Aural rehabilitation in the elderly: supply of hearing aids related to measured need and self-assessed hearing problems

Self-Reported Benefit and Satisfaction with a Beamforming Body-Worn Hearing Aid for Elderly Adults

Hearing impairment is a leading cause of disability globally and is particularly prevalent in elderly populations. Hearing aids are commonly recommended to mitigate the adverse effects on communication associated with hearing loss. However, the acceptability of hearing aids to elderly individuals is low and the majority of potential users do not wear hearing aids. Most hearing aids are designed with a discreet form factor in mind, to minimize device visibility. Given the range of comorbidities associated with hearing loss in the elderly, this conventional form factor may not always be optimal. The present study examined the experiences of elderly individuals with a recently developed, unconventional, body-worn hearing instrument, the EasyHear™ Grand (Logital Co. Ltd., Hong Kong). The bilaterally fitted instrument incorporates large controls, a color display, beamforming sound processing, and Bluetooth capabilities. Forty-three elderly participants (mean age=71; range 46-88 years) were surveyed to gauge level of benefit and satisfaction with the device and opinions regarding the hearing aid. They were assessed using three standardized questionnaires (the International Outcome Inventory-Hearing Aids, the Profile of Hearing Aid Benefit, and the Client Oriented Scale of Improvement) and through open-ended, structured interviews. Participants rated their EasyHear device fitting highly for hours of use and improved quality of life and rated the device favorably for improved communication and benefit in background noise. A majority of users felt the device improved listening ability in their expressed area of greatest need, and also for their second highest prioritized area of greatest need. Less than 10% of users felt their listening was only occasionally or hardly ever improved when using the body-worn device. Benefit and satisfaction ratings with the EasyHear Grand were comparable to those in studies involving conventional form factor devices. Interviews highlighted areas where users felt the device could be improved-extra noise reduction, changes to device dimensions, receiver/eartip fit, and cableless technology were among the areas mentioned. Many participants valued smartphone linkage and Bluetooth capability. The EasyHear Grand, with its body-worn design and large, simple controls, was well accepted by the majority of participants. Hearing aids that break from conventional design formats may benefit many elderly individuals with hearing impairment and promote increased user acceptability.

How sociodemographic and hearing related factors were associated with use of hearing aid in a population-based study: The HUNT Study

Background

The purpose was to study hearing aid (HA) use in persons 65 years and older, and to investigate how socioeconomic and hearing related factors were associated to use of HA.

Method

This study included 11,602 persons (65 years and above) from the second Nord-Trøndelag Health Study (HUNT2) and the integrated North-Trøndelag hearing loss study (NTHLS) in 1995–1997. Audiometry was taken of all participants. Missing information about use of HA in possible users of HA existed in data from 1103 (9.5 %) of the participants. Effects of sociodemographic variables, low, medium and high frequency hearing thresholds and being bothered by their hearing were explored in men and women, adjusting the effects for each other. Cross tabulations and logistic regression analyses were used.

Results

In all, 14 % (1472 of 10,499) were users of HA, but 62 % had a mean hearing impairment (HI) based on 0.5, 1, 2, 4 kHz over both ears >25 dB. Use of HA was associated with higher education. Adjusting for all covariates and hearing variables, each 10 dB medium frequency threshold shift increased the chance of HA-use by a factor of two-three in both men and women. Having reported being bothered by hearing loss additionally increased the chance around sevenfold. Low frequency hearing thresholds were not associated with HA-use in women. In men, low frequency hearing thresholds up to 50 dB increased odds for use of HA, but low frequency hearing thresholds ≥ 70 dB decreased odds for use of HA. Men living with a spouse had higher odds for using HA compared to men without a spouse. For women there is no difference between those with and without spouse in use of HA. Men and women without spouse did not differ in their use of HA.

Conclusions

About two third of 65 years and older participants had a HI higher than 25 dB, but only one seventh used HA. Use of HA was associated with higher than basic education. Men without a spouse were less likely to use HA compared to men with a spouse.

Validation of the Swedish Hearing Handicap Inventory for the Elderly (Screening Version) and Evaluation of Its Effect in Hearing Aid Rehabilitation

Self-reports of subjective hearing difficulties by people with hearing loss may be a useful complement to audiometry in hearing aid rehabilitation. To be useful, such self-reports need to be reliable. This study investigated the reliability and the validity of the Swedish Hearing Handicap Inventory for the Elderly (Screening Version; HHIE-S). Sixty-nine participants completed a questionnaire before hearing aid rehabilitation. Of these individuals, 49 completed hearing aid rehabilitation (aged between 23 and 94 years), and 41 of these 49 participants completed the questionnaire after completing the rehabilitation. The Swedish HHIE-S exhibited good internal consistency (Cronbach's alpha coefficient of .77). The questionnaire was effective for evaluating hearing aid rehabilitation, and a statistically significant reduction in hearing difficulties was observed. The clinicians found the questionnaire easy to administer and effective in hearing aid rehabilitation. The findings from the study support the use of the HHIE-S in clinical practice.

Unmet hearing health care needs: the Beaver Dam offspring study

OBJECTIVES

We evaluated the use of hearing health care services (hearing testing and hearing aids) by adults aged 21 to 84 years.

METHODS

Hearing was tested and medical and hearing health histories were obtained as part of the Beaver Dam Offspring Study between 2005 and 2008 (n = 3285, mean age = 49 years).

RESULTS

Of the cohort, 34% (55% of participants aged ≥ 70 years) had a hearing test in the past 5 years. In multivariate modeling, older age, male gender, occupation, occupational noise, and having talked with a doctor about a hearing problem were independently associated with having had a hearing test in the past 5 years. Hearing aid use was low among participants with a moderate to severe hearing impairment (22.5%) and among participants with a hearing handicap (8.6%), as determined by the Hearing Handicap Inventory.

CONCLUSIONS

Data support the need for improvement in hearing health care. Hearing aids' effectiveness is limited if patients do not acquire them or do not use them once acquired. Future research should focus on developing effective strategies for moving patients from diagnosis to treatment.

Hearing-aid use and benefit: a long-term follow-up in patients undergoing surgery for otosclerosis

OBJECTIVES

The aims of the study were to assess hearing-aid uptake in patients with otosclerosis 28-30 years after stapedectomy and to evaluate hearing-aid benefit to users.

DESIGN

A retrospective study was performed; it included a review of medical records and follow-up 28-30 years after surgery, including audiometry, clinical examination, structured interview, and a validated questionnaire, IOI-HA.

STUDY SAMPLE

Sixty-five patients, who had undergone stapedectomy at a tertiary referral center in 1977-79.

RESULTS

In 95% of the subjects there was a theoretical need for hearing-aid amplification at follow-up; 46% of the subjects had no hearing aids, while 26% had unilateral and 28% bilateral hearing aids. Hearing sensitivity in the best ear predicted hearing-aid uptake. Of the subjects with a hearing aid, 94% were everyday users and 54% were full-time users (> 8 hours/day). The subjects reported a high level of satisfaction (mean 4.5) and benefit (mean 4.2), but also residual activity limitations (mean 3.1).

CONCLUSIONS

The study shows that there is an unmet need for long-term hearing rehabilitation among patients previously undergoing surgery for otosclerosis. The patients who were using hearing aids were generally very satisfied with their hearing aids, but they still reported residual activity limitations.

Changes in hearing in 80-year-old people: a 10-year follow-up study

The aims of this prospective 10-year longitudinal population study were to report changes in hearing in people aged 80 years at baseline, and to assess such changes by comparing results from both cross-sectional and longitudinal analyses. The study population comprised all residents of the city of Jyväskylä born in 1910 (n = 291). The subjects' hearing was tested on three occasions at 5-year intervals with the use of pure-tone audiometry, speech audiometry, and self-report on hearing difficulties. The results showed a significant deterioration in hearing sensitivity in both the longitudinal and cross-sectional assessments over the 10-year follow-up. However, the change in self-assessed hearing difficulties was not significant. Hearing aids were not used by over 75%, of those who had moderate hearing impairment. Self-assessed hearing difficulties at baseline were associated with increased mortality. Hearing deterioration in elderly people and their low level of use of hearing aids deserve closer attention in the healthcare system.

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.

[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.

