Factors affecting older adults' hearing-aid use

Hearing impairment is one of the most common disabilities among Western populations and represents a considerable communication disorder. Increasing human longevity is expected to raise the number of elderly people suffering from hearing loss. A major challenge of audiological rehabilitation has been to encourage those who have fitted hearing aids to use them. The aim of the present study was to describe hearing-aid use among older adults and to identify motivational factors associated with hearing-aid use. A 17-item questionnaire was developed. Ninety participants (=65 years of age) were recruited from a waiting list for hearing-aid refitting. Twenty-two percent had used their previously fitted hearing aids for less than one hour per day. A factor analysis revealed four factors related to hearing-aid use (Cronbach's alpha): ‘accepted need’–defined as the acknowledgement of a need for hearing aids (0.869); ‘follow-up support’–defined as organized check-ups and accessibility to professionals (0.900); ‘social assessment’ (0.552); and ‘consciousness’ (0.505). The first two factors explained 25% and 24% of the variance, respectively. Logistic regression revealed that the use of hearing aids was significantly associated with ‘accepted need’ and ‘follow-up support’, suggesting that these factors are important and should be emphasized in rehabilitation programmes

Hearing loss in the elderly : Consequences of hearing loss and considerations for audiological rehabilitation

Presbyacusis is the most common cause of hearing loss and is considered to be among the three most commonly reported chronic health problems of the elderly. In future years, the problem is predicted to be aggravated as the expected life span of the population increases. The psychological and social consequences of hearing impairment have been the subject of several texts. Numerous articles have been published expressing concerns involving the considerable number of hearing aids that are not being put to use and are permanently ending up in drawers. However, several unresolved issues regarding the practical implications of hearing loss, including the expectations and motivational factors regarding hearing aid use, still remain. These issues concern the elderly population, who represent the primary hearing aid users in society, in particular. Declining health, varying conditions of life, increased age and the considerable number of individuals living alone may influence the experience of hearing loss. Such knowledge could be of substantial importance to treatment and potentially be beneficial to the development of rehabilitation programmes. Objective and aims. The overall objective of this thesis was to obtain understanding and knowledge regarding hearing loss and hearing aid use among the elderly, in order to develop suitable audiological rehabilitation programmes. The specific aims: - To assess daily life consequences of hearing loss in older adults and to explore the influence of hearing loss through a subjective assessment of health and general life satisfaction, gender, age and marital status. - To describe preconceptions and expectations of older adults about getting hearing aids and to explore the influences of hearing loss, hearing aid experience, gender, age and marital status on these preconceptions and expectations. - To describe hearing aid use among older adults and to identify motivational factors associated with their use. Subjective and methods. This thesis is based on data from 174 men and women randomly selected from a waiting list for hearing aid fittings. The participants were all clients of the Department of Otolaryngology at the Lovisenberg Diakonale Hospital, a community hospital in Oslo. The inclusion criteria were that the participants were aged 65 years and above and that they expressed a need for hearing aids. Exclusion criteria were serious illness, senility and not being able to communicate in Norwegian. The study sample consisted of 174 individuals: 113 women (65%) and 61 men (35%) with an age range of 65–93 years. The mean age was 79.7 years. All participants were examined by an ear, nose and throat specialist and were given a hearing test at their initial appointment at the hospital. Hearing loss was measured using pure tone audiometry according to recommended procedures. The Hearing Disability and Handicap Scale (HDHS) was used to measure perceived activity limitation and perceived participation restriction. The hearing aid scale, a 35-item questionnaire in three sections, was constructed with specific focus on preconceptions and expectations regarding obtaining hearing aids and experiences regarding previous use. Demographic data were gathered to describe the study sample. Main findings. Perceived activity limitation was significantly associated with increased hearing loss and decreased health, and participation restriction significantly was associated with decreased life satisfaction. Gender, age and marital status did not appear to be determinant factors for perceived activity limitation and participation restriction. (Article I). Preconceptions and expectations of older adults regarding obtaining hearing aids revealed three factors: positive expectations, barriers and social pressure. Participants with moderate to severe hearing loss and hearing aid experience had significantly higher expectations towards hearing aids than participants with mild hearing loss and no hearing aid experience. The male gender was associated with fewer barriers toward hearing aids. Age and marital status had no influence on the three factors (Article II). The use of hearing aids was positively and significantly associated with follow-up support and acceptance of need. Twenty-two per cent had used their previously fitted hearing aids less than one hour a day. The degree of hearing loss, gender, age and marital status demographics were all not significantly associated with hearing aid use (Article III). Conclusions and implications for practice. The findings suggest that daily life consequences of hearing loss, health conditions and life satisfaction are closely related. The findings are also enlightening regarding the considerable impact on the individual experiencing hearing loss, whose life is affected and activities in daily life are limited. Health factors and psychosocial aspects should be considered as a part of the overall situation during the process of hearing aid fitting and rehabilitation. There are also indications of considerably varied preconceptions and expectations towards hearing aids among elderly hearing-impaired individuals. Less positive expectations and more problemoriented preconceptions among subjects with mild hearing loss may explain why hearing aids are scarcely used. The subjective acceptance of hearing loss, assessed need for hearing aids and experiences with follow-up support seem to be equally important to the benefits and use of hearing aids. Follow-up support, including individual rehabilitation programmes, may be of great importance to hearing aids being used, especially among individuals with a slight loss of hearing. Hearing aid fitting must be considered a long-term process that includes sufficient time for information, education and training as well as easy access to professionals when problems arise. The individual should be well informed regarding what the hearing rehabilitation process involves and what is required as far as individual achievements and patience. Our findings indicate an unmet need for audiological rehabilitation and follow-up support among elderly hearing aid users, which, at least to some extent, is verified by the vast number of fitted hearing aids that are seldom or never used. Audiological rehabilitation, including psychosocial aspects and educational aspects of hearing aids and communication, may well constitute an important contribution to increased social activity and participation rates by the elderly population with hearing impairments

