Hearing Loss and the. Healthcare system

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1 Hearing Loss and the 1 Healthcare system Nicholas S. Reed, AuD Assistant Professor Dept. Otolaryngology Core Faculty Cochlear Center for Hearing and Public Health Johns Hopkins University Baltimore, Maryland

2 Prevalence of Hearing Loss in the 2 United States, Hearing loss defined as a better-ear PTA of 0.5-4kHz tones > 25 db Lin et al., Arch Int Med. 2011

3 Hearing Loss and Health Aging 3 Cognitive Vitality & Avoiding Dementia Avoiding Injury Maintaining Physical Mobility & Activity Keeping Socially Engaged & Active Health Resource Utilization Lin JAMA 2014

4 Hearing Loss & Hearing Aid Use 4 Prevalence in the U.S Chien, W. Arch Int Med. 2012

5 Hearing Loss: Primer 5

6 Hearing Loss: Primer 6

7 Hearing Loss: Primer 7 You should go to the pharmacy before you get to your house.

8 Patient-Provider Communication 8 IOM 2001: Patient-provider care is cornerstone of patient-centered care care that is respectful of and responsive to individual patient preferences, needs, and value Only 23.9% (16/67) of patient-provider communication papers involving older adults included any mention of hearing loss Of those 16, only 4 included hearing loss in analyses Systematic review of inpatient patient-provider communication 13/13 studies that included hearing loss found it associated with poorer patient-provider communication Shukla et al AM J Med Qual; IOM 2001; Cohen et al. (2017) JAGS; Cudmore et al (2017) JAMA-OTO

9 Patient-Provider Communication 9 Patient-provider communication impacts healthcare metrics quality of care time to diagnosis length of stay treatment adherence satisfaction with care Hearing Loss? Healthcare metrics Shukla et al (under review); IOM 2001

10 Objectives of Talk 10 Part 1; Secondary Analyses Hearing Loss and satisfaction: Cross sectional analyses The impact of hearing loss on health care cost and utilization measures Part 2; Primary Data Development and feasibility investigation of a systematic strategy to address hearing loss in the inpatient setting

11 Secondary Analysis 11 Satisfaction - Methods Data Sources: Medicare Current Beneficiaries Survey 2015 Sample weighted national sample of US Medicare Beneficiaries Interview conducted survey (8% respond by proxy) Atherosclerosis Risk in Communities Study Objective audiometry pilot offered to ~300 persons Washington County, MD site Reed et al. (2018) JAGS (in press); Reed et al (in-prep)

12 Secondary Analysis 12 Satisfaction - Methods Exposure: Hearing Loss Medicare Current Beneficiary Survey No trouble hearing A little trouble hearing A lot of trouble hearing If applicable: w/ hearing aid Functional Hearing Loss Atherosclerosis Risk in Communities Objective pure-tone audiometry Conducted in sound booth with calibrated equipment Pure-tone average (speech frequency sounds) Defined according to W.H.O criteria Objective Hearing Loss Reed et al. (2018) JAGS (in press); Reed et al (in-prep)

13 Secondary Analysis 13 Satisfaction - Methods Outcome: Self-report satisfaction Medicare Current Beneficiaries Survey: Please tell me how satisfied you have been with the following: The overall quality of the health care [you have] received [over the past year/since (reference date)]. Very Satisfied, Satisfied, Dissatisfied, Very Dissatisfied Atherosclerosis Risk in Communities: Overall, how satisfied are you with the quality of care you received from your healthcare providers over the past 12 months? Very Dissatisfied, Somewhat Dissatisfied, Somewhat Satisfied, Very Satisfied Reed et al. (2018) JAGS (in press); Reed et al (in-prep)

14 Secondary Analysis 14 Satisfaction - Methods Outcome: Self-report satisfaction Medicare Current Beneficiaries Survey: Please tell me how satisfied you have been with the following: The overall quality of the health care [you have] received [over the past year/since (reference date)]. Very Satisfied, Satisfied, Dissatisfied, Very Dissatisfied Atherosclerosis Risk in Communities: Overall, how satisfied are you with the quality of care you received from your healthcare providers over the past 12 months? Very Dissatisfied, Somewhat Dissatisfied, Somewhat Satisfied, Very Satisfied Reed et al. (2018) JAGS (in press); Reed et al (in-prep)

