Hearing Screening Across a Lifetime: Addressing the Needs of Older Adults

To shed light on continued shifts in the global epidemiology of hearing loss while also highlighting available solutions and current challenges, the World Health Organization (WHO) launched the first World Report on Hearing last year. The report establishes several priorities, including the need for hearing screening across the course of an individual’s life. “Increasing hearing screening and early intervention coverage during the next 10 years requires an additional annual per capita investment of US$ 1.33,” according to the WHO report. “The resulting health gain during the 10-year period would avert nearly 130 million DALYs (disability adjusted life years), benefit 1.4 billion people and yield a return of nearly US$ 16 for each 1 dollar invested.” 1 In an effort to support the implementation of their recommendations, which includes the urgent need for evidence-based policy action, WHO developed the handbook HEARING Screening: Considerations for Implementation.2 This resource provides guidance on how to address hearing loss in key demographics, including older adults. The need for hearing screening among the aging population has been well-established and audiologists are poised to play a key role in this aspect of care. Integrating hearing services, and more specifically, hearing screening into the care of this patient population begins with an understanding of healthy aging, according to Yuka Sumi, MD, PhD, MPH, Acting Head of the Aging and Health Unit, and Medical Officer at WHO. During a recent webinar led by WHO, Sumi and other experts shared their experiences as well as discussed current challenges and how they can be addressed. “In 2015, the World Report on Aging and Health defined healthy aging as the process of developing and maintaining the functional ability that enables well-being in older age,” noted Sumi, while outlining the key factors of healthy aging: functional ability, intrinsic capacity, and environments. “These three components are very important for the healthy aging,” she continued. “When people age our intrinsic capacity tends to decline, and then the issue becomes more complex and chronic, but by providing a support environment, our functional ability can be maintained.” TOOLS FOR SUCCESS One way to support this patient population is with the right tools, such as Integrated Care for Older People (ICOPE), which “reflects a continuum of care that will help to reorient health and social services towards a more person-centred and coordinated model of care that supports optimising functional ability for older people,” according to Sumi. The WHO ICOPE screening tool takes a closer look at the key conditions associated with declines in intrinsic capacity, including hearing loss. This and other tools are important when looking at aging and more specifically, hearing loss. Lack of awareness and ongoing stigma must also be addressed to ensure older patients receive the necessary care. When Dr. Arun Agarwal, Medical Advisor – Innovation, Education & Clinical Excellence, Apollo Hospitals Group, India, and colleagues sought to create a program for hearing screening for older adults, they faced a lack of understanding regarding the importance of hearing as well as a stigma that led individuals to often hide their hearing loss and avoid hearing aids. In 1995, Agarwal and his team began advocating with the Government of Delhi and a camp-based approach was initiated. By 1998, 17,000 elderly patients had been screened and 4,000 free hearing aids fitted. This success and the awareness raised among policymakers opened the door to a discussion regarding a national initiative, and in 2007 the Prevention of Control of Deafness was started. Today more than 70% of India’s population is being covered under this program, Agarwal said during his presentation. This example underscores the importance of raising awareness among the public and working closely with policymakers to create true impact and change. A POSITIVE PERSPECTIVE ON AGING As mentioned above, the stigma of hearing loss—and other conditions associated with aging—must be acknowledged and tackled to ensure individuals do not hesitate to seek care or the necessary support. “There is a power to our attitude and our views of aging,” noted Kathy Pichora-Fuller, PhD, Professor Emerita, Department of Psychology, University of Toronto, and Adjunct Professor, Department of Gerontology, Simon Fraser University. “There can be discrimination from other people, but we can also discriminate against ourselves if we don’t think about aging in a positive way.” The literature shows that attitude can have an impact on outcomes for older adults, she noted, while referencing a study that found that individuals who don’t have positive attitudes have faster declines in their audiogram. 3 Pichora-Fuller and colleagues have explored how individual’s views of aging affect their self-perception of their hearing, and there continues to be a focus on this area of research. Why does this matter? While screening for hearing loss is crucial, patient attitudes and beliefs are equally important because it often determines whether they decide to follow up and engage in services, explained Pichora-Fuller, who emphasized the need to address these issues directly. “We have to head this off at the pass and counteract some of the negative views of hearing loss and hearing aids, and how those combine with negative views of aging.” Ensuring widespread access to hearing screen and associated care requires a concerted effort from all stakeholders. Success depends on creating a collaborative environment across the continuum of care that not only addresses the importance of hearing and hearing services but also a comprehensive understanding of the unique challenges and needs of older adults. Thoughts on something you read here? Write to us at [email protected]

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