Medicare Beneficiaries With Self-Reported Functional Hearing Difficulty Have Unmet Health Care Needs

Perceptions of Health Care Provider Interactions Among Medicare Beneficiaries With Hearing Trouble and the Role of an Accompanying Companion

PURPOSE

Hearing trouble (HT) impairs communication with health care providers (HCPs) and may lead to negative care experiences that impact health outcomes. The current study aimed to examine how HT influences patient perceptions of provider interactions and whether having an accompanying companion during health care visits modifies perceptions of provider interactions.

METHOD

This cross-sectional study analyzed 9,104 responses from the 2016 Medicare Current Beneficiary Survey.

RESULTS

Compared to beneficiaries without HT, those with HT had greater odds of negative perceptions of HCP interactions. Beneficiaries with HT had greater odds of disagreeing with positive statements about care, including provider competence, provider cares to check everything, provider response, and provider rarely in a hurry. Having an accompanying companion during health care visits was not found to significantly modify perceptions of interactions.

CONCLUSION

Findings suggest HT is a modifiable factor impacting health care communication. Implementing simple accommodation strategies in clinical practice can improve nursing care for older adults with HT. [Journal of Gerontological Nursing, xx(xx), xx-xx.].

Prevalence and risk factors of hearing loss in the Chinese population aged 45 years and older: Findings from the CHARLS baseline survey

OBJECTIVE

This study aimed to determine the prevalence of hearing loss and identify associated risk factors in a Chinese population aged 45 years and older.

STUDY DESIGN

This study employed a cross-sectional research design. Data from the 4th wave survey of the China Health and Retirement Longitudinal Study (CHARLS) conducted in 2018 were utilized. Participants were assessed using self-reported questionnaires, and various demographic and comorbidity factors were analyzed to elucidate the risk factors associated with hearing loss.

METHODS

A total of 17,695 individuals from 10,257 households in 450 villages and urban settlements were included in the study. Hearing loss was assessed through self-reported questionnaires. Risk factors, including demographic characteristics and comorbidities, were analyzed to identify associations with hearing loss.

RESULTS

The study population had a hearing loss prevalence rate of 17.9% (n = 3,179). Regional variations were observed, with highest rates in Chongqing (28.67%), Yunnan (25.12%), and Qinghai (24.36%), and lowest rates in Zhejiang (17.71%), Tianjin (10.56%), and Shanghai (9.26%). Age ≥70 was associated with higher risk (OR = 3, p<0.05), while being female was associated with reduced risk (OR = 0.81, p<0.05). Higher education level showed lower risk (OR<1, p<0.05). Non-agricultural workers had lower risk (OR = 0.67, p<0.05). Fewer social activities were correlated with decreased risk (OR = 0.89, p = 0.024). Ethnic minorities had slightly higher risk (OR = 1.23, p<0.05).

CONCLUSION

This study provides valuable insights into the prevalence and risk factors associated with hearing loss in the Chinese population aged 45 years and older. The findings emphasize the importance of early detection and intervention, particularly among older individuals and those residing in specific regions, for effective hearing loss management.

Hearing Loss, Hearing Aids, and Satisfaction With Health Care in the National Health Interview Survey

OBJECTIVE

Hearing loss may negatively impact satisfaction with health care via patient-provider communication barriers and may be amenable to hearing care treatment.

STUDY DESIGN

Cross-sectional.

SETTING

National Health Interview Survey, a nationally representative survey of noninstitutionalized US residents, 2013 to 2018 pooled cycles.

METHODS

Participants described satisfaction with health care in the past year, categorized as optimal (very satisfied) versus suboptimal (satisfied, dissatisfied, very dissatisfied) satisfaction. Self-report hearing without hearing aids (excellent, good, a little trouble, moderate trouble, a lot of trouble) and hearing aid use (yes, no) were collected. Weighted Poisson regression models adjusted for sociodemographic and health covariates were used to estimate prevalence rate ratios (PRRs) of satisfaction with care by hearing loss and hearing aid use.

RESULTS

Among 137,216 participants (mean age 50.9 years, 56% female, 12% black), representing 77.2 million Americans in the weighted model, 19% reported trouble hearing. Those with good (PRR = 1.20, 95% confidence interval [CI]: 1.18-1.23), a little trouble (PRR = 1.27, 95% CI, 1.23-1.31), moderate trouble (PRR = 1.29, 95% CI, 1.24-1.35), and a lot of trouble hearing (PRR = 1.26, 95% CI, 1.18-1.33) had a higher prevalence rate of suboptimal satisfaction with care relative to those with excellent hearing. Among all participants with trouble hearing, hearing aid users had a 17% decrease in the prevalence rate of suboptimal satisfaction with care (PRR = 0.83, 95% CI, 0.78-0.88) compared to nonusers.

