Factors associated with success with hearing aids in older adults

Abstract

Objective: To examine associations between audiological and non-audiological factors and successful hearing aid use in older adults. Design: In a retrospective study, audiological factors, attitudinal beliefs (as derived from the health belief model), client demographics, psychological factors, and age-related factors were evaluated. Study sample: Participants included 160 individuals, 60 years or older, with unilateral or bilateral hearing impairment (HI), fitted with hearing aids for the first time in the previous two years. Participants were assigned to either an unsuccessful hearing aid owner group (n = 75) or a successful hearing aid owner group (n = 85) based on their self-reported hearing aid use and benefit. Results: A multivariate, binomial logistic regression model indicated five factors associated with group membership: participants who had greater support from significant others; more difficulties with hearing and communication in everyday life before getting hearing aids; more positive attitudes to hearing aids; coupled with greater perceived self-efficacy for advanced handling of hearing aids; or who were receiving more gain from their devices; were more likely to be successful hearing aid owners. Conclusions: These findings highlight the importance of addressing non-audiological factors in order to assist older adults achieve success with hearing aids.     

Adults with mild hearing impairment: Are we meeting the challenge?

Objective: Acquired hearing impairment is recognized by the World Health Organization as the third leading cause of disability, with a mild impairment being the most prevalent. The aim of this study was to review research literature concerned with adults with acquired mild hearing impairment; the definitions and prevalence, the resulting activity limitations and participation restrictions, and hearing-aid interventions. Design: This study involved a systematized review of research literature identified through searches in citation databases and through reference checking. Study sample: A total of 151 papers were identified and of these, 33 papers were included in this review. Results: Prevalence rates are significantly influenced by the definition used for mild hearing impairment, and range from 1 in 3 to 1 in 5 adults. The weak correlations between audiological assessments and self-reported difficulties suggest that further assessment of individuals with mild hearing impairment is warranted. The most common intervention is the provision of hearing aids with varying rates of use, benefit, and satisfaction. Conclusions: The development of appropriate audiological assessment in the clinic, and further evaluation of the real-world listening needs and performance of people with mild hearing impairment is required to provide a more effective pathway for this clinical population.     

Quality of life,effort and disturbance perceived in noise: A comparison between employees with aided hearing impairment and normal hearing

Abstract

Objectives: The aims were to compare health-related quality of life (HRQOL) and hearing handicap between two groups of employees with normal hearing and aided hearing impairment (HI). HRQOL was also compared to a normative population. The second aim was to compare perceived effort (PE) and disturbance after completing a task in office noise between the two study groups. Design: A Swedish version of the short form-36 (SF-36) and the hearing handicap inventory for adults (HHIA) was used to determine HRQOL and hearing handicap. The Borg-CR 10 scale was used to measure PE and disturbance. Study sample: Hearing impaired (n = 20) and normally hearing (n = 20) participants. The normative sample comprised of 597 matched respondents. Results: Hearing-impaired employees report relatively good HRQOL in relation to the normative population, but significantly lower physical functioning and higher PE than their normally-hearing peers in noise. Results from the HHIA showed mild self-perceived hearing handicap. Conclusions: The current results demonstrate that physical health status can be negatively affected even at a mild-moderate severity of HI, and that a higher PE is reported from this group when performing a task in noise, despite the regular use of hearing aids.     

Hearing aid and hearing assistance technology use in Aotearoa/New Zealand

Objective: The purpose of this study was to describe factors that are related to hearing aid and hearing assistance technology ownership and use in Aotearoa/New Zealand. Design: Adults with hearing impairment living in New Zealand were surveyed regarding health-related quality of life and device usage. Audiometric data (hearing sensitivity and speech in noise) were collected. Study sample: Data were obtained from 123 adults with hearing impairment: 73 reported current hearing-aid use, 81 reported current hearing assistance technology use. Results: In both analyses, device users had more difficulty understanding speech in background noise, had poor hearing in both their better and worse hearing ears, and perceived more consequences of hearing impairment in their everyday lives (both emotionally and socially) than non-hearing-aid users. Discriminant analyses showed that the social consequences of hearing impairment and the better ear hearing best classified hearing aid users from non-users but social consequences and worse ear hearing best classified hearing assistance technology users from non-users. Conclusions: Quality of life measurements and speech-in-noise assessments provide useful clinical information. Hearing-impaired adults in New Zealand who use hearing aids also tend to use hearing assistance technology, which has important clinical implications.     