The non-use of hearing aids in people aged 75 years and over in the city of Kuopio in Finland

Hearing loss is one of the most prevalent chronic conditions affecting the health of the aged. It is typically medically non-treatable, and hearing aid (HA) use remains the treatment of choice. However, only 15-30% of older adults with hearing impairment possess an HA. Many of them never use it. The purpose of our study was to investigate the use of provided HAs and reasons for the non-use of HAs. This population-based survey was set in the city of Kuopio in eastern Finland. A total of 601 people aged 75 years or older participated in this study. A geriatrician and a trained nurse examined the subjects. Their functional and cognitive capacity was evaluated. A questionnaire about participants' socioeconomic characteristics and the use of HAs were included in the study protocol. The subjects who had an HA were assigned to three groups on the basis of HA use: full-time users, part-time users and non-users. Inquiries were made about the subjective reasons for the non-use of HAs. An HA had been prescribed earlier to 16.6% of the study group. Fourteen percent of the females and 23% of the males had been provided with an HA. The HA owners were older than persons who had not been provided with an HA. Twenty-five percent of the HA owners were non-users, and 55% were full-time users. A decline in cognitive or functional capacity and low income explained the non-use of HAs. The most common subjective reasons for the non-use of HAs were that the use did not help at all (10/24), the HA was broken (4/24) or it was too complicated to use (5/24). The non-use of HAs is still common among the aged. Elderly people who have been provided with an HA and who have a cognitive or functional decline are at risk to be a non-user of an HA. Therefore, they need special attention in counseling.

Modeling relationships between various domains of hearing aid provision

Various inventories have been developed to quantify the success of hearing aid provision. Though numerous parameters including initial measures (hearing disability, handicap) or 'outcome measures' (e.g. benefit, satisfaction and usage) are recorded, relationships and interactions among them are still unclear. A study applying a questionnaire addressing 11 domains relevant to amplification was conducted in order to generate different psychometric models with the AMOS software package for structural equation modeling. The models expose easily interpretable interactions and are helpful in understanding effects occurring with commonly used outcome measures: benefit reflects the difference between the aided and unaided condition but additionally comprises the importance of the hearing aid within a specific situation. Satisfaction is highly reliant on benefit. Usage is strongly dependent on the severity of hearing problems and therefore not appropriate in assessing the success of amplification. Moreover, the models help to predict the outcome of clinically used inventories (i.e. the Glasgow Hearing Aid Benefit Profile).

Hearing confirms existence and identity--experiences from persons with presbyacusis

The purpose of the present qualitative study was to describe how elderly persons with presbyacusis experience living with that type of hearing loss. The ultimate goal is for these experiences to be used in personal-adjustment counselling in audiological rehabilitation. The study included seven men and seven women with mild-to-moderate hearing impairment of the typical presbyacusis type. Open-ended interviews were conducted with each person. The interviewees were analysed according to the phenomenographic approach, and 10 categories emerged: 'Conversation takes away or maintains identity', 'It's other people's fault that I can't hear', 'Other people make you realize you can't hear', 'Society makes you think you shouldn't mind about your hearing loss', 'It's natural to hear badly when you are old', 'You should hear well all your life', 'You want to keep a feeling of continuity in your daily life in spite of your hearing loss', 'You don't need to hear everything', 'You want to hear so you feel that you're alive', and 'You want to hear so you understand and keep yourself informed'. All these categories deal with identity or existence and form the basis for how the hearing impairment is experienced and managed. The subjects protected their identity in various ways, but above all by blaming their poor hearing on old age, and managing it with simple everyday strategies that did not break the feeling of continuity in everyday life. Not until they experienced the lack of sound as a lack of contact with life was there any interest in help in the form of hearing technology. There is a need for information about the possibility of rehabilitating presbyacusis, as hearing is important not only for communication and spatial orientation, but also as affirmation of our existence as human beings.

The two faces of presbyacusis: hearing impairment and psychosocial consequences

A study of hearing disability and handicap was performed in a sample of elderly persons living in an urban area of Göteborg, Sweden. The aim was to describe the psychosocial consequences of presbyacusis. For this purpose, elderly persons with fairly uncontaminated presbyacusis were chosen. The study group consisted of 154 persons (59 men and 95 women) between the ages of 70 and 91 with a median age of 78 years. The methods used included a self-assessed hearing instrument, pure-tone audiometry, and registration of desired services regarding rehabilitative audiology. The questionnaire included 26 items, 20 of them within four areas: assessment of normality, communication, quality of life and environment/orientation. The results showed that the assessment, whether the hearing was normal or not, was correlated with audiometrically measured hearing. Many of the participants expressed concern that their hearing had deteriorated. Communication situations with background noise were troublesome for many of the participants, but they had only minor problems when performing daily activities like shopping. The quality of life in general was only mildly affected by hearing loss. Items regarding environment and orientation showed varying results. Some everyday aspects of listening were related to hearing ability, but directional hearing was not correlated with measured hearing. In spite of the participants' worry about hearing deterioration, only 8% requested hearing aids as a result of the examination.