Survivors need to be evaluated for these neurotoxicities and receive appropriate interventions. Referrals to audiologists and physical therapists are warranted to improve survivors' hearing ability, functional status, and QOL.

Context Most hip fracture care models are grounded in curative models where the goal is to return the patient to independent function. In many instances, however, hip fractures contribute to continued functional decline and mortality. While the negative impact of hip fractures is appreciated once they have occurred, what is less understood is what proportion of older adults have high illness burden prior to experiencing hip fracture and might benefit from geriatric palliative care. Objectives Using data from the Health and Retirement Study linked to Medicare claims (January 1992 through December 2010), we sought to understand the extent of premorbid illness burden prior to hip fracture. Methods Characteristics were based on the interview before hip fracture. Features used to indicate need for geriatric palliative care included evidence of functional and medical vulnerability, pain and depression. Results 856 older adults who experienced a hip fracture were compared to 851 age, gender and race-matched controls. Older adults with hip fractures had significantly more premorbid functional vulnerability (ADL dependent 25.7% vs 16.1% (p<0.001); dementia 16.2% vs 7.3% (p<0.001); use of helpers 41.2% vs 28.7% (p<0.001)). They also experienced more medical vulnerability (multimorbidity 43% vs 29.8% (p<0.001); high healthcare utilization 30.0% vs 20.9% (p<0.001); and poor prognosis 36.1% vs 25.4% (p<0.001) in controls). There was no difference in premorbid pain and depression between subsequent hip fracture patients and controls. CONCLUSION A significant proportion of older adults have evidence of functional and medical vulnerability prior to hip fracture. For these individuals, integration of geriatric palliative care may be particularly important for optimizing quality of life and addressing the high morbidity experienced by this population.

The NIH Toolbox project has assembled measurement tools to assess a wide range of human perception and ability across the lifespan. As part of this initiative, a small but comprehensive battery of auditory tests has been assembled. The main tool of this battery, pure-tone thresholds, measures the ability of people to hear at specific frequencies. Pure-tone thresholds have long been considered the "gold standard" of auditory testing, and are normally obtained in a clinical setting by highly trained audiologists. For the purposes of the Toolbox project, an automated procedure (NIH Toolbox Threshold Hearing Test) was developed that allows nonspecialists to administer the test reliably. Three supplemental auditory tests are also included in the Toolbox auditory test battery: assessment of middle-ear function (tympanometry), speech perception in noise (the NIH Toolbox Words-in-Noise Test), and self-assessment of hearing impairment (the NIH Toolbox Hearing Handicap Inventory Ages 18-64 and the NIH Toolbox Hearing Handicap Inventory Ages 641). Tympanometry can help differentiate conductive from sensorineural pathology. The NIH Toolbox Words-in-Noise Test measures a listener's ability to perceive words in noisy situations. This ability is not necessarily predicted by a person's pure-tone thresholds; some people with normal hearing have difficulty extracting meaning from speech sounds heard in a noisy context. The NIH Toolbox Hearing Handicap Inventory focuses on how a person's perceived hearing status affects daily life. The test was constructed to include emotional and social/situational subscales, with specific questions about how hearing impairment may affect one's emotional state or limit participation in specific activities. The 4 auditory tests included in the Toolbox auditory test battery cover a range of auditory abilities and provide a snapshot of a participant's auditory capacity. Neurology The human auditory system has the capacity to detect sounds, recognize and discriminate among sounds, comprehend the meaning of acoustic events, localize sound sources, and determine the direction and presence of sound movement. Hearing involves both the physical processing of acoustic signals (e.g., intensity and frequency) and their psychological percepts (e.g., loudness and pitch). Humans can detect, discriminate, and localize a wide variety of auditory stimuli, including linguistic sounds (e.g., speech syllables, words, sentences), and nonlinguistic sounds (e.g., clicks, tones, music). Audition research, traditionally concerned primarily with functions supported by mechanisms in the auditory periphery, has recently begun to examine more central aspects of processing auditory information and the role of hearing as it relates more broadly to human communication. 1Audition occurs when acoustic energy enters the outer ear and stimulates the eardrum (tympanic membrane), which transduces acoustic energy into mechanical energy. This mechanical energy is transmitted via the ossicles (malleus, incus, stapes) to the inner...