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Kanninen JC, Kautiainen H, Holm A. Health screening and its association with emergency department visits and related costs among home-dwelling older adults. Scand J Prim Health Care 2024:1-10. [PMID: 39511717 DOI: 10.1080/02813432.2024.2423233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Accepted: 10/23/2024] [Indexed: 11/15/2024] Open
Abstract
BACKGROUND The aim of this study was to evaluate the effectiveness of the health screening procedure for home-dwelling older adults in reducing emergency department visits and associated costs. METHODS Data were derived from health screenings from 2020 to 2021 for 75-year-old home-dwelling residents of Western Finland. The study compared emergency department visits and associated costs between older adults who participated in the health screening (intervention group) and those who did not (non-intervention group). For each older adult, three non-intervention controls were matched according to age, sex, health screening year and wellbeing service county. Emergency department visits and International Classification of Diseases (ICD)-10 codes from one year before to two years after health screening were analyzed. RESULTS In the non-intervention group, a 19% increase in emergency visit rates was seen (457-564 per 1000 person-years), while the intervention group showed a 67% decrease (165-23). Annual costs for the non-intervention group increased from 148 euros (€) to €183, a mean ratio increase of 1.24 per person-year (range 1.08-1.40). In contrast, the intervention group's costs decreased from €53 to €8, a mean reduction ratio of 0.15 per person-year (range 0.10-0.71). The intervention group had lower frequency of visits for respiratory and circulatory diseases but higher for digestive and metabolic diseases, unlike the non-intervention group. CONCLUSIONS The implementation of the health screening is an effective strategy for reducing both the frequency of emergency department visits and associated costs in home-dwelling older adults in good condition.
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Affiliation(s)
| | - Hannu Kautiainen
- Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland
- Folkhälsan Research Center, Helsinki, Finland
| | - Anu Holm
- Faculty of Medicine, University of Turku, Turku, Finland
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Felicio-Briegel A, Müller J, Pollotzek M, Neuling M, Polterauer D, Gantner S, Simon J, Briegel I, Simon F. Hearing impairment amongst people with Osteogenesis Imperfecta in Germany. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08983-5. [PMID: 39333311 DOI: 10.1007/s00405-024-08983-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2024] [Accepted: 09/10/2024] [Indexed: 09/29/2024]
Abstract
INTRODUCTION Hearing impairment concerns a relevant percentage of individuals with Osteogenesis Imperfecta (OI). When looking at the current literature, the percentage of affected individuals with OI varies greatly from 32 to 58% of patients having mild OI and 21% to 27% of patients having moderate to severe OI. Little is known about the German population with OI. METHOD The goal of this study was to detect how many patients with OI, who visited the annual meeting of the German Association for Osteogenesis Imperfecta in 2023, proved to have a hearing impairment. In this prospective, cross-sectional study, each included individual obtained ear microscopy, audiometry, stapedius reflexes, tympanometry, and OAEs. Furthermore, each patient was asked a set of questions concerning the medical history. RESULTS Of the included patients, 33% had hearing impairment. A significant difference was found for the mean air-bone gap (ABG) as well as the hearing threshold of the right ears. The difference was found between OI type III and IV (p = 0.0127) for the mean ABG and OI type I and IV (p = 0.0138) as well as III and IV (p = 0.0281) for the hearing threshold. Spearman's rank correlation showed a high correlation between age and hearing threshold. Of the patients between 40 and 50 years old, 56% had hearing loss. CONCLUSION Hearing loss in individuals with OI is still a relevant problem, especially age-related in OI type I. Audiometry should be performed at least when individuals experience subjective hearing loss. The implementation of a screening starting at 40 years should be discussed and studied.
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Affiliation(s)
- A Felicio-Briegel
- Department of Otorhinolaryngology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
| | - J Müller
- Department of Otorhinolaryngology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - M Pollotzek
- Department of Otorhinolaryngology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - M Neuling
- Department of Otorhinolaryngology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - D Polterauer
- Department of Otorhinolaryngology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - S Gantner
- Department of Otorhinolaryngology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - J Simon
- Department of Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - I Briegel
- Department of Pulmonology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - F Simon
- Department of Otorhinolaryngology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
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Tsai Do BS, Bender K, Keenan TA, Palmer CV, Ross EJ, Reyes J, Dhepyasuwan N. Plain Language Summary: Age-Related Hearing Loss. Otolaryngol Head Neck Surg 2024; 170:1228-1233. [PMID: 38682759 DOI: 10.1002/ohn.751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 03/16/2024] [Accepted: 03/19/2024] [Indexed: 05/01/2024]
Abstract
The plain language summary explains age-related hearing loss to patients, families, and care partners. The summary is for any patient aged 50 years and older, families, and care partners. It is based on the 2024 "Clinical Practice Guideline: Age-Related Hearing Loss." This plain language summary is a companion publication to the full guideline, which provides greater detail for clinicians. Guidelines and their recommendations may not apply to every patient, but they can be used to find best practices and quality improvement opportunities.
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Affiliation(s)
| | - Kaye Bender
- Mississippi Public Health Association, Jackson, Mississippi, USA
| | | | | | | | - Joe Reyes
- Department of Research and Quality, American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
| | - Nui Dhepyasuwan
- Department of Research and Quality, American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
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Tsai Do BS, Bush ML, Weinreich HM, Schwartz SR, Anne S, Adunka OF, Bender K, Bold KM, Brenner MJ, Hashmi AZ, Keenan TA, Kim AH, Moore DJ, Nieman CL, Palmer CV, Ross EJ, Steenerson KK, Zhan KY, Reyes J, Dhepyasuwan N. Clinical Practice Guideline: Age-Related Hearing Loss. Otolaryngol Head Neck Surg 2024; 170 Suppl 2:S1-S54. [PMID: 38687845 DOI: 10.1002/ohn.750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 03/20/2024] [Accepted: 03/21/2024] [Indexed: 05/02/2024]
Abstract
OBJECTIVE Age-related hearing loss (ARHL) is a prevalent but often underdiagnosed and undertreated condition among individuals aged 50 and above. It is associated with various sociodemographic factors and health risks including dementia, depression, cardiovascular disease, and falls. While the causes of ARHL and its downstream effects are well defined, there is a lack of priority placed by clinicians as well as guidance regarding the identification, education, and management of this condition. PURPOSE The purpose of this clinical practice guideline is to identify quality improvement opportunities and provide clinicians trustworthy, evidence-based recommendations regarding the identification and management of ARHL. These opportunities are communicated through clear actionable statements with explanation of the support in the literature, evaluation of the quality of the evidence, and recommendations on implementation. The target patients for the guideline are any individuals aged 50 years and older. The target audience is all clinicians in all care settings. This guideline is intended to focus on evidence-based quality improvement opportunities judged most important by the guideline development group (GDG). It is not intended to be a comprehensive, general guide regarding the management of ARHL. The statements in this guideline are not intended to limit or restrict care provided by clinicians based on their experience and assessment of individual patients. ACTION STATEMENTS The GDG made strong recommendations for the following key action statements (KASs): (KAS 4) If screening suggests hearing loss, clinicians should obtain or refer to a clinician who can obtain an audiogram. (KAS 8) Clinicians should offer, or refer to a clinician who can offer, appropriately fit amplification to patients with ARHL. (KAS 9) Clinicians should refer patients for an evaluation of cochlear implantation candidacy when patients have appropriately fit amplification and persistent hearing difficulty with poor speech understanding. The GDG made recommendations for the following KASs: (KAS 1) Clinicians should screen patients aged 50 years and older for hearing loss at the time of a health care encounter. (KAS 2) If screening suggests hearing loss, clinicians should examine the ear canal and tympanic membrane with otoscopy or refer to a clinician who can examine the ears for cerumen impaction, infection, or other abnormalities. (KAS 3) If screening suggests hearing loss, clinicians should identify sociodemographic factors and patient preferences that influence access to and utilization of hearing health care. (KAS 5) Clinicians should evaluate and treat or refer to a clinician who can evaluate and treat patients with significant asymmetric hearing loss, conductive or mixed hearing loss, or poor word recognition on diagnostic testing. (KAS 6) Clinicians should educate and counsel patients with hearing loss and their family/care partner(s) about the impact of hearing loss on their communication, safety, function, cognition, and quality of life (QOL). (KAS 7) Clinicians should counsel patients with hearing loss on communication strategies and assistive listening devices. (KAS 10) For patients with hearing loss, clinicians should assess if communication goals have been met and if there has been improvement in hearing-related QOL at a subsequent health care encounter or within 1 year. The GDG offered the following KAS as an option: (KAS 11) Clinicians should assess hearing at least every 3 years in patients with known hearing loss or with reported concern for changes in hearing.