Paediatric hearing aid management: a demonstration project for using virtual visits to enhance parent support

Objective: The purpose of this study was to explore the use of virtual visits to monitor hearing aid use with data logging measurements and provide parent support for hearing aid management. Design: A 6-month longitudinal case study design was used. Study sample: Four families and two providers participated. Results: Average hours of daily hearing aid use increased 3.5?h from the beginning to the end of the study period. Prior to receiving virtual visits, the parents and the clinicians generally indicated they were hopeful about the benefits of virtual visits including the frequency and convenience of the appointments but had some concerns about technical difficulties. These concerns diminished at the conclusion of the study. Conclusion: Virtual visits provided benefits to families including flexibility and timely access to support. The ability to collect data logging information more frequently was important for effective problem-solving to increase hearing aid use. Both parents and clinicians were accepting of tele-support. Parents and professionals would benefit from technology that allows them to access data logging information more easily and frequently.     

The patient journey of adults with hearing impairment: the patients’ views

Clin. Otolaryngol. 2011, 36 , 227–234 Objective: The term ‘patient journey’ refers to the experiences and processes the patient goes through during the course of a disease and its treatment. The study explores the perspectives of adults with acquired hearing impairment and to further develop the patient journey template based on the Ida model. Design: Qualitative approach using thematic analysis and process mapping. Setting: Support groups of people with hearing impairment. Participants: Thirty‐two adults with acquired hearing impairment from two hearing impaired groups in Wales. All were hearing aid users. Main outcome measure: Participants worked in small groups to describe their experiences through hearing loss. These data were used to develop a template of the patients’ perspective of the journey. This was then compared with the perspective of professionals, and a ‘patient journey template for adults with acquired hearing impairment’ was developed. Results: This template identifies seven main phases as follows: (i) pre‐awareness; (ii) awareness; (iii) movement; (iv) diagnostics; (v) rehabilitation; (vi) self‐evaluation; and (vii) resolution. The study identified a number of new components. The self‐evaluation component was not defined by professionals and reflects the need for patients to consider the costs, benefits and alternatives to the approach provided by audiologists. It is important for audiologists to be aware of this. Conclusion: The study highlighted the differences and commonalities in perspectives of professionals and patients. Use of the patient journey can help clinicians to understand the unique experiences their patients go through help them to develop patient‐centred treatment.     

Development of Telscreen: a telephone-based speech-in-noise hearing screening test with a novel masking noise and scoring procedure

Objective: In 2006 the National Acoustic Laboratories was commissioned to create a telephone-based hearing screening test. Design: NAL developed ‘Telscreen’, a speech-in-noise test modelled on the Dutch and UK telephone tests. The first version, Telscreen I, had several novel features: individual scoring of digits; individual equalization of digit intelligibility; and accuracy-determined test termination. Evaluation of Telscreen I revealed that it did not discriminate satisfactorily between those with and without hearing impairment. Subsequently Telscreen II, which included a novel sensitized masking noise, was developed. Study sample: Telscreen I was evaluated by 105 participants (22–86 years), 37% with normal hearing (all thresholds?<20?dB HL in the test ear), 63% with hearing impairment (all thresholds?>20?dB HL in the test ear). Telscreen II was evaluated by 75 participants (25–86 years), 33% with normal hearing, 67% with hearing impairment. Results: Correlations between Telscreen I results and hearing thresholds, r?=?0.57, and hearing disability scores, r?=?0.51 were highly significant, but lower than expected. Correlations for Telscreen II were higher: r?=?0.77 and 0.65, respectively. Telscreen II was found to have high sensitivity: 90%; and specificity: 90.2%. Conclusions: Telscreen II is an efficient, reliable, and innovative hearing screening test that provides a solid foundation for future tests delivered via mobile and internet technologies.     

The Hearing Handicap Inventory for the Elderly as a measure of hearing aid benefit

Hearing impairment in older adults is associated with psychological and social difficulties. The goal of hearing aid fitting is to reduce the perceived handicap resulting from the hearing loss. Measures of self-perceived handicap are being increasingly incorporated into the clinicians armamentarium as an objective measure of the outcome of intervention. Eighteen elderly hearing-impaired males and their spouses responded to the Hearing Handicap Inventory for the Elderly (HHIE) prior to and following 1 year of hearing aid provision. Our findings revealed a significant reduction in the perceived emotional and social effects of hearing impairment following 1 year of hearing aid use. The reduction in perceived handicap, as measured using the HHIE, was greater for the hearing aid users than for their spouses. The findings attest to the construct validity of the HHIE as a measure of hearing aid benefit.     

