Functional status of elderly people with hearing loss

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Abstract

The objective is to determine the prevalence of hearing loss in people over 65 years of age, to describe the functional status of people with hearing loss and to identify the need for hearing aid use. In a cross-sectional study, a random sample of 1387 people aged 65 years and over was selected. The primary study variables were: hearing level by audiometric assessment, self-perceived hearing loss, screening for hypoacusia using the Hearing Handicap Inventory for the Elderly-Screening (HHIE-S) and physical, cognitive and emotional functional status. Using the HHIE-S it was determined that 11.3% of the subjects had severe hearing handicap. According to the Ventry/Weinstein criteria 43.6% had hearing handicap. When asked about the use of hearing aids, 4.5% of the study subjects said they used them, although 41.9% had hearing loss of 35 dB or more in their better ear. The variables associated with the need for a hearing aid were age >75 years (odds ratio = OR = 3.2), ADL dependence (OR = 2.7), cognitive impairment (OR = 2.0), multiple health problems (OR = 1.8), male sex (OR = 1.6) and single/widowed (OR = 1.5). In conclusion, there is a high prevalence of hearing loss associated with other functional limitations. Of those people who would benefit from a hearing aid (more than a third of people over 65 years old), 89.3% do not own one. The screening of hearing loss needs to be improved.

Introduction

Hearing loss in the elderly is very common in industrialized societies. This is especially true in urban settings, where advanced age and intense noise interact to produce such deterioration. Changes that occur during aging affect the auditory system, from the middle ear to the cortex. This results in a reduced sensitivity to pure tones, signal distortion, difficulty in localization and in understanding speech in noisy situations. These alterations have been termed presbycusis and, although there is no pathognomonic lesion, there are circumstances, such as previous illnesses, vascular alterations or exposure to noise that could favor the progression of sensorineural hearing loss (Davanipour et al., 2000). The onset and level of intensity of the age-related degenerative changes vary widely and large differences in auditory function are observed in older people (Frisina and Frisina, 1997, Weber and Klein, 1999, Marcincuk and Roland, 2002).

Unfortunately, the prognosis for patients with presbycusis is progressive hearing loss. However, this progression is usually slow and the patient may have useful, if diminished, hearing for many years. Furthermore, the disorder can be improved through diagnosis and appropriate management (Ruckenstein, 1995), helping the elderly person and the family members to understand the problem and providing the means to improve the patient's quality of life. Correctly fitted hearing aids could contribute to successful rehabilitation of the patient and have a positive effect on the elderly person's perception of health and on their functional adaptation (Tolson et al., 2002).

Hearing loss is a serious problem in our society, and mainly occurs in the elderly population in whom hearing could compensate for other physical or sensorial limitations (Cacciatore et al., 1999). Hearing loss affects the elderly person's family and social life (Megighian et al., 2000), due to repetitions that are necessary when conversing and the increase in volume, intensity and tone of instruments and sounds. All these reduce communication, cause social isolation and a greater tendency for depressive disorders (Espmark et al., 2002). Hearing loss could also be the hidden cause of cognitive disorders in the elderly. On occasions, elderly people with hearing loss do not recognize their impairment and think that those around them are at fault and therefore do not accept the need to use a hearing aid.

In Spain, we have observed that hearing loss is a major cause of disability in the elderly and is often added to chronic health problems and to psychological problems. Furthermore, only a small part of those who would benefit from the use of a hearing aid actually own one, thus provision is clearly inadequate. In view of this, our first aim is to determine the prevalence of hearing loss in the population aged 65 years and over and to describe the functional status of those affected. Secondly we will assess the use of hearing aids and identify the real need for their use.

Section snippets

Study design and sampling

This is an observational, cross-sectional study in a population aged 65 years or over to determine the prevalence of hearing loss. It was carried out in Albacete, Spain, which has a population of 159,518 inhabitants, 13.4% of whom are aged 65 years or over. Anticipating that 35% of the elderly people would have hearing problems we would need to study 971 subjects (95% confidence level, precision ±3%), however providing for a 30% non-response, calculated using the formula “adjusted number of

Participant characteristics

In accordance with the inclusion and exclusion criteria, 1387 elderly people were included in the study, of whom 1162 could be assessed. The response rate was 83.7%. The mean age of the participants was 73.3 (59) years. The rest of the characteristics studied are given in Table 1.

A total of 131 subjects scored over 10 on the HHIE-S questionnaire (11.3%; 95% CI = 9.5, 13.1), indicating a severe hearing loss. When asked the question “How good do you think your hearing is? 63.0% (731 subjects) rated

Summary of main findings

The results of our study demonstrate a very high prevalence of hearing loss in people over 65 years. This hearing loss is associated with other physical, mental or functional limitations and constitutes a serious health problem with important implications. The detection of hearing loss in the elderly by the family doctor is essential to the prevention of disability. However, our results indicate there is a need to improve screening for hearing impairment. There are rehabilitative measures for

Conflict of interest statement

The authors declare that any potential conflict of interest related with the article doesn’t exist.

Acknowledgements

This study was financed by the Instituto de Salud Carlos III (Biomedical and Health Science Research Promotion Programme, Ministry of Health and Consumer Affairs (Orden SCO/3425/2002 of 20 December. Dossier P1031562) and the Health Ministry of the Castilla-La Mancha Autonomous Community (Directive 05-09-2003. D.O.C.M. no. 131 of 12 September 2003).

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