15 Secondary Analysis 15 Odds Dissatisfaction With Care Medicare Current Beneficiaries Survey: Self-Report Difficulty Hearing Total N (unweighted) Total N (weighted) Dissatisfied with Care Odds Ratio [95% CI] P-Value No Trouble Hearing million 3.10% REF A little Trouble Hearing million 4.64% 1.47 [ ] A Lot of Trouble Hearing million 6.52% 1.74 [ ] Total Million 3.94% - - Note: Logistic Regression model includes age, sex, race, income, education level, general health, functional limitations, and martial status; Capitalist Sensitivity Slides Analyses using ordinal logistic and excluding disabled led to similar results Reed et al. (2018) JAGS (in press); Reed et al (in-prep)

Secondary Analysis 16 Odds Dissatisfaction With Care Atherosclerosis Risk in Communities: 75-year-old participant: Every 10 db increase in HL, odds of < satisfied increased.94 (95% CI:0.74-1.20).

16 Secondary Analysis 16 Odds Dissatisfaction With Care Atherosclerosis Risk in Communities: 75-year-old participant: Every 10 db increase in HL, odds of < satisfied increased.94 (95% CI: ). 85-year-old participant: Every 10 db increase in HL, odds of < satisfied increased 1.33 (95% CI: ). Note: Logistic regression model for odds of less than optimal satisfaction and hearing loss adjusted for age, sex, global cognitive score, Capitalist comorbidity Slides count (diabetes, hypertension, myocardial infarction, asthma, cancer, stroke, and hospital stay). Reed et al. (2018) JAGS (in press); Reed et al (in-prep)

17 Objectives of Talk 17 Part 1; Secondary Analyses Hearing Loss and satisfaction: A cross sectional analysis The impact of hearing loss on health care cost and utilization measures Part 2; Primary Data Development and feasibility investigation of a systematic strategy to address hearing loss in the inpatient setting

18 Secondary Analysis 18 Cost/Utilization - Methods Data Source: OptumLabs Data Warehouse (Jan 1, 2000 to Dec 31, 2014) 125 million de-identified data claims from across US Private and Medicare Advantage Physician, hospital, prescription claims information Socioeconomic and satisfaction measures (survey) Reed et al. (2018) JAMA-OTO

19 Secondary Analysis 19 Cost/Utilization - Methods Outcome Variables: 1. Medical Costs Total Health plan paid Out of Pocket Isolated to hearing loss 2. Number inpatient hospitalizations 3. Total days hospitalized 4. Number of readmissions with 30-days of discharge 5. Number Emergency Department Visits 6. Number of days with at least one outpatient visit Reed et al. (2018) JAMA-OTO

20 Secondary Analysis 20 Cost/Utilization - Methods Exposure Variable: Evidence of Hearing Loss from ICD codes 50 years No hearing aid usage evidence from ICD codes No hearing loss ICD code two years prior to index date Included ICD codes for hearing loss and/or sensorineural hearing loss Excluded ICD hearing codes such as sudden, hyperacusis, neural, conductive, central, etc. Persons with same year code related to ear disease such as otorrhea, otalgia Reed et al. (2018) JAMA-OTO

21 Secondary Analysis 21 Cost/Utilization - Methods Sample: Propensity matched (1:1) to those with evident hearing loss to those without any evidence of hearing loss (at any point) Matching variables Insurance type Demographic (Age, Sex, Education, Income) Census geographic region Education level Charlson comorbidty index Number of office visits, inpatient stays, ED visits Dementia, depression, stroke, cancer (breast, prostate, renal cell, colorectal) Baseline medical costs Reed et al. (2018) JAMA-OTO