Educating teenagers about hearing health by training them to educate children

Objective: We investigated the change in hearing-health behaviour amongst teenagers trained to deliver the Dangerous Decibels programme to younger children. Design: The Dangerous Decibels programme uses a two-stage process to train 8–12 year-old children to protect their hearing from noise: (1) a team of experts train ‘Educators’ who (2) give classroom training to children in schools. Training teenagers as Educators may add a second level of benefit if teenagers internalize the hearing-health messages that they present and thus protect their own hearing better. They were assessed before training, immediately after, and three months later (after all had presented the classroom training) using a questionnaire. In addition, a focus group was conducted with a subgroup of the Educators to assess their subjective experience. Study sample: We trained 44 Educators aged 14–17 years. Results: Results were generally positive: there were significant and sustained improvements in knowledge, self-reported behaviour, and perceived supports towards protecting hearing, and trends but not significant changes in attitudes or perceived barriers to hearing protection. Conclusions: Providing training to teenagers had benefits beyond the delivery of training to younger children, but improvements in the delivery model may increase the uptake and impact on the teenagers.     

Why do people fitted with hearing aids not wear them?

Abstract

Objective: Age-related hearing loss is an increasingly important public health problem affecting approximately 40% of 55–74 year olds. The primary clinical management intervention for people with hearing loss is hearing aids, however, the majority (80%) of adults aged 55–74 years who would benefit from a hearing aid, do not use them. Furthermore, many people given a hearing aid do not wear it. The aim was to collate the available evidence as to the potential reasons for non-use of hearing aids among people who have been fitted with at least one. Design: Data were gathered via the use of a scoping study. Study sample: A comprehensive search strategy identified 10 articles reporting reasons for non-use of hearing aids. Results: A number of reasons were given, including hearing aid value, fit and comfort and maintenance of the hearing aid, attitude, device factors, financial reasons, psycho-social/situational factors, healthcare professionals attitudes, ear problems, and appearance. Conclusions: The most important issues were around hearing aid value, i.e. the hearing aid not providing enough benefit, and comfort related to wearing the hearing aid. Identifying factors that affect hearing aid usage are necessary for devising appropriate rehabilitation strategies to ensure greater use of hearing aids.     

Subjective benefit after BAHA system application in patients with congenital unilateral conductive hearing impairment.

OBJECTIVE: To study whether unilateral Bone-anchored Hearing Aid (BAHA) fitting led to subjective hearing benefit in patients with congenital unilateral conductive hearing impairment. STUDY DESIGN: Prospective evaluation on 20 patients. SETTING: Tertiary referral center. PATIENTS: Ten adults and 10 children with congenital unilateral conductive hearing impairment, with a mean air-bone gap of 50 dB, were included. METHODS: Subjective bilateral hearing benefit after BAHA fitting was measured using 2 disability-specific questionnaires: Chung and Stephens and the Speech, Spatial and Qualities of hearing profile (children's version in the patients aged <18 yr). The Glasgow children's benefit inventory was also used to measure patient's health benefit after BAHA fitting. RESULTS: Chung and Stephens' questionnaire showed an overall preference for the BAHA in several specific hearing situations. The Glasgow children's benefit inventory demonstrated an overall mean improvement of +34, which was the most prominent in the learning domain. The 10 adults showed an already good score on the Speech, Spatial and Qualities of hearing scale in the unaided situation. CONCLUSION: The BAHA was well accepted by most of the patients with congenital unilateral conductive hearing impairment. A preoperative trial of the BAHA system with the BAHA on a headband is part of the preoperative procedure. In children with unilateral conductive hearing loss, with regard to possible childs' development and communication difficulties, intervention with BAHA can be considered as an option.     