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Affiliation(s)
| | - Matthew L Bush
- University of Kentucky Medical Center, Lexington, Kentucky, USA
| | | | | | | | | | - Kaye Bender
- Mississippi Public Health Association, Jackson, Mississippi, USA
| | | | | | | | | | - Ana H Kim
- Columbia University Medical Center, New York, New York, USA
| | | | - Carrie L Nieman
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | | | | | | | - Joe Reyes
- American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
| | - Nui Dhepyasuwan
- American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
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Ferrán S, Manrique-Huarte R, Lima JP, Rodríguez-Zanetti C, Calavia D, Andrade CJ, Terrasa D, Huarte A, Manrique M. Early Detection of Hearing Loss among the Elderly. Life (Basel) 2024; 14:471. [PMID: 38672742 PMCID: PMC11051108 DOI: 10.3390/life14040471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 03/21/2024] [Accepted: 03/28/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Age-related hearing loss (ARHL) is a complex communication disorder that affects the cochlea and central auditory pathway. The goal of this study is to characterize this type of hearing loss and to identify non-invasive, inexpensive, and quick tests to detect ARHL among elderly adults, seeking to preserve quality of life and reduce the burden on healthcare systems. METHODS An observational, prospective study is conducted with >55-year-old subjects divided into the following groups: normal range (Group A), detected but not treated (Group B), and detected and treated (Group C). During follow-up, Speech Spatial Qualities (SSQ12), and Hearing Handicap Inventory in the Elderly Screening test (HHIE-S) questionnaires were assessed, along with hearing levels (hearing thresholds at 4 kHz were studied in more depth), and a series of tests and questionnaires to assess balance, cognitive level, level of dependence, and depression. RESULTS A total of 710 patients were included in this study. The duration of hearing loss (11.8 yr. in Group B and 21.0 yr. in Group C) and average time-to-treatment for Group C (14.1 yr.) are both protracted. Both of the used questionnaires show statistically significant differences among the groups, revealing greater handicaps for Group C. Audiometry performed at 4 kHz shows how hearing loss progresses with age, finding differences between men and women. There is a correlation between time-to-treatment in Group C and the cognitive test DSST (-0.26; p = 0.003). CONCLUSIONS HHIE-S, SSQ12, and 4 kHz audiometry are sensitive and feasible tests to implement in screening programs.
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Affiliation(s)
| | | | - Janaina P. Lima
- Clínica Universidad de Navarra, 31008 Pamplona, Spain; (S.F.); (R.M.-H.); (C.R.-Z.); (D.C.); (C.J.A.); (D.T.); (A.H.); (M.M.)
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Purnami N, Palandeng RW, Nugroho PS, Falerina R, Wiyadi HMS, Arifianto D, Moon IS. Screening for hearing loss using the electronic whisper test: A prospective cross-sectional study. Int J Crit Illn Inj Sci 2023; 13:173-177. [PMID: 38292393 PMCID: PMC10824205 DOI: 10.4103/ijciis.ijciis_21_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/19/2023] [Accepted: 07/10/2023] [Indexed: 02/01/2024] Open
Abstract
Background Hearing screening is a method for early identification of hearing loss. Hearing screening is widely used in hospitals as part of physical examination. However, some of them are difficult to operate outside the hospitals regarding portability and user-friendliness. Therefore, we developed a simple yet easy-to-use portable electronic whisper test (EWT) for field deployment, particularly on many subjects. The EWT validity is a hearing screening method compared to pure-tone audiometry. Methods This study was a cross-sectional comparative with a prospective approach. The subjects were outpatients at the Audiology Clinic of Dr. Soetomo Academic Medical Center, Surabaya, Indonesia, who met the inclusion and exclusion criteria. Statistical analysis made sensitivity and specificity tables using a 2 × 2 table, positive and negative predictive values. Results Samples of 50 participants (100 ears) obtained a sensitivity value of 83%, specificity of 78%, positive predictive value of 45%, and negative predictive value of 95%. Conclusions The EWT is valid for use as a hearing screening method.
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Affiliation(s)
- Nyilo Purnami
- Department of Otorhinolaryngology, Head and Neck Surgery, Universitas Airlangga, Dr. Soetomo General Academic Hospital Center, Indonesia
| | - Rian Waraney Palandeng
- Department of Otorhinolaryngology, Head and Neck Surgery, Universitas Airlangga, Dr. Soetomo General Academic Hospital Center, Indonesia
| | - Puguh Setyo Nugroho
- Department of Otorhinolaryngology, Head and Neck Surgery, Universitas Airlangga, Dr. Soetomo General Academic Hospital Center, Indonesia
| | - Rosa Falerina
- Department of Otorhinolaryngology, Head and Neck Surgery, Universitas Airlangga, Dr. Soetomo General Academic Hospital Center, Indonesia
| | - H. M. S. Wiyadi
- Department of Otorhinolaryngology, Head and Neck Surgery, Universitas Airlangga, Dr. Soetomo General Academic Hospital Center, Indonesia
| | - Dhany Arifianto
- Department of Otorhinolaryngology, Head and Neck Surgery, Universitas Airlangga, Dr. Soetomo General Academic Hospital Center, Indonesia
| | - In Seok Moon
- Department of Otorhinolaryngology, Yonsei University, Seoul, South Korea
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Dubno JR, Majumder P, Bettger JP, Dolor RJ, Eifert V, Francis HW, Pieper CF, Schulz KA, Silberberg M, Smith SL, Walker AR, Witsell DL, Tucci DL. A pragmatic clinical trial of hearing screening in primary care clinics: cost-effectiveness of hearing screening. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2022; 20:26. [PMID: 35751122 PMCID: PMC9233354 DOI: 10.1186/s12962-022-00360-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 05/27/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Hearing loss is a high prevalence condition among older adults, is associated with higher-than-average risk for poor health outcomes and quality of life, and is a public health concern to individuals, families, communities, professionals, governments, and policy makers. Although low-cost hearing screening (HS) is widely available, most older adults are not asked about hearing during health care visits. A promising approach to addressing unmet needs in hearing health care is HS in primary care (PC) clinics; most PC providers (PCPs) do not inquire about hearing loss. However, no cost assessment of HS in community PC settings has been conducted in the United States. Thus, this study conducted a cost-effectiveness analysis of HS using results from a pragmatic clinic trial that compared three HS protocols that differed in the level of support and encouragement provided by the PC office and the PCPs to older adults during their routine visits. Two protocols included HS at home (one with PCP encouragement and one without) and one protocol included HS in the PC office. METHODS Direct costs of the HS included costs of: (1) educational materials about hearing loss, (2) PCP educational and encouragement time, and (3) access to the HS system. Indirect costs for in-office HS included cost of space and minimal staff time. Costs were tracked and modeled for each phase of care during and following the HS, including completion of a diagnostic assessment and follow-up with the recommended treatment plan. RESULTS The cost-effectiveness analysis showed that the average cost per patient is highest in the patient group who completed the HS during their clinic visit, but the average cost per patient who failed the HS is by far the lowest in that group, due to the higher failure rate, that is, rate of identification of patients with suspected hearing loss. Estimated benefits of HS in terms of improvements in quality of life were also far greater when patients completed the HS during their clinic visit. CONCLUSIONS Providing HS to older adults during their PC visit is cost-effective and accrues greater estimated benefits in terms of improved quality of life. TRIAL REGISTRATION clinicaltrials.gov (Registration Identification Number: NCT02928107).
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Affiliation(s)
- Judy R Dubno
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA.
| | | | - Janet Prvu Bettger
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Rowena J Dolor
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC, USA
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Victoria Eifert
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Howard W Francis
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Carl F Pieper
- Center for Study of Aging and Human Development, Duke University School of Medicine, Durham, NC, USA
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA
| | - Kristine A Schulz
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Mina Silberberg
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC, USA
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC, USA
| | - Sherri L Smith
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC, USA
- Center for Study of Aging and Human Development, Duke University School of Medicine, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Amy R Walker
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC, USA
| | - David L Witsell
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Debara L Tucci
- National Institute On Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, MD, USA
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Hsu AK, Bassett SM, O'Dwyer LC, McHugh M, Heinemann AW, Jordan N, Dhar S. Cost-Effectiveness of Hearing Screening in Older Adults: A Scoping Review. Res Aging 2021; 44:186-204. [PMID: 33973495 DOI: 10.1177/01640275211008583] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Age is the most common predictor of hearing loss; however, many older adults are not screened. Hearing screening could improve healthcare access, participation, and outcomes. Establishing whether hearing screening in older adults is cost-effective could improve the availability and utilization of screening. METHODS We searched nine databases in January 2020. Studies with populations aged 50+ and provided data on the cost-effectiveness of hearing screening were included in the review. RESULTS Five studies met the inclusion criteria and all found hearing screening programs to be cost-effective compared to no hearing screening, regardless of screening method (i.e., instrument or strategy). The maximum number of repeated screenings, coupled with younger ages, was most cost-effective. DISCUSSION This review suggests that hearing screening in older adults is cost-effective, however, the evidence is limited. There is pressing need for research focused on economic impacts of hearing healthcare in older adults to inform research, policy and practice.
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