22 Coronary Artery Disease, N (%) 8,744 (11.3) 8,850 (11.5) 2,119 (9.4) 2,195 (9.8) 208 (8.8) 224 (9.5) 2-year 5-year 10-year Baseline Characteristics: Hearing loss No hearing loss Hearing loss No hearing loss Hearing loss No hearing loss Secondary Analysis (n=77,207) (n=77,207) (n=22,426) (n=22,426) (n=2,364) (n=2,364) Demographics Age, mean (sd) (9.74) (9.70) (9.22) (9.20) (9.30) (9.28) Female, N (%) Cost/Utilization - Results 37,309 (48.3) 37,155 (48.1) 10,792 (48.1) 10,671 (47.6) 1,150 (48.6) 1,130 (47.8) Race, N (%) Asian 1,707 (2.2) 1,626 (2.1) 385 (1.7) 352 (1.6) 39 (1.6) 34 (1.4) Black 4,367 (5.7) 4,420 (5.7) 1,312 (5.9) 1,373 (6.1) 144 (6.1) 162 (6.9) Hispanic 3,933 (5.1) 4,039 (5.2) 1,061 (4.7) 1,050 (4.7) 89 (3.8) 95 (4.0) Unknown 20,428 (26.5) 20,452 (26.5) 6,282 (28.0) 6,389 (28.5) 605 (25.6) 642 (27.2) White 46,772 (60.6) 46,670 (60.4) 13,386 (59.7) 13,262 (59.1) 1,487 (62.9) 1,431 (60.5) Region, N (%) Midwest 21,896 (28.4) 21,951 (28.4) 6,903 (30.8) 6,796 (30.3) 861 (36.4) 830 (35.1) Northeast 14,536 (18.8) 14,323 (18.6) 3,966 (17.7) 3,906 (17.4) 418 (17.7) 436 (18.4) South 31,820 (41.2) 31, 929 (41.4) 9,205 (41.0) 9,329 (41.6) 882 (37.3) 899 (38.0) West 8,955 (11.6) 9,004 (11.7) 2,352 (10.5) 2,395 (10.7) 203 (8.6) 199 (8.4) Net worth, N (%) Unknown 22,874 (29.6) 22,951 (29.7) 6,978 (31.1) 7,137 (31.8) 673 (28.5) 718 (30.4) <$25,000 2,771 (3.6) 2,707 (3.5) 729 (3.3) 682 (3.0) 80 (3.4) 77 (3.3) $24,000-$149,000 7,610 (9.9) 7,447 (9.6) 2,038 (9.1) 1,998 (8.9) 206 (8.7) 185 (7.8) $150,000-$249,000 7,678 (9.9) 7,815 (10.1) 2,047 (9.1) 2,043 (9.1) 195 (8.2) 193 (8.2) $250,000-$499,000 16,404 (21.2) 16,564 (21.5) 4,745 (21.2) 4,738 (21.1) 558 (23.6) 560 (23.7) $500k+ 19,870 (25.7) 19,723 (25.5) 5,889 (26.3) 5,828 (26.0) 652 (27.6) 631 (26.7) Education, N (%) Less than 12 th grade 231 (0.3) 219 (0.3) 39 (0.2) 37 (0.2) ** ** High School diploma 14,647 (19.0) 14,568 (18.9) 3,937 (17.6) 3,890 (17.3) 380 (16.1) 386 (16.3) Less than bachelor s degree 31,981 (41.4) 32,166 (41.7) 9,139 (40.8) 9,072 (40.5) 992 (42.0) 965 (40.8) Bachelor s degree or more 12,068 (15.6) 11,886 (15.4) 3,621 (16.1) 3,594 (16.0) 444 (18.8) 430 (18.2) Unknown 18,280 (23.7) 18,368 (23.8) 5,690 (25.4) 5,833 (26.0) <546 <585 Medicare, N (%) 24,028 (31.1) 24,028 (31.1) 6,025 (26.9) 6,025 (26.9) 755 (31.9) 755 (31.9) Baseline Utilization Inpatient stays, mean (sd) 0.14 (0.47) 0.14 (0.43) 0.12 (0.42) 0.12 (0.39) 0.10 (0.34) 0.10 (0.33) Total inpatient days, mean (sd) 0.79 (4.94) 0.82 (4.30) 0.61 (3.31) 0.64 (3.22) 0.54 (2.49) 0.54 (2.36) Outpatient encounters, mean (sd) (18.18) (17.84) (16.07) (15.67) (14.35) (13.33) 22 ER visits, mean (sd) 0.32 (0.77) 0.32 (0.75) 0.27 (0.69) 0.27 (0.66) 0.24 (0.59) 0.22 (0.54) Medical costs, mean (sd) $8, ($20,645.18) $8, ($19, $7, ($17,586.02) $7, ($15,933.56) $6, ($14,413.20) $6, ($11,928.82) Baseline Comorbidities Charlson Comorbidity Index, mean (sd) 1.12 (1.71) 1.12 (1.68) 0.89 (1.48) 0.90 (1.47) 0.69 (1.24) 0.68 (1.20) Acute Myocardial Infarction, N (%) 324 (0.4) 301 (0.4) 87 (0.4) 76 (0.3) 13 (0.5) 14 (0.6) Depression, N (%) 8,358 (10.8) 8,325 (10.8) 2,147 (9.6) 2,109 (9.4) 201 (8.5) 192 (8.1) Dementia, N (%) 2,104 (2.7) 2,189 (2.8) 381 (1.7) 411 (1.8) 14 (0.6) 18 (0.8) Stroke, N (%) 1,963 (2.5) 1,953 (2.5) 466 (2.1) 437 (1.9) 35 (1.5) 30 (1.3) Mild Cognitive Impairment, N (%) 107 (0.1) 113 (0.1) ** ** ** ** Reed et al. (2018) JAMA-OTO