Proposed norms for the Glasgow hearing-aid benefit profile (Ghabp) questionnaire

Abstract

Objective: To form a normative set of responses to the GHABP questionnaire from a large regional dataset. Design: Participants were asked to rate their hearing disability, handicap, hearing-aid (HA) use, HA benefit, HA satisfaction, and residual (aided) disability on a five-point scale for four situations: quiet conversation, television (TV) listening, noisy conversation, and group conversation. A subset of participants also estimated the time spent in these situations. Study sample: A group of 1574 adults with normal to profound hearing thresholds participated. Results: There was a significant relationship between increasing perceived disability and increasing hearing loss as given by the better-ear audiometric average (BEA). Responses for HA measures did not vary greatly with hearing loss: HA use was reported as high, whereas residual disability, HA benefit, and satisfaction were all reported on average as moderate. Conclusions: The results can be used as a normative dataset with which to evaluate individual responses in the clinic, where the GHABP provides a useful short-form questionnaire to engage the patient. The lack of systematic changes in hearing-aid related responses shows room for improvement in the benefit afforded by amplification.     

Representations of workers with hearing loss in Canadian newspapers: a thematic analysis

Objective: Participation in the labour force with a hearing impairment presents a number of challenges. This study describes how Canadian newspapers represent workers with hearing loss. Design: Taking a critical framing theory approach, thematic analysis was performed through coding relevant articles, abstracting and hierarchically categorising themes. Study sample: Seven English-language Canadian newspapers were searched for publications between 1995 and 2016. Twenty-six articles met our criteria: discussing paid workers with hearing loss who used English rather than sign language on the job and making reference to workers’ competence. Results: We identified a global theme, Focussing on a good worklife or focussing on a limited worklife, composed of three organising themes (1) Prominent individuals struggle, take action, and continue despite hearing loss, (2) Workers with hearing loss in the community create their best day themselves, and (3) Workers with hearing loss, as a generalised whole, are portrayed as either competent or limited. Conclusions: The dominant framing portrays individual workers as ingenious, determined, and successful. Negative framings were predominantly generalisations to these workers as a group. To generate more positive framings, professionals can build relationships with consumer groups and, when contacted by the media, direct journalists to interview workers with hearing loss.     

An investigation of factors that influence help-seeking for hearing impairment in older adults

Abstract

Objective: To examine the influence of audiological and non-audiological factors on help-seeking for hearing impairment (HI) in older adults. Design: A retrospective research design was employed. Participants completed 14 measures, after which two multivariate, multinomial logistic regression models were fitted to the data to determine which factors were associated with consultation for HI and hearing aid uptake. Study sample: Three-hundred-and-seven individuals who were 60 years or older and who presented with a unilateral or bilateral HI participated in the study. Non-hearing aid owners were assigned to a non-consulter group (n = 55) or a consulter group (n = 92); hearing aid owners were assigned to an unsuccessful hearing aid owner group (n = 75) or a successful hearing aid owner group (n = 85). Results: A similar combination of factors was associated with the decisions to consult a health professional about HI and/or to adopt hearing aids. The most important factors related to attitudinal beliefs (e.g. perceived benefits of hearing aids) and external cues to action (e.g. support from significant others). Greater HI also influenced consultation and adoption of hearing aids. Conclusions: Findings highlight the importance of non-audiological factors in hearing rehabilitation to improve consultation for HI and hearing aid adoption.     

Application of the health belief model: Development of the hearing beliefs questionnaire (HBQ) and its associations with hearing health behaviors

Abstract

Objective: To develop a hearing beliefs questionnaire (HBQ) that assesses hearing beliefs within the constructs of the health belief model, and to investigate whether HBQ scores are associated with hearing health behaviors. Design: A 60-item version of the questionnaire was developed and completed by 223 participants who also provided information about their hearing health behaviors (help seeking, hearing-aid acquisition, and hearing-aid use). Study sample: Individuals aged between 22 and 90 years recruited from a primary care waiting area at a Veterans hospital. Seventy-six percent were male, 80% were Veterans. Results: A 26-item version of the HBQ with six scales was derived using factor analysis and reliability analyses. The scales measured: perceived susceptibility, perceived severity, perceived benefits, perceived barriers, perceived self-efficacy, and cues to action. HBQ scores differed significantly between individuals with different hearing health behaviors. Logistic regression analyses resulted in robust models of hearing health behaviors that correctly classified between 59% and 100% of participant hearing health behaviors. Conclusions: The HBM appears to be an appropriate framework for examining hearing health behaviors, and the HBQ is a valuable tool for assessing hearing health beliefs and predicting hearing health behaviors.     

Identifying the barriers and facilitators to optimal hearing aid self-efficacy

Abstract

Objective: Many older adults with hearing impairment are not confident in their ability to use hearing aids (i.e. experience low hearing aid self-efficacy), which has been found to be a barrier to hearing help-seeking and hearing aid use. This study aimed to determine what factors were associated with achieving adequate hearing aid self-efficacy. Design: A retrospective research design was employed wherein hearing aid self-efficacy was the primary outcome. Explanatory variables included personal demographics, visual disability, and experiences related to participants’ hearing ability and hearing aids. Study sample: A total of 307 older adults with hearing impairment participated in the study (147 non hearing aid owners and 160 hearing aid owners). Results: Non-hearing aid owners were more likely to report adequate hearing aid self-efficacy if they reported no visual disability, had experienced hearing loss for longer, reported more positive support from a significant other, and were not anxious about wearing hearing aids. Hearing aid owners were more likely to report adequate hearing aid self-efficacy if they had had a positive hearing aid experience and no visual disability. Conclusions: More research is needed to develop and evaluate intervention approaches that promote optimal levels of hearing aid self-efficacy among older adults with hearing impairment.     

Individualised active communication education (I-ACE): another clinical option for adults with hearing impairment with a focus on problem solving and self-management

Objective: This clinical note describes the Individualised – Active Communication Education (I-ACE) programme designed to improve problem solving and self-management in adults with hearing impairment.

Design: The I-ACE was offered to adult clients seeking help for the first time and effects were measured for participants using self-report questionnaires: the Client Oriented Scale of Improvement (goal attainment), the Hearing Handicap Questionnaire (hearing disability), and the International Outcome Inventory – Alternative Interventions (outcomes) immediately after programme completion and 3?months later. Participants also provided qualitative feedback about I-ACE.

Study sample: Twenty-three participants completed I-ACE, with 22 completing all self-report questionnaires and 23 participants providing qualitative feedback.

Results: The participants reported positive outcomes and goal attainment, but no change in hearing disability post-programme. The effects were maintained 3?months later. Qualitative feedback indicated that I-ACE supported participants in recognising and increasing awareness of their hearing difficulties and in developing potential solutions to these difficulties. Participants also enjoyed the opportunity to involve communication partners.

Conclusion: I-ACE is an appropriate option for adults with hearing impairment who wish to become more aware of their hearing difficulties and how to solve them.     

Determinants of hearing-aid adoption and use among the elderly: A systematic review

Objective: While the benefits of hearing aids among older adults with presbycusis have been well documented, there is limited research on hearing-aid usage. The aim of this review is to synthesize current evidence to identify the determinants of hearing-aid adoption and use among the elderly. Design: Systematic review. Study sample: Articles were identified through systematic searches in the Web of Science, Medline, CINAHL, and a manual search. Studies that explore the potential determinants of hearing-aid usage were to be included. Results: A total of twenty-two articles were reviewed. Four audiological determinants (the severity of hearing loss, the type of hearing aids, background noise acceptance, and insertion gain) and seven non-audiological determinants (self-perceived hearing problems, expectation, demographics, group consultation, support from significant others, self-perceived benefit, and satisfaction) were identified as affecting the adoption and use of hearing aids. Conclusions: There is a need to explore the influence of significant others, health professionals, and user demographics on hearing rehabilitation for future research. The determinants identified in this review depicted the stage progression of the trans-theoretical model (TTM) in explaining an individual's readiness to hearing-aid usage.     

Occupational performance: comparing normally-hearing and hearing-impaired employees using the Amsterdam Checklist for Hearing and Work

This study compares the occupational performance of employees with and without hearing impairment, and aims to identify occupational difficulties specifically related to hearing loss. The Amsterdam Checklist for Hearing and Work was administered to 150 hearing-impaired employees and 60 normally-hearing colleagues. A multivariate analysis of variance was performed to test group effects, and to examine differences between means. Factors predicting sick-leave were identified by regression analyses. A significant group effect (p < 0.01) was found. Hearing-impaired employees differed from normally-hearing colleagues in their perception of 'environmental noise', 'job control' and the 'necessity to use hearing activities' at work. Also, sick-leave due to distress occurred significantly more often in the hearing impaired group (p < 0.05). 'Hearing impairment', 'job demand', and the requirement to 'recognize/distinguish between sounds' were the strongest risk-factors for stress related sick-leave. The importance of hearing functions besides speech communication is discussed. Implications for rehabilitation are suggested. In future research, hearing loss should be considered as a risk factor for fatigue and mental distress which may lead to sick-leave.