Abstract
The validity and reliability of auditory screening tests were evaluated in 34 demented and 31 non-demented elderly outpatients. In reference to an audiometric gold standard (40-dB HL bearing loss in speech frequencies), 512-Hz and 1024-Hz tuning forks, finger rub, and whispered voice tests performed well (ROC curve areas =0.82 to 0.94). Simultaneously high (>0.80) sensitivities and specificities were achievable for all these tests in demented patients. In non-demented patients, however, only the whispered voice test achieved simultaneously high specificity and sensitivity. The most accurate rule for air conduction screening audiometry was the inability to bear ≥ two of four 40-dB HL speech frequencies (sensitivity =1.0, specificity =0.75 in non-demented patients; sensitivity =0.97, specificity =0.74 in demented patients). Interobserver/test-retest reliability was generally high for tuning forks, finger rub, and whispered voice tests (range of intraclass correlation coefficients =0.38 to 0.90), and was somewhat higher in demented than in non-demented patients. These results suggest that some of the simple, traditional methods of auditory screening may have considerable validity and reliability in demented and non-demented older adults.
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References
American Public Health Association Work Group on Health Promotion/Disease Prevention. Criteria for the development of health promotion and education programs. Am J Public Health. 1986;77:89–92.
Feller BA. Prevalence of selected impairments, United States, 1977. Vital and health statistics, series 10, no. 134. DHHS publication (PHS) 81-1562. National Center for Health Statistics, 1981.
Williamson J, Stokoe IH, Gray S, et al. Old people at home: their unreported needs. Lancet. 1964;i:1117–1120.
Herbst KG, Humphrey C. Hearing impairment and mental state in the elderly living at home. Br Med J. 1980;281:903–5.
Weinstein BE, Ventry IM. Hearing impairment and social isolation in the elderly. J Speech Hear Res. 1982;25:593–9.
Corbin SL, Eastwood MR. Sensory deficits and mental disorders of old age: causal or coincidental associations? Psychol Med. 1986;16:251–6.
Uhlmann RF, Larson EB, Koepsell TD. Hearing impairment and cognitive decline in senile dementia of the Alzheimer’s type. J Am Geriatr Soc. 1986;34:207–10.
Lewis HP. The history and physical examination. New York: Appleton-Century-Crofts, 1979.
Burns KR, Johnson PJ. An introduction to clinical medicine. 16th ed. Englewood Cliffs, NJ: Prentice-Hall, 1980.
Walker HK, Hall WD, Hurst JW. Clinical methods: the history, physical, and laboratory examinations. 2nd ed. Boston: Butterworth, 1980.
DeGowin EL, DeGowin RL. Bedside diagnostic evaluation. 4th ed. New York: MacMillan, 1981.
Hillman RS, Goodell BW, Grundy SM, et al. Clinical skills: interviewing, history taking, and physical diagnosis. New York: McGraw-Hill, 1981.
Prior JA, Silberstein JS, Stang JM. Physical diagnosis: the history and examination of the patient. 6th ed. St. Louis, C. V. Mosby, 1981.
Delp MH, Manning RT. Major’s physical diagnosis. 8th ed. Philadelphia: W. B. Saunders, 1982.
Judge RD, Zuidema GD, Fitzgerald FT: Clinical diagnosis: a physical approach. Boston: Little, Brown, 1982.
Bates B. A guide to physical examination and history taking. 4th ed. Philadelphia: J. B. Lippincott, 1987.
Seidel HM, Ball HW, Dains JE, Benedict GW. Mosby’s guide to physical examination. St. Louis: C. V. Mosby, 1987.
Burnside JW, McGlynn TJ. Physical diagnosis. 17th ed. Baltimore: Williams and Wilkins, 1987.
Anthony JC, LeResche L, Niaz U, et al. Limits of the “Mini-Mental State” as a screening test for dementia and delirium among hospital patients. Psychol Med. 1982;12:397–408.
McKhann G, Drachman D, Folstein M. Clinical diagnosis of Alzheimer’s disease. Neurology. 1984;34:939–44.
Folstein MF, Folstein SE, McHugh PR. “Mini-Mental State.” A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189–98.
ASHA Committee on Audiometric Evaluation. Guidelines for determining the threshold level for speech. ASHA. 1979;21:353–6.
American National Standards Institute. American National Standard specifications for audiometers (S3.6-1969). American National Standards Institute, New York, 1970.
American National Standards Institute. American standard criteria for permissible ambient noise during audiometric testing (S3.1-1977), American National Standards Institute, New York, 1977.
ASHA Committee on Audiometric Evaluation. Guidelines for identification audiometry. ASHA. 1975;17:94–9.
ASHA Committee on Audiometric Evaluation. Guidelines for manual pure tone threshold audiometry. ASHA. 1978;20:297–301.
American Academy of Otolaryngology Committee on Hearing and Equilibrium, and the American Council of Otolaryngology Committee on the Medical Aspects of Noise. Guide for the evaluation of hearing handicap. JAMA. 1979;241:2055–9.
Ventry IM, Weinstein BE. Identification of elderly people with hearing problems. ASHA. 1983;25:37–42.
McNeil BJ, Hanley HA. Statistical approaches to the analysis of receiver operating characteristic curves. Med Decis Making. 1984;4:137–50.
Fleiss JL. The design and analysis of clinical experiments. New York: John Wiley and Sons, 1986;1–32.
Zar JH. Biostatistical analysis. 2nd ed. Englewood Cliffs, NJ: Prentice-Hall, 1984;309–18.
Lichtenstein MJ, Bess FH, Logan SA. Validation of screening tools for identifying hearing-impaired elderly in primary care. JAMA. 1988;259:2875–8.
Sox HC. Probability theory in the use of diagnostic tests: an introduction to critical study of the literature. Ann Intern Med. 1986;104:60–6.
Canadian Task Force on the Periodic Health Examination. Task Force Report—the periodic health examination. Can Med Assoc J. 1979;121:1193–254.
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Supported by the Robert Wood Johnson Foundation Research and Development Program to Improve Patient Functional Status, the University of Washington Alzheimer’s Disease Research Center (National Institutes of Health Grant No. AG 05136), and National Institute on Aging Academic Award No. K08 AG00265 (Dr. Uhlmann). The views expressed within are not necessarily those of the Robert Wood Johnson Foundation.
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Uhlmann, R.F., Rees, T.S., Psaty, B.M. et al. Validity and reliability of auditory screening tests in demented and non-demented older adults. J Gen Intern Med 4, 90–96 (1989). https://doi.org/10.1007/BF02602346
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DOI: https://doi.org/10.1007/BF02602346