1. Predictive value of the Hearing-Dependent Daily Activities Scale
-HDDA- to detect hearing loss in institutionalized elderly people
Facultat de Psicologia, Ciències de l’Educació i de l’Esport Blanquerna. Universitat Ramon Llull, Barcelona.
Unitat de Convalescència i Rehabilitació. Hospital Sociosanitari. Parc Sanitari Pere Virgili, Barcelona.
Valero-Garcia, J. (1) Vila-Rovira, J.M. (1) Porteiro, M. (1) & Talleda, N. (2)
Figure 1. Mean hearing threshold for each ear and frequency explored.
Figure 3. Relationship between mean scores using the TA and the HDDA Scale, according to the degree of hearing loss.
The results from the pure tonal audiometry were not influenced by the presence or absence of mild cognitive impairment (t=- .397; p= .692). However, with the HDDA Scale, we could observe the following scores (Figure 6).
The difference is statistically significant (t= 2.564; p< .05; d= .44). That is, the results of the HDDA Scale could be somehow influenced by the presence or no presence of mild cognitive impairment.
Discussion
Self-assessment scales can be useful to get to know the impact of hearing loss on a person’s daily life, as they help us in early detection and diagnosis.
In our study, the HDDA Scale was administered to a highly old population, 48.1% of them with mild cognitive impairment. This allowed us to corroborate the effectiveness of the Scale to identify individuals with hearing loss over 40dB. However, it is important to note that, in the case of people with mild cognitive impairment, we observed that their answers to the questionnaire are less reliable, as they tend to underestimate the potential problems posed by hearing loss in their everyday life.
Introduction
Hearing loss is a significant problem for the elderly, which has better prognosis when early detected. There is more and more evidence that hearing loss in the elderly presents a higher risk of comorbidity with other problems such as cognitive impairment or depression (Lin et al, 2011; Valero-García, Bruno & Signo, 2012).
There are some factors that are considered to be more and more necessary: to promote early detection from mainstream health care systems; to help users acquire hearing aids; to carry out follow-ups of their application; and to develop rehabilitation programms adjusted to the specificity of elderly people with hearing problems.
An instrument developed to identify the functional impact of possible hearing loss in the elderly is the Hearing-Dependent Daily Activities Scale -HDDA- (López-Torres et al., 2008; Boix, 2009).
Objective
Presenting the results of a research study to test the effectiveness of the HDDA Scale as a tool for detecting hearing loss, while also considering the influence of mild cognitive impairment –MCI-.
Figure 4. Relationship between TA and HDDA Scale, grouped according to the degree of hearing loss (± 40dB).
Table 1. Comparison of results using the TA and the HDDA Scale
No HL
SHL
MHL
TAa -
34.30dB (DT=3.86)
52.04dB (DT=8.08)
78.51dB (DT=5.60)
ADDAb
19.62
(DT= 4.55)
18.95
(DT= 3.82)
10.91
(DT=6.62)
10.0
(DT=8.87)
Method
Cross sectional study in 135 elderly (81 female and 54 male) with an average age of years old, 110 institutionalized. Various tests have been conducted. For hearing abilities: Tonal Audiometry –TA- and HDDA Scale; for cognitive abilities: Pfeiffer’s Questionnaire.
Results
68 subjects had audition levels within parameters of normality. 22 subjects had mild hearing loss; 38 had moderate hearing loss, and 7 subjects had severe hearing loss, mainly first-degree. Figure 1 shows the audiometric profile for each ear for the people with hearing impairment.
According to the HDDA Scale, 55 subjects (40.8%) had no hearing loss, whereas the rest, 80 subjects (59.2%), did show some evidence of hearing loss. Table 1 shows results obtained through the TA and scores in the Scale for every degree of hearing loss reported.
If we compare results from both examinations, we can see some relationship when the audition of the entire sample was examined using both the TA and the HDDA Scale (Figures 2 and 3).
The HDDA Scale is particularly sensitive to detect moderate and severe hearing loss (t= .836; p< .001; d= 1.54) (Figure 4).
Pfeiffer’s Questionnaire was administered to find out the degree of cognitive impairment in all the subjects of our sample, resulting in very similar mean scores for both men and women [8.84 (SD= 1.44) and 8.22 (SD= 2.22), respectively].
If we only consider those subjects with hearing loss, there were statistically significant differences [t= .019 (p< .05)]. These data show that there is a relationship among cases with worse results in the audiometric test and higher Pfeiffer scores. Both results from the TA and the HDDA Scale statistically correlate with Pfeiffer’s Questionnaire: [r= .665 (p< .01)] for the HDDA Scale, and [r= .310 (p< .05)] for the TA (Figure 5).
References
Boix, C. (2009). Estudio de la deficiencia auditiva en las personas mayores. Diseño y validación de la Escala ADDA. Tesis Doctoral, Universidad Autónoma de Madrid, Facultad de Medicina.
López-Torres, J., Boix, C., Téllez, J., Parraga, I., López, M. A., Escobar, F. & Otero, A. (2008). The Hearing-Dependent Daily Activities Scale to Evaluate Impact of Hearing Loss in Older People. Ann Fam Med. Sep. 6 (5),
Lin, F. R., Metter, E. J., O'Brien, R. J., Resnick, S. M., Zonderman, A. B. & Ferrucci L. (2011). Hearing loss and incident dementia. Archives of Neurology, 68 (2),
Valero-Garcia, J., Bruna, O. & Signo, S. (2012). Envelliment i comunicació: interrelació entre factor auditius, cognitius i emocionals. Aloma. Revista de Psicologia i Ciències de l’Educació. 30, 1,
a. Mean audition in decibels for every group with hearing loss. The total average hearing loss for the group was 45.7dB.
b. Mean scores for every group using the HDDA Scale. The total mean score for the entire sample was 16.7.
Figure 2. Correlation of the audition examination carried out with the TA and the HDDA Scale.
Figure 5. Mean scores from Pfeiffer’s Q., considering presence or no presence of hearing loss.
Acknowledgements:
We thank the Hospital Sociosanitari Pere Virgili of Barcelona and those responsible
of Nursing and Therapies their collaboration.
Financial support:
This study received financial support by Programa de Ayudas a Proyectos de Investigación de la FPCEE Blanquerna. Universitat Ramon Llull. 
Figure 6. Comparison of mean scores for the sample in the HDDA Scale, according to Pfeiffer’s Q. scores.
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