1. Hearing Aid Use and Perceived Hearing Handicap in Older Adults
Terry L. Wiley
Mary E. Fischer
David M. Nondahl
Karen J. Cruickshanks
University of Wisconsin-Madison
This research was supported in part by grants from the National Institute on Aging (NIH RO1 AG11099, KJC) and the National Eye Institute (NIH U01 EY0694, R. Klein & B.E.K. Klein).

2. Hearing loss is prevalent in older adults
In earlier reports from the Epidemiology of Hearing Loss Study (EHLS), the significant prevalence and incidence of hearing impairment among older adults have been documented (Cruickshanks et al., 1998; Cruickshanks et al., 2003).

3. EHLS Numbers N at risk % All 3556 45.9 48-59 yrs 1246 20.6 60-69 yrs
1056
43.8
70-79 yrs
892
66.0
80-92 yrs
362
90.0

4. Hearing loss increases with age

5. And, is greater for men than for women

6. But, the prevalence of hearing aid use is low

7. More Details on Hearing Aid Use
In the Popelka et al (1998) study, for example, the prevalence of current hearing aid use among older adults with a hearing loss (pure-tone average > 25 dB HL for 500, 1000, 2000, and 4000 Hz in the worse ear) was only 14.6 %.
Even among the most severely affected participants, the prevalence was only 55%.

8. Hearing Aid Acquisition
Recently, Fischer et al (2008) reported findings on hearing aid acquisition for participants in the EHLS cohort.
Among those participants with significant hearing loss followed for 10 years, approximately 36% had acquired a hearing aid.
Close to two-thirds of the subjects followed for 10 years did not acquire a hearing aid although hearing ability had worsened.

9. Disappointing Findings
The relatively low prevalence of hearing aid use among older adults is disappointing because the majority of people with significant hearing impairment are likely to derive at least some benefit from a hearing aid (Jerger et al., 1995; Mulrow et al., 1990).

10. Current Study
Purpose: To evaluate the effect of hearing aid use on perceptions of hearing handicap.
Specifically, we evaluated self-perception of hearing handicap for older adults who did and did not use a hearing aid.
The central question of interest was do older adults with a hearing loss who are hearing aid users report a lower prevalence of hearing handicap than nonusers with hearing loss, even when adjusting for other factors?

11. Participants
Participants were examined as part of the 10-year follow-up examination of the Epidemiology of Hearing Loss Study (EHLS) (n = 2395; ages years). 
Characteristics of the original cohort have been published in earlier works (Cruickshanks et al, 1998; Cruickshanks et al, 2003). 
In the current study, we sampled 363 participants with a mean age of 80.6 years who had a pure-tone average (PTA) ( Hz) > 40 dB HL in the better ear, answered yes to the question "Do you use your hearing aid now?" and for whom we had complete information for HHIE, age, sex and self-perceived hearing quality.

12. Procedures
Each participant answered the 10 questions from the Hearing Handicap Inventory for the Elderly-Screening Version (HHIE-S), and
reported on their perceived hearing ability (Excellent, Very Good, Good, Fair, or Poor), and
reported on their use of a hearing aid. 

13. HHIE-S
The HHIE-S was administered to all participants; hearing aid users answered the HHIE-S items based on their experiences while wearing the hearing aid.
For purposes of this report, an
HHIE-S score greater than 8 was considered indicative of a self-reported hearing handicap (Bess et al, 1989; ASHA, 1997, p. 54).

14. Data Analyses
Chi-square and unpaired t-tests were used to compare characteristics of subjects with and without a self-reported hearing handicap.
Logistic regression analyses provided estimates of the effect of hearing aid use on hearing handicap—specifically odds ratios (OR) and 95% confidence intervals (95% C.I.).

15. Covariates
age
gender
pure-tone average (PTA) for Hz in the better ear
self-perception of hearing quality (Excellent, Very Good, Good, Fair, Poor)

16. Results
Of the 363 participants (mean age = 80.6 years, mean PTA = 51.3 dB HL), 167 (46%) were hearing aid users and 196 (54 %) did not wear a hearing aid.
For the group using a hearing aid, 52% reported a perceived hearing handicap; 56% of those not using a hearing aid reported a hearing handicap (OR=0.9, 95% C.I.=0.6,1.3).

17. Logistic Regression Table
Characteristic
OR (95% C.I.)
Hearing Aid User
0.46 (0.28,0.77)
Age
0.96 (0.93,0.99)
Male Sex
0.92 (0.57,1.49)
PTA
1.03 (0.999,1.05)
Perceived hearing: Excellent, Very Good, or Good
1.0
Perceived Hearing: Fair
3.71 (1.91,7.20)
Perceived Hearing: Poor
9.09 (4.35,19.02)

18. More Results
After adjusting for the degree of hearing loss, age, gender, and self-perception of hearing quality, participants wearing a hearing aid were approximately half as likely to report a hearing handicap than those not wearing an aid (OR=0.5, 95% C.I.=0.3,0.8).

19. Conclusion and Implication
In the current study, older adults using hearing aids were approximately half as likely to report a hearing handicap than those not wearing an aid.
This finding, at least in part, suggests derived benefit from hearing aid use and supports continued efforts aimed at addressing the underutilization of hearing aids in older adults.