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.     

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.     

Exploring the relationship between technology use,hearing help-seeking,and hearing aid outcomes in older adults

Abstract

Objective: The objective of this study was to explore technology use and its relationship to help-seeking for hearing impairment (HI) and success with hearing aids among older adults. Previous research had suggested a link between higher levels of technology use and hearing aid success. Design: General technology use was evaluated using a purposefully developed 25-item questionnaire. Twelve items related to everyday technology use (e.g. DVD player) and 13 related to advanced technology use (e.g. Bluetooth). Study sample: Four groups of older adults with HI participated in the study: (1) non-consulters (n = 49), (2) consulters (n = 62), (3) unsuccessful hearing aid owners (n = 61), and (4) successful hearing aid owners (n = 79). Results: Preliminary analyses revealed a main effect in the use of everyday and advanced technology across the four participant groups. However, it was found that age and living arrangements accounted for most of the variance in reported everyday technology use (p = .030; p = .029, respectively) and age and gender accounted for the variance in reported advanced technology use (p <.001; p = .040, respectively). For everyday technology, an increase in age and living alone were associated with decreased technology use and for advanced technology use, age and female gender were associated with decreased technology use. Conclusions: Although we hypothesized that technology use would be less amongst non-consulters and unsuccessful hearing aid owners, our findings did not support this prediction. Technology use did not vary by group membership once the covariates of age, gender, and living arrangements were accounted for.     

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.     

Autonomous motivation is associated with hearing aid adoption

Objective: To use the self-determination theory of motivation to investigate whether different forms of motivation were associated with adults’ decisions whether or not to adopt hearing aids. Design: A quantitative approach was used in this cohort study. Participants completed the treatment self-regulation questionnaire (TSRQ), which measured autonomous and controlled motivation for hearing aid adoption. Sociodemographic data and audiometric information were also obtained. Study sample: Participants were 253 adults who had sought information about their hearing but had not consulted with a hearing professional. Participants were categorized as hearing aid adopters if they had been fitted with hearing aids 4–6 months after completing the TSRQ, and as non-adopters if they had not. Results: Multivariate logistic regression was used to examine associations between autonomous and controlled motivation, sociodemographic and audiometric variables, and hearing aid adoption (n = 160). Three factors were significantly associated with increased hearing aid adoption when the influence of other variables was accounted for: autonomous motivation, perceived hearing difficulty, and poorer hearing. Controlled motivation was not found to influence hearing aid adoption. Conclusion: These empirical findings that link autonomous motivation to decisions of hearing help-seekers have implications for the ways practitioners may evaluate motivation and could inform discussions with clients about hearing aid adoption.     

Prediction of the use of conventional hearing aids in Korean adults with unilateral hearing impairment

Objective: To determine the use of a hearing aid at six months post-fitting and to evaluate the predictors of its ongoing use in Korean adults with unilateral hearing impairment (HI). Design: Retrospective study at a secondary referral hospital over a 15-year period. Study sample: This study analysed 119 adults with unilateral HI who had been recommended for hearing amplification (55 men and 64 women, mean age, 58.0 ± 11.7 years). Six months after the fitting, all of the participants were surveyed regarding subsequent decisions and actions about obtaining hearing aids. Results: General uptake rate for a hearing aid was 68.1% (58.0% of participants surveyed were successful users, and 10.1% were intermittent users). The most significant parameter associated with hearing-aid use was social and/or work activities (R² = 0.457), and the significant predictors for successful hearing-aid use were social and/or work activities and method of signal processing (discriminatory power = 56.3%). Conclusions: Six months post-fitting, 68.1% of Korean adults with unilateral HI who had agreed to try a hearing aid continued to use it regularly. The predictors for hearing-aid use six months post-fitting included social and/or work activities and digital signal processing.     

Are hearing aid owners able to identify and self-report handling difficulties? A pilot study

Objective: Although clinician administered surveys evaluating hearing aid handling skills exist, the development of a self-administered version may reduce clinical load, save consultation time, and facilitate more frequent use than face-to-face consultations allow. However, there is currently no evidence to support whether hearing aid owners can accurately self-report hearing aid handling skills via self-report survey that systematically evaluates the ability to accurately perform the individual aspects of hearing aid handling required for effective hearing aid management. Design: An explorative pilot study using a prospective research design. Study sample: Nineteen adult hearing aid owners, aged between 65 and 93 years. Results: The self-administered survey demonstrated high sensitivity when compared with clinician evaluation of skills, with 93% of participants accurately self-identifying and reporting whether hearing aid handling skill training was required. Conclusions: Hearing aid owners are able to accurately self-report hearing aid handling difficulties when provided with an itemised list of skills.     

