rush SR, Nickels LD, Wu L, Bhattarai GR, Yeh CS. Limited Health Literacy and Hearing Loss Among Older Adults. Health Lit Res Pract 2021; 4:e129-e137. [PMID: 32510569 PMCID: PMC7274562 DOI: 10.3928/24748307-20200511-01] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 06/05/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Effective communications between health care providers and patients are critical for high-quality health care. OBJECTIVE This study sampled adults age 65 years and older to explore (1) characteristics associated with limited health literacy (LHL) and (2) medical costs and gaps in care based on health literacy, hearing loss, and hearing aid use status. METHODS The study included 19,223 adults age 65 years and older who completed a health survey that was linked to his or her medical claims that were generated after medical care provided in the year prior to survey completion. Health literacy, hearing loss, and hearing aid use were assessed through self-reports. Health literacy was coded as limited and adequate. Hearing loss and hearing aid use were coded into five categories: no hearing loss, unaided mild, aided mild, unaided severe, and aided severe hearing loss. KEY RESULTS Seven percent reported LHL and 41% reported hearing loss. Hearing loss, especially unaided severe, was associated with LHL, as were memory loss, depression, loneliness, older age, and male gender. People with aided severe hearing loss and LHL had higher annual medical costs than those with adequate health literacy. Similarly, those with no hearing loss and LHL had higher annual medical costs than those with adequate health literacy. CONCLUSIONS Unaided mild, aided severe, and unaided severe hearing loss were positively associated with LHL, although the association was reduced among hearing aid users. Specifically, aided mild or severe hearing loss had lower odds of LHL, compared to unaided mild or severe hearing loss, respectively. We also observed that people with both hearing loss and LHL were more likely to have higher medical costs. Continued focus on solutions to address both LHL and hearing loss remains warranted. [HLRP: Health Literacy Research and Practice. 2020;4(2):e129-e137.] PLAIN LANGUAGE SUMMARY: Health survey and medical claims data were used for this study. Hearing loss, especially unaided severe, was associated with limited health literacy, as were memory loss, depression, loneliness, older age, and male gender. Those with both limited health literacy and hearing loss had the highest medical costs. Health literacy and hearing loss can affect health care communications, warranting further study.
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Affiliation(s)
- Timothy S. Wells
- Address correspondence to Timothy S. Wells, PhD, Research for Aging Populations, Optum, 315 E. Eisenhower Parkway, Suite 305, Ann Arbor, MI 48108;
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Assi L, Reed NS, Nieman CL, Willink A. Factors Associated With Hearing Aid Use Among Medicare Beneficiaries. Innov Aging 2021; 5:igab021. [PMID: 34316520 PMCID: PMC8306709 DOI: 10.1093/geroni/igab021] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Indexed: 12/05/2022] Open
Abstract
Background and Objectives In the United States, up to two-thirds of older adults have hearing loss. Untreated hearing loss can have significant health outcomes, yet less than 20% of adults with hearing loss use hearing aids. In this study, we examined potential factors associated with hearing aid use, including detailed measures of health status, access to care, patient engagement, and technology use, in a nationally representative sample of Medicare beneficiaries. Research Design and Methods Cross-sectional study using the 2017 Medicare Current Beneficiary Survey. Participants with self-reported hearing loss were included. The primary outcome was hearing aid use. Factors potentially associated with hearing aid use included: sociodemographics, health determinants, access to care, patient activation, and technology access/use. Results Overall, 5,146 participants were included. Of them, 27% reported using hearing aids. In a multivariable logistic regression model, predisposing factors associated with greater odds of hearing aid use included older age, identifying as a man, identifying as White, having completed college, having 3 or more chronic conditions, having dementia, not having trouble seeing, not having limitations in activities of daily living, having moderate relative to low information-seeking scores, and having a personal computer at home (range of odds ratios [ORs]: 1.22–4.46). Enabling factors associated with greater odds of hearing aid use included higher income, living alone relative to living with family members other than a spouse, and having a usual source of care (range of ORs: 1.43–1.54). Discussion and Implications In addition to addressing previously identified factors associated with hearing aid use, improving access to health care, technology, and information about hearing aids may improve the uptake of hearing aids. These findings help further inform our understanding on how to address low treatment levels of hearing loss in the community by identifying new populations to target and potentially modifiable risk factors for hearing aid use.
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Affiliation(s)
- Lama Assi
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Nicholas S Reed
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Carrie L Nieman
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Amber Willink
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Menzies Centre for Health Policy and Economics, University of Sydney, Camperdown, Australia
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Hsu AK, Bassett SM, O'Dwyer LC, McHugh M, Heinemann AW, Jordan N, Dhar S. Cost-Effectiveness of Hearing Screening in Older Adults: A Scoping Review. Res Aging 2021; 44:186-204. [PMID: 33973495 DOI: 10.1177/01640275211008583] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Age is the most common predictor of hearing loss; however, many older adults are not screened. Hearing screening could improve healthcare access, participation, and outcomes. Establishing whether hearing screening in older adults is cost-effective could improve the availability and utilization of screening. METHODS We searched nine databases in January 2020. Studies with populations aged 50+ and provided data on the cost-effectiveness of hearing screening were included in the review. RESULTS Five studies met the inclusion criteria and all found hearing screening programs to be cost-effective compared to no hearing screening, regardless of screening method (i.e., instrument or strategy). The maximum number of repeated screenings, coupled with younger ages, was most cost-effective. DISCUSSION This review suggests that hearing screening in older adults is cost-effective, however, the evidence is limited. There is pressing need for research focused on economic impacts of hearing healthcare in older adults to inform research, policy and practice.
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25
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West JS, Lynch SM. Demographic and Socioeconomic Disparities in Life Expectancy With Hearing Impairment in the United States. J Gerontol B Psychol Sci Soc Sci 2021; 76:944-955. [PMID: 32944746 PMCID: PMC8063680 DOI: 10.1093/geronb/gbaa166] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Hearing impairment is one of the most common disabilities among older people, and its prevalence will increase as the U.S. population ages. However, little is known about social disparities in onset or transitions into and out of hearing impairment, nor how these transitions impact years of life to be spent impaired. METHOD We investigate the number of years an "average" person can expect to live with and without hearing impairment after age 50; sex, race, educational, and regional differences in these expectancies; and the implication of hearing impairment for remaining life expectancy. Bayesian multistate life table methods are applied to 9 waves of data from the Health and Retirement Study (1998-2014) to investigate social disparities in life expectancy with hearing impairment (n = 20,200) for the general population, people hearing impaired at age 50, and people hearing unimpaired at age 50. RESULTS Men, Hispanics, persons with less educational attainment, and those born in the south can expect to live a larger proportion of their remaining lives hearing impaired. Although transitions from hearing impaired to unimpaired occur, those with some hearing impairment at age 50 can expect to live more years with hearing impairment, and hearing impairment does not shorten remaining life expectancy. DISCUSSION Significant sociodemographic disparities in hearing impaired life expectancy exist. In contrast to past research, we find that hearing impairment does not affect total life expectancy. Future research should consider the consequences of hearing impairment for years to be lived with other age-related and potentially downstream health outcomes.
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Affiliation(s)
- Jessica S West
- Department of Sociology, Duke University, Durham, North Carolina
| | - Scott M Lynch
- Department of Sociology, Duke University, Durham, North Carolina
- Duke University Population Research Institute, Duke University, Durham, North Carolina
- Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina
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26
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Mitra M, McKee MM, Akobirshoev I, Ritter GA, Valentine AM. Pregnancy and Neonatal Outcomes Among Deaf or Hard of Hearing Women: Results From Nationally Representative Data. Womens Health Issues 2021; 31:470-477. [PMID: 33888398 DOI: 10.1016/j.whi.2021.03.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 01/05/2021] [Accepted: 03/11/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Although the literature suggests that women with disabilities are at increased risk for pregnancy complications and adverse birth outcomes, there are few population-based studies of the pregnancy outcomes among deaf and hard of hearing (DHH) women in the United States. OBJECTIVE To compare pregnancy complications and neonatal outcomes between deliveries to DHH and non-DHH women using national hospitalization discharge record data. STUDY DESIGN We used the 2007-2016 Healthcare Cost and Utilization Project National Inpatient Sample to compare pregnancy complications and outcomes among deliveries to DHH women with deliveries to non-DHH women using bivariate and Poisson regressions, controlling for sociodemographic, hospital, and clinical characteristics. RESULTS DHH women had an increased risk of adverse pregnancy outcomes and chronic medical conditions, including preexisting diabetes (relative risk [RR], 2.01; 95% confidence interval, 1.68-2.42; p < .001), gestational diabetes (RR, 1.31; 95% CI, 1.19-1.44; p < .001), chronic hypertension (RR, 1.51; 95% CI, 1.33-1.72; p < .001), preeclampsia and eclampsia (RR, 1.35; 95% CI, 1.21-1.51; p < .01), placenta previa (RR, 1.62; 95% CI, 1.22-2.16; p < .01), placental abruption (RR, 1.43; 95% confidence interval, 1.15-1.78; p < .01), labor induction (RR, 1.16; 95% CI, 1.05-1.27; p < .01), chorioamnionitis (RR, 1.43; 95% CI, 1.22-1.69; p < .001), cesarean delivery (RR, 1.09; 95% CI, 1.04-1.14; p < .001), premature rupture of membranes (RR, 1.34; 95% CI, 1.20-1.50; p < .001), antepartum hemorrhage (RR, 1.36; 95% CI, 1.13-1.64; p < .001), and postpartum hemorrhage (RR, 1.30; 95% CI, 1.13-1.49; p < .001). After adjustment for socioeconomic and hospital characteristics, the risk for gestational diabetes, preeclampsia and eclampsia, placenta previa, and chorioamnionitis remained unexplained. CONCLUSIONS DHH women are at an increased risk for adverse pregnancy, fetal, and neonatal outcomes, illuminating the need for awareness among obstetric and primary care providers as well as the need for systematic investigation of outcomes and evidence-based guidelines.
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Affiliation(s)
- Monika Mitra
- The Lurie Institute for Disability Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, 02453.
| | - Michael M McKee
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Ilhom Akobirshoev
- The Lurie Institute for Disability Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, 02453
| | - Grant A Ritter
- The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Anne M Valentine
- The Lurie Institute for Disability Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, 02453
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Mahmoudi E, Zazove P, Pleasant T, Meeks L, McKee MM. Hearing Loss and Healthcare Access among Adults. Semin Hear 2021; 42:47-58. [PMID: 33883791 DOI: 10.1055/s-0041-1726000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Hearing loss (HL) is common among individuals aged 50 and older and is associated with increased healthcare costs. Whether HL is associated with less access to healthcare is unclear. In this study, we examined the association between HL and access to medical care and prescription drugs among individuals 50+ with and without HL. We used nationally representative 2013-2014 Medical Expenditure Panel Survey data, consisting of 1,977 adults with HL and 17,399 without. We applied an inverse propensity score weighting and regression modeling to adjust for any potential differences in health and socioeconomic conditions between the two groups. Adults with HL were more likely to be white, less educated, poorer, and with public insurance ( p < 0.001). They were also likely to have hypertension, heart disease, stroke, emphysema, high cholesterol, diabetes, joint pain, and arthritis ( p < 0.001). The odds of reporting unmet medical needs (odds ratio [OR] = 1.85; 95% confidence interval [CI] = 1.29-2.66), delay in getting medical needs met (OR = 1.37; 95% CI = 1.00-1.87), and having unfilled prescriptions (OR = 1.81; 95% CI = 1.27-2.59) were higher among individuals with HL compared with their counterparts without HL. Individuals with HL have less access to care and prescription drugs. To ensure equitability in access, public health policies should address specific needs of people with HL.
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Affiliation(s)
- Elham Mahmoudi
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Philip Zazove
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Terrence Pleasant
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan
| | - Lisa Meeks
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Michael M McKee
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
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28
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Mezuk B, Tarraf W, Johnson-Lawrence V, Ilardo J, Lichtenberg PA, Jackson JS. Analytic Training for Junior Investigators in Minority Aging Research: The Michigan Model. THE GERONTOLOGIST 2021; 60:1392-1402. [PMID: 32352144 DOI: 10.1093/geront/gnaa001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Indexed: 11/12/2022] Open
Abstract
Since 1997, the Resource Centers for Minority Aging Research Program at the National Institute on Aging has been the model for training social and behavioral scientists in minority aging and health disparities research. The latest cycle of these Centers implemented a new structure for the analytic training of junior investigators and for advancing methodologic work relevant to improving the rigor of minority aging research. In this article, we describe the conceptual framework, logistical approaches, challenges, and lessons learned from our experience training junior investigators in methodology through the Michigan Center for Urban African American Aging Research over the past 20 years, with the goal of informing future analytic training efforts for the next generation of scholars focused on minority aging issues.
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Affiliation(s)
- Briana Mezuk
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Wassim Tarraf
- Institute of Gerontology, Wayne State University, Detroit, Michigan
| | - Vicki Johnson-Lawrence
- Division of Public Health, College of Human Medicine, Michigan State University, Flint, Michigan
| | - Joan Ilardo
- Office of Research, College of Human Medicine, Michigan State University, East Lansing, Michigan
| | | | - James S Jackson
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan
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29
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Ye X, Zhu D, He P. The role of self-reported hearing status in the risk of hospitalisation among Chinese middle-aged and older adults. Int J Audiol 2021; 60:754-761. [PMID: 33529120 DOI: 10.1080/14992027.2021.1871671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To determine the association between self-reported hearing status and risk of hospitalisation among Chinese middle-aged and older adults. DESIGN Prospective cohort study. Discrete-time hazards models and negative binomial models were fitted to examine the relationship. STUDY SAMPLE About 11,902 participants aged 45 years or older with no hospitalisation at baseline. RESULTS 49.28-62.70% of the participants reported their hearing as fair or poor. For older adults aged 60 and above, compared to people with excellent and very good hearing, those with good, fair or poor hearing reported shorter time to first hospitalisation [hazard ratio (HR) = 1.38, 1.38, 1.63, respectively]. They also manifested greater number of hospitalisations [incident rate ratio (IRR) = 1.21, 1.25, 1.54, respectively], and longer duration of hospitalisation (IRR = 1.36, 1.26, 1.53, respectively). However, there was no significant association between hearing status and hospitalisation for middle-aged adults for none of the hearing categories. CONCLUSIONS Although no significant relationship between hearing and hospitalisation was found for middle-aged adults, older adults with poorer hearing experienced greater risk of hospitalisation. Given that hearing impairment is highly prevalent among older adults, future analyses are needed to investigate whether hearing rehabilitative therapies could help mitigate hospitalisations in hearing-impaired older adults.
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Affiliation(s)
- Xin Ye
- School of Public Health, Peking University, Beijing, China.,China Center for Health Development Studies, Peking University, Beijing, China
| | - Dawei Zhu
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Ping He
- China Center for Health Development Studies, Peking University, Beijing, China
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30
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Reed NS, Stolnicki W, Gami A, Myers C, Kohn C, Willink A. Association of Self-Reported Trouble Hearing and Patient-Provider Communication with Hospitalizations among Medicare Beneficiaries. Semin Hear 2021; 42:26-36. [PMID: 33883789 PMCID: PMC8050416 DOI: 10.1055/s-0041-1725998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Several studies have recently illuminated the relationship between hearing loss and hospitalizations, but little is understood as to why hearing loss is associated with greater risk for hospitalizations. This study examines the role of patient-provider communication as the mechanism by which those with hearing loss are more likely to be hospitalized, using the self-reported data from 12,654 Medicare beneficiaries from the 2016 Medicare Current Beneficiary Survey (MCBS) Cost and Use File. Multivariable logistic regression was used to model the odds of any hospitalization in the past year and negative binomial regression to model the incident rate ratio of hospitalization based on number of hospitalizations in the past year. It was found that Medicare beneficiaries who experience impaired communication with their physician due to trouble hearing have greater odds of hospitalization and a higher rate of all hospitalization over a 1-year period. Understanding the complex relationship between hearing loss, patient-provider communication, and hospitalizations may provide health care professionals with a better rational to address not only hearing loss but also impaired communication in the care of an individual.
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Affiliation(s)
- Nicholas S. Reed
- Cochlear Center for Hearing and Public Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland,Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland,Address for correspondence Nicholas S. Reed, Au.D. 2024 E. Monument St, 2-700, Baltimore, MD 21211
| | | | - Abhishek Gami
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Clarice Myers
- Cochlear Center for Hearing and Public Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Christina Kohn
- Cochlear Center for Hearing and Public Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Amber Willink
- Cochlear Center for Hearing and Public Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland,Mcnzies Centre for Health Policy, University of Sydney, Sydney, NSW, Australia
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31
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Kaur P, Chong SL, Kannapiran P, Teo WSK, Ling CNW, Weichen CW, Ruling G, Yin LS, Leng TY, Pei SY, Kang TT, Han LZ, Peizhen L, Yee LLH, George PP. Cost-utility analysis of hearing aid device for older adults in the community: a delayed start study. BMC Health Serv Res 2020; 20:1112. [PMID: 33261603 PMCID: PMC7709244 DOI: 10.1186/s12913-020-05977-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 11/25/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Hearing aids (HA) is the primary medical intervention aimed to reduce hearing handicap. This study assessed the cost-effectiveness of HA for older adults who were volunteered to be screened for hearing loss in a community-based mobile hearing clinic (MHC). METHODS Participants with (1) at least moderate hearing loss (≥40 dB HL) in at least one ear, (2) no prior usage of HA, (3) no ear related medical complications, and (4) had a Mini-Mental State Examination score ≥ 18 were eligible for this study. Using a delayed-start study design, participants were randomized into the immediate-start (Fitted) group where HA was fitted immediately or the delayed-start (Not Fitted) group where HA fitting was delayed for three months. Cost utility analysis was used to compare the cost-effectiveness of being fitted with HA combined with short-term, aural rehabilitation with the routine care group who were not fitted with HA. Incremental cost effectiveness ration (ICER) was computed. Health Utility Index (HUI-3) was used to measure utility gain, a component required to derive the quality adjusted life years (QALY). Total costs included direct healthcare costs, direct non-healthcare costs and indirect costs (productivity loss of participant and caregiver). Demographic data was collected during the index visit to MHC. Cost and utility data were collected three months after index visit and projected to five years. RESULTS There were 264 participants in the Fitted group and 163 participants in the Not Fitted group. No between-group differences in age, gender, ethnicity, housing type and degree of hearing loss were observed at baseline. At 3 months, HA fitting led to a mean utility increase of 0.12 and an ICER gain of S$42,790/QALY (95% CI: S$32, 793/QALY to S$62,221/QALY). At five years, the ICER was estimated to be at S$11,964/QALY (95% CI: S$8996/QALY to S$17,080/QALY) assuming 70% of the participants continued using the HA. As fewer individuals continued using their fitted HA, the ICER increased. CONCLUSIONS HA fitting can be cost-effective and could improve the quality of life of hearing-impaired older individuals within a brief period of device fitting. Long term cost-effectiveness of HA fitting is dependent on its continued usage.
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Affiliation(s)
- Palvinder Kaur
- Health Services and Outcomes Research, National Healthcare Group, 3 Fusionopolis Link #03-08 Nexus@One-north, Singapore, 138543, Singapore
| | - Sheue Lih Chong
- Ear, Nose and Throat Head & Neck Department, National University Hospital, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
| | - Palvannan Kannapiran
- Health Services and Outcomes Research, National Healthcare Group, 3 Fusionopolis Link #03-08 Nexus@One-north, Singapore, 138543, Singapore
| | - W-S Kelvin Teo
- Health Services and Outcomes Research, National Healthcare Group, 3 Fusionopolis Link #03-08 Nexus@One-north, Singapore, 138543, Singapore
| | - Charis Ng Wei Ling
- Health Services and Outcomes Research, National Healthcare Group, 3 Fusionopolis Link #03-08 Nexus@One-north, Singapore, 138543, Singapore
| | - Chiang Win Weichen
- Ear, Nose and Throat Head & Neck Department, National University Hospital, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
| | - Gan Ruling
- Ear, Nose and Throat Head & Neck Department, National University Hospital, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
| | - Lee Sing Yin
- Ear, Nose and Throat Head & Neck Department, National University Hospital, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
| | - Tang Ying Leng
- Ear, Nose and Throat Head & Neck Department, National University Hospital, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
| | - Soo Ying Pei
- Ear, Nose and Throat Head & Neck Department, National University Hospital, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
| | - Then Tze Kang
- Ear, Nose and Throat Head & Neck Department, National University Hospital, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
| | - Lim Zhen Han
- Ear, Nose and Throat Head & Neck Department, National University Hospital, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
| | - Lin Peizhen
- Ear, Nose and Throat Head & Neck Department, National University Hospital, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
| | - Lynne Lim Hsueh Yee
- Ear Nose Throat & Hearing Centre, 3 Mount Elizabeth, Singapore, 228510, Singapore
| | - Pradeep Paul George
- Health Services and Outcomes Research, National Healthcare Group, 3 Fusionopolis Link #03-08 Nexus@One-north, Singapore, 138543, Singapore.
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Zazove P, Plegue MA, McKee MM, DeJonckheere M, Kileny PR, Schleicher LS, Green LA, Sen A, Rapai ME, Mulhem E. Effective Hearing Loss Screening in Primary Care: The Early Auditory Referral-Primary Care Study. Ann Fam Med 2020; 18:520-527. [PMID: 33168680 PMCID: PMC7708285 DOI: 10.1370/afm.2590] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 05/04/2020] [Accepted: 05/11/2020] [Indexed: 12/11/2022] Open
Abstract
PURPOSE Hearing loss, the second most common disability in the United States, is under-diagnosed and under-treated. Identifying it in early stages could prevent its known substantial adverse outcomes. METHODS A multiple baseline design was implemented to assess a screening paradigm for identifying and referring patients aged ≥55 years with hearing loss at 10 family medicine clinics in 2 health systems. Patients completed a consent form and the Hearing Handicap Inventory for the Elderly (HHI). An electronic alert prompted clinicians to screen for hearing loss during visits. RESULTS The 14,877 eligible patients during the study period had 36,701 encounters. Referral rates in the family medicine clinics increased from a baseline rate of 3.2% to 14.4% in 1 health system and from a baseline rate of 0.7% to 4.7% in the other. A general medicine comparison group showed referral rate increase from the 3.0% baseline rate to 3.3%. Of the 5,883 study patients who completed the HHI 25.2% (n=1,484) had HHI scores suggestive of hearing loss; those patients had higher referral rates, 28% vs 9.2% (P <.001). Of 1,660 patients referred for hearing testing, 717 had audiology data available for analysis: 669 (93.3%) were rated appropriately referred and 421 (58.7%) were considered hearing aid candidates. Overall, 71.5% of patients contacted felt their referral was appropriate. CONCLUSION An electronic alert used to remind clinicians to ask patients aged ≥55 years about hearing loss significantly increased audiology referrals for at-risk patients. Audiologic and audiogram data support the effectiveness of the prompt. Clinicians should consider adopting this method to identify patients with hearing loss to reduce its known and adverse sequelae.
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Affiliation(s)
- Philip Zazove
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan
| | - Melissa A Plegue
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan
| | - Michael M McKee
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan
| | | | - Paul R Kileny
- Otorhinolaryngology Department, University of Michigan, Ann Arbor, Michigan
| | | | - Lee A Green
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Ananda Sen
- Department of Family Medicine and Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Mary E Rapai
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan
| | - Elie Mulhem
- Department of Family Medicine, Oakland University William Beaumont School of Medicine, Rochester, Michigan
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Jilla AM, Johnson CE, Huntington-Klein N. Hearing aid affordability in the United States. Disabil Rehabil Assist Technol 2020; 18:246-252. [PMID: 33112178 DOI: 10.1080/17483107.2020.1822449] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE Substantial out-of-pocket costs for hearing aids constitute a barrier to hearing health care accessibility for older adults among whom prevalence of hearing loss is high. This study is the first to estimate the proportion of Americans with functional hearing loss for which out-of-pocket expenditures for hearing aids would be unaffordable at current average costs and determine how affordability varies by sociodemographic factors. MATERIALS AND METHODS We utilized data from the 2016 American Community Survey to determine the proportion of adults with functional hearing loss for whom hearing aids would constitute ≥3% of annual income or have post-purchase income below a poverty standard. Chi-square tests were used to identify differences in affordability outcomes by sociodemographic characteristics. RESULTS Results indicated that an average bundled cost of $2500 would constitute a catastrophic expense for 77% of Americans with functional hearing loss (N = 7,872,292) and would add an additional 4% of the population into poverty for the year (N = 423,548). Affordability outcomes varied significantly by age, race, sex, educational attainment and geographic location. CONCLUSIONS Hearing aids were unaffordable for three-fourths of Americans with functional hearing loss, and their purchase would result in impoverishment for hundreds of thousands of individuals. Reductions in out-of-pocket hearing aid costs to $500 or $1000 would alleviate affordability issues for many Americans with hearing loss. Future federal and state policy should address poor rates of insurance coverage for hearing care, specifically among Medicare and Medicaid, to reduce out-of-pocket costs for hearing care particularly for older adults.Implications for rehabilitationAn average out-of-pocket hearing care cost of $2500 was unaffordable for over three quarters of Americans with functional hearing loss.Hearing care affordability varied significantly by demographic characteristics such as age, sex, gender, educational attainment and geographic region.Affordability constitutes a significant barrier to hearing care accessibility in the United States, where most costs of hearing aids and rehabilitation are statutorily excluded from insurance coverage, including the largest insurer of Americans, Medicare.
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Affiliation(s)
- Anna Marie Jilla
- Department of Communication Sciences and Disorders, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Carole E Johnson
- Department of Communication Sciences and Disorders, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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Deardorff WJ, Sloane RJ, Pavon JM, Hastings SN, Whitson HE. Hospitalization Risk Among Older Adults with Sensory Impairments: Development of a Prognostic Model. J Am Geriatr Soc 2020; 68:2650-2655. [PMID: 32852787 DOI: 10.1111/jgs.16800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 07/21/2020] [Accepted: 08/03/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To develop a prognostic model for hospital admissions over a 1-year period among community-dwelling older adults with self-reported hearing and/or vision impairments based on readily obtainable clinical predictors. DESIGN Retrospective cohort study. SETTING Medicare Current Beneficiary Survey from 1999 to 2006. PARTICIPANTS Community-dwelling Medicare beneficiaries, aged 65 years and older, with self-reported hearing and/or vision impairment (N = 15,999). MEASUREMENTS The primary outcome was any hospital admission over a predefined 1-year study period. Candidate predictors included demographic factors, prior healthcare utilization, comorbidities, functional impairment, and patient-level factors. We analyzed the association of all candidate predictors with any hospital admission over the 1-year study period using multivariable logistic regression. The final model was created using a penalized regression method known as the least absolute shrinkage and selection operator. Model performance was assessed by discrimination (concordance statistic (c-statistic)) and calibration (evaluated graphically). Internal validation was performed via bootstrapping, and results were adjusted for overoptimism. RESULTS Of the 15,999 participants, the mean age was 78 years and 55% were female. A total of 2,567 participants (16.0%) had at least one hospital admission in the 1-year study period. The final model included seven variables independently associated with hospitalization: number of inpatient admissions in the previous year, number of emergency department visits in the previous year, activities of daily living difficulty score, poor self-rated health, and self-reported history of myocardial infarction, stroke, and nonskin cancer. The c-statistic of the final model was 0.717. The optimism-corrected c-statistic after bootstrap internal validation was 0.716. A calibration plot suggested that the model tended to overestimate risk among patients at the highest risk for hospitalization. CONCLUSION This prognostic model can help identify which community-dwelling older adults with sensory impairments are at highest risk for hospitalization and may inform allocation of healthcare resources.
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Affiliation(s)
- William J Deardorff
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Richard J Sloane
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina
| | - Juliessa M Pavon
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina.,Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina.,Geriatrics Research Education and Clinical Center, Durham Veterans Affairs Health Care System, Durham, North Carolina
| | - Susan N Hastings
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina.,Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina.,Geriatrics Research Education and Clinical Center, Durham Veterans Affairs Health Care System, Durham, North Carolina.,Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina.,Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Heather E Whitson
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina.,Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina.,Geriatrics Research Education and Clinical Center, Durham Veterans Affairs Health Care System, Durham, North Carolina.,Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina
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Wells TS, Wu L, Bhattarai GR, Nickels LD, Rush SR, Yeh CS. Self-Reported Hearing Loss in Older Adults Is Associated With Higher Emergency Department Visits and Medical Costs. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2020; 56:46958019896907. [PMID: 31893952 PMCID: PMC6940601 DOI: 10.1177/0046958019896907] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Hearing loss is common among older adults. Thus, it was of interest to explore
differences in health care utilization and costs associated with hearing loss
and hearing aid use. Hearing loss and hearing aid use were assessed through
self-reports and included 5 categories: no hearing loss, aided mild, unaided
mild, aided severe, and unaided severe hearing loss. Health care utilization and
costs were obtained from medical claims. Those with aided mild or severe hearing
loss were significantly more likely to have an emergency department visit.
Conversely, those with aided severe hearing loss were about 15% less likely to
be hospitalized. Individuals with unaided severe hearing loss had the highest
annual medical costs ($14349) compared with those with no hearing loss ($12118,
P < .001). In this study, those with unaided severe
hearing loss had the highest medical costs. Further studies should attempt to
better understand the relationship between hearing loss, hearing aid use, and
medical costs.
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Depression in older Medicare beneficiaries with hearing impairment by sex, race/ethnicity and insurance status. Int Psychogeriatr 2020; 32:535-536. [PMID: 31631828 PMCID: PMC7165050 DOI: 10.1017/s1041610219001443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Angara P, Tsang DC, Hoffer ME, Snapp HA. Self-Perceived Hearing Status Creates an Unrealized Barrier to Hearing Healthcare Utilization. Laryngoscope 2020; 131:E289-E295. [PMID: 32181884 DOI: 10.1002/lary.28604] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 01/24/2020] [Accepted: 02/16/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To examine sociodemographic and audiometric factors associated with hearing aid (HA) uptake in adults with hearing loss (HL), and to investigate the role of self-perceived hearing status on pursuit of hearing treatment. The relationship between self-perceived hearing status and HA adoption has not been reported in a nationally representative sample of United States (US) adults. STUDY DESIGN Cross-sectional analysis of nationwide household health survey. METHODS Audiometric and questionnaire data from the 2005 to 2012 National Health and Nutrition Examination Survey cycles were used to examine trends in untreated HL and HA adoption in US adults. Adjusted odds ratios for HA adoption were calculated for individuals with measured HL. RESULTS Of 5230 respondents, 26.1% had measurable HL, of which only 16.0% correctly self-identified their hearing status, and only 17.7% used an HA. Age, higher education, severe hearing impairments, and recent hearing evaluations, were positively associated with HA adoption. CONCLUSION Hearing loss is a global public health concern placing significant economic burden on both the individual and society. Self-reported hearing status is not a reliable indicator for HL, and measured HL is not correlated with increased rates of treatment. Recent hearing evaluation is positively associated with increased rates of treatment. Routine hearing assessment will help to better identify those with HL and improve access to hearing treatment. LEVEL OF EVIDENCE III Laryngoscope, 131:E289-E295, 2021.
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Affiliation(s)
- Prashant Angara
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, U.S.A.,Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, U.S.A
| | - Darren C Tsang
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, U.S.A.,Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, U.S.A
| | - Michael E Hoffer
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, U.S.A.,Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, U.S.A
| | - Hillary A Snapp
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, U.S.A
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Mitra M, McKee MM, Akobirshoev I, Valentine A, Ritter G, Zhang J, McKee K, Iezzoni LI. Pregnancy, Birth, and Infant Outcomes Among Women Who Are Deaf or Hard of Hearing. Am J Prev Med 2020; 58:418-426. [PMID: 31952943 PMCID: PMC7039738 DOI: 10.1016/j.amepre.2019.10.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 10/10/2019] [Accepted: 10/11/2019] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Being deaf or hard of hearing can be marginalizing and associated with inequitable health outcomes. Until recently, there were no U.S. population-based studies of pregnancy outcomes among deaf or hard of hearing women. In light of inconsistent findings in the limited available literature, this study sought to conduct a more rigorous study using population-based, longitudinal linked data to compare pregnancy complications, birth characteristics, and neonatal outcomes between deaf or hard of hearing and non-deaf or hard of hearing women. METHODS Researchers conducted a retrospective cohort study in 2019 using the Massachusetts Pregnancy to Early Life Longitudinal data system. This system links all Massachusetts birth certificates, fetal death reports, and delivery- and nondelivery-related hospital discharge records for all infants and their mothers. The study included women with singleton deliveries who gave birth in Massachusetts between January 1998 and December 2013. RESULTS The deaf or hard of hearing women had an increased risk of chronic medical conditions and pregnancy complications including pre-existing diabetes, gestational diabetes, pre-eclampsia and eclampsia, and placental abruption. Deliveries to deaf or hard of hearing women were significantly associated with adverse birth outcomes, including preterm birth, low birth weight or very low weight, and low 1-minute Apgar score or low 5-minute Apgar score. No significant differences were found in size for gestational age, fetal distress, or stillbirth among deaf or hard of hearing women. CONCLUSIONS Findings from this 2019 study indicate that deaf or hard of hearing women are at a heightened risk for chronic conditions, pregnancy-related complications, and adverse birth outcomes and underscore the need for systematic investigation of the pregnancy- and neonatal-related risks, complications, costs, mechanisms, and outcomes of deaf or hard of hearing women.
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Affiliation(s)
- Monika Mitra
- Lurie Institute for Disability Policy, Brandeis University, Waltham, Massachusetts.
| | - Michael M McKee
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Ilhom Akobirshoev
- Lurie Institute for Disability Policy, Brandeis University, Waltham, Massachusetts
| | - Anne Valentine
- Lurie Institute for Disability Policy, Brandeis University, Waltham, Massachusetts
| | - Grant Ritter
- The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Jianying Zhang
- Statistician Consultant to the Lurie Institute for Disability Policy, Brandeis University, Waltham, Massachusetts
| | - Kimberly McKee
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Lisa I Iezzoni
- The Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, Massachusetts
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Mahmoudi E, Basu T, Langa K, McKee MM, Zazove P, Alexander N, Kamdar N. Can Hearing Aids Delay Time to Diagnosis of Dementia, Depression, or Falls in Older Adults? J Am Geriatr Soc 2019; 67:2362-2369. [PMID: 31486068 DOI: 10.1111/jgs.16109] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 07/03/2019] [Accepted: 07/08/2019] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To examine the association between hearing aids (HAs) and time to diagnosis of Alzheimer disease (AD) or dementia, anxiety or depression, and injurious falls among adults, aged 66 years and older, within 3 years of hearing loss (HL) diagnosis. DESIGN Retrospective cohort study. SETTING We used 2008 to 2016 national longitudinal claims data (based on office visit, inpatient, or outpatient healthcare encounters) from a large private payer. We used Kaplan-Meier curves to examine unadjusted disease-free survival and crude and adjusted Cox regression models to examine associations between HAs and time to diagnosis of three age-related/HL-associated conditions within 3 years of HL diagnosis. All models were adjusted for age, sex, race/ethnicity, census divisions, and prior diagnosis of cardiovascular conditions, hypertension, hypercholesterolemia, obesity, and diabetes. PARTICIPANTS The participants included 114 862 adults, aged 66 years and older, diagnosed with HL. MEASUREMENT Diagnosis of (1) AD or dementia; (2) depression or anxiety; and (3) injurious falls. INTERVENTION Use of HAs. RESULTS Large sex and racial/ethnic differences exist in HA use. Approximately 11.3% of women vs 13.3% of men used HAs (95% confidence interval [CI] difference = -0.024 to -0.016). Approximately 13.6% of whites (95% CI = 0.13-0.14) vs 9.8% of blacks (95% CI = 0.09-0.11) and 6.5% of Hispanics (95% CI = 0.06-0.07) used HAs. The risk-adjusted hazard ratios of being diagnosed with AD/dementia, anxiety/depression, and injurious falls within 3 years after HL diagnosis, for those who used HAs vs those who did not, were 0.82 (95% CI = 0.76-0.89), 0.89 (95% CI = 0.86-0.93), and 0.87 (95% CI = 0.80-0.95), respectively. CONCLUSIONS Use of HAs is associated with delayed diagnosis of AD, dementia, depression, anxiety, and injurious falls among older adults with HL. Although we have shown an association between use of HAs and reduced risk of physical and mental decline, randomized trials are needed to determine whether, and to what extent, the relationship is causal. J Am Geriatr Soc 67:2362-2369, 2019.
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Affiliation(s)
- Elham Mahmoudi
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Tanima Basu
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Kenneth Langa
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan.,Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan.,Institute for Social Research, University of Michigan, Ann Arbor, Michigan.,Veteran Affairs (VA) Center for Clinical Management Policy Research, Ann Arbor, Michigan
| | - Michael M McKee
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Philip Zazove
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Neil Alexander
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan.,Institute of Gerontology, University of Michigan, Ann Arbor, Michigan
| | - Neil Kamdar
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan.,Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, Michigan.,Department of Surgery, University of Michigan Medical School, Ann Arbor, Michigan.,Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan
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40
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Associations among hearing loss, hospitalization, readmission and mortality in older adults: A systematic review. Geriatr Nurs 2019; 40:367-379. [DOI: 10.1016/j.gerinurse.2018.12.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 12/20/2018] [Accepted: 12/21/2018] [Indexed: 12/26/2022]
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Piccirillo JF. JAMA Otolaryngology-Head & Neck Surgery-The Year in Review, 2018. JAMA Otolaryngol Head Neck Surg 2019; 145:403-404. [PMID: 30896729 DOI: 10.1001/jamaoto.2019.0389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Jay F Piccirillo
- Department of Otolaryngology-Head and Neck Surgery, Washington University in St Louis School of Medicine, St Louis.,Editor
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Audiologist availability and supply in the United States: A multi-scale spatial and political economic analysis. Soc Sci Med 2019; 222:216-224. [DOI: 10.1016/j.socscimed.2019.01.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 12/31/2018] [Accepted: 01/09/2019] [Indexed: 12/18/2022]
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Willink A, Reed NS, Lin FR. Cost-Benefit Analysis of Hearing Care Services: What Is It Worth to Medicare? J Am Geriatr Soc 2019; 67:784-789. [DOI: 10.1111/jgs.15757] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 12/07/2018] [Accepted: 12/09/2018] [Indexed: 02/03/2023]
Affiliation(s)
- Amber Willink
- Cochlear Center for Hearing and Public Health; Johns Hopkins University Bloomberg School of Public Health; Baltimore Maryland
- Department of Health Policy and Management; Johns Hopkins University Bloomberg School of Public Health; Baltimore Maryland
| | - Nicholas S. Reed
- Cochlear Center for Hearing and Public Health; Johns Hopkins University Bloomberg School of Public Health; Baltimore Maryland
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins University School of Medicine; Baltimore Maryland
| | - Frank R. Lin
- Cochlear Center for Hearing and Public Health; Johns Hopkins University Bloomberg School of Public Health; Baltimore Maryland
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins University School of Medicine; Baltimore Maryland
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Affiliation(s)
- Michael M. McKee
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor
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45
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McKee MM, Lin FR, Zazove P. State of research and program development for adults with hearing loss. Disabil Health J 2018; 11:519-524. [DOI: 10.1016/j.dhjo.2018.07.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 07/26/2018] [Accepted: 07/28/2018] [Indexed: 10/28/2022]
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