Older American adults with hearing loss not using hearing aids

Hearing aids are underutilised despite the high prevalence of significant hearing loss in adults aged over 70, a new study has confirmed.  

The US research, published in the Journal of the American Medical Association (JAMA), a peer-reviewed medical journal, also suggested that previously reported rates of hearing loss were underestimated, with the authors saying their research helps “shed light onto the pervasive nature of hearing loss among older adults” and should guide resource allocation and public health policy in this area. 

According to the study, which involved a nationally representative sample of 2,803 older adults who were Medicare beneficiaries, approximately two-thirds of those older than 71 years and nearly all adults older than 85 years have hearing loss. By the time they reach the age of 90, hearing loss was “almost ubiquitous”, said the authors. 

Yet despite this high prevalence, relatively few people with hearing loss were seen to use hearing aids. Indeed, the authors reported that fewer than three in 10 of those with hearing loss used hearing aids, despite their proven success as a public health intervention to reduce the health and social burden of hearing loss. They say that US public health policy should be changed to reflect this, and their findings should feed into ongoing and future hearing policy initiatives. 

It was found that an estimated 65.3% of adults 71 years and older had at least some degree of hearing loss. For 37%, this was mild, it was moderate for 24.1% and severe hearing loss affected 4.2% of the study population.  As an aside, the authors pointed out that when the newly adopted World Health Organization thresholds were applied, the prevalence of hearing loss increased such that eight in 10 US individuals aged 71 years and older were defined as having hearing loss. 

It was also seen that the prevalence was higher among white, male, lower-income, and lower education attainment subpopulations and increased with age, with 96.2% of adults aged over 90 experiencing hearing loss. “As age increased, the difference in prevalence of hearing loss among demographic subgroups narrowed to nearly no difference,” said the authors. 

Among those with hearing loss, just 29.2% reported using hearing aids, with lower estimates among black and Hispanic individuals and low-income individuals. Hearing aid use, however, also increased with increasing age, with 31.2% of adults aged 80 to 85 years and 36.9% of those aged 85 years and older using hearing aids. 

The authors were keen to emphasise the “robustness” of their estimates, given the large sample size involved. “[These figures] are higher than previous estimates and provide updated metrics for resource planning related to ongoing and future hearing policy initiatives,” add the authors. 

In their discussion, they highlight the documented association of hearing loss with cognitive decline, impaired physical function, poorer health resource utilisation, and dementia. “Importantly, evidence suggests that hearing treatment may mitigate these associations and prevent poor health outcomes,” they state. 

Consideration of “discrete severity measures of hearing loss” in this population, rather than binary hearing loss terminology, is warranted, they add. “Clinicians and public health officials should consider moving away from broad binary descriptions of hearing loss, especially among the oldest age groups, toward more granular categories to improve understanding and perceptions of hearing.” 

These latest findings from the US echo European data, which suggests that – while the adoption of hearing aids in Europe has been on the rise in recent years – only around 40% of those in need of hearing aids are using them. EHIMA (European Hearing Instrument Manufacturers Association) recommends that, to increase market penetration, hearing aids should enjoy mandatory health insurance coverage, while public health measures should focus on systematic public health screening at a younger age as a preventative measure. 

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