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.     

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.     

Assessment of basal sound identification skills and communication abilities in profoundly deaf children fitted with hearing aids or a cochlear implant

Basal auditory functions and early verbal communication skills were examined in young, profoundly deaf children with hearing aids or a cochlear implant. The hearing aid users (n = 23) were subdivided on the basis of their (unaided) hearing thresholds into: group A (pure tone average (PTA) at 0.5, 1 and 2 kHz: 90–100 dB HL); group B (PTA: 100–110 dB HL); and group C (PTA > 110 dB HL). All the children with a cochlear implant (n = 20) had a profound sensorineural hearing loss with a PTA that exceeded 120 dB HL. Functional hearing was evaluated by means of basal sound identification. The child’s communication abilities with hearing aids or a cochlear implant were assessed using structured observations on the Scales of Early Communication Skills for Hearing Impaired Children. The basal auditory functions on a sound identification level improved over time in the cochlear implant users and groups A and B. Hardly any improvement was seen in group C. The performance of all the groups (either hearing aid or cochlear implant) on the Scales of Early Communication Skills for Hearing Impaired Children at 6 months after fitting the device and at later evaluations, was close to the average level for their age.     

Hearing aid use in the elderly as measured by datalogging and self-report

Objectives: The primary aim was to compare the objective and the subjective assessments of hearing aid use among elderly people at a 6-month follow-up after fitting. A secondary aim was to determine whether advanced knowledge of follow-up impacts hearing aid use. Design: Hearing aid use was assessed by datalogging (objective) and self-report (subjective) 6 months after initial fitting. Participants were also randomised to an intervention (informed of 6-month follow-up at fitting) or control group (informed just prior to follow-up). Study sample: A total of 181 hearing aid recipients?≥60 years (mean age?=?79.2 years). Results: Daily hearing aid use based on datalogging (mean?=?6.12?h, SD?=?4.94) was significantly less than self-reports (mean?=?8.39?h, SD?=?5.07). More severe hearing impairment and prior hearing aid experience were associated with increased hearing aid use. Advanced knowledge of the follow-up had no significant impact on use, which did not differ between intervention (n?=?93) and control (n?=?88) groups. Conclusions: Elderly people typically use their hearing aids for a substantial part of the day in the 6 months after fitting, but tend to overestimate their usage. Datalogging is recommended to identify those who do not use or rarely use their aids so that appropriate rehabilitation and support can be provided.     

MarkeTrak 2022: Insights into the Evolving Hearing Market: MarkeTrak—Tracking the Pulse of the Hearing Aid Market

The MarkeTrak surveys conducted by the Hearing Industries Association have been looking at trends in the hearing industry since 1989. The latest survey, MarkeTrak 2022, reviews ongoing trends in hearing device adoption including PSAPs and implants, satisfaction with hearing aids and hearing professionals, and a look into insurance coverage and price considerations. These are discussed as they relate to the five key areas of the marketing mix: people, products, price, place, and perception. The key takeaways from this survey include: adoption has doubled in the past 25 years; more than 75% of hearing aid owners feel the hearing professional play an important role in their success with hearing aids; financial assistance has doubled since 1991 to 54%; and additional efforts are needed to educate consumers on the technology and benefits of hearing aids and early intervention.     

Provision,perception and use of trainable hearing aids in Australia: a survey of clinicians and hearing impaired adults

Objective: This study set out to obtain information on the impact of trainable hearing aids among clinicians and hearing aid users and candidates. Design: Two online adaptive surveys were developed to evaluate provision, uptake and experience or expectation of trainable hearing aids. Study sample: Responses from 259 clinicians, 81 hearing aid users and 23 candidates for hearing aids were included. Results: Over half of the clinicians surveyed activated trainable features in hearing aids. Most of these clinicians activated trainable features for selected users and reported positive findings. Most commonly trainable features were not activated because the hearing aid controls had already been disabled for management or client preference. One-third reported that they had no access to trainable aids or they were unsure about the presence or activation of trainable features. The remaining clinicians never activated trainable features. One in five users reported having used trainable aids and 93% would train again. Over 85% of the remaining hearing-impaired adults were interested in trainable aids.

Conclusions: Positive reports from most providers and users who had experience with the trainable feature support the provision of trainable aids to selected clients, pending more evidence-based data to support the clinical management of such devices.     

