Caring for Persons With Dementia in Audiology

While hearing loss is highly prevalent among patients with dementia, it frequently goes unidentified and unmanaged. It has been a commonly-held belief that older adults with dementia are unable to benefit from hearing rehabilitation, but recent evidence shows that many individuals with dementia can successfully use amplification, helping to improve communication, social interaction and quality of life for these individuals and their caregivers. This presentation will describe how modifications to practice led to successful outcomes for the majority of patients of a geriatric audiology clinic with co-morbid hearing loss and cognitive impairment. In a study of hearing aid use in 67 patients with these comorbidities, over 90% used hearing aids successfully with measurable benefit for both patients and caregivers. Furthermore, we will discuss approaches to improving communication for LTC residents with dementia and hearing loss through the support of audiologists during remote visits with physicians and families during the pandemic.

Neuropsychiatric Symptoms and Hearing Loss in Dementia: Unmet Need and Opportunity for Intervention

Hearing loss is one of the most common comorbidities among persons with dementia, with prevalence of 60->90%. Most go untreated and disparities exist. However, sensory impairment may influence the health of individuals and care partners. We will share findings from a clinic-based cohort of persons with dementia (n=101). Controlling for demographic and clinical factors, we found that every 10 decibel increase in hearing loss was associated with nearly an additional neuropsychiatric symptom (b = 0.7 per 10 dB; p = 0.01) and 1.3-point increase in severity (b = 1.3 per 10 dB; p = 0.04). These findings provide the first estimates that utilize objective audiometry. Furthermore, hearing aid use appeared to be protective. Hearing care may represent an additional, but underutilized, non-pharmacological intervention. We will discuss these findings in the context of the epidemiology of hearing loss in dementia and highlight new opportunities for managing hearing loss through community-based approaches.

Alternative Pathways for Hearing Care May Address Disparities in Access

Background/Objectives: Low-uptake of hearing aids among older adults has long dogged the hearing care system in the U.S. and other countries. The introduction of over-the-counter hearing aids is set to disrupt the predominantly high-cost, specialty clinic-based delivery model of hearing care with the hope of increasing accessibility and affordability of hearing care. However, the current model of hearing care delivery may not be reaching everyone with hearing loss who have yet to use hearing aids. In this study, we examine the group of people who do not use hearing aids and describe their characteristics and health care utilization patterns. We also consider what other healthcare pathways may be utilized to increase access to hearing treatment.Design: Cross-sectional, the 2017 Medicare Current Beneficiary Survey.Setting: Non-institutionalized adults enrolled in Medicare, the U.S. public health insurance program for older adults (65 years and older) and those with qualifying medical conditions and disabilities.Participants: A nationally representative sample of 7,361 Medicare beneficiaries with self-reported trouble hearing and/or hearing aid use.Measurements: Survey-weighted proportions described the population characteristics and health care utilization of those with hearing loss by hearing aid use, and the characteristics of those with untreated hearing loss by health care service type utilized.Results: Women, racial/ethnic minorities, and low-income Medicare beneficiaries with self-reported hearing trouble were less likely to report using hearing aids than their peers. Among those who do not use hearing aids, the most commonly used health care services were obtaining prescription drugs (64%) and seeing a medical provider (50%). Only 20% did not access either service in the past year. These individuals were more likely to be young and to have higher educational attainment and income.Conclusion: Alternative models of care delivered through pharmacies and general medical practices may facilitate access to currently underserved populations as they are particularly high touch-points for Medicare beneficiaries with untreated hearing trouble. As care needs will vary across a spectrum of hearing loss, alternative models of hearing care should look to complement not substitute for existing access pathways to hearing care.

Dementia and hearing-aid use: a two-way street

Objectives: Hearing-aid use may reduce risk of dementia, but cognitive impairment makes hearing-aid use more challenging. These two causal pathways may both manifest as an association between reduced hearing-aid use and incident dementia. This study examined the effects of each pathway separately, through a unique combination of longitudinal data regarding hearing, general health, dementia diagnoses and continuity of HA use. Methods: Longitudinal health records data from 380,794 Veterans who obtained hearing aids from the US Veterans Affairs healthcare system were analysed. Analysis 1 (n=72,180) used logistic regression to model the likelihood of a dementia diagnosis at 3 year 6 months (3y6m) to 5 years post hearing-aid fitting for patients previously free of dementia and mild cognitive impairment (MCI). Analysis 2 (n=350,918) modelled the likelihood of being a persistent hearing aid user at 3y2m after fitting, contrasting subgroups with differing levels of cognitive function at the time of fitting. Models controlled for relevant predictors available in the dataset. Results: In analysis 1, the adjusted OR for incident dementia was 0.73 (ci 0.66-0.81) for persistent (vs. non persistent) hearing-aid users. In analysis 2, the adjusted OR for hearing-aid use persistence was 0.46 (ci 0.43-0.48) in those with pre-existing dementia (vs. those remaining free of MCI and dementia). Conclusion: The results indicate substantial effects from both causal pathways. Research studying protective effects of hearing-aid use against dementia needs to account for this. Clinically, hearing devices and hearing care processes must be accessible and usable for all, regardless of their level of cognitive function.