Technological Tools to Improve Communication in Patients With Hearing Loss

Abstract

The risk of hearing loss increases as the population ages, with approximately 23 million adults aged 70 years or older (63%) in the US having diminished speech perception. 1 Although hearing loss is common in elderly people, management is largely ineffective due to several factors: poor screening, high cost of hearing aids, vanity, hearing loss stigma, and inadequate training of health care practitioners. As a result, hearing loss results in adverse consequences both in health care settings and in everyday life. 2 Studies have demonstrated that those with untreated hearing loss use hospitals and emergency departments more often than those without hearing loss and generate, on average, an additional $22 000 in health care expenses over 10 years. 3 Chang et al 4 analyzed Medicare recipients with hearing loss and selfreported communication difficulties and found that they were 32% more likely to be readmitted to the hospital within 30 days of discharge compared with those who did not report hearing loss or communication difficulties.Hearing loss is a major source of social isolation among older adults and causes health care communication breakdowns between clinicians and patients, 5 reducing patients' health care satisfaction and adherence. 6 Despite the considerable adverse effects of age-related hearing loss, hearing aid use remains low even though these aids provide communication benefits, reduce social isolation, and improve quality of life. Less than 20% of those aged 70 years or older with hearing loss reported hearing aid use. 7 Due to infrequent use of hearing aids, many older adults with hearing loss struggle with understanding clinicians. 6 A potential tool is the use of personal sound amplification products (PSAPs); these devices, not much larger than a smartphone, amplify sounds close to the user while reducing noises farther away. In previous small studies, PSAPs have shown benefits in improving the quality of hearing and communication. 8,9 In this issue of JAMA, Nieman et al 10 report a randomized trial of a community health worker-delivered PSAP intervention among 151 older adults with hearing loss. Participants in the intervention group received 1 of 2 PSAPs and were encouraged to use the device in their daily routines. The community health worker-led device instruction took place in 1 to 2 individual sessions in less than 2 hours of total time. The primary outcome was self-perceived communication at 3 months; secondary outcomes included physical health, depression, social isolation, loneliness, and self-efficacy in