23 Secondary Analysis 23 Cost/Utilization - Results Post-Match, Unadjusted Health Service Costs and Utilization, Hearing Loss vs. No Hearing Loss Healthcare Outcome Measure Medical costs, mean (sd) Non-hearing loss Medical Costs, mean (sd) 2-year 5-year 10-year Hearing No hearing No hearing No hearing Hearing Loss Hearing Loss Loss loss loss loss (n=77,207) (n=77,207) (n=22,426) (n=22,426) (n=2,364) (n=2,364) $18, ($40,628.30) $18, ($40,613.22) $14, ($32,038.23) $14, ($32,038.23) $41, ($64,387.99) $40, ($64,371.86) $30, ($49,259.55) $30, ($49,259.55) $70, ($84,918.08) $70, ($84,894.26) $48, ($60,954.44) $48, ($60,954.44) Inpatient stays, mean (sd) 0.28 (0.78) 0.24 (0.69) 0.62 (1.34) 0.48 (1.08) 1.24 (2.05) 0.86 (1.60) Inpatient days, mean (sd) 1.57 (6.78) 1.31 (5.43) 3.25 (9.83) 2.50 (8.25) 6.56 (14.81) 4.46 (10.88) Outpatient visit days, mean (sd) Non-hearing loss office visit days, mean (sd) (36.49) (36.17) (35.18) (35.00) (72.64) (71.99) (62.21) (61.76) ($123.25) (121.14) (95.37) (94.79) ER visits, mean (sd) 0.64 (1.37) 0.52 (1.30) 1.39 (2.85) 1.10 (2.14) 2.61 (3.61) 1.81 (2.77) 30 Day Readmission, N (%) 1,542 (2.0) 1,198 (1.6) 829 (3.7) 646 (2.9) 164 (6.9) 114 (4.8) Reed et al. (2018) JAMA-OTO

24 Secondary Analysis 24 Cost/Utilization - Results Difference in Unadjusted Mean Patient Paid, Plan Paid, and Total Costs, Hearing Loss vs. No Hearing Loss Hearing loss associated with a 46.5% increase in healthcare costs over a 10- year period Reed et al. (2018) JAMA-OTO

25 Secondary Analysis 25 Results Unadjusted Difference in 30-day Readmissions for Subjects with Uncorrected Hearing Loss vs. No Hearing Loss Hearing loss associated with a 44% increase in risk of 30-day readmissions over 10-years Reed et al. (2018) JAMA-OTO

26 Secondary Analysis 26 Conclusion Hearing loss is associated with increase healthcare expenditures and resource utilization over a 10-year period. Hearing Loss is associated with higher odds of dissatisfaction with medical care. Patient-Provider communication as a mechanism? Limitations: Claims data has inherent limitations Exposure capture (those with means to access healthcare) Hearing loss individuals in non-hearing loss group No indirect costs (hearing aids?) Residual unmeasured confounding (despite matching) Reed et al. (2018) JAMA-OTO

27 Objectives of Talk 27 Part 1; Secondary Analyses The impact of hearing loss on health care cost and utilization measures Hearing Loss and satisfaction: A cross sectional analysis Part 2; Primary Data Development and feasibility investigation of a systematic strategy to address hearing loss in the inpatient setting

28 Screening and Intervention 28 Background Development and feasibility investigation of a systematic strategy to address hearing loss in the inpatient setting No universal program to identify and intervene on hearing loss in adults in the hospital system Many calls for adult hearing screening but most have ignored basic principles of implementation science Reed et al. (2018) In-Progress

Screening and Intervention 29 Background Implementation Science: Translating evidence into sustainable practice Current state of hearing screenings for adults: Run by foreign units (audiology) Single

29 Screening and Intervention 29 Background Implementation Science: Translating evidence into sustainable practice Current state of hearing screenings for adults: Run by foreign units (audiology) Single person screening all Generally from outside Purpose is generally for referral for formal hearing care Indirect implications Use specialized equipment Training, time Label patient (puts responsibility on patient) Lack training programs Lack of buy-in Pronovost, Berenholtz, & Needham et al. (2008) JAMA; Reed et al. (2018) In-Progress

30 ENHANCE 30 Background ENgaging Healthcare to Address Communication Environments Imbedded within current workflow Universal training end education sessions Improve fidelity and buy-in Purpose is to improve patient-provider communication Direct implications for staff Onus of communication placed on staff/providers Self-report hearing loss Minimizes training, time Pronovost, Berenholtz, & Needham et al. (2008) JAMA; Reed et al. (2018) In-Progress

31 ENHANCE 31 Background Admission: Screen for hearing loss using selfreport as part of common procedures No Hearing Loss Mild Hearing Loss Moderate Hearing Loss No Intervention Communication Signage Signage + Amplifier Pronovost, Berenholtz, & Needham et al. (2008) JAMA; Reed et al. (2018) In-Progress

32 ENHANCE 32 Background Pronovost, Berenholtz, & Needham et al. (2008) JAMA; Reed et al. (2018) In-Progress

33 ENHANCE 33 Background Pronovost, Berenholtz, & Needham et al. (2008) JAMA; Reed et al. (2018) In-Progress

34 ENHANCE 34 3-month feasibility From Jan Mar 2018: Feasibility Trial Med A and Med B at Bayview Hospital (Community Hospital) Engage (prior): 1 meeting with Armstrong Institute 2 meetings with ADA compliance office 3 meetings with Aesthetics Committee 3 meetings with Bayview Med A+B administration 5 meetings with Med A +B clinical nurse specialists, charge nurses Champion: Clinical nurse specialist 6 lunch and learn events with staff (3 each Med A and B) Pronovost, Berenholtz, & Needham et al. (2008) JAMA; Reed et al. (2018) In-Progress

35 ENHANCE 35 3-month feasibility Educate: 6 lunch and learn prior to kick off Materials were printed and distributed to all staff and providers 8 lunch and learn during program (~15-20 minutes) 4 in 2 nd week 4 in 4 th week 16 check-in huddles (~1-2 minutes) 4 in 1 st week 4 in 3 rd week 4 in 6 th week 4 in 8 th week Amounts to 8 formal education opportunities per shift over period Pronovost, Berenholtz, & Needham et al. (2008) JAMA; Reed et al. (2018) In-Progress

36 ENHANCE 36 3-month feasibility Evaluate : Patient perspective 502 screenings captured (77.9% of all admitted per charge nurse number reports) 41 indicated form not completed (15 unresponsive patient, 14 refusals, 12 time constraints) 543/644 for 84.3% capture rate Pronovost, Berenholtz, & Needham et al. (2008) JAMA; Reed et al. (2018) In-Progress

37 Age, mean (sd) Screened No HL Mild HL (n=157) ENHANCE (n=264) years years 3-month (±7.87) feasibility (±7.52) Moderate HL (n=81) years (±6.71) Overall (n=502) years (±4.35) Device Distributed 0/264 (0%) 7/157 (04.4%) 75/81 (91.4%) 82/502 (16.3%) Discharge Completed 121/ /157 71/81 (87.6%) 306 (60.9%) Evaluate : Patient perspective(45.8%) (72.6%) Previous communication troubles? Never 23 (19.0%) 17 (14.9%) 3 (04.2%) 43 (14.1%) Of 502 screened, 60.9% Sometimes (306) 71 completed (58.6%) 42 discharge (36.8%) 11 form (15.5%) 124 (40.5%) Most of the time 21(17.3%) 46 (40.4%) 41 (57.7%) 108 (35.3%) Always 6 (04.9%) 9 (07.9%) 16 (22.5%) 31 (10.1%) Hearing an issue previously in communication? No 116 (95.8%) 82 (71.9%) 19 (26.8%) 217 (70.9%) Yes 5 (04.1%) 32 (28.1%) 52 (73.2%) 89 (29.7%) Improved communication during current stay? No difference 21 (17.4%) 3 (02.6%) 4 (05.6%) 28 (09.2%) Slight Improvement 36 (29.8%) 21 (18.4%) 9 (12.7%) 66 (21.6%) Improved A little 46 (38.0%) 58 (50.9%) 17 (23.9%) 121 (39.5%) Improved A lot 18 (14.9%) 32 (28.1%) 41 (57.7%) 91 (23.7%) Satisfied with communication during current stay? Not Satisfied 11 (9.09%) 5 (04.4%) 1 (01.4%) 17 (5.6%) Somewhat Satisfied 12 (9.92%) 13 (11.4%) 4 (05.6%) 29 (9.5%) Mostly Satisfied 18 (14.9%) 15 (13.2%) 7 (09.9%) 40 (13.1%) Completely Satisfied 80 (66.1%) 81 (71.1%) 59 (83.1%) 220 (71.9%) See communication program used in other healthcare settings? No 21 (17.4%) 6 (05.3%) 1 (01.4%) 28 (09.2%) Yes Pronovost, 92 Berenholtz, (76.0%) 103 (90.4%) 67 (94.4%) & Needham et al. (2008) JAMA; Reed et 262 al. (2018) (85.6%) In-Progress Yes, with changes 8 (06.6%) 5 (04.4%) 3 (04.2%) 16 (5.2%) 37