CONCLUSION

Hearing loss decreases patient satisfaction with health care, which is tied to Medicare hospital reimbursement models. Hearing aid use may improve patient-provider communication and patient satisfaction, although prospective studies are warranted to truly establish their protective effect.

Hospitalizations, Emergency Department Visits, and Home Health Use Among Older Adults With Sensory Loss

Objectives: This study examines healthcare resource use (hospitalizations, emergency department [ED] visits, and home health episodes) among adults 65 and older diagnosed with hearing, vision, or dual sensory loss (SL) seen in the primary care setting of an academic health system. Methods: Multivariable logistic regression models were used to examine the relationship between SL (identified using ICD-10 codes) and healthcare resource use for 45,000 primary care patients. Results: The sample included 5.5% (N = 2479) with hearing loss, 10.4% (N = 4697) with vision loss, and 1.0% with dual SL (N = 469). Hearing loss increased the likelihood of having an ED visit (OR = 1.22, CI: 1.07-1.39), and home health services (OR = 1.27, CI: 1.07-1.51) compared to older adults without any SL. Vision loss reduced the likelihood of having a hospitalization (OR = .81, CI: .73-.91). Discussion: Findings support research into the drivers of healthcare use among older adults with sensory loss.

The Association Between Self-Reported Hearing Loss and Loss of Usual Source of Health Care Among Older Medicare Beneficiaries: Evidence From the National Health and Aging Trends Study

Background and Objectives

The purpose of the study is to investigate the association of hearing loss (HL) with maintaining a usual source of care (USOC).

Research Design and Methods

In this study we implemented a time-to-event analysis using data from the National Health and Aging Trends Study (NHATS), a nationally representative study of older Medicare beneficiaries in the United States. The study sample included 2 114 older adults, aged 65+ years, 58.9% female, 20.4% Black, who reported having a USOC during the baseline round of NHATS and who remained community-dwelling during the 2011-2018 study period. Based on self-report measures at baseline, individuals' hearing status was classified into 3 categories: no HL, treated HL (hearing aids users), and untreated HL (nonhearing aid users who reported having hearing difficulties). Time-to-event was computed as the time elapsed between baseline and the study round in which the respondent first reported no longer having a USOC. Discrete-time proportional hazard models were estimated.

Results

In fully adjusted models, untreated HL at baseline was associated with a hazard ratio (HR) for losing one's USOC 1.60 (95% confidence interval: 1.01, 2.56) times higher than that of participants with no HL. We found no HR differences between the treated- and no-HL group.

Discussion and Implications

Untreated HL at baseline was associated with a higher probability of losing one's USOC over time. Noninvasive interventions such as hearing aids may be beneficial for maintaining a USOC.

COVID-19 Vaccination Rates Among US Adults With Vision or Hearing Disabilities

Importance

Despite persistent care delivery inequities, limited studies have assessed COVID-19 vaccination rates among adults with vision or hearing disabilities.

Objective

To estimate the prevalence of and factors in COVID-19 vaccination among US adults with vision or hearing disabilities.

Design, Setting, and Participants

This cross-sectional study assessed data from adults who participated in the US Census Bureau Household Pulse Survey from April 2021 through March 2022. The survey assessed COVID-19 vaccine initiation, vaccine series completion, and determinants of health care access, including demographic characteristics, clinical characteristics, and social determinants of health.

Exposures

Vision disability (serious difficulty seeing even with eyeglasses or blindness) and hearing disability (serious difficulty hearing even with a hearing aid or deafness).

Main Outcomes and Measures

First dose of COVID-19 vaccine. Adjusted estimated probabilities and 95% CIs of COVID-19 vaccine initiation were calculated using multivariable logistic regression adjusted for survey week, demographic characteristics, clinical characteristics, and social determinants of health.

Results

In this study of 916 085 US adults (weighted population, 192 719 992; mean [SD] age, 54.0 [15.9] years; 52.0% women), most participants had initiated the COVID-19 vaccine series (82.7%). Adults with serious difficulty seeing (mean difference, -6.3%; 95% CI, -7.5% to -5.1%; P < .001) and blindness (mean difference, -20.1%; 95% CI, -25.1% to -15.0%; P < .001) had lower vaccination rates compared with adults with little to no vision impairment. Adults with serious difficulty hearing (mean difference, -2.1%; 95% CI, -3.5% to -0.7%; P = .003) and deafness (mean difference, -17.7%; 95% CI, -21.8% to -13.6%; P < .001) were less likely to initiate the COVID-19 vaccine compared with adults with little to no hearing impairment. Controlling for other factors, adults with blindness (mean difference, -6.3%; 95% CI, -11.1% to -1.5%; P = .009) were less likely to initiate the COVID-19 vaccine compared with adults with little to no vision impairment. Controlling for other factors, adults with deafness (mean difference, -5.5%; 95% CI, -9.2% to -1.9%; P = .003) were less likely to initiate the COVID-19 vaccine compared with adults with little to no hearing impairment.