Hearing-aid use and long-term health outcomes: Hearing handicap,mental health,social engagement,cognitive function,physical health,and mortality

Objective: To clarify the impact of hearing aids on mental health, social engagement, cognitive function, and physical health outcomes in older adults with hearing impairment. Design: We assessed hearing handicap (hearing handicap inventory for the elderly; HHIE-S), cognition (mini mental state exam, trail making, auditory verbal learning, digit-symbol substitution, verbal fluency, incidence of cognitive impairment), physical health (SF-12 physical component, basic and instrumental activities of daily living, mortality), social engagement (hours per week spent in solitary activities), and mental health (SF-12 mental component) at baseline, five years prior to baseline, and five and 11 years after baseline. Study sample: Community-dwelling older adults with hearing impairment (N = 666) from the epidemiology of hearing loss study cohort. Results: There were no significant differences between hearing-aid users and non-users in cognitive, social engagement, or mental health outcomes at any time point. Aided HHIE-S was significantly better than unaided HHIE-S. At 11 years hearing-aid users had significantly better SF-12 physical health scores (46.2 versus 41.2; p = 0.03). There was no difference in incidence of cognitive impairment or mortality. Conclusion: There was no evidence that hearing aids promote cognitive function, mental health, or social engagement. Hearing aids may reduce hearing handicap and promote better physical health.     

Hearing impairment among adults: The impact of cardiovascular diseases and cardiovascular risk factors

Objective: To investigate the influence of cardiovascular diseases on hearing impairment (HI) among adults. Furthermore, to seek other potential risk factors for HI, such as smoking, obesity, and socioeconomic class. Design: A cross-sectional, unscreened, population-based, epidemiological study among adults. Study sample: The subjects (n = 850), aged 54–66 years, were randomly sampled from the population register. A questionnaire survey, an otological examination, and pure-tone audiometry were performed. Results: Cardiovascular diseases did not increase the risk for HI in a propensity-score adjusted logistic regression model: OR 1.24, 95% CI 0.79 to 1.96 for HI defined by better ear hearing level (BEHL), and OR 1.48, 95% CI 0.96 to 2.28 for HI defined by worse ear hearing level (WEHL), in the 0.5–4 kHz frequency range. Heavy smoking is a risk factor for HI among men (BEHL: OR 1.96, WEHL: OR 1.88) and women (WEHL: OR 2.4). Among men, obesity (BEHL, OR 1.85) and lower socioeconomic class (BEHL: OR 2.79, WEHL: OR 2.28) are also risk factors for HI. Conclusion: No significant association between cardiovascular disease and HI was found.     

Benefits of amplification for unaided speech discrimination in age-related hearing loss with flat type audiogram

ObjectiveThe present study aimed to investigate whether hearing aid use can induce improvement as acclimatization effect in unaided speech perception in patients with age-related hearing loss.MethodsFifty ears in 41 patients (age range: 65-91 years) diagnosed as age-related hearing loss were enrolled in this study. They used hearing aids for more than 8 hours per day. Unaided speech audiometry using 67-S Japanese monosyllabic word list was performed one or two years after the commencement of hearing aid use. The changes in the unaided speech discrimination score before and after the commencement of hearing aid use were analyzed. To investigate factors for improvement, the patients’ backgrounds in terms of age, sex, pure tone average, unaided maximum speech discrimination score, fitting period (one year/two years), fitting ear (bilateral/unilateral), audiogram type (flat-type/other-type), and the level of amplification were also analyzed.ResultsSignificant improvement in the unaided speech discrimination score after hearing aid use was seen only in the flat-type audiogram group. More than half of older patients in the flat-type audiogram group improved their unaided maximum speech discrimination score 10 % or more. The analysis of aided hearing thresholds revealed that the flat-type audiogram group had significantly lower thresholds of 3kHz and 4kHz than the other-type audiogram group. The age, sex, pure tone average, fitting period, fitting ear, functional gain were not influential factors for improvement. On the other hand, unaided maximum speech discrimination score before using hearing aid and aided hearing threshold at 4kHz had a negative correlation with improvement.ConclusionThe findings suggested that older patients with age-related hearing loss whose audiogram is a flat type can benefit from amplification as means of improving their unaided speech perception since flat-type audiogram can be more easily adjusted to sufficiently amplify speech sound at high frequencies. It should be considered that the potential for experience-dependent plasticity is retained even in older adults.     

A comparison of single-channel linear amplification and two-channel wide-dynamic-range-compression amplification by means of an independent-group design

The present study used an independent-group design to compare the benefits provided by binaural, single-channel, linear, full-shell in-the-ear hearing aids and binaural, 2-channel, wide-dynamic-range-compression in-the-canal hearing aids in groups of older hearing aid wearers. Hearing aid outcome measures were obtained at both 1-month (n = 53) and 6-month (n = 34) postfit intervals with each device. Outcome measures included multiple measures of speech-recognition performance and self-report measures of hearing aid benefit, satisfaction, and usage. Aided sound-quality measurements were also obtained. Although both devices provided significant benefits to the wearers, there were no significant differences in the benefits provided by either device at the 1-month or 6-month postfit intervals.     

