American Journal of Audiology Vol.19 1-2 June 2010. doi:10.1044/1059-0889(2010/ed-01)
© American Speech-Language-Hearing Association
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Barriers to Hearing Health Care: Current Status and a Glimpse at the Future

Sheila R. Pratt, Editor

American Journal of Audiology

Hearing loss is one of the most common chronic health conditions reported by older adults, especially by men (Pleis & Coles, 2003; Ries, 1982). The onset of hearing loss varies across individuals, but hearing loss and perceived hearing impairment are common by middle age (Agrawal, Platz, & Niparko, 2008; Pleis & Coles, 2003). By age 70, approximately 30% of the U.S. population perceive themselves to be hearing impaired, and about 50% of adults age 80 and older report being hearing impaired (Desai, Pratt, Lentzner, & Robinson, 2001). Furthermore, hearing loss severity, as tested by pure-tone audiometry, is highly correlated with age. Although it is arguable whether hearing loss necessarily has to occur with age, all but about 10% of the population acquire some hearing loss if they live to be 80 years old (Cruickshanks et al., 1998; Morrell, Gordon-Salant, Pearson, Brant, & Fozard, 1996).

Despite hearing loss being widespread in the adult population, treatment options have not been broadly accepted by the general population, especially among those with mild to moderate losses. For example, in the United States, less than 25% of adults with hearing loss own hearing aids, and the percentage is less for persons with mild to moderate losses than for those with more severe losses (Kochkin, 2005, 2007). Many of these adults do not perceive or acknowledge a hearing loss, and even if a hearing loss is reported, many adults with hearing loss do not seek hearing aids for 10 to 13 years after first detection, at which time the severity of the loss usually has increased (Davis, Smith, Ferguson, Stephens, & Gianopoulos, 2007; Kochkin, 2007). Accessing auditory rehabilitation services beyond the fitting of sensory devices is even more restricted, despite a limited number of recent studies suggesting their effectiveness (Sabes & Sweetow, 2007; Sweetow & Sabes, 2006).

Given the impact of auditory deprivation on the auditory system (Munro, 2008; Neuman, 2005; Silman, Gelfand, & Silverman, 1984), there is reason to believe that early amplification with adults, especially those with mild and moderate losses, might alleviate some of the central auditory issues observed in older adults with hearing loss. Early amplification might also affect other conditions that commonly co-occur with or are consequent to hearing loss in older adults, such as social isolation, depression, reduced mobility, impaired vision, and cognitive decline (Arlinger, 2003; Campbell, Crews, Moriarty, Zack, & Blackman, 1999; Mulrow et al., 1990; Uhlmann, Larson, Rees, Koepsell, & Duckert, 1989). Younger adults and adults with more residual hearing might acclimate quicker to amplification than older adults and adults with less residual hearing. They might also demonstrate greater benefit from auditory and communication training and counseling procedures. Yet substantive barriers exist that interfere with early and more universal treatment of hearing loss in adults of all ages (Kochkin, 2007).

The priorities of the U.S. Department of Health and Human Services, as indicated by Healthy People 2020, include timely and appropriate hearing screening and assessment as well as increased fitting and usage rates of hearing aids and other sensory devices in persons with hearing loss (U.S. Department of Health and Human Services, 2009). In addition, the National Institute on Deafness and Other Communication Disorders (NIDCD) at the National Institutes of Health considers this goal a priority. The NIDCD Senate Report language for fiscal year 2010 recommended support for research to develop and improve hearing aids, and reduce hearing aid costs (S. Rep. No. 110–410, 2009). The NIDCD also formed a working group that was convened in August 2009 to review the status of hearing health care delivery models and barriers to accessible and affordable hearing health care for adults with mild to moderate hearing loss. The working group developed a substantial list of specific research recommendations but generally recommended that the NIDCD support research looking at access to services, development and assessment of screening and assessment procedures, hearing aid innovation and outcomes, patient variables and outcomes, workforce factors, delivery systems, and medical evaluations and regulatory issues.

The summary report from this working group can be viewed at www.nidcd.nih.gov/funding/programs/09HHC/summary.htm. The NIDCD acted on the recommendations of the working group with two requests for applications and one program announcement targeting accessible and affordable hearing health care (see http://grants.nih.gov/grants/guide/rfa-files/RFA-DC-10-001.html, http://grants.nih.gov/grants/guide/rfa-files/RFA-DC-10-002.html, and http://grants.nih.gov/grants/guide/pa-files/PAR-10-112.html). These funding mechanisms target clinically related and clinically applied research topics, and if successful should produce direct, widespread, and long-term influences on the profession of audiology and how patients with hearing loss are evaluated and treated. Therefore, I encourage the readers of the American Journal of Audiology to review the working group summary and the NIDCD funding announcements to consider the current status of hearing health care and get a glimpse at our future.


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References
 
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