JAMA Associate Editor Thomas B. Cole, MD, MPH, gives editorial insight into a randomized clinical trial investigating whether a hearing care intervention consisting of a community health worker–delivered personal sound amplification device improves communication function among older adults with hearing loss, published in the December 20, 2022, issue of JAMA.
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Hello, I’m JAMA Associate Editor Thomas Cole. I'd like to discuss a randomized clinical trial that was recently published in JAMA about an intervention for hearing loss in older adults. Mild to moderate hearing loss is a common problem for people aged 65 and older. It can interfere with daily communication, and is associated with increased risks of dementia, falls, and depression. Hearing aids are effective treatments for hearing loss, but they need to be fitted and adjusted by an audiologist, they’re expensive, and the cost is seldom covered by Medicare or other forms of insurance-- so patients may have to pay thousands of dollars out-of-pocket.
Many older adults with hearing loss may benefit from personal sound amplification products, also known as PSAPs, which are much less expensive than hearing aids and do not require fitting by an audiologist. The clinical trial published in JAMA investigated their effect on self-perceived communication. PSAPs can be purchased over-the-counter at pharmacies and other retail stores. Most PSAPs cost $200-400, which is a fraction of the cost of hearing aids. Some PSAPs are even less expensive. Here is one example of a PSAP that can be purchased online. It has a headset that fits over the ears, like this, and a microphone that is pointed toward the person who is speaking, like this. The volume is adjusted here. Other types of PSAPs are small devices that fit over the ear, like hearing aids.
In this trial, trained community health workers provided a PSAP to each study participant and explained how it works. The participants selected either a device that was similar to a conventional behind-the-ear hearing aid or a device with a wired headset, like the one I showed you. Three months after receiving the PSAP, each participant completed an interviewer-administrated questionnaire about the influence of hearing loss on daily communicative function, including restrictions in participation in daily life. Compared with hearing-impaired older adults who had not received a PSAP, those who did receive a PSAP had significantly improved self-perceived communication function.
The findings of this study apply to older adults with age-related hearing loss. Patients with other types of hearing loss may require specialized evaluation by an audiologist. The participants in this study were a primarily urban-dwelling population of individuals who identify as low income, so the study may have limited generalizability to other populations, such as to higher-income patients. Study participants were evaluated 3 months after receiving a PSAP, and it is not clear from this trial whether communication improvement would persist over a longer period of follow-up. However, I find it encouraging that a low-cost, widely available technology helped the older adults in this trial to cope with their hearing impairment and better engage with their community environments.
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