Biopsychosocial Classification of Hearing Health Seeking in Adults Aged Over 50 Years in England

Abstract

Objectives: Approximately 10 to 35% of people with a hearing impairment own a hearing aid. The present study aims to identify barriers to obtaining a hearing aid and inform future interventions by examining the biopsychosocial characteristics of adults aged 50+ according to 7 categories: (i) Did not report hearing difficulties, (ii) Reported hearing difficulties, (iii) Told a healthcare professional about experiencing hearing difficulties, (iv) Referred for a hearing assessment, (v) Offered a hearing aid, (vi) Accepted a hearing aid, and (vii) Reported using a hearing aid regularly. Design: The research was conducted using the English Longitudinal Study of Aging wave 7 with data obtained from 9666 adults living in England from June 2014 to May 2015. Cross-sectional data were obtained from a subset of 2845 participants aged 50 to 89 years of age with a probable hearing impairment measured by hearing screening (indicating a hearing threshold of >20 dB HL at 1 kHz or >35 dB HL at 3 kHz in the better ear). Classification according to hearing health-seeking category was via participants’ self-report. Participants in each category were compared with people in all subsequent categories to examine the associations between each category and biopsychosocial correlates (sex, age, ethnicity, educational level, wealth, audiometric hearing level, self-reported health status, cognitive performance, attitudes to aging, living alone, and engagement in social activities) using multiple logistic regression. Results: The proportions of individuals (N = 2845) in categories i to vii were 40.0% (n = 1139), 14.0% (n = 396), 4.5% (n = 129), 4.0% (n = 114), 1.2% (n = 34), 7.7% (n = 220), and 28.6% (n = 813), respectively. Severity of hearing impairment was the only factor predictive of all the categories of hearing health-seeking that could be modeled. Other correlates predictive of at least one category of hearing health-seeking included sex, age, self-reported heath, participation in social activities, and cognitive function. Conclusions: For the first time, it was shown that 40.0% of people with an audiometrically identified probable hearing impairment did not report hearing difficulties. Each of the five categories of hearing health-seeking that could be modeled had different drivers and consequently, interventions likely should vary depending on the category of hearing health-seeking.

The association between non-communicable disease and hearing aid adoption in older adults with hearing loss

“…Overall, our findings in a large and recent clinical sample of older adults converge with the existent literature, showing self-reported hearing difficulties, audiometric hearing loss, and age are some of the strongest predictors of hearing aid adoption in this population (Hartley et al, 2010;Knudsen et al, 2010;Gopinath et al, 2011;Meyer & Hickson, 2012;Öberg et al, 2012;Meyer et al, 2014;Saunders et al, 2016;Pronk et al, 2017;Pronk et al, 2019;Sawyer et al, 2019;Sawyer et al, 2020). Furthermore, while previous research has similarly shown that hearing aid adoption and ownership is lower in older adults reporting better general health (Rosenhall & Espmark, 2003;Öberg et al, 2012;Meyer et al, 2014), our study further suggests that the presence of specific noncommunicable diseases, namely, hypertension and diabetes, are associated with lower odds of hearing aid adoption.…”

“…While the reviews completed by Knudsen et al (2010) and Meyer and Hickson (2012) spanned three decades of research (from 1980 to 2010), most of the studies included employed crosssectional study designs of small, clinic-based samples. Successive studies investigating the factors that predict hearing aid adoption and/or use have subsequently attempted to investigate much larger populations (Hartley et al, 2010;Gopinath et al, 2011;Öberg et al, 2012;Meyer et al, 2014;Saunders et al, 2016;Pronk et al, 2017;Pronk et al, 2019;Sawyer et al, 2019;Sawyer et al, 2020). For example, in a community-based sample of 1,371 older adults (>55 years) living in Australia, Gopinath et al (2011) found that, relative to non-owners, individuals that owned hearing aids were more likely to be older, self-report experiencing hearing loss and hearing handicap (or participation restrictions), and have poorer hearing sensitivity.…”

Conceptual Model of Hearing Health Inequalities (HHI Model): A Critical Interpretive Synthesis

“…Recent evidence from the United Kingdom shows that specific demographic groups are unlikely to obtain hearing aids, proving that people of low SEP face other nonfinancial barriers. These differences do not only reflect the differences in the health systems and hearing aid provisions among countries, as suggested by Sawyer et al (2020), but also emphasize individuals' inability to identify their hearing difficulties as a barrier in their help-seeking process, even in countries where the hearing aids are available free of charge (Tsimpida et al, 2020a).…”

Listening-Based Communication Ability in Adults With Hearing Loss: A Scoping Review of Existing Measures

“…For example, two listeners with the same audiometric thresholds can have different speech-in-noise performance ( Gifford et al, 2007 ), and many individuals report significant hearing difficulties that are not reflected in hearing threshold measurement ( Füllgrabe et al, 2015 ; Bakay et al, 2018 ; Barbee et al, 2018 ; Vermiglio et al, 2018 ). In contrast, a large study exploring access barriers to hearing intervention in older adults, found that 40% of adults with audiometrically measurable hearing loss did not report a hearing difficulty ( Sawyer et al, 2020 ). The review findings indicate that, despite these well-evidenced shortcomings, measurement at the level of detection continues to be the dominant assessment measure reported in published studies of adults with hearing loss.…”

“…This information could be used in clinical practice and research to provide a more nuanced evaluation of the listening abilities of adults with hearing loss. The reductive approach to measurement described in this review may account for the contrast between what is measured and the priorities and perspectives of adults living with hearing loss ( Sawyer et al, 2020 ). The review findings may also assist in addressing the possible disconnect between people’s understanding of hearing loss and its relationship to communication.…”