Prevalence and associated factors of hearing aid use among older adults in Chile

Objective: The aim of this study was to determine the prevalence of use of hearing aids by older adults in Chile and the influence of some variables such as education level, income level and geographic area of residence on the prevalence of hearing aids. Design: A national cross-sectional survey which was carried out in 2009. Study sample: A representative sample of 4766 Chilean older adults aged 60 years and above. Results: The percentage of older adults in Chile who self-reported hearing problems and used hearing aids was 8.9%. Such prevalence increased for adults living in urban areas and for those who knew about the new Chilean programme of universal access to health services (AUGE). For older adults who did not know about this programme, significant associations between the use of hearing aids and the variables of age, geographic area of residence, and income level were found. Conclusions: People’s knowledge about AUGE programme may positively influence the use of hearing aids, although a direct effect cannot be attributed.     

The effectiveness of commercial desiccants and uncooked rice in removing moisture from hearing aids

Objective: In many low- and middle-income countries, the availability of hearing technology is limited, with few options for hearing aid repairs. Minimising moisture damage to hearing aid electronics improves function and longevity; however, desiccants that absorb moisture from hearing aid components are unavailable in many regions. This study compared the effectiveness of uncooked white rice and seven commercial silica gel desiccants in removing moisture from hearing aids. Design: Relative humidity measurements in a test chamber were obtained from a water-saturated BTE hearing aid prior to and after placement in uncooked white rice and seven different silica gel desiccants. Study sample: Two BTE hearing aids, seven silica gel desiccants and white rice comprised the study sample. Results: All desiccants and the white rice were effective in removing moisture from hearing aids, with Hal Hen Super Dri Aid showing the largest mean reduction in relative humidity. Based on analysis of covariance results, white rice was statistically similar to several of the commercial desiccants. Conclusions: White rice shows promise as an effective alternative to commercial desiccants in reducing moisture in hearing aids when silica gel products are unavailable. As this study was conducted in a relatively dry region, additional research may be needed.     

Survey on hearing aid outcome in Switzerland: Associations with type of fitting (bilateral/unilateral), level of hearing aid signal processing,and hearing loss

Abstract

The present investigation further analysed results of a previously reported survey with a large sample of hearing aid owners () to determine the individual and technological factors related to hearing aid outcome. In particular the associations of hearing loss, level of signal processing, and fitting type (bilateral versus unilateral fitting) with hearing aid use, satisfaction with and management of the aid were evaluated. A sub-group with symmetrical hearing loss was analysed (n = 6027). Regular use was more frequent in bilateral users and in owners of devices with more complex signal processing, but the strongest determinant of regular use was severity of hearing loss. Satisfaction was higher in the group wearing simple devices, while fitting type and degree of hearing loss had no influence on satisfaction rates. Moderate and severe hearing loss was associated more frequently with poor management of the aid than mild hearing loss. It was concluded that bilateral amplification and advanced signal processing features may contribute to successful hearing aid fitting, but the resulting differences must be considered to be relatively small.

Sumario

La presente investigación analiza más a fondo los resultados previamente reportados de una encuesta realizada a una muestra grande de dueños de auxiliares auditivos () para determinar los factores individuales y tecnológicos relacionados con el resultado de dicha adaptación. En particular, se evaluó la asociación de la hipoacusia, el nivel de procesamiento de la señal, el tipo de adaptación (bilateral versus unilateral), con el uso del auxiliar auditivo, la satisfacción y el manejo de dicho audífono. Un sub-grupo con hipoacusia simétrica fue analizado (n = 6027). El uso regular fue más frecuente en usuarios bilaterales y en dueños de dispositivos con procesamiento más complejo de la señal, pero el determinante más fuerte de uso frecuente fue la severidad de la pérdida auditiva. La satisfacción fue mayor en el grupo que usaba dispositivos simples, en tanto que el tipo de adaptación o el grado de hipoacusia no tuvieron influencia en la tasa de satisfacción. Las hipoacusias moderadas y severas se asociaron más frecuentemente con un pobre manejo del auxiliar que las pérdidas leves. Se concluyó que la amplificación bilateral y los rasgos de procesamiento avanzado de la señal pueden contribuir con una adaptación exitosa de un auxiliar auditivo, aunque las diferencias resultantes pueden considerarse relativamente pequeñas.