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Hearing Aids for Adults With Mild to Moderate Hearing Loss

Author/s: 
Karina C. De Sousa, De Wet Swanepoel

Hearing loss is defined as an impaired ability to hear sounds at thresholds considered to be normal. Projections based on audiometric data from the National Health and Nutrition Examination Survey estimate that by 2030, approximately 55 million US adults will have hearing loss, including 35 million with mild loss (25-40 dB) and nearly 20 million with moderate or greater loss (>40 dB).1 The most common cause of hearing loss among hearing aid users is bilateral sensorineural hearing loss due to cochlear hair cell or auditory nerve degeneration. Functional effects of hearing loss differ with severity. Mild hearing loss may affect the ability to understand speech in noisy environments; moderate or greater hearing loss affects the ability to have individual conversations in a quiet room.

Untreated hearing loss is associated with social isolation that can reduce quality of life.2 A meta-analysis of 5 randomized trials (825 adults with mild to moderate hearing loss) that compared those not receiving hearing aids with those who received hearing aids that amplified sounds via air conduction had improved ability to discriminate sound and speech and hearing-related quality of life based on Hearing Handicap Inventory for the Elderly,2 which quantifies self-perceived functional and emotional hearing handicap (such as negative feelings and psychological distress from communication problems). The Hearing Handicap Inventory for the Elderly scores (lower scores indicate less handicap; scale, 0-100) improved by −26.5 (95% CI, −42.2 to −10.8) points with hearing aids, exceeding the minimal clinically important difference of 18.7 points.2

Amplification with hearing aids is the primary treatment for hearing loss, but use is limited. Traditional Medicare does not cover hearing aids, and coverage for associated services remains limited. In a nationally representative cohort using data from the National Health and Aging Trends Study, hearing aid use among US adults aged 71 years and older with hearing loss was 29.2% in 2021, including 14.4% among those with mild loss and 45.3% among those with moderate hearing loss.3 Although reasons for nonuse were not directly assessed, lower-income individuals, along with those who have milder degrees of hearing loss, are less likely to use hearing aids.3 Until recently, hearing aids in the US could only be obtained through licensed hearing care professionals such as audiologists. However, since October 2022, the US Food and Drug Administration has allowed adults to buy hearing aid devices without a medical examination, prescription, or professional fitting. This regulatory change has enabled over-the-counter (OTC) direct-to-consumer hearing aids, with potential to broaden access.

Keywords 
hearing loss hearing aids Audiologists quality of life

Seasonal Affective Disorder

What is seasonal affective disorder?

Many people go through short periods when they feel sad or unlike their usual selves. Sometimes, these mood changes begin and end when the seasons change. Many people feel "down" or have the "winter blues" when the days get shorter in the fall and winter and feel better in the spring when longer daylight hours return.

Sometimes, these mood changes are more serious and can affect how a person feels, thinks, and behaves. If you have noticed significant changes in your mood and behavior when the seasons change, you may be experiencing seasonal affective disorder (SAD).

In most cases, SAD symptoms start in the late fall or early winter and go away during the spring and summer, known as winter-pattern SAD or winter depression. Other people experience depressive symptoms during the spring and summer months, known as summer-pattern SAD or summer depression. Summer-pattern SAD is less common.

Keywords 
Seasonal Affective Disorder depression sleep Appetite Season winter

The frequency and impact of undiagnosed benign paroxysmal positional vertigo in outpatients with high falls risk

Author/s: 
Hawke, L. J., Barr, C. J., McLoughlin, J. V.

Background
The frequency and impact of undiagnosed benign paroxysmal positional vertigo (BPPV) in people identified with high falls risk has not been investigated.

Objective
To determine the frequency and impact on key psychosocial measures of undiagnosed BPPV in adult community rehabilitation outpatients identified with a high falls risk.

Design
A frequency study with cross-sectional design.

Setting
A Community Rehabilitation Program in Melbourne, Australia.

Subjects
Adult community rehabilitation outpatients with a Falls Risk for Older People in the Community Screen score of four or higher.

Methods
BPPV was assessed in 34 consecutive high falls risk rehabilitation outpatients using the Dix–Hallpike test and supine roll test. Participants were assessed for anxiety, depression, fear of falls, social isolation and loneliness using the Hospital Anxiety and Depression Scale, Falls Efficacy Scale-International and De Jong Gierveld 6-Item Loneliness Scale.

Results
A total of 18 (53%; 95% confidence interval: 36, 70) participants tested positive for BPPV. There was no significant difference between those who tested positive for BPPV and those who did not for Falls Risk for Older People in the Community Screen scores (P = 0.555), Hospital Anxiety and Depression Scale (Anxiety) scores (P = 0.627), Hospital Anxiety and Depression Scale (Depression) scores (P = 0.368) or Falls Efficacy Scale-International scores (P = 0.481). Higher scores for the De Jong Gierveld 6-Item Loneliness Scale in participants with BPPV did not reach significance (P = 0.056).

Conclusions
Undiagnosed BPPV is very common and associated with a trend towards increased loneliness in adult rehabilitation outpatients identified as having a high falls risk.

Legal Advocacy To Improve Care For Older Adults With Complex Needs

Author/s: 
Hooper, Sarah, Parekh, Ami, Fabiny, Anne, Teitelbaum, Joel

Legal advocacy is a recognized strategy to address social factors that influence the health of populations with complex care needs. Such advocacy can improve housing stability, increase access to public benefits that support a host of social needs, assure that medical and financial proxy decision makers are in place, and reduce psychosocial distress. 

Keywords 
Elderly care elder abuse social workers home care dementia medicare elderly aged
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