38 ENHANCE 38 3-month feasibility Evaluate : Provider/Staff Perspective Best intervention ever! I normally have a loud voice and some people still can't hear me, but once they put the headphones on, then they can hear. It's nice not loosing your voice :) Such a wonderful program for patients. This has come in handy and patients truly benefit from this. This has made my job much easier! Thank you! Pronovost, Berenholtz, & Needham et al. (2008) JAMA; Reed et al. (2018) In-Progress

39 Negatively disrupted workflow ENHANCE 3-month feasibility Evaluate : Provider/Staff Perspective 18 completed survey Strongly Agree Took too long Made it easier to communicate with patients During program, found I was repeating myself less often During the program I found that patients were less confused when discussing care I found the program saved me time by making communication easier I found myself using best-practice communication more often regardless of whether patients had hearing loss Patients appreciated the program I felt like I needed more training to implement the program I would like to see this program implemented throughout the system The hearing screening and intervention program has value in the medical setting 39 Agree Neutral Disagree Strongly Disagree Pronovost, Berenholtz, & Needham et al. (2008) JAMA; Reed et al. (2018) In-Progress

40 ENHANCE 40 Implications Universal Adult Hearing Screening: Move towards acceptance Educating the rest of the medical community Future for objective measures Professionals in the context of OTC: Raise awareness Potential for knowledge disbursement Establishing a hearing care ecosystem HCAHPS (the Hospital Consumer Assessment of Healthcare Providers and Systems: Medicare reimbursement Hospital Incentive Pronovost, Berenholtz, & Needham et al. (2008) JAMA; Reed et al. (2018) In-Progress

General (Boston, MA): (2 floors, pre and post) nurse feedback, length of stay, HCAHPS Bayview Surgical Units: Process evaluation of

41 ENHANCE 41 Future Fall 2018: Redesign of materials Integrate demographic variables to calculate hearing loss Webinar training video with quiz Spring 2018: Mass. General (Boston, MA): (2 floors, pre and post) nurse feedback, length of stay, HCAHPS Bayview Surgical Units: Process evaluation of new materials and webinar looking at compliance and retention of knowledge Summer/Fall 2019: Johns Hopkins East Baltimore: cluster trial, length of stay Pronovost, Berenholtz, & Needham et al. (2008) JAMA; Reed et al. (2018) In-Progress

42 Special Thanks 42 Frank Lin, MD PhD Jennifer Deal, PhD Amber Willink, PhD Josh Betz, PhD Emily Boss, MD Esther Oh, MD, PhD Megru Liao, MFA Emily Pedersen, MPH Charlotte Yeh, MD (AARP) Aylin Altan, PhD (OptumLabs) Kevin Frick, AuD, PhD (MEEI, Harvard) NIH Kl2 ICTR (Johns Hopkins) Cochlear, Inc (Sydney, Australia)

Healthy Aging 11/10/2011. Frank R. Lin, M.D. Ph.D. Maintaining Physical Mobility & Activity. Keeping Socially Engaged & Active.

Healthy Aging 11/10/2011. Frank R. Lin, M.D. Ph.D. Maintaining Physical Mobility & Activity. Keeping Socially Engaged & Active. & Frank R. Lin, M.D. Ph.D. Assistant Professor Johns Hopkins Department of Otolaryngology-HNS Core Faculty Johns Hopkins Center on Aging & Health 27 October 2011 & Overview Why study hearing loss? physiology