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J Am Acad Audiol 2021; 32(06): 355-365
DOI: 10.1055/s-0041-1728800
Research Article

Heterogeneity in Vision, Hand Function, Cognition, and Health Literacy Among Older Veterans: Impacts, Outcomes, and Clinical Recommendations for First-Time Hearing Aid Users

Gabrielle H. Saunders 
1   VA Rehabilitation Research and Development Service (RR&D), National Center for Rehabilitative Auditory Research, VA Portland Health Care System, Portland, Oregon
2   Manchester Center for Audiology and Deafness (ManCAD), School of Social Sciences, University of Manchester, Manchester, United Kingdom
,
Leslie Grush
1   VA Rehabilitation Research and Development Service (RR&D), National Center for Rehabilitative Auditory Research, VA Portland Health Care System, Portland, Oregon
,
Jay Vachhani
1   VA Rehabilitation Research and Development Service (RR&D), National Center for Rehabilitative Auditory Research, VA Portland Health Care System, Portland, Oregon
,
Katharina V. Echt
3   Department of Veterans Affairs Birmingham/Atlanta Geriatric Research, Education and Clinical Center (GRECC), Birmingham, Alabama and Atlanta, Georgia
4   Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
,
Susan Griest
1   VA Rehabilitation Research and Development Service (RR&D), National Center for Rehabilitative Auditory Research, VA Portland Health Care System, Portland, Oregon
5   Department of Otolaryngology/Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon
,
M. Samantha Lewis
1   VA Rehabilitation Research and Development Service (RR&D), National Center for Rehabilitative Auditory Research, VA Portland Health Care System, Portland, Oregon
5   Department of Otolaryngology/Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon
6   School of Audiology, Pacific University, Hillsboro, Oregon
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Abstract

Background Age-related changes (both normal and pathological), and health literacy are relevant to audiological practice. Changes associated with the musculoskeletal, vascular, and nervous systems drive manual, visual, and cognitive function. These in turn affect the capabilities required for effective hearing aid (HA) skill acquisition, use, and management. Meanwhile, health literacy influences the ability to gain access to, understand, and use information, which is important for promoting and maintaining HA use and management. Understanding the interindividual variability of these variables can help audiologists characterize those individuals who might have suboptimal HA outcomes. This knowledge can then inform better clinical practices and guide implementation of processes to improve care quality and outcomes.

Purpose The aim of the study is to assess the variation in manual, visual, and cognitive function, and health literacy, among community-dwelling older individuals, and to determine whether and which of these variables are associated with reported HA outcome and/or the knowledge and skill to manage HAs.

Research Design Data presented here were collected as part of an efficacy trial of four variants of HA orientation. The data were collected at baseline (prior to HA fitting) and after 4 to 8 weeks of HA use.

Study Sample The study sample consists of 265 U.S. Veterans aged 51 to 87 years with no previous HA experience who were scheduled to receive their first pair of HAs from the Veterans Administration.

Data Collection and Analysis We assessed baseline measures of hand function, vision, cognition, and health literacy just prior to participants receiving their first pair of HAs. HA management skills and knowledge, and HA outcome were measured after 4 to 8 weeks of HA use using the Hearing Aid Skills and Knowledge (HASK) and International Outcomes Inventory for Hearing Aids (IOI-HA), respectively. Data collected here was compared with published norms to assess variation in baseline measures. Associations between baseline performance and outcomes data were examined using t-tests comparing participants who performed at or above age-based norms with those who performed below age-based norms.

Results Participants' performance on the baseline measures was highly variable, with the proportions of individuals performing below norms varying by test measure. When combining data across the nine baseline measures, approximately 10% of participants performed below published norms on five or more measures, and 85% performed below norms on at least one measure. Poor manual dexterity, ability to learn a new task, and ability to draw inferences from spoken information negatively impacted HA management and outcome.

Conclusion There was a considerable heterogeneity among a community-dwelling sample of first time HA users in terms of sensory, cognitive, and motor function. Clinicians should consider modifying their clinical practice to account for such heterogeneity and best support their patients in adapting to new HAs.

Keywords

hearing aids - auditory rehabilitation - individual differences


Publication History

Received: 14 October 2020

Accepted: 11 January 2021

Article published online:
01 June 2021

© 2021. American Academy of Audiology. This article is published by Thieme.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 World Health Organization. World report on ageing and health. 2015 . Accessed April 10, 2021 at: https://www.who.int/ageing/events/world-report-2015-launch/en/
    PubMedGoogle Scholar
  • 2 Lowsky DJ, Olshansky SJ, Bhattacharya J, Goldman DP. Heterogeneity in healthy aging. J Gerontol A Biol Sci Med Sci 2014; 69 (06) 640-649
    CrossrefPubMedGoogle Scholar
  • 3 Santoni G, Angleman S, Welmer A-K, Mangialasche F, Marengoni A, Fratiglioni L. Age-related variation in health status after age 60. PLoS One 2015; 10 (03) e0120077
    CrossrefPubMedGoogle Scholar
  • 4 Carmeli E, Patish H, Coleman R. The aging hand. J Gerontol A Biol Sci Med Sci 2003; 58 (02) 146-152
    CrossrefPubMedGoogle Scholar
  • 5 Owsley C. Vision and aging. Annu Rev Vis Sci 2016; 2: 255-271
    CrossrefPubMedGoogle Scholar
  • 6 Harada CN, Natelson Love MC, Triebel KL. Normal cognitive aging. Clin Geriatr Med 2013; 29 (04) 737-752
    CrossrefPubMedGoogle Scholar
  • 7 Saunders GH, Dillard LK, Zobay O, Cannon JB, Naylor G. Electronic health records as a platform for audiological research: data validity, patient characteristics and hearing-aid use persistence among 731,213 US Veterans. Ear Hear 2021; 42 (04) 927-940
    CrossrefPubMedGoogle Scholar
  • 8 Kumar M, Hickey S, Shaw S. Manual dexterity and successful hearing aid use. J Laryngol Otol 2000; 114 (08) 593-597
    CrossrefPubMedGoogle Scholar
  • 9 Singh G, Pichora-Fuller MK, Hayes D, von Schroeder HP, Carnahan H. The aging hand and the ergonomics of hearing aid controls. Ear Hear 2013; 34 (01) e1-e13
    CrossrefPubMedGoogle Scholar
  • 10 Meister H, Lausberg I, Kiessling J, von Wedel H, Walger M. Identifying the needs of elderly, hearing-impaired persons: the importance and utility of hearing aid attributes. Eur Arch Otorhinolaryngol 2002; 259 (10) 531-534
    CrossrefPubMedGoogle Scholar
  • 11 Watson G, Echt KV. Aging and vision loss. In: Corn A, Koenig A. eds. Foundations of Low Vision: Clinical and Functional Perspectives. New York: AFB Press; 2010: 871-916
    Google Scholar
  • 12 Echt KV. Harnessing technology to enhance health literacy in aging. Cogn Technol 2007; 12 (01) 45-54
    Google Scholar
  • 13 Saunders GH, Echt KV. An overview of dual sensory impairment in older adults: perspectives for rehabilitation. Trends Amplif 2007; 11 (04) 243-258
    CrossrefPubMedGoogle Scholar
  • 14 Fuller SD, Mudie LI, Siordia C, Swenor BK, Friedman DS. Nationwide prevalence of self-reported serious sensory Impairments and their associations with self-reported cognitive and functional difficulties. Ophthalmology 2018; 125 (04) 476-485
    CrossrefPubMedGoogle Scholar
  • 15 Wisdom NM, Mignogna J, Collins RL. Variability in Wechsler Adult Intelligence Scale-IV subtest performance across age. Arch Clin Neuropsychol 2012; 27 (04) 389-397
    CrossrefPubMedGoogle Scholar
  • 16 Anstey KJ, Wood J. Chronological age and age-related cognitive deficits are associated with an increase in multiple types of driving errors in late life. Neuropsychology 2011; 25 (05) 613-621
    CrossrefPubMedGoogle Scholar
  • 17 Murman DL. The impact of age on cognition. Semin Hear 2015; 36 (03) 111-121
    Article in Thieme ConnectPubMedGoogle Scholar
  • 18 Desjardins JL, Alicea CA, Doherty KA. The effect of memory span and manual dexterity on hearing aid handling skills in new and experienced hearing aid users. Am J Audiol 2019; 28 (01) 37-47
    CrossrefPubMedGoogle Scholar
  • 19 Convery E, Keidser G, Caposecco A, Swanepoel W, Wong LL, Shen E. Hearing-aid assembly management among adults from culturally and linguistically diverse backgrounds: toward the feasibility of self-fitting hearing aids. Int J Audiol 2013; 52 (06) 385-393
    CrossrefPubMedGoogle Scholar
  • 20 Dupuis K, Reed M, Bachmann F, Lemke U, Pichora-Fuller MK. The circle of care for older adults with hearing loss and comorbidities: a case study of a geriatric audiology clinic. J Speech Lang Hear Res 2019; 62 (4S): 1203-1220
    CrossrefPubMedGoogle Scholar
  • 21 Rampey BD, Finnegan R, Goodman M. et al. Skills of U.S. Unemployed, Young, and Older Adults in Sharper Focus: Results From the Program for the International Assessment of Adult Competencies (PIAAC) 2012/2014: First Look (NCES 2016–039rev). U.S. Department of Education. Washington, DC: National Center for Education Statistics; 2016
    Google Scholar
  • 22 Nutbeam D. Health promotion glossary. Health Promot Int 1998; 13 (04) 349-364
    CrossrefGoogle Scholar
  • 23 Berkman ND, Sheridan SL, Donahue KE. et al. Health literacy interventions and outcomes: an updated systematic review. Evid Rep Technol Assess (Full Rep) 2011; 199 (199) 1-941
    Google Scholar
  • 24 Mackey LM, Doody C, Werner EL, Fullen B. Self-management skills in chronic disease management: what role does health literacy have?. Med Decis Making 2016; 36 (06) 741-759
    CrossrefPubMedGoogle Scholar
  • 25 Kutner M, Greenberg E, Jin Y, Paulsen C, White S. The Health Literacy of America's Adults Results From the 2003 National Assessment of Adult Literacy. U.S. Department of Education. Washington, DC: National Center for Education Statistics; 2006
    Google Scholar
  • 26 Sørensen K, Pelikan JM, Röthlin F. et al; HLS-EU Consortium. Health literacy in Europe: comparative results of the European health literacy survey (HLS-EU). Eur J Public Health 2015; 25 (06) 1053-1058
    CrossrefPubMedGoogle Scholar
  • 27 Cutilli CC. Health literacy in geriatric patients: an integrative review of the literature. Orthop Nurs 2007; 26 (01) 43-48
    CrossrefPubMedGoogle Scholar
  • 28 Public Health England. Local action on health inequalities improving health literacy to reduce health inequalities. Practice resource: September 2015. Accessed October 3, 2021 at: http://www.healthliteracyplace.org.uk/media/1239/hl-and-hi-ucl.pdf
    Google Scholar
  • 29 National Academies of Sciences, Engineering, and Medicine. Hearing Health Care for Adults: Priorities for Improving Access and Affordability. Washington, DC: The National Academies Press; 2016
    Google Scholar
  • 30 Nair EL, Cienkowski KM. The impact of health literacy on patient understanding of counseling and education materials. Int J Audiol 2010; 49 (02) 71-75
    CrossrefPubMedGoogle Scholar
  • 31 Sciacca A, Meyer C, Ekberg K, Barr C, Hickson L. Exploring audiologists' language and hearing aid uptake in initial rehabilitation appointments. Am J Audiol 2017; 26 (02) 110-118
    CrossrefPubMedGoogle Scholar
  • 32 Convery E, Hickson L, Meyer C, Keidser G. Predictors of hearing loss self-management in older adults. Disabil Rehabil 2019; 41 (17) 2026-2035
    CrossrefPubMedGoogle Scholar
  • 33 Munson Klyn NA, Mohammed Shaikh Z, Dhar S. Health literacy and self-reported hearing aid use in the Health and Retirement Study. Ear Hear 2020; 41 (02) 386-394
    CrossrefPubMedGoogle Scholar
  • 34 Matthews CG, Klove H. Instruction Manual for the Adult Neuropsychology Test Battery. Madison, WI: University of Wisconsin Medical School; 1964
    Google Scholar
  • 35 Stoelting Co. J.V.P. Domes for Cutaneous Spatial Resolution Measurement. Operations Manual. Woodale, IL: Stoelting Co; 1997
    Google Scholar
  • 36 Dreiser RL, Maheu E, Guillou GB, Caspard H, Grouin JM. Validