Older adult performance on the Communication Profile for the Hearing Impaired: gender difference

Depression and Health-Related Quality of Life Among Older Adults With Hearing Loss in the ACHIEVE Study

Hearing loss is associated with cognitive/physical health; less is known about mental health. We investigated associations between hearing loss severity, depression, and health-related quality of life among older adults with unaided hearing loss. Data (N = 948) were from the Aging and Cognitive Health Evaluation in Elders Study. Hearing was measured by pure-tone average (PTA), Quick Speech-in-Noise (QuickSIN) test, and the Hearing Handicap Inventory for the Elderly (HHIE-S). Outcomes were validated measures of depression and health-related quality of life. Associations were assessed by negative binomial regression. More severe hearing loss was associated with worse physical health-related quality of life (ratio: .98, 95% CI: .96, 1.00). Better QuickSIN was associated with higher mental health-related quality of life (1.01 [1.00, 1.02]). Worse HHIE-S was associated with depression (1.24 [1.16, 1.33]) and worse mental (.97 [.96, .98]) and physical (.95 [ .93, .96]) health-related quality of life. Further work will test effects of hearing intervention on mental health.

Hearing Loss and Sociodemographic Barriers to Health Care Access Using the All of Us Research Program

OBJECTIVE

To explore how gender and low-income status independently influence general health care access in patients with hearing loss.

STUDY DESIGN

Cross-sectional study.

SETTING

National database.

METHODS

Patients with a diagnosis of sensorineural hearing loss from the National Institutes of Health All of Us database were included. Data entered from May 2018 to November 2022 was analyzed. Patient demographics such as age, gender, educational level, and insurance status were assessed. Multivariate logistic regressions were performed for statistical evaluation.

RESULTS

A subset of 8875 patients (48.3% male, mean age 69) were evaluated. After multivariate analysis, female participants were more likely than male participants to report difficulty affording prescribed medications (odds ratio [OR]: 1.7, p < .0005) and specialists (OR: 1.4, p < 0.005). Female patients were also more likely to delay care due to elder care responsibilities (OR: 2.6, p < .0005), employment obligations (OR: 1.7, p < .0005), and feelings of apprehension in seeing a provider (OR: 1.7, p < .0005). Finally, female participants reported feeling less likely to be involved in their own medical care compared to males (OR: 1.2, p < .005). Low-income (<$25,000) participants reported less likely to feel respected (OR: 3.2, p < .0005) and delivered understandable health information (OR: 2.3, p < .0005) by providers compared to participants of higher income.

CONCLUSION

This work suggests that patients with hearing loss, female gender, and lower socioeconomic status independently introduce barriers to health care access and utilization. These factors should be considered in efforts to promote equity in the care of patients with hearing loss.

Sex-Linked Biology and Gender-Related Research Is Essential to Advancing Hearing Health

There is robust evidence that sex (biological) and gender (behavioral/social) differences influence hearing loss risk and outcomes. These differences are noted for animals and humans-in the occurrence of hearing loss, hearing loss progression, and response to interventions. Nevertheless, many studies have not reported or disaggregated data by sex or gender. This article describes the influence of sex-linked biology (specifically sex-linked hormones) and gender on hearing and hearing interventions, including the role of sex-linked biology and gender in modifying the association between risk factors and hearing loss, and the effects of hearing loss on quality of life and functioning. Most prevalence studies indicate that hearing loss begins earlier and is more common and severe among men than women. Intrinsic sex-linked biological differences in the auditory system may account, in part, for the predominance of hearing loss in males. Sex- and gender-related differences in the effects of noise exposure or cardiovascular disease on the auditory system may help explain some of these differences in the prevalence of hearing loss. Further still, differences in hearing aid use and uptake, and the effects of hearing loss on health may also vary by sex and gender. Recognizing that sex-linked biology and gender are key determinants of hearing health, the present review concludes by emphasizing the importance of a well-developed research platform that proactively measures and assesses sex- and gender-related differences in hearing, including in understudied populations. Such research focus is necessary to advance the field of hearing science and benefit all members of society.

Objective and Subjective Hearing Difficulties Are Associated With Lower Inhibitory Control

OBJECTIVE

Evidence suggests that hearing loss increases the risk of cognitive impairment. However, the relationship between hearing loss and cognition can vary considerably across studies, which may be partially explained by demographic and health factors that are not systematically accounted for in statistical models.

DESIGN

Middle-aged to older adult participants (N = 149) completed a web-based assessment that included speech-in-noise (SiN) and self-report measures of hearing, as well as auditory and visual cognitive interference (Stroop) tasks. Correlations between hearing and cognitive interference measures were performed with and without controlling for age, sex, education, depression, anxiety, and self-rated health.

RESULTS

The risk of having objective SiN difficulties differed between males and females. All demographic and health variables, except education, influenced the likelihood of reporting hearing difficulties. Small but significant relationships between objective and reported hearing difficulties and the measures of cognitive interference were observed when analyses were controlled for demographic and health factors. Furthermore, when stratifying analyses for males and females, different relationships between hearing and cognitive interference measures were found. Self-reported difficulty with spatial hearing and objective SiN performance were better predictors of inhibitory control in females, whereas self-reported difficulty with speech was a better predictor of inhibitory control in males. This suggests that inhibitory control is associated with different listening abilities in males and females.

CONCLUSIONS

The results highlight the importance of controlling for participant characteristics when assessing the relationship between hearing and cognitive interference, which may also be the case for other cognitive functions, but this requires further investigations. Furthermore, this study is the first to show that the relationship between hearing and cognitive interference can be captured using web-based tasks that are simple to implement and administer at home without any assistance, paving the way for future online screening tests assessing the effects of hearing loss on cognition.

Self-Perception of Hearing Difficulties and Quality of Life in Individuals with Hearing Loss

Objectives: To characterize the results of the Short Form Health Survey-36 (SF-36), Abbreviated Profile of Hearing Aid Benefit (APHAB), and the Hearing Handicap Inventory for Adults (HHIA) questionnaires in individuals with mild to moderate sensorineural hearing loss and compare them with brainstem auditory evoked potentials (BAEPs). Methods: There were 26 individuals with mild to moderate bilateral symmetrical sensorineural hearing loss who participated in the study. They were aged between 13 and 59 years old, right-hand preference, of both sexes, and were assigned to one of two groups according to the result of a BAEP test: normal (n = 16) or altered (n = 10). All subjects underwent a brief, cognitive screening battery and answered the SF-36, APHAB, and HHIA self-assessment questionnaires. For analysis of results, descriptive measures and inferential analysis were used. Results: On the SF-36 questionnaire, scores below 80 points were found in both groups, signifying minimal impact in the domains of pain, general health, vitality, and mental health compared to the other domains. The results of the APHAB questionnaire showed worse scores on the environmental noise subscale, and evaluation with the HHIA revealed a perception of severe restriction in participation in daily life activities. In a comparison between the groups, normal or abnormal BAEPs, no significant differences were found for any of the questionnaires. Conclusions: The results of the self-assessment questionnaires indicate that individuals with hearing loss can experience reduced quality of life, with limitations and restrictions for participation in daily living. The use of BAEPs as a criterion for dividing the groups was not effective in isolating the central component in the results of the self-assessment questionnaires.

How do face masks impact communication amongst deaf/HoH people?

Face coverings have been key in reducing the spread of COVID-19. At the same time, they have hindered interpersonal communication, particularly for those who rely on speechreading to aid communication. The available research indicated that deaf/hard of hearing (HoH) people experienced great difficulty communicating with people wearing masks and negative effects on wellbeing. Here we extended these findings by exploring which factors predict deaf/HoH people’s communication difficulties, loss of information, and wellbeing. We also explored the factors predicting perceived usefulness of transparent face coverings and alternative ways of communicating. We report the findings from an accessible survey study, released in two written and three signed languages. Responses from 395 deaf/HoH UK and Spanish residents were collected online at a time when masks were mandatory. We investigated whether onset and level of deafness, knowledge of sign language, speechreading fluency, and country of residence predicted communication difficulties, wellbeing, and degree to which transparent face coverings were considered useful. Overall, deaf/HoH people and their relatives used masks most of the time despite greater communication difficulties. Late-onset deaf people were the group that experienced more difficulties in communication, and also reported lower wellbeing. However, both early- and late-onset deaf people reported missing more information and feeling more disconnected from society than HoH people. Finally, signers valued transparent face shields more positively than non-signers. The latter suggests that, while seeing the lips is positive to everyone, signers appreciate seeing the whole facial expression. Importantly, our data also revealed the importance of visual communication other than speechreading to facilitate face-to-face interactions.

Late-onset deaf people experienced more difficulties in communication and low wellbeing.

Severely/profoundly deaf people missed more information and felt disconnected from society.

Signers preferred completely transparent face coverings.

More frequent use of masks doesn’t necessarily imply more difficulty communicating.

Visual communication, pro-social behaviour, and societal structure might help easing communication.

A Comparison of the Perceived Hearing Difficulties of Community and Clinical Samples of Older Adults

Purpose This study aimed to compare the perceived hearing difficulties of a community sample of older adults to two clinical samples of older adults, one with no hearing aid experience and the other with hearing aid experience. Method Scale scores from the Communication Profile for the Hearing Impaired (CPHI) were analyzed for a community sample of older adults (N = 243) and compared to scores from two clinical samples, one without (N = 342) and one with prior hearing-aid experience (N = 179). General linear model (GLM) analyses were performed to examine the effects of data sample type and other factors on CPHI scale scores. Scores for the Hearing Handicap Inventory for the Elderly (HHIE) were also available for most participants and were analyzed. Results GLM analyses of each of the 20 CPHI scale scores showed significant effects of sample type with hearing-loss severity and age most frequently showing significant effects as well. GLM analyses controlling for hearing-loss severity and age across sample types found significant differences on most CPHI scales between the community sample and each of the two clinical samples. Significant differences between the two clinical samples were also found on several CPHI scales and on the HHIE. Conclusions Older adults from the community who did not seek help for hearing difficulties self-reported less difficulty and a greater denial or lack of awareness of communication problems than those who sought assistance at an audiology clinic. For those presumed to have sought a hearing evaluation, those acquiring hearing aids perceived greater communication difficulties in all environments, had greater awareness of communication difficulties, were more accepting of their hearing loss, but tended to allocate more responsibility for their difficulties to others, compared to those who sought clinical assistance but did not acquire hearing aids.

Factors Associated With Self-Perceived Hearing Handicap in Adults From Hispanic/Latino Background: Findings From the Hispanic Community Health Study/Study of Latinos

OBJECTIVES

We sought to determine what factors, including acculturation (language and social contact preferences), were associated with self-perceived hearing handicap among adults from Hispanic/Latino background. We utilized the Aday-Andersen behavioral model of health services utilization to frame our hypotheses that predisposing characteristics (age, sex, education, city of residence, Hispanic/Latino background, and acculturation), enabling resources (annual income and current health insurance coverage), and need (measured hearing loss and self-reported hearing loss) would be related to clinically-significant self-perceived hearing handicap as measured by the Hearing Handicap Inventory - Screening (HHI-S) version.

DESIGN

We analyzed baseline data collected from 2008 to 2011 as part of the multisite Hispanic Community Health Study/Study of Latinos. Data were from 6585 adults with hearing loss (defined by a worse-ear 500, 1000, 2000, and 4000 Hz pure-tone average [PTA] of ≥25 dB HL and/or a 4000, 6000, and 8000 Hz high-frequency PTA of ≥25 dB HL) aged 18 to 74 years from various Hispanic/Latino backgrounds. We conducted a series of multivariable logistic regression models examining the roles of independent variables of interest representing predisposing, enabling, and need indicators on the occurrence of clinically-significant self-perceived hearing handicap (e.g., HHI-S score > 8).

RESULTS

Among included participants, 953 (14.5%) had an HHI-S score >8. The final model revealed significant associations between predisposing characteristics, enabling resources, need, and HHI-S outcome. Predisposing characteristics and need factors were associated with higher odds of reporting self-perceived hearing handicap (HHI-S score >8) including acculturation as measured by the Short Acculturation Scale for Hispanics (odds ratio [OR] = 1.28, 95% confidence interval [CI]: 1.09-1.50), female sex (OR = 1.72, 95% CI: 1.27-2.33), and poorer worse ear 500, 1000, 2000, and 4000 Hz PTA (OR = 1.02, 95% CI: 1.01-1.03); suggesting that a 5-decibel increase in a person's PTA was consistent with 10% higher odds of a HHI-S score of >8. Greater enabling resources were associated with lower odds of reporting clinically-significant self-perceived hearing handicap: compared with individuals with income <$10,000/year, the multivariable-adjusted OR among individuals with income $40,000 to $7500/year was 0.55 (95% CI: 0.33-0.89) and among individuals with income >$75,000/year was 0.28 (95% CI: 0.13-0.59]; p-trend < 0.0001).

CONCLUSIONS

Our findings suggest there are associations between predisposing, enabling and need variables consistent with the Aday-Andersen model and self-perceived hearing handicap among adults from Hispanic/Latino background. The influence of language and culture on perceived hearing loss and associated handicap is complex, and deserves more attention in future studies. Our findings warrant further investigation into understanding the role of language and language access in hearing health care utilization and outcomes, as the current body of literature is small and shows mixed outcomes.

Differences Between Older Adults Who Do and Do Not Try Hearing Aids and Between Those Who Keep and Return the Devices

The focus of this study was on the differences between older adults who complied with a clinical recommendation for hearing-aid acquisition (adherents; N = 105) and those who did not (nonadherents; N = 34) among a group of research volunteers from the community. All participants were first-time hearing-aid users. Differences between adherents and nonadherents were examined across several domains, including demographic variables, audiometric measures, measures of affect and personality, cognitive variables, hearing-aid expectations, and the perceived hearing difficulties of the older adults and their adjustments to those difficulties. It was found that the adherents differed significantly (p < .05) from the nonadherents primarily in their perceived difficulties and reactions to them as well as their expectations for hearing aids. Importantly, the pattern of differences between the adherents and nonadherents was primarily confined to measures that could potentially be shaped by appropriate counseling and education of the older adult. In a secondary analysis, among the 105 adherents, a small group (N = 21) returned their hearing aids for credit with 15 of them completing the outcome measures at the end of a 1-month trial period. When comparisons were made between the adherents who kept their hearing aids (N = 84) and those who returned them, the primary differences between these two groups of adherents were in the poorer aided outcomes obtained by those who returned their devices.

The Effect of Hearing Aid Use on Cognition in Older Adults: Can We Delay Decline or Even Improve Cognitive Function?

Hearing loss is a modifiable risk factor for dementia in older adults. Whether hearing aid use can delay the onset of cognitive decline is unknown. Participants in this study (aged 62–82 years) were assessed before and 18 months after hearing aid fitting on hearing, cognitive function, speech perception, quality of life, physical activity, loneliness, isolation, mood, and medical health. At baseline, multiple linear regression showed hearing loss and age predicted significantly poorer executive function performance, while tertiary education predicted significantly higher executive function and visual learning performance. At 18 months after hearing aid fitting, speech perception in quiet, self-reported listening disability and quality of life had significantly improved. Group mean scores across the cognitive test battery showed no significant decline, and executive function significantly improved. Reliable Change Index scores also showed either clinically significant improvement or stability in executive function for 97.3% of participants, and for females for working memory, visual attention and visual learning. Relative stability and clinically and statistically significant improvement in cognition were seen in this participant group after 18 months of hearing aid use, suggesting that treatment of hearing loss with hearing aids may delay cognitive decline. Given the small sample size, further follow up is required.

An epidemiological profile of communication disability among older adults with complex needs: A national cross-sectional study

Purpose: Research on the prevalence of communication disability among community living older adults is scant, and often suffers from limitations. Using a national database, this study presents an epidemiological profile of communication disability in older community residents within New Zealand and examines whether ethnic populations are disproportionately represented.Method: Since 2012, all New Zealand community care recipients have undergone a standardised needs assessment, which includes questions directed at expressive and receptive language abilities. Those assessed between 1 September 2012 and 31 January 2016, aged ≥65 years, and who provided consent were included. Directly standardised prevalence estimates were calculated and logistic regression used to investigate age, sex and ethnic differences.Result: Overall, 71 859 people were eligible (mean age = 82.7 years, 61% female, 89.2% European/other), with 30.6% and 36.2% exhibiting at least some expression and comprehension communication disability, respectively. Māori, Pasifika and Asian people, males and those who were older were more likely to have at least some communication disability compared to their European/other, female and younger counterparts.Conclusion: Communication disability is common among older adults. With the increased provision of home-based integrated models of care, the impact of communication disability on service seeking and delivery must be recognised and accommodated.

Acquired Hearing Loss, Anger, and Emotional Distress: The Mediating Role of Perceived Disability

The aim of the study was to test whether acquired hearing loss (AHL)-related perceived disability mediates the association between AHL and psychological outcomes, including anger. Two-hundred ninety-seven consecutive outpatients with AHL assessed by pure tone average (PTA) loss completed the following: Hearing Handicap Inventory for Adults (HHIA), State-Trait Anger Expression Inventory-2 (STAXI-2), Brief Symptom Inventory (BSI), Diagnostic Criteria for Use in Psychosomatic Research (DCPR), and Social Functioning Questionnaire. In the sample, composed of 44.5% males with a mean age of 53.8 and a mean PTA of 30.7, AHL was associated to perceived hearing handicap, also correlating to all psychological measures except DCPR demoralization. Associations were stronger between the HHIA-Emotional Subscale, STAXI-2 State Anger and Feeling Angry, and BSI-Somatization, Interpersonal Sensitivity, Depression, and Psychoticism. Perceived disability predicted the presence of almost all psychosocial outcomes and confirms to be the most significant target of clinical action.

Hear–Communicate–Remember: Feasibility of delivering an integrated intervention for family caregivers of people with dementia and hearing impairment via telehealth

Purpose

To evaluate the feasibility of Hear–Communicate–Remember, a training programme developed for family caregivers of people with dementia and hearing impairment that integrated hearing, communication and memory strategies, which was intended to be delivered via telehealth.

Materials and methods

Participants included six dyads consisting of adults with dementia and hearing impairment and their family caregivers. Data collection involved a combination of semi-structured interviews, self-report questionnaires and field notes.

Results

Analysis of the qualitative interviews revealed four themes: appropriateness of intervention resources, considerations for the delivery of intervention via telehealth, knowledge and application of intervention strategies, and impact of the intervention on day-to-day life. Results from the satisfaction survey indicated that caregiver participants were mostly satisfied with all aspects of the intervention except the use of some technological components. The field notes described challenges with implementation via telehealth.

Conclusions

Future research involving a cohort comparison study with a larger cohort of dyads is needed to establish treatment efficacy.

Reported benefits of peer support group involvement by adults with hearing loss

OBJECTIVE

The purpose of this study was to better understand the benefits of self-help group involvement by adults with hearing loss.

DESIGN

A secondary content analysis of interview transcripts of participants from a previous study on the impact of stigma on help-seeking was carried out.

STUDY SAMPLE

Ten members (aged 55-76 years) of self-help groups for persons with hearing loss in the United States of America and Canada participated in the interviews.

RESULTS

Three themes describing the benefits of self-help group participation emerged: (1) Practical and accessible information about hearing loss; (2) Social belonging leading to personal transformation; and (3) A new and mutually beneficial direction.

CONCLUSIONS

The findings are discussed in relation to the "helper therapy principle", as well as group audiological rehabilitation.

Gender-Specific Associations of Sensory Impairments with Depression and Cognitive Impairment in Later Life

OBJECTIVE

Sensory impairments, such as vision and hearing impairments, increase with age, and studies have shown that self-reported vision and hearing impairments are associated with adverse mental health outcomes in later life. Although gender differences may exist in the associations between sensory impairments and geriatric mental health outcomes, little research has been done examining gender differences in the above associations. Therefore, the purpose of this study was to investigate the relationship between self-reported sensory impairments and geriatric mental health outcomes with the aim of determining whether any association differs by gender.

METHODS

The study sample was drawn from a nationally representative data set, the 2012 Korean Longitudinal Study of Ageing, and the final sample consisted of 2,167 females and 1,664 males aged 65 and over. Self-reported sensory impairments were categorized into four groups: no sensory impairment (reference), vision impairment only, hearing impairment only, and dual sensory impairment. Depression and cognitive impairment were used as dependent variables in separate analyses.

RESULTS

Adjusted for confounding variables, results from a multivariate analysis showed that vision impairment was significantly associated with depression only among women. Moreover, hearing impairment was significantly associated with cognitive impairment for women, but not for men. Having dual sensory impairment was associated with depression only among men, while having dual sensory impairment was associated with cognitive impairment only among women.

CONCLUSION

These findings suggest that the associations between sensory impairments and geriatric mental health outcomes vary according to gender. Therefore, gender-specific strategies in healthcare policies are needed.

Explaining Discrepancies Between the Digit Triplet Speech-in-Noise Test Score and Self-Reported Hearing Problems in Older Adults

PURPOSE

The purpose of this study is to determine which demographic, health-related, mood, personality, or social factors predict discrepancies between older adults' functional speech-in-noise test result and their self-reported hearing problems.

METHOD

Data of 1,061 respondents from the Longitudinal Aging Study Amsterdam were used (ages ranged from 57 to 95 years). Functional hearing problems were measured using a digit triplet speech-in-noise test. Five questions were used to assess self-reported hearing problems. Scores of both hearing measures were dichotomized. Two discrepancy outcomes were created: (a) being unaware: those with functional but without self-reported problems (reference is aware: those with functional and self-reported problems); (b) reporting false complaints: those without functional but with self-reported problems (reference is well: those without functional and self-reported hearing problems). Two multivariable prediction models (logistic regression) were built with 19 candidate predictors. The speech reception threshold in noise was kept (forced) as a predictor in both models.

RESULTS

Persons with higher self-efficacy (to initiate behavior) and higher self-esteem had a higher odds to being unaware than persons with lower self-efficacy scores (odds ratio [OR] = 1.13 and 1.11, respectively). Women had a higher odds than men (OR = 1.47). Persons with more chronic diseases and persons with worse (i.e., higher) speech-in-noise reception thresholds in noise had a lower odds to being unaware (OR = 0.85 and 0.91, respectively) than persons with less diseases and better thresholds, respectively. A higher odds to reporting false complaints was predicted by more depressive symptoms (OR = 1.06), more chronic diseases (OR = 1.21), and a larger social network (OR = 1.02). Persons with higher self-efficacy (to complete behavior) had a lower odds (OR = 0.86), whereas persons with higher self-esteem had a higher odds to report false complaints (OR = 1.21). The explained variance of both prediction models was small (Nagelkerke R2 = .11 for the unaware model, and .10 for the false complaints model).

CONCLUSIONS

The findings suggest that a small proportion of the discrepancies between older individuals' results on a speech-in-noise screening test and their self-reports of hearing problems can be explained by the unique context of these individuals. The likelihood of discrepancies partly depends on a person's health (chronic diseases), demographics (gender), personality (self-efficacy to initiate behavior and to persist in adversity, self-esteem), mood (depressive symptoms), and social situation (social network size). Implications are discussed.

Gender-Specific Incidence and Predictors of Cognitive Impairment among Older Koreans: Findings from a 6-Year Prospective Cohort Study

OBJECTIVE

This study investigated gender-specific incidence and predictors of cognitive impairment among community-dwelling older adults in South Korea.

METHODS

Using data from the 2006 and 2012 Korean Longitudinal Study of Ageing (KLoSA), 925 females and 834 males aged 65 and over without cognitive impairment at 2006 were analyzed separately. Cognitive impairment was measured based on the Korean version of the Mini-Mental State Exam (K-MMSE) normative score. Generalized Estimating Equations (GEE) was conducted to examine the predictors of cognitive impairment at 6-year follow up.

RESULTS

Incidence of cognitive impairment at 2012 was significantly higher for women (30.5%) than men (26.1%). GEE result showed that depression was significantly associated with cognitive impairment for both genders (female: OR=2.26, 95% CI=1.63-3.12; male: OR=3.26, 95% CI=2.19-4.83). Having IADL limitations (OR=1.15, 95% CI=1.03-1.28), high blood pressure (OR=1.72, 95% CI=1.27-2.34), poor hearing (OR=1.94, 95% CI=1.29-2.92), regular exercise (OR=0.67, 95% CI=0.45-0.99), and normal weight (OR=1.39, 95% CI=1.03-1.86) were significant predictors of cognitive impairment only among women. In contrast, age (OR=1.04, 95% CI=1.01-1.07) and ADL limitations (OR=1.48, 95% CI=1.21-1.82) were significant predictors of cognitive impairment at follow-up only among men.

CONCLUSION

Findings of this study show gender-specific predictors of cognitive impairment among older Koreans. This study can provide information for clinicians and policy makers to develop different intervention strategies considering gender differences in the progress of cognitive impairment.

Tradução e Adaptação Transcultural para o Português Brasileiro do Questionário Hearing Implant Sound Quality Index - (HISQUI19)

RESUMO Objetivo Traduzir e adaptar transculturalmente o instrumento HISQUI19 (Hearing Implant Sound Quality Index), e caracterizar a população e o desempenho auditivo em usuários de Implante Coclear (IC) pela aplicação da versão síntese. Método Realizou-se a avaliação das equivalências conceitual, de item, semântica e operacional. A versão síntese foi aplicada como um pré-teste que contou com 33 sujeitos no resultado final, caracterizando a amostra e o desempenho do questionário. Os resultados foram analisados estatisticamente. Resultado A tradução final (TF) foi retrotraduzida e comparada à versão original, mostrando diferença mínima entre itens, e as modificações da TF para a versão síntese caracterizaram-se pela aplicação de vocabulário simplificado utilizado no cotidiano. No pré-teste, o escore médio entre os entrevistados foi de 90,2 e confirmou-se alto grau de confiabilidade interna (0,83). Conclusão A tradução e a adaptação do questionário HISQUI19 mostraram adequação para as equivalências semântica, cultural, conceitual e de item. Na caracterização da amostra, a qualidade de som foi classificada como boa com melhor desempenho nas categorias de localização e distinção de sons/vozes.

What Is the International Classification of Functioning, Disability and Health and Why Is It Relevant to Audiology?

The World Health Organization's International Classification of Functioning, Disability and Health (ICF) is widely used in disability and health sectors as a framework to describe the far-reaching effects of a range of health conditions on individuals. This biopsychosocial framework can be used to describe the experience of an individual in the components of body functions, body structures, and activities and participation, and it considers the influence of contextual factors (environmental and personal) on these components. Application of the ICF in audiology allows the use of a common language between health care professionals in both clinical and research settings. Furthermore, the ICF is promoted as a means of facilitating patient-centered care. In this article, the relevance and application of the ICF to audiology is described, along with clinical examples of its application in the assessment and management of children and adults with hearing loss. Importantly, the skills necessary for clinicians to apply the ICF effectively are discussed.

Relationship between cognitive anxiety level and client variables at initial consultation for adults with hearing impairment

The purpose of this study was to use the Cognitive Anxiety Scale (CAS) to investigate relationships between state-anxiety level (cognitive anxiety) and audiometric variables in adults with hearing impairment at their initial consultation. Thirty-five adults with hearing impairment who consulted an audiologist for the first time participated in this study. An interview to obtain information about cognitive anxiety was conducted prior to the audiological assessment. The results indicated that cognitive anxiety was significantly related to an ability to understand speech in noise. Further, cognitive anxiety and ability to understand speech in noise significantly contributed to the classification of hearing aid adopters and non-adopters. These results indicate that the measure of cognitive anxiety may have clinical applications in the future.

LEARNING OUTCOMES

The reader will be able to: (1) discuss the relationship between anxiety and hearing impairment; (2) define cognitive anxiety; (3) state the relationship between cognitive anxiety and audiometric variables; (4) state the relationship between cognitive anxiety and the decision to adopt hearing aids; (5) identify signs of cognitive anxiety in adults with hearing impairment.

Hearing Status in Older Persons: A Significant Determinant of Depression and Loneliness? Results From the Longitudinal Aging Study Amsterdam

Purpose

In this study, the authors' aims were to (a) determine the longitudinal relationships between baseline hearing status and 4-year follow-up depression and loneliness in an older population and (b) investigate possible differences across subgroups in these relationships.

Method

The authors used data from 2 waves of the Longitudinal Aging Study Amsterdam (4-year follow-up, baseline ages 63–93 years). Sample sizes were 996 (self-report analyses) and 830 (speech-in-noise test analyses). The authors used multiple linear regression analyses to assess the associations between baseline hearing status and 4-year follow-up of depression, social loneliness, and emotional loneliness. Hearing was measured by self-report and by a speech-in-noise test. Age, gender, hearing aid use, baseline depression or loneliness, and relevant confounders and effect modifiers were incorporated.

Results

Both hearing measures showed significant associations with loneliness ( p < .05), but these effects were confined to specific subgroups of older persons. For instance, adverse effects were confined to nonusers of hearing aids (self-report, social loneliness model) and men (self-report and speech-in-noise test, emotional-loneliness model). No significant effects appeared for depression.

Conclusion

Significant adverse effects of poor hearing on loneliness were found for specific subgroups of older persons. In future research, investigators should further examine the subgroup effects observed. Eventually, this may contribute to the development of tailored prevention programs.

Perception of quality of life for adults with hearing impairment in the LGBT community

The purpose of the this study was to examine the perception of both generic and disease-specific quality of life (QoL) in adults with hearing impairment who are members of the lesbian, gay, bisexual, and transgender (LGBT) community. Eighty-three adults who self-identified as having hearing impairment and as being members of the LGBT community and 80 adults with hearing impairment who do not self-identify as being members of the LGBT community (comparison group) participated in this study. The mean age of the participants in the LGBT group was 64.65 years, and the mean age for the comparison group was 63.26 years. Demographic information about the participants included: self-identification in the LGBT community, age, current and previous gender, relationship status, and hearing aid use. Participants received an audiometric evaluation and completed a disease-specific QoL instrument (Hearing Handicap Inventory for the Elderly/Adults) and a generic QoL instrument (Short-Form 36 Health Survey). The results from this study indicate that factors such as gender, relationship status, and hearing aid use are related to the perception of QoL for individuals with hearing impairment who are members of the LGBT community. Differences were found between the participants in the LGBT group and the comparison group.

LEARNING OUTCOMES

After reading this article, readers should be able to: (1) describe the disease-specific QoL affects of hearing loss on members of the LGBT community compared with a group of adults with hearing impairment who are not members of the LGBT community, (2) describe the gender diffferences in perception of QoL for members of the LGBT community and participants not in the LGBT community, and (3) discuss clinical implications of the findings.

A qualitative study of the impact of living with neurofibromatosis type 2

Neurofibromatosis type 2 (Nf2) is an inherited autosomal dominant syndrome characterised by the development of nervous system tumours, ocular abnormalities and skin tumours. Symptoms of Nf2 can vary depending on the size and location of the tumour and include hearing loss, balance deficits and facial palsy. This study explored the physical, emotional and social impact of Nf2. Six patients were recruited through a neurofibromatosis clinic and underwent a semi-structured interview. Interviews were recorded and analysed using Framework analysis. Participants spoke of the negative impact of Nf2 on daily activities, including work. Social isolation resulted from the avoidance of social situations and was often a consequence of difficulties with communication due to loss of hearing. Patients expressed a range of negative emotional reactions in response to their diagnosis and the impact of the disease. Furthermore, the findings highlighted the important role of partners and family who were relied on for physical as well as emotional and psychological support. Patients also expressed frustration at the limited awareness of Nf2 among health professionals and a desire for improved access to information on Nf2 within their local community.

Spousal interrelations in self-reports of cognition in the context of marital problems

BACKGROUND

Problems with cognitive function are common among older adults, yet there is little research assessing the extent to which the cognitive problems of older husbands and wives are related to those of their partners and whether any observed relationships are moderated by gender or marital quality.

OBJECTIVES

Our purpose was to analyze longitudinal relationships between older spouses' cognitive function and the cognitive function of their partners 5 years later, as well as to assess moderating roles of gender and marital quality.

METHODS

The subjects were 378 community-dwelling couples aged 46-89 years at baseline who were followed for 5 years. Cognitive function was measured with a scale assessing problems remembering names, finding the right word, misplacing things and paying attention. Marital quality was assessed by comparing those reporting marital problems often or sometimes with those reporting marital problems rarely or never. All data were collected by self-report. Statistical models adjusted for paired data where appropriate and included partner cognitive function, age, chronic conditions and financial hardship. Stratified models assessed moderating roles of gender and marital problems.

RESULTS

We found a negative relationship between husbands' baseline lower cognitive function and wives' subsequent cognitive function but only for the wives reporting marital problems. We found no comparable relationship between wives' baseline lower cognitive function and their husbands' subsequent cognitive function.

CONCLUSIONS

Our gender-specific finding for wives is consistent with the gender differences noted in 2 previous studies. The limitation to wives with problems in their marriages is a new finding and might follow increased stress and depression responding to changes in their husbands' cognitive functioning.

Factor structure and reliability of the Dutch version of seven scales of the Communication Profile for the Hearing Impaired (CPHI)

PURPOSE

Seven scales of the Communication Profile for the Hearing Impaired (CPHI; M. E. Demorest & S. A. Erdman, 1987) were translated into Dutch: Maladaptive Behavior, Verbal Strategies, and Nonverbal Strategies (within the area of Communication Strategies) and Self-Acceptance, Acceptance of Loss, Stress, and Withdrawal (within the area of Personal Adjustment).

METHOD

This cross-sectional study evaluated the factor structure, internal consistency, test-retest reliability, and measurement error of the Dutch CPHI scales. In all, 399 adults with impaired hearing participated, and data on a subgroup of 40 patients were included in the test-retest analyses. The participants completed the questionnaire before routine clinical care or at home. Demographic data and data on pure-tone hearing thresholds were also collected.

RESULTS

Based on item factor analyses, we omitted 5 items, moved 3 items to different scales, and combined the Stress and Withdrawal scales. The resulting 6 scales, containing 52 items, showed good internal consistency (alphas between 0.81 and 0.94), good test-retest reliability (intraclass correlation coefficients between 0.78 and 0.86), and small standard error of measurement (between 0.28 and 0.46).

CONCLUSIONS

The suggested revisions of the Dutch CPHI scales will increase their interpretability. Further research is needed to evaluate their usefulness for monitoring patients and in longitudinal studies by determining their responsiveness and minimal important change values.

Self-reported hearing difficulties, communication strategies and psychological general well-being (quality of life) in patients with acquired hearing impairment

PURPOSE

The aims were to (i) translate the Amsterdam Inventory for Auditory Disability and Handicap (AIADH) into Swedish and evalute its usefulness, (ii) describe hearing difficulties and psychological well-being (quality of life) and (iii) explore variables related to psychological well-being in a Swedish population.

METHOD

Seventy-nine consecutive patients, referred to the hearing clinic for hearing examination and audiological rehabilitation, formed the study sample. Along with pure-tone audiometry, the AIADH, the Psychological General Well-being index and the Communication Strategies Scale were used.

RESULTS

Men had significantly worse hearing on the high frequencies (2, 3, 4 and 6 kHz) than women but their quality of life was significantly higher than for women. Men scored significantly lower on 'auditory localization' and adopted non-verbal communication strategies less often than women. A stepwise regression analysis showed that 'maladaptive behaviours' and 'intelligibility in quiet' explained 48% of the variance in quality of life.

CONCLUSION

Psychosocial consequences of hearing loss, such as lowered quality of life, cannot be predicted from audiometric data alone. The adverse relationship between maladaptive behaviour and quality of life emphasizes the relevance of developing training programs aiming to improve coping with the consequences of a hearing impairment. The AIADH may be useful in assessing self-reported difficulties among patients with hearing problems, but needs to be further developed in terms of psychometric evaluations and reliability testings based on a larger representative sample.

Impact of Spouse Vision Impairment on Partner Health and Well-Being: A Longitudinal Analysis of Couples

OBJECTIVES

The purpose of this study was to assess the impact of older spouses' vision impairment on the health and well-being of their partners and to test for gender differences.

METHODS

Participants were 418 older couples from the Alameda County Study. Vision impairment was assessed in 1994 with a 9-point scale assessing difficulty seeing in everyday situations; outcomes were assessed in 1999. Longitudinal analyses included multivariate statistical models adjusting for paired data and partners' own vision impairment, age, gender, chronic conditions, and financial problems. We include results on outcomes for partners' own vision impairment for comparative purposes. We assessed gender differences with interaction tests.

RESULTS

Spouse vision impairment negatively impacted partner depression, physical functioning, well-being, social involvement, and marital quality; these effects were not greatly different in magnitude from those associated with partners' own vision impairment. Three of four outcomes with significant gender differences evidenced stronger impacts of husbands' vision impairment on wives' well-being and marital quality than the reverse.

DISCUSSION

Spouses do not live in isolation; characteristics of one impact the other. Both treatment and rehabilitation programs should include spouses and other family members of visually impaired patients. Why wives appear more sensitive to their husbands' vision impairment is unclear and warrants further study.

Issues associated with the measurement of psychosocial benefits of group audiologic rehabilitation programs

The purpose of this review is to describe the psychosocial effects of hearing loss, review the literature that has attempted to measure the psychosocial benefits of group audiologic rehabilitation programs, and offer suggestions for the design of future studies. The psychosocial aspects of hearing loss are multidimensional and may include the emotional, cognitive, interpersonal, behavioral, and physical responses to hearing loss. As a result of the stigma of hearing loss, individuals may isolate themselves, avoid social interactions, and/or bluff their way through communication breakdowns. Participation in group audiologic rehabilitation programs is a straightforward way to deal with the stigma and the loss of social identity associated with hearing loss, and these groups are an ideal forum for teaching communication strategies. Yet, the literature on the efficacy of group audiologic rehabilitation has produced equivocal results. Several factors may have contributed to the lack of psychosocial benefits reported in the literature, including the theoretical framework upon which the program was designed, the actual class content, the effectiveness of the outcome measures, and the demographic characteristics of the participants in the programs. Future research should determine (1) if the theoretical framework and/or the content covered in group audiologic rehabilitation programs influences the psychosocial outcomes, (2) if instructor training influences psychosocial outcomes, (3) the ideal test battery to assess the psychosocial benefits of group audiologic rehabilitation programs, (4) the participant demographic and personality characteristics that influence psychosocial outcomes, and (5) whether experienced hearing aid users have different hearing-loss related psychosocial needs than new hearing aid users.

Who Wants a Hearing Aid? Personality Profiles of Hearing Aid Seekers

OBJECTIVE

Evidence indicates that elderly hearing-impaired people who use amplification live happier, healthier, and longer lives than those who do not. Nevertheless, only a small fraction (approximately 23%) of hearing-impaired adults actually seek and use hearing aids. This study explored the personalities of hearing aid seekers in an attempt to determine whether those who seek hearing aids are systematically different from the general population.

DESIGN

In this cross-sectional survey, self-report data were obtained from 230 older adults with bilateral, symmetrical, sensorineural, mild to moderately severe hearing impairment. Subjects were representative of patients served either in a publicly funded hospital-based system (VA) or in a free-standing private practice system (PP). All subjects were seeking new hearing aids. Subjects completed a comprehensive personality questionnaire (NEO-Five-Factor Inventory) as well as questionnaires determining locus of control and preferred coping strategies.

RESULTS

Individuals who seek amplification are not simply a random sample of the general population and presumably not a random sample of the hearing-impaired population. Compared with the typical adult, hearing aid seekers tended to be more pragmatic and routine-oriented and probably less imaginative in coming up with novel approaches to dealing with a complex problem such as hearing impairment. These individuals also were found to feel relatively more personally powerful in dealing with life's challenges. Further, hearing aid seekers reported using social support coping strategies less frequently than their non-hearing-impaired peers. In addition, there were significant differences in personality patterns between hearing aid seekers in the PP and VA systems. Differences noted in the personality traits of Openness and Neuroticism might be a useful guide to selecting treatment approaches and expectations for patients in each setting. Additional differences in Agreeableness imply that patients in the private practice system were more trusting than those in the general population, whereas this was not seen for patients in the public health VA system. One interpretation of this finding is that hearing-impaired individuals who are more suspicious and cynical are reluctant to try amplification in the PP system. This observation underscores the need to improve the public image of hearing health care to increase the uptake of hearing aids in general.

CONCLUSIONS

Although individual hearing aid seekers display personality characteristics within the range of normal, this study suggested that they are not simply a random sample of the general population. Possible explanations are offered for significant personality differences, and potential clinical relevance is noted for some effects. The data also point to a need to improve the public image of hearing health care in the PP system.

[Identifying factors before the provision of hearing aids. Results from a pilot study]

OBJECTIVE

Systematic research on factors before the provision of hearing aids is scarce. In order to identify parameters which promote or impede the use of hearing aids, a questionnaire-based survey was conducted.

SUBJECTS AND METHODS

A total of 35 randomly chosen, hard of hearing adults indicated for a hearing aid were examined. The importance of speech in quiet and in noise, wearing comfort, sound quality, appearance and costs, as well as expectations, willingness to use a hearing aid and reasons for and against provision were determined.

RESULTS

Speech in noise and quiet were most important, followed by comfort of wearing and appearance of the aid. Expectations towards the hearing aids were in general high. The willingness to use hearing devices was positively affected by the expectation that it would improve quality of life and negatively by the amount of social activity of the person. The main reasons against the use of hearing aids were appearance and lack of confidence in hearing aid technology.

CONCLUSIONS

This pilot-study identified several parameters which might affect willingness to use hearing aids. In particular, expectations towards the aids, personal attitude towards hearing and communication problems and the appearance of hearing aids should be subject to further examination.

Impact of Self-Assessed Hearing Loss on a Spouse: A Longitudinal Analysis of Couples

OBJECTIVES

Hearing loss is increasingly common among older persons and is negatively associated with health and well-being. Its impact on spouses, however, is poorly researched. This study analyzed the relationship between a spouse's self-assessed hearing loss and his or her partner's physical, psychological, and social well-being 5 years later.

METHODS

Subjects were 418 older married couples from the Alameda County Study. Hearing loss and adjustment variables were assessed in 1994 and outcomes in 1999. Longitudinal analyses included multivariate statistical models using generalized estimating equations to adjust for paired data and partners' hearing loss, age, gender, chronic conditions, and financial problems.

RESULTS

Spouse hearing loss increased the likelihood of subsequent poorer physical, psychological, and social well-being in partners. The negative impact of husbands' hearing loss on wives' well-being appears stronger than the reverse.

DISCUSSION

Findings suggest that early diagnosis and treatment of hearing loss constitute important clinical strategies to enhance the well-being of both hearing-impaired individuals and their spouses and support policy change to cover hearing devices by insurance. Further research incorporating theoretical perspectives from communication theory and qualitative methodology would enhance understanding of how hearing loss impacts older couples and support refinement of interventions to promote quality of life.

Factors associated with development of speech production skills in children implanted by age five

OBJECTIVE

This study investigated speech production outcomes and the factors influencing the outcomes in children who had 4 to 6 yr of experience with a multichannel cochlear implant. Production variables examined included speech intelligibility, accuracy of consonant and vowel production, percentage of plosives and fricatives produced, duration of sentences, percentage of time involved in communication breakdowns during a communication sample, and responses to a speech usage questionnaire.

DESIGN

181 children between the ages of 8 and 9 yr who received a multichannel cochlear implant before age 5 yr participated as subjects. Independent variables were the amount and type of educational intervention and intervening variables were distributed across child, family and implant characteristics. Multiple regression analyses provided a measure of the amount of variance associated with speech production skills accounted for by the intervening and independent variables.

RESULTS

Performance for the key words in the speech intelligibility measured averaged 63.5% for the group of children. Accuracy of phoneme production was higher for consonants (68.0%) than for vowels (61.6%) for the group. More plosives were present for acoustic analyses (91.6%) than were fricatives (78.4%). Duration for the speech intelligibility sentences averaged 2572.3 msec. Communication breakdowns occurred on average 14.5% of the time involved in a language sample. Significant predictors of high levels of oral communication skills included higher nonverbal intelligence, gender, longer use of SPEAK processing strategy, a fully active electrode array, greater dynamic range, and greater growth of loudness. The primary rehabilitative factors contributing to high levels of oral communication were an emphasis on oral-aural communication and classrooms that emphasized dependence on speech and listening.

CONCLUSIONS

Speech production performance in children with cochlear implants is influenced by nonverbal intelligence, gender, implant characteristics including the length of time using the newest speech processing strategies, and educational programs emphasizing oral-aural communication. Factors previously thought to be major contributors to speech production performance, such as age of onset of deafness and age of implantation, did not appear to play significant roles in predicting levels of speech production performance.

Hearing loss- and hearing aid-related stigma: perceptions of women with age-normal hearing

Impaired hearing and the use of hearing aids are often perceived negatively. Many adults deny hearing loss and reject amplification, in part due to such stigma. Women and men differ in how they age and adjust to impaired hearing, yet little is known specifically about women's perceptions of stigma related to hearing loss and hearing aid use. The purpose of this study was to examine the degree of stigma associated with hearing loss and hearing aid use among women in three age groups (35-45 years, 55-65 years, and 75-85 years). Participants were 191 women with hearing within normal limits based on age-related norms. Using pairs of descriptors (i.e., semantic differentials), participants completed statements related to hearing loss and hearing aid use. Results suggest that negative perceptions associated with hearing loss and hearing aid use are affected by age. Younger women perceive greater stigma than older women. Less stigma is associated with hearing aid use than hearing loss, suggesting a positive effect of hearing loss management. Implications for clinical practice and marketing of hearing instruments are discussed.

Personal and social conditions potentially influencing women's hearing loss management

Little gender-specific data related to hearing loss and hearing loss management are available. The purpose of this investigation was to examine personal and social conditions affecting women at selected stages of the adult life course that may influence hearing loss management. In all, 191 women in three age groups, ranging from 35 to 85 years old, participated. None reported hearing problems. Participants completed a demographic data form and were given a standard audiometric evaluation to confirm age-normal hearing. Each completed assessments of speech understanding in quiet and noise, auditory signal duration discrimination, and binaural processing. Measures of hearing knowledge, behaviors, and attitudes; health-related locus of control; ego strength; and, social support were administered. Results revealed that although some variables deteriorate among subsequent age groups (i.e., hearing thresholds, central auditory processing, and ego strength), the reverse is true for others (i.e., social interaction and satisfaction with income). Age-specific sociodemographic burdens that may interfere with hearing loss management were noted. New psychosocial data are revealed against which women and men with impaired hearing may be compared.

The influence of nonaudiological variables on audiological rehabilitation outcomes

The link between nonaudiological variables and outcomes measurement is explored. Hearing impairment can affect an individual's everyday communication in numerous ways. Both audiological and nonaudiological variables interact with each other to produce a unique predicament for each individual with hearing impairment. The nonaudiological variables that are addressed in this article include race/ethnicity, gender, age, personality, self-efficacy, and social support, as well as a number of other factors. Some of these variables, such as personality, have been found to exert more influence than audiological factors on audiological rehabilitation outcomes. The potential influence of each variable is discussed and directions for future research are provided.