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 recipients60 years (mean age=79.2 years). Results: Daily hearing aid use based on datalogging (mean=6.12h, SD=4.94) was significantly less than self-reports (mean=8.39h, 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

Older adults’ experiences and issues with hearing aids in the first six months after hearing aid fitting

Objectives: This study describes older adults’ experiences with a new hearing aid (HA) during the first 6 months after fitting. Design: In a longitudinally designed study, experiences and issues with HA use were assessed at a six-month follow-up appointment in individual structured interviews lasting 30 min. Associations between HA experiences and demographic factors, degree of hearing loss, and an objective measure of HA use (datalogging) were also examined. Study sample: 181 HA recipients (≥60 years) attending a six-month follow-up appointment. Results: Participants reported an average of 1.4 issues (range 0–5, median = 1, mode = 1) with HA use, the most common pertaining to the earmold (26.5%), sound quality (26.0%) and handling (25.5%). Participants who reported at least one issue had fewer hours of use per day, but were not more likely to be non-users

Hearing loss and work participation: a cross-sectional study in Norway

Objective: To study work participation of persons with hearing loss, and associations with hearing disabilities, self-reported workability, fatigue and work accommodation. Design: Cross-sectional internet-based survey. Study sample: A total of 10,679 persons with hearing loss within working-age were invited to answer the survey, where 3330 answered (35.6%). Results: Degree of hearing loss was associated with low workability, fatigue and work place accommodation, while sick leave was associated with fatigue. Degree of hearing loss was positively associated with being unemployed (p < .001) and having part-time work (p < .01) (often combined with disability benefits) for women. Work place accommodation was more frequently provided among respondents working with sedentary postures, high seniority, long-term sick leave or low workability. Additional unfavourable sensory conditions were associated with decreased employment (p < .001) and workability, and an increase in sick leave (p < .01) and fatigue (p < .001). Conclusions: Hearing loss seemed to influence work participation factors negatively; particularly, for moderate hearing loss and for women, even though the degree of employment was high. A lack of work place accommodation when there was a need for such was found. This implies increased attentiveness towards individual needs concerning the experienced disability a hearing loss may produce. A more frequent use of hearing disability assessment is suggested