Conclusion and Relevance

The findings of this cross-sectional study suggest that COVID-19 vaccine initiation is lower among adults with vision or hearing disabilities compared with adults without disabilities; this information may inform initiatives to promote equitable and accessible vaccination. Additional research may be needed to monitor COVID-19 vaccination disparities among adults with vision or hearing disabilities and to address disparities.

Longitudinal Associations of Self-Reported Visual, Hearing, and Dual Sensory Difficulties With Symptoms of Depression Among Older Adults in the United States

Evidence conflicts on the association between sensory difficulty and depression. Few studies have examined this association using longitudinal or population-based data. We used data from Rounds 1-9 of the nationally representative National Health and Aging Trends Study to evaluate the longitudinal association between self-reported visual, hearing, and dual sensory difficulties and clinically significant depressive symptoms. Multivariable Cox regression models were used to evaluate the hazard of incident depressive symptoms. Group-based trajectory modeling identified depressive symptom trajectories (DSTs). Multinomial logistic regression was used to examine the association between sensory status and DSTs. A total of 7,593 participants were included: 56.5% were female, 53.0% were 65-74 years old, 19.0% (95% CI 17.9-20.2%) had hearing, 5.6% (4.9-6.4%) had visual, and 3.3% (2.9-3.8%) had dual sensory difficulties at baseline. Hazard ratios for depressive symptoms in those with visual, hearing, and dual sensory difficulties were 1.25 (95% CI 1.00-1.56, p = 0.047), 0.98 (95% CI 0.82-1.18, p = 0.82), and 1.67 (95% CI 1.29-2.16, p < 0.001), respectively, relative to those without sensory difficulty. A model with four trajectory groups best fit the data. Group 1 (35.8% of the sample, 95% CI: 34.1-37.4) had persistently low risk of depressive symptoms; Group 2 (44.8%, 43.4-46.3) had low but increasing risk; Group 3 (7.1%, 6.2-8.3) had moderate risk; and Group 4 (12.4%, 11.5-13.3) had moderate to high risk that increased. Compared to those without sensory difficulties, individuals with each difficulty were significantly more likely to belong to a group other than Group 1. This study reveals associations between sensory difficulties and mental health that can inform public health interventions.

Alternative Pathways for Hearing Care May Address Disparities in Access

Background/Objectives: Low-uptake of hearing aids among older adults has long dogged the hearing care system in the U.S. and other countries. The introduction of over-the-counter hearing aids is set to disrupt the predominantly high-cost, specialty clinic-based delivery model of hearing care with the hope of increasing accessibility and affordability of hearing care. However, the current model of hearing care delivery may not be reaching everyone with hearing loss who have yet to use hearing aids. In this study, we examine the group of people who do not use hearing aids and describe their characteristics and health care utilization patterns. We also consider what other healthcare pathways may be utilized to increase access to hearing treatment. Design: Cross-sectional, the 2017 Medicare Current Beneficiary Survey. Setting: Non-institutionalized adults enrolled in Medicare, the U.S. public health insurance program for older adults (65 years and older) and those with qualifying medical conditions and disabilities. Participants: A nationally representative sample of 7,361 Medicare beneficiaries with self-reported trouble hearing and/or hearing aid use. Measurements: Survey-weighted proportions described the population characteristics and health care utilization of those with hearing loss by hearing aid use, and the characteristics of those with untreated hearing loss by health care service type utilized. Results: Women, racial/ethnic minorities, and low-income Medicare beneficiaries with self-reported hearing trouble were less likely to report using hearing aids than their peers. Among those who do not use hearing aids, the most commonly used health care services were obtaining prescription drugs (64%) and seeing a medical provider (50%). Only 20% did not access either service in the past year. These individuals were more likely to be young and to have higher educational attainment and income. Conclusion: Alternative models of care delivered through pharmacies and general medical practices may facilitate access to currently underserved populations as they are particularly high touch-points for Medicare beneficiaries with untreated hearing trouble. As care needs will vary across a spectrum of hearing loss, alternative models of hearing care should look to complement not substitute for existing access pathways to hearing care.