Abstract
This cross-sectional study examines hearing testing and hearing aid use among older adults with dual sensory impairment compared with individuals with hearing loss alone in a US-based nationally representative sample.
Among older adults, the prevalence of dual sensory impairment (DSI) represents a considerable portion of the US population, and older adults with DSI experience worse physical, mental, social-emotional, and cognitive outcomes.1,2 As compared with individuals with a single impairment, older adults with DSI may face additional barriers to care, including hearing health care.3 A lack of care may particularly affect individuals with DSI given the potential for limited compensation through reliance on one sense for the other (eg, lipreading) or one impairment may influence treatment of the other (eg, difficulty manipulating a hearing aid). As the population ages, the number of individuals with DSI will increase. Limited information is available regarding the use of hearing health care among older adults with DSI. In this cross-sectional study, we examine hearing testing and hearing aid use among older adults with DSI compared with individuals with hearing loss alone in a US-based nationally representative sample.
Methods
We analyzed data from participants 70 years and older from the 2005 to 2006 cycle of the National Health and Nutrition Examination Survey (NHANES), an ongoing cross-sectional study of a representative sample of the noninstitutionalized US population. Data were collected from the 2005 to 2006 cycle because it was the most recent cycle to include hearing and vision measures for older adults. Participants completed air conduction pure-tone audiometry in a sound-attenuated booth. Per the World Health Organization criteria, a speech-frequency pure-tone average of greater than 25 dB in the better-hearing ear was defined as hearing loss. Visual acuity was determined for each eye using the participant’s presenting correction (if any) and reassessed after autorefraction in eyes with a presenting acuity worse than 20/25. Visual impairment was defined as having a postautorefraction visual acuity worse than 20/40 in the better-seeing eye. Information regarding NHANES design and protocols are available.4 Population prevalence was estimated through sample weights using STATA statistical software (StataCorp), version 15.1, and prevalence data were applied to the 2017 to 2018 American Community Survey data to determine population estimates. The NHANES was approved by the institutional review board of the National Center for Health Statistics, and all participants provided written informed consent.
Results
In a nationally representative sample of approximately 10 million individuals, older adults with DSI had a lower prevalence of hearing health care use, including hearing testing and hearing aid use, compared with older adults with hearing loss alone (Tables 1 and 2).
Table 1. Weighted Demographic Characteristicsa.
| Characteristic | HL only, %b | DSI, % |
|---|---|---|
| Mean age, y | 77.8 | 79.9 |
| Sex | ||
| Female | 54.2 | 60.9 |
| Male | 45.8 | 39.1 |
| Race and ethnicityc | ||
| Black or African American | 4.9 | 5.0 |
| White | 89.2 | 91.2 |
| Otherd | 5.8 | 3.8 |
Abbreviations: DSI, dual sensory impairment; HL, hearing loss.
Data are from the 2005 to 2006 cycle of the National Health and Nutrition Examination Survey (unweighted n = 312).4
Hearing loss is defined as speech frequency (0.5-2.0 kHz) pure-tone average greater than 25 dB in the better-hearing ear.
Race and ethnicity are self-identified by participants. Only the 3 most common categories are specified.
Owing to National Health and Nutrition Examination Survey guidance regarding minimum cell size, Other includes Mexican American and individuals who identify as other races and ethnicities.
Table 2. Prevalence and Numbers of Individuals With Hearing Testing and Hearing Aid Use Among Older US Adults With Hearing Loss Compared With Individuals With Dual Sensory Impairmenta.