Hearing loss in Norwegian adults with achondroplasia

Background Achondroplasia is the most common form of disproportionate skeletal dysplasia. The condition is caused by a mutation in the FGFR3 gene, affecting endochondral bone growth, including the craniofacial anatomy. Recurrent otitis media infections, chronic middle ear effusion, and hearing loss are common in children with achondroplasia, but few studies have investigated hearing loss in adults with this condition. Objectives This population-based study investigated the prevalence, severity, and type of hearing loss in Norwegian adults with achondroplasia. Methods We collected data on 45 adults with genetically confirmed achondroplasia: 23 men and 22 women, aged 16–70 years. All participants underwent a comprehensive audiologic assessment, including medical history, pure-tone audiometry, speech audiometry, and impedance audiometry. According to the Global Burden of Disease classification, pure-tone average ≥ 20 decibel hearing level (dB HL) was considered clinically significant hearing loss. Results Insertion of ventilation tubes had been performed in 44% (20/45) of the participants, 49% (22/45) had a history of adenoidectomy, while 20% (9/45) used hearing aids. Hearing loss in at least one ear was found in 53% (24/45) of the participants; in 57% (13/23) of the men and 50% (11/22) of the women. In the youngest age group (age 16–44 years), 50% (14/28) had hearing loss, although predominantly mild (20–34 dB HL). An abnormal tympanometry (Type B or C) was found in 71% (32/45) of the participants. The majority (15/24) had conductive hearing loss, or a combination of conductive and sensorineural hearing loss (8/24). Conclusions Adults with achondroplasia are at increased risk of early hearing loss. Our findings underline the importance of a regular hearing assessment being part of standard care in achondroplasia, including adolescents and young adults. In adult patients diagnosed with hearing loss, an evaluation by an otolaryngologist should be considered, and the need for hearing aids, assistive listening devices, and workplace and educational accommodations should be discussed. Clinical trial registration ClinicalTrials.gov identifier NCT03780153

An evaluation of motivational interviewing for increasing hearing aid use: A pilot study

Background: Motivational interviewing (MI) has been used in consultation settings to motivate hearing aid users to increase hearing aid usage. However, the effect of MI on those who use their hearing aids only rarely or not at all has not been explored. Purpose: The aims of this pilot study were to evaluate the effect of MI counseling with elderly hearing aid recipients found to have low hearing aid use at a six-month follow-up appointment and to describe clients' subjective assessments of their perceived need for hearing aids three months after MI counseling. Research Design: The study had a within-subjects pretest-posttest design. Study Sample: Forty seven hearing aid recipients who had used their new hearing aids, an average of,90 min/day, were recruited at a follow-up appointment six months after hearing aid fitting. Intervention: Thirty minutes of MI counseling was provided at the six-month follow-up appointment. If needed, hearing aid adjustments and technical support were also provided. Data Collection and Analysis: The effect of MI counseling in combination with adjustments and technical support was assessed in relation to datalogged hearing aid use, which was assessed immediately before (at the six-month follow-up) and three months after (at the nine-month follow-up) the intervention. Hearing aid experiences were also assessed three months after MI. Results: Thirty seven participants (79%) returned for the nine-month follow-up visit and had modest but significant increases in datalogged hearing aid use in the three months following MI counseling. Of the 37 participants who returned, 51% had increased their hearing aid use to at least 2 h/day after the MI counseling. Most of the 37 participants who attended the nine-month follow-up reported increased need for (59%) or increased benefit and contentment with (57%) their hearing aid three months after MI; these participants also had significantly higher datalogged hearing aid use following MI. Conclusions: These findings suggest that follow-up appointments using MI counseling in conjunction with technical support may be useful for increasing hearing aid usage among low-users, and a randomized controlled trial is warranted

Hearing loss and work participation: a cross-sectional study in Norway

<p><b>Objective:</b> To study work participation of persons with hearing loss, and associations with hearing disabilities, self-reported workability, fatigue and work accommodation.</p> <p><b>Design:</b> Cross-sectional internet-based survey.</p> <p><b>Study sample:</b> A total of 10,679 persons with hearing loss within working-age were invited to answer the survey, where 3330 answered (35.6%).</p> <p><b>Results:</b> Degree of hearing loss was associated with low workability, fatigue and work place accommodation, while sick leave was associated with fatigue. Degree of hearing loss was positively associated with being unemployed (<i>p</i> < .001) and having part-time work (<i>p</i> < .01) (often combined with disability benefits) for women. Work place accommodation was more frequently provided among respondents working with sedentary postures, high seniority, long-term sick leave or low workability. Additional unfavourable sensory conditions were associated with decreased employment (<i>p</i> < .001) and workability, and an increase in sick leave (<i>p</i> < .01) and fatigue (<i>p</i> < .001).</p> <p><b>Conclusions:</b> Hearing loss seemed to influence work participation factors negatively; particularly, for moderate hearing loss and for women, even though the degree of employment was high. A lack of work place accommodation when there was a need for such was found. This implies increased attentiveness towards individual needs concerning the experienced disability a hearing loss may produce. A more frequent use of hearing disability assessment is suggested.</p