The prevalence of hearing impairment and its burden on the quality of life among adults with Medicare Supplement Insurance

Association Between Limited English Proficiency and Hearing Healthcare Use in the United States

OBJECTIVES

To determine whether limited English proficiency (LEP) is associated with likelihood of prior audiogram and hearing aid use among US adults with hearing loss.

METHODS

This cross-sectional study of four merged National Health and Nutrition Examination Survey (NHANES) cycles included 12,636 adults with subjective (self-reported) or objective (audiometric) hearing loss. Subjects were classified as LEP if they completed the NHANES survey in a language other than English, or with the help of an interpreter. Likelihood of audiogram among participants with subjective and objective hearing loss, and likelihood of hearing aid use among participants with objective hearing loss were assessed using unadjusted and adjusted logistic regression.

RESULTS

Individuals with LEP were less likely to have undergone audiogram among subjects with subjective (odds ratio [OR] 0.72, 95% confidence interval [CI] 0.67-0.77), and objective (OR 0.70, 95% CI 0.65-0.74) hearing loss. The association persisted for those with subjective hearing loss (OR 0.79, 95% CI 0.72-0.86), and objective hearing loss (OR 0.81, 95% CI 0.73-0.89) after adjusting for relevant covariates. Individuals with LEP were less likely to use hearing aids (OR 0.88, 95% CI 0.84-0.93). This association disappeared (OR 0.99, 95% CI 0.95-1.04) after adjustment.

CONCLUSION

LEP is associated with lower utilization of hearing healthcare services. This may be due to the complex interplay of socioeconomic and language disparities, which may act as barriers to hearing healthcare utilization. Individuals with LEP should be prioritized when designing interventions to improve accessibility to hearing healthcare.

LEVEL OF EVIDENCE

Level 3 Laryngoscope, 2024.

Immigrant Status Disparities in Hearing Health Care Use in the United States

OBJECTIVE

To determine whether immigrant status is associated with likelihood of audiogram and hearing aid use among US adults with hearing loss.

STUDY DESIGN

Cross-sectional study.

SETTING

Nationally representative data from 2009 to 2010, 2011 to 2012, 2015 to 2016, and 2017 to 2020 National Health and Nutrition Examination Survey (NHANES) cycles.

METHODS

This cross-sectional study of 4 merged cycles of NHANES included 12,455 adults with subjective (self-reported) or objective (audiometric) hearing loss. Sequentially adjusted logistic regressions were used to assess the association of immigration status with likelihood of having undergone audiogram among those with objective and self-reported hearing loss, and with likelihood of hearing aid use among candidates with objective hearing loss.

RESULTS

Immigrants were less likely to have received an audiogram among subjects with subjective (odds ratio [OR]: 0.81, 95% confidence interval [CI]: 0.75-0.87), and objective (OR: 0.76, 95% CI: 0.72-0.81) hearing loss, compared to nonimmigrants. The association persisted for those with subjective (OR: 0.88, 95% CI: 0.81-0.96), and objective (OR: 0.87, 95% CI: 0.80-0.96) hearing loss after adjusting for sociodemographic factors, comorbidities, insurance, and hearing quality, but disappeared in both groups after adjusting for English proficiency. Immigrants were less likely to use hearing aids (OR: 0.90, 95% CI: 0.87-0.93). However, this association disappeared (OR: 0.98, 95% CI: 0.93-1.04) in the adjusted model.

CONCLUSION

Immigrant status is a significant barrier to hearing health care and is associated with lower rates of audiometric testing and hearing aid use among individuals with hearing loss.

The Physiologic Role of Corticosteroids in Menière's Disease: An Update on Glucocorticoid-mediated Pathophysiology and Corticosteroid Inner Ear Distribution

: There are multiple treatment options for Ménière's disease (MD), including dietary modifications, aminoglycoside therapy, and surgery. All have limitations, ranging from limited effectiveness to permanent hearing loss. Corticosteroids have long been used to manage MD due to their relative efficacy and tolerability, but the exact mechanism for disease alleviation is uncertain. Until recently, the precise distribution and role that glucocorticoid receptors play in inner ear diseases have remained largely uninvestigated. Several studies propose they influence mechanisms of fluid regulation through ion and water homeostasis. This review will provide an update on the basic science literature describing the activity of endogenous glucocorticoids and exogenous corticosteroids in the inner ear and the relevance to MD, as well as early clinical trial data pertaining to the application of novel technologies for more effective administration of corticosteroids for the treatment of MD.

