Affordable, accessible, community‐delivered hearing care among individuals with cognitive impairment: Lessons from the HEARS RCT
Bibliographic record
Abstract
Abstract Background Hearing loss is highly prevalent and associated with adverse health outcomes but undertreated among individuals with cognitive impairment, particularly African Americans. The incorporation of community health worker (CHW)‐partnered models may increase access and reduce disparities. The HEARS intervention is a hearing care program delivered by CHWs that provides a low‐cost amplification device. To assess the efficacy of CHW‐delivered hearing care provided to community‐dwelling older adults, including those with cognitive impairment, a randomized clinical trial was conducted. Method An open label randomized clinical trial took place in 13 community sites in Baltimore, Maryland. 348 older adults were screened and 151 participants with hearing loss were randomized to receive a CHW‐delivered hearing care intervention versus 3‐month waitlist control. The primary outcome was change in communication function (Hearing Handicap Inventory for the Elderly‐Screening [HHIE‐S]) from baseline to 3‐months post‐randomization. The average treatment effect was estimated using the doubly‐robust weighted least squares estimator. This pre‐specified subgroup analysis was stratified by cognitive status using the total MoCA score (≤25: cognitive impairment; post hoc sensitivity analysis using ≤22). Result Among 149 randomized participants with MoCA data, 100 individuals were cognitively impaired (Mean adjusted MoCA: 21(SD 3.5); 52% African American; 70% low‐income). At 3‐months post‐intervention, 66% with cognitive impairment reported daily device use versus 76% for those without cognitive impairment. Communication function significantly improved among individuals with cognitive impairment compared with the control, with an estimated average treatment effect of ‐13.92 HHIE‐S change (95% CI:‐16.84,‐10.86), comparable to those without cognitive impairment (‐11.47; 95% CI:‐18.04,‐4.17). Post hoc sensitivity analysis using a ≤22 MoCA cut‐off for cognitive impairment yielded similar findings. Conclusion Among individuals with cognitive impairment, a CHW‐delivered low‐cost amplification device intervention, compared with a waitlist control, significantly improved communication function. The improvements were comparable to participants without cognitive impairment and similar in magnitude to improvements documented for older adults who received conventional clinic‐based hearing care with hearing aids fit by audiologists. To the authors’ knowledge, this trial was the largest trial to date of a hearing care intervention in the U.S. of African American older adults and low‐income older adults with hearing loss and cognitive impairment.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.041 | 0.074 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.004 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.002 | 0.003 |
| Open science | 0.002 | 0.003 |
| Research integrity | 0.003 | 0.004 |
| Insufficient payload (model declined to judge) | 0.007 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".