Committee on Accessible and Affordable Hearing Health Care for Adults

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1 Committee on Accessible and Affordable Hearing Health Care for Adults IOM April 27, 2015 Molly V. Wagster, PhD Chief, Behavioral & Systems Neuroscience Branch Division of Neuroscience National Institute on Aging

2 Hearing Loss and Aging Strong relationship between hearing loss and age older adults 50% ages 75 years or older have significant hearing loss 25% ages % ages Hearing loss also a concern for middleaged adults 0.9M aged M aged have significant hearing loss

3 Prevalence of Hearing Loss in the United States, Lin et al., Arch Int Med. 2011

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

5 Only 20% of those with hearing loss who could benefit from hearing aids actually use them. 30% aged 70 and older; 16% aged 20 to 69 Perceived benefit, cost, stigma, belief they can get along without help Many individuals are reluctant to admit/treat hearing loss Most hearing-aid users have hearing loss for several years and progress to mod-severe before acquiring a hearing aid The needs of the majority of adults with hearing loss are not being met.

6 Jan 2014 IOM Workshop on Hearing Loss and Healthy Aging Hearing Loss and impact on physical, cognitive, and psychosocial function with age Current state of hearing health care delivery Rapidly changing technologies and opportunities Innovative care approaches Research needs Collaborative strategies

7 Hearing Loss and Function Psychosocial Function Hearing loss linked to increased risk of depression MacDonald, 2011 Saito, et al., JAGS, 2010 Gopinath, et al., Age and Aging, 2012 Increased social isolation linked to hearing loss Wallhagen et al., JAGS, 2001 Weinstein & Ventry, J Speech, Language & Hearing Res, 1982 Physical Function Hearing loss linked to increased risk of falls Viljanen et al., JAGS, 2009 Greater levels of hearing loss associated with poorer function Chen et a., JAGS, 2014 Driving Ability Individuals with hearing loss more likely to stop driving Gilhotra et al., Clin & Exp Ophthal., 2001 Hearing loss associated with significantly poorer driving performance in the presence of auditory distractors Hickson et al., JAGS, 2010

8 Hearing Loss and Cognition Association between hearing loss and brain structure Peelle et al., J Neurosci, 2011 Lin et al., Neuroimage, 2014 Association between hearing loss and cognitive decline Lin et al., JAMA Int Med., 2013 Uhlmann et al., JAMA, 1989 Association between hearing loss and dementia Gallacher et al., 2012 Lin et al., Arch Neurol., 2011

9 Hearing Loss & Incident Dementia Dementia incidence in 639 adults followed for >10 years in the BLSA Hazard ratio of incident all-cause dementia (compared to normal hearing) a HR 95% CI p Mild Moderate Severe a Adjusted for age, sex, race, education, DM, smoking, & hypertension Lin et al., Arch Neurol., 2011

10 Intervention at the earliest stages may lead to better outcomes Beneficial to initiate care early, maintain quality of life, before cognitive or other age-related declines occur Plasticity effects may require less auditory retraining

11 Dying to Be Heard: Hearing Healthcare at the End of Life Hearing_Healthcare_at_t he_end.1.aspx In the fall, the Institute of Medicine (IOM) released Dying in America, a major consensus report on improving the quality and availability of services for people nearing the end of their lives. The report listed a dozen proposed core components of quality end-of-life care, including: * Frequent assessment of the patient's physical, emotional, social, and spiritual well-being * Management of emotional distress * Counseling of patient and family * Attention to the patient's social and cultural context and social needs * Attention to the patient's spiritual and religious needs These items, and many of the other elements of quality care proposed by the IOM, have one thing in common: they require communication with the patient an ability that is seriously hampered by the hearing impairments that affect at least one of every three people age 65 and over.

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