| Hearing health care | Prevalence (95% CI), % | Estimated difference between HL only and DSI groups (95% CI)b | Population estimate (in millions)c | ||
|---|---|---|---|---|---|
| HL onlyd | DSI | HL only | DSI | ||
| Hearing testede | |||||
| <4 y ago | 49.2 (43.4 to 55.0) | 41.0 (21.0 to 61.1) | −0.08 (−0.26 to 0.10) | 8.4 | 1.7 |
| ≥5 y ago | 27.4 (22.6 to 32.2) | 31.2 (19.6 to 42.9) | 0.04 (−0.08 to 0.16) | 4.7 | 1.3 |
| Never | 23.4 (18.6 to 28.3) | 27.7 (16.1 to 39.4) | 0.04 (−0.07 to 0.16) | 4.0 | 1.1 |
| Ever worn hearing aid, amplifier, or implantf | 27.0 (23.0 to 30.9) | 15.9 (5.7 to 26.1) | −0.11 (−0.22 to 0.002) | 4.7 | 0.7 |
| Regular hearing aid usef,g | 17.8 (14.4 to 21.2) | 6.5 (1.8 to 11.2) | −0.11 (−0.17 to −0.06)h | 3.1 | 0.2 |
Abbreviations: DSI, dual sensory impairment; HL, hearing loss.
Data are from the 2005 to 2006 cycle of the National Health and Nutrition Examination Survey (unweighted n = 312).4
Estimated proportion difference between groups was calculated using linear regression.
Weighted to the American Community Survey.
Hearing loss is defined as speech frequency (0.5-2.0 kHz) pure-tone average greater than 25 dB in the better-hearing ear.
Missing values were removed for prevalence to sum to 100% (unweighted n = 305).
Unweighted n = 312.
Regular use was defined as wearing a hearing aid for at least 5 hours per week for the past year.
Statistically significant at P < .05.
Discussion
This study provides nationally representative estimates of hearing health care use among older US adults with DSI, and we found clinically meaningful disparities between individuals with DSI and individuals with hearing loss alone. Lower prevalence of testing and hearing aid use among individuals with DSI may be secondary to difficulties related to the care system or the intervention (eg, manipulating small batteries and devices). For example, those with DSI report more dissatisfaction with care quality and more difficulty finding a health care provider.3 The present findings also indicate lower use of hearing aids among those with DSI than other studies, which may reflect an associated financial burden specific to the US, where studies outside of the US estimate hearing aid ownership at 31.6% to 59.8%.5,6
Limitations in this study include a reliance on data from 2005 to 2006, which may underestimate current prevalence given potential differences such as in the availability of testing or technology quality. Furthermore, the sample size is small and limits additional analyses. Nonetheless, we found disparities in hearing health care among those with DSI, highlighting the need for targeted interventions to address the needs of the growing population of individuals aging with concurrent visual and hearing impairment.
References
- 1.Swenor BK, Ramulu PY, Willis JR, Friedman D, Lin FR. The prevalence of concurrent hearing and vision impairment in the United States. JAMA Intern Med. 2013;173(4):312-313. doi: 10.1001/jamainternmed.2013.1880 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Heine C, Browning C. Dual sensory loss in older adults: a systematic review. Gerontologist. 2015;55(5):913-928. doi: 10.1093/geront/gnv074 [DOI] [PubMed] [Google Scholar]
- 3.Assi L, Shakarchi AF, Sheehan OC, Deal JA, Swenor BK, Reed NS. Assessment of sensory impairment and health care satisfaction among Medicare beneficiaries. JAMA Netw Open. 2020;3(11):e2025522. doi: 10.1001/jamanetworkopen.2020.25522 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.National Health and Nutrition Examination Survey: NHANES 2005-2006. National Centers for Health Statistics . Accessed April 30, 2022. https://wwwn.cdc.gov/nchs/nhanes/continuousnhanes/default.aspx?BeginYear=2005.
- 5.Schneider JM, McMahon CM, Gopinath B, et al. Dual sensory impairment and hearing aid use among clients attending low-vision services in Australia: the vision-hearing project. J Aging Health. 2014;26(2):231-249. doi: 10.1177/0898264313513610 [DOI] [PubMed] [Google Scholar]
- 6.Vreeken HL, van Rens GH, Knol DL, et al. Dual sensory loss: a major age-related increase of comorbid hearing loss and hearing aid ownership in visually impaired adults. Geriatr Gerontol Int. 2014;14(3):570-576. doi: 10.1111/ggi.12136 [DOI] [PubMed] [Google Scholar]