Functional Connectivity of Heschl's Gyrus Associated With Age-Related Hearing Loss: A Resting-State fMRI Study

A large proportion of older adults experience hearing loss. Yet, the impact of hearing loss on the aging brain, particularly on large-scale brain networks that support cognition and language, is relatively unknown. We used resting-state functional magnetic resonance imaging (fMRI) to identify hearing loss-related changes in the functional connectivity of primary auditory cortex to determine if these changes are distinct from age and cognitive measures known to decline with age (e.g., working memory and processing speed). We assessed the functional connectivity of Heschl's gyrus in 31 older adults (60-80 years) who expressed a range of hearing abilities from normal hearing to a moderate hearing loss. Our results revealed that both left and right Heschl's gyri were significantly connected to regions within auditory, sensorimotor, and visual cortices, as well as to regions within the cingulo-opercular network known to support attention. Participant age, working memory, and processing speed did not significantly correlate with any connectivity measures once variance due to hearing loss was removed. However, hearing loss was associated with increased connectivity between right Heschl's gyrus and the dorsal anterior cingulate in the cingulo-opercular network even once variance due to age, working memory, and processing speed was removed. This greater connectivity was not driven by high frequency hearing loss, but rather by hearing loss measured in the 0.5-2 kHz range, particularly in the left ear. We conclude that hearing loss-related differences in functional connectivity in older adults are distinct from other aging-related differences and provide insight into a possible neural mechanism of compensation for hearing loss in older adults.

Communication and Healthcare: Self-Reports of People with Hearing Loss in Primary Care Settings

Objectives: To assess the experiences of people with hearing loss in healthcare environments to characterize miscommunication and unmet needs, and guide recommendations for improving outcomes and access. Methods: Anonymous survey developed by subject-matter experts was posted on a large national hearing-loss consumer and advocacy organization website and email listserv. Data were collected and managed via RedCAP. Results: Responses were received from 1581 individuals. Respondents reported moderate or significant difficulty communicating with all listed providers. Three communication situations emerged as often presenting communication difficulties: hearing one's name when called in the waiting room, hearing when the speaker's back was turned, and hearing when communicating by telephone. Despite 93% of respondents indicating they sometimes or often let providers know about their hearing loss, 29.3% of all respondents still reported that no arrangements were made to improve communication. Conclusions: This study clearly demonstrates the ongoing difficulties faced by individuals with hearing loss, particularly older adults, as they attempt to navigate both providers and situations associated with a typical primary care office visit. Clinical Implications: Inexpensive and efficient changes to improve communication include (1) Improving one-on-one provider communication by facing the individual with good lighting, clear speaking, and not obstructing one's mouth; (2) Environmental changes such as using visual or tactile alerting devices in waiting rooms and adding noise-dampening carpeting and curtains; and (3) Avoiding telephones and conveying health information in writing.

Association Between Hearing Aid Use and Health Care Use and Cost Among Older Adults With Hearing Loss

Importance

Hearing loss (HL) is common among older adults and is associated with poorer health and impeded communication. Hearing aids (HAs), while helpful in addressing some of the outcomes of HL, are not covered by Medicare.

Objective

To determine whether HA use is associated with health care costs and utilization in older adults.

Design, Setting, and Participants

This retrospective cohort study used nationally representative 2013-2014 Medical Expenditure Panel Survey data to evaluate the use of HAs among 1336 adults aged 65 years or older with HL. An inverse propensity score weighting was applied to adjust for potential selection bias between older adults with and without HAs, all of whom reported having HL. The mean treatment outcomes of HA use on health care utilization and costs were estimated.

Exposures

Encounter with the US health care system.

Main Outcomes and Measures

(1) Total health care, Medicare, and out-of-pocket spending; (2) any emergency department (ED), inpatient, and office visit; and (3) number of ED visits, nights in hospital, and office visits.

Results

Of the 1336 individuals included in the study, 574 (43.0%) were women; mean (SD) age was 77 (7) years. Adults without HAs (n = 734) were less educated, had lower income, and were more likely to be from minority subpopulations. The mean treatment outcomes of using HAs per participant were (1) higher total annual health care spending by $1125 (95% CI, $1114 to $1137) and higher out-of-pocket spending by $325 (95% CI, $322 to $326) but lower Medicare spending by $71 (95% CI, -$81 to -$62); (2) lower probability of any ED visit by 2 percentage points (PPs) (24% vs 26%; 95% CI, -2% to -2%) and lower probability of any hospitalization by 2 PPs (20% vs 22%; 95% CI, -3% to -1%) but higher probability of any office visit by 4 PPs (96% vs 92%; 95% CI, 4% to 4%); and (3) 1.40 more office visits (95% CI, 1.39 to 1.41) but 0.46 (5%) fewer number of hospital nights (95% CI, -0.47 to -0.44), with no association with the number of ED visits, if any (95% CI, 0.01 to 0).

Conclusions and Relevance

This study demonstrates the beneficial outcomes of use of HAs in reducing the probability of any ED visits and any hospitalizations and in reducing the number of nights in the hospital. Although use of HAs reduced total Medicare costs, it significantly increased total and out-of-pocket health care spending. This information may have implications for Medicare regarding covering HAs for patients with HL.

Age and sex differences in hearing loss association with depressive symptoms: analyses of NHANES 2011-2012

BACKGROUND

Depression is a common and significant health problem. Hearing loss is the third most common chronic physical condition in the USA and might be a factor in depression. To determine whether hearing loss is associated with depressive symptoms in US adults ages 20-69 years.

METHODS

National Health and Nutrition Examination Survey (NHANES) data (2011-2012) were used to assess the potential relationship between hearing loss and depression, in adults (20-69 years) who answered the Patient Health Questionnaire (PHQ-9) depression screening module, with pure tone audiometry measurements, and complete information on the co-variates data (n = 3316). The degree of speech-frequency hearing loss (SFHL) and high-frequency hearing loss (HFHL) were defined as slight/mild hearing loss ⩾26-40 dB; moderate/worse hearing loss ⩾41 dB by pure tone audiometry examination.

RESULTS

Moderate/worse HFHL was statistically significantly associated with depressive symptoms (OR 1.54, 95% CL 1.04-2.27) when the analyses were conducted among all participants. Further stratification by gender and age groups found that moderate/worse HFHL (OR 3.85, 95% CL 1.39-10.65) and moderate/worse SFHL (OR 5.75, 95% CL 1.46-22.71) were associated with depressive symptoms in women ages 52-69 years.

CONCLUSIONS

Moderate/worse speech frequency and HFHL are associated with depression in women ages 52-69 years, independent of other risk factors. Hearing screenings are likely to reduce delays in diagnosis and provide early opportunities for noise prevention counseling and access to hearing aids. Health professionals should be aware of depressive signs and symptoms in patients with hearing loss.

Quality of life in older adults with sensory impairments: a systematic review

PURPOSE

Sensory impairments are common in older adults. Hearing and visual impairments affect their physical and mental health and quality of life adversely. However, systematic reviews of the relationship between hearing impairment, visual impairment, dual sensory impairment, and quality of life are scarce. The purpose of this systematic review was to determine the relationship between hearing impairment, visual impairment, dual sensory impairment, and quality of life.

METHODS

Searches of EMBASE, PubMed, CINAHL, MEDLINE, Cochrane Library, and Airiti Library were conducted between January 2006 and December 2017 using the keywords "quality of life," "life satisfaction," "well-being," "hearing impairment," and "visual impairment." Two authors independently assessed methodologic quality using a modified Downs and Black tool. Data were extracted by the first author and then cross-checked by the second author.

RESULTS

Twenty-three studies consisting mostly of community-dwelling older adults were included in our review. Sensory impairment was found to be in significant association with quality of life, with an increase in hearing impairment or visual impairment severity resulting in a lower quality of life. Quality of life for dual sensory impairment was worse than for hearing impairment or visual impairment individually.

CONCLUSIONS

A significant association was confirmed between hearing impairment, visual impairment, dual sensory impairment, and quality of life. Our review can be used to enhance health care personnel's understanding of sensory impairment in older adults and enable health care personnel to actively assess older adults' sensory functions, so that they can help alleviate the negative impact of sensory impairments on QOL in older adults.

Investigation of Psychophysiological and Subjective Effects of Long Working Hours - Do Age and Hearing Impairment Matter?

Following current prognosis, demographic development raises expectations of an aging of the working population. Therefore, keeping employees healthy and strengthening their ability to work, becomes more and more important. When employees become older, dealing with age-related impairments of sensory functions, such as hearing impairment, is a central issue. Recent evidence suggests that negative effects that are associated with reduced hearing can have a strong impact at work. Especially under exhausting working situations such as working overtime hours, age and hearing impairment might influence employees’ well-being. Until now, neither the problem of aged workers and long working hours, nor the problem of hearing impairment and prolonged working time has been addressed explicitly. Therefore, a laboratory study was examined to answer the research question: Do age and hearing impairment have an impact on psychophysiological and subjective effects of long working hours. In total, 51 white-collar workers, aged between 24 and 63 years, participated in the laboratory study. The results show no significant effects for age and hearing impairment on the intensity of subjective consequences (perceived recovery and fatigue, subjective emotional well-being and physical symptoms) of long working hours. However, the psychophysiological response (the saliva cortisol level) to long working hours differs significantly between hearing impaired and normal hearing employees. Interestingly, the results suggest that from a psychophysiological point of view long working hours were more demanding for normal hearing employees.

Impact of Age and Hearing Impairment on Work Performance during Long Working Hours

Based on demographic prognoses, it must be assumed that a greater number of older workers will be found in the future labor market. How to deal with their possible age-related impairments of sensory functions, like hearing impairment and work performance during extended working time, has not been addressed explicitly until now. The study addresses this interplay. The study was performed on two consecutive days after normal working hours. The 55 participants had to “work” in the study at least three additional hours to simulate a situation of long working hours. The tested measures for (job) performance were: general attention, long-term selective attention, concentration, and reaction time. All of the investigated variables were taken at both days of the study (2 × 2 × 2 repeated measurement design). The results show effects for age, the interaction of hearing impairment and time of measurement, and effects of the measurement time. Older participants reacted slower than younger participants did. Furthermore, younger participants reacted more frequently in a correct way. Hearing impairment seems to have a negative impact especially on measures of false reactions, and therefore especially on measurement time 1. The results can be interpreted in a way that hearing-impaired participants are able to compensate their deficits over time.

Design Considerations for Internet-Delivered Self-Management Programs for Adults With Hearing Impairment

PURPOSE

Hearing impairment (HI) is a chronic condition; thus, even with treatment, residual participation restrictions and activity limitations typically remain. Individuals must learn to self-manage their HI. The purpose of this research note is to review components of successful Internet-based self-management programs and to evaluate group auditory rehabilitation (AR) programs with varying content, in order to make recommendations for the design of future Internet-based self-management programs.

METHOD

Effect sizes for changes in HI-specific quality of life following group AR activities from 4 published studies were calculated to determine if effect size varied systematically as a function of group activities. These findings are described using a self-management framework.

RESULTS

Successful group AR activities include (a) psychosocial activities to promote role management, emotional management, and social support; (b) informational lectures and group discussion to promote education; (c) communication strategy exercises to promote self-efficacy and self-management skills; and (d) the inclusion of a frequent communication partner to promote social support and self-tailoring.

CONCLUSIONS

It is recommended that future Internet-based self-management programs focus on the mechanisms of social support and education to promote learning and self-management skills. Future research will determine if these AR activities may be implemented effectively via the Internet.

Self-reported hearing is associated with time spent out-of-home and withdrawal from leisure activities in older community-dwelling adults

BACKGROUND

Hearing difficulties are prevalent among older people and can lead to difficulties in social interaction. These difficulties may increase the tendency to remain at home and withdraw from leisure activities.

AIMS

To investigate whether self-reported hearing problems are associated with time spent out-of-home and withdrawal from a leisure activity among older persons.

METHODS

Cross-sectional and longitudinal data on 75- to 90-year-old community-dwelling men and women (n = 767) was used. Self-reports of hearing, diseases, and difficulty walking 2 km were obtained via home interviews at baseline, and withdrawal from a leisure activity via 1- and 2-year follow-up telephone interviews. Time spent out-of-home was obtained from a subsample (n = 532) via seven-day diaries at baseline.

RESULTS

Hearing problems were associated with time spent out-of-home (p = 0.025) and withdrawal from a leisure activity (p = 0.025) among persons reporting no walking difficulty, but not among those reporting walking difficulty (p = 0.269 and 0.396, respectively). Among the former, persons with major hearing problems spent significantly less time out-of-home (estimated marginal mean 161 min, 95 % CI 122-212) than those with good hearing (242, 95 % CI 218-270). Persons with major hearing problems also had 3.0 times higher odds (95 % CI 1.3-7.1) for withdrawal from a leisure activity than persons with good hearing during the two-year follow-up.

DISCUSSION AND CONCLUSIONS

Among older adults without walking difficulty, hearing problems may reduce time spent out-of-home and increase the likelihood for withdrawal from a leisure activity. Decreased leisure and out-of-home activity may have negative effects on older persons' social, mental and physical functioning.

The impact of hearing impairment and noise-induced hearing injury on quality of life in the active-duty military population: challenges to the study of this issue

The objectives of this research were to 1) summarize the available evidence on the impact of hearing loss on quality of life (QOL) among U.S. active-duty service members, 2) describe the QOL instruments that have been used to quantify the impact of hearing loss on quality of life, 3) examine national population-level secondary databases and report on their utility for studying the impact of hearing loss on QOL among active-duty service members, and 4) provide recommendations for future studies that seek to quantify the impact of hearing loss in this population. There is a lack of literature that addresses the intersection of hearing impairment, the military population, and quality of life measures. For audiological research, U.S. military personnel offer a unique research population, as they are exposed to noise levels and blast environments that are highly unusual in civilian work settings and can serve as a model population for studying the impact on QOL associated with these conditions. Our team recommends conducting a study on the active-duty service member population using a measurement instrument suitable for determining decreases in QOL specifically due to hearing loss.

Big Data, Little Data, and Care Coordination for Medicare Beneficiaries with Medigap Coverage

Most healthcare data warehouses include big data such as health plan, medical, and pharmacy claims information for many thousands and sometimes millions of insured individuals. This makes it possible to identify those with multiple chronic conditions who may benefit from participation in care coordination programs meant to improve their health. The objective of this article is to describe how large databases, including individual and claims data, and other, smaller types of data from surveys and personal interviews, are used to support a care coordination program. The program described in this study was implemented for adults who are generally 65 years of age or older and have an AARP(®) Medicare Supplement Insurance Plan (i.e., a Medigap plan) insured by UnitedHealthcare Insurance Company (or, for New York residents, UnitedHealthcare Insurance Company of New York). Individual and claims data were used first to calculate risk scores that were then utilized to identify the majority of individuals who were qualified for program participation. For efficient use of time and resources, propensity to succeed modeling was used to prioritize referrals based upon their predicted probabilities of (1) engaging in the care coordination program, (2) saving money once engaged, and (3) receiving higher quality of care. To date, program evaluations have reported positive returns on investment and improved quality of healthcare among program participants. In conclusion, the use of data sources big and small can help guide program operations and determine if care coordination programs are working to help older adults live healthier lives.

Hearing loss in an aging American population: extent, impact, and management

Despite contributing substantially to disability in the United States, age-related hearing loss is an underappreciated public health concern. Loss of hearing sensitivity has been documented in two-thirds of adults aged 70 years and older and has been associated with communication difficulties, lower health-related quality of life, and decreased physical and cognitive function. Management strategies for age-related hearing loss are costly, yet the indirect costs due to lost productivity among people with communication difficulties are also substantial and likely to grow. Hearing aids can improve health-related quality of life, but the majority of people with documented hearing loss do not report using them. Uncovering effective means to improve the utilization of hearing health care services is essential for meeting the hearing health care demands of our aging population. The importance of hearing for general well-being warrants an effort to enhance awareness among the general population of the indications of hearing loss and options for assistance.

The role of intracochlear drug delivery devices in the management of inner ear disease

INTRODUCTION

Diseases of the inner ear include those of the auditory and vestibular systems, and frequently result in disabling hearing loss or vertigo. Despite a rapidly expanding pipeline of potential cochlear therapeutics, the inner ear remains a challenging organ for targeted drug delivery, and new technologies are required to deliver these therapies in a safe and efficacious manner. In addition to traditional approaches for direct inner ear drug delivery, novel microfluidics-based systems are under development, promising improved control over pharmacokinetics over longer periods of delivery, ultimately with application towards hair cell regeneration in humans.

AREAS COVERED

Advances in the development of intracochlear drug delivery systems are reviewed, including passive systems, active microfluidic technologies and cochlear prosthesis-mediated delivery. This article provides a description of novel delivery systems and their potential future clinical applications in treating inner ear disease.

EXPERT OPINION

Recent progresses in microfluidics and miniaturization technologies are enabling the development of wearable and ultimately implantable drug delivery microsystems. Progress in this field is being spurred by the convergence of advances in molecular biology, microfluidic flow control systems and models for drug transport in the inner ear. These advances will herald a new generation of devices, with near-term applications in preclinical models, and ultimately with human clinical use for a range of diseases of the inner ear.

The relationship between body mass index and quality of life in community-living older adults living in the United States

BACKGROUND

Carrying excess weight is associated with various chronic conditions especially in older adults, and can have a negative influence on the quality of life of this population.

OBJECTIVE

The objective of this study was to estimate the independent (i.e. adjusted for demographic, socioeconomic and health status differences) impact of Body Mass Index (BMI) on health-related quality of life.

DESIGN

A mail survey was sent to 60,000 older adults living in 10 states.

METHODS

The survey assessed quality of life using the average physical component scores (PCS) and mental component scores (MCS) obtained from the Veterans Rand 12-item (VR-12) health status tool embedded in the survey. Ordinary least squares (OLS) regression techniques were used to estimate the independent impact of each BMI category on quality of life, compared to the impact of other chronic conditions.

RESULTS

A total of 22,827 (38%) eligible sample members responded to the survey. Of those, 2.2% were underweight, 38.5% had a normal BMI, 37.0% were overweight, 18.5% were obese and 1.9% were morbidly obese. Following OLS regression techniques, respondents' PCS values were statistically significantly lower for the underweight, overweight, obese and morbidly obese BMI categories, compared to the normal BMI group. Compared with all other chronic conditions, being morbidly obese (-6.0 points) had the largest negative impact on the PCS. Underweight was the only BMI category with a statistically significantly lower MCS value.

CONCLUSIONS

The greatest negative impacts of the various BMI categories on quality of life were on physical rather than mental aspects, especially for those in the underweight, obese and morbidly obese categories, more so than many other chronic conditions.

Hearing, mobility, and pain predict mortality: a longitudinal population-based study

OBJECTIVE

Measures of health-related quality of life (HRQL), including the Health Utilities Index Mark 3 (HUI3) are predictive of mortality. HUI3 includes eight attributes, vision, hearing, speech, ambulation, dexterity, cognition, emotion, and pain and discomfort, with five or six levels per attribute that vary from no to severe disability. This study examined associations between individual HUI3 attributes and mortality.

STUDY DESIGN AND SETTING

Baseline data and 12 years of follow-up data from a closed longitudinal cohort study, the 1994/95 Canadian National Population Health Survey, consisting of 12,375 women and men aged 18 and older. A priori hypotheses were that ambulation, cognition, emotion, and pain would predict mortality. Cox proportional hazards regression models were applied controlling for standard determinants of health and risk factors.

RESULTS

Single-attribute utility scores for ambulation (hazard ratio [HR]=0.10; 0.04-0.22), hearing (HR=0.18; 0.06-0.57), and pain (HR=0.53; 0.29-0.96) were statistically significantly associated with an increased risk of mortality; ambulation and hearing were predictive for the 60+ cohort.

CONCLUSION

Few studies have identified hearing or pain as risk factors for mortality. This study is innovative because it identifies specific components of HRQL that predict mortality. Further research is needed to understand better the mechanisms through which deficits in hearing and pain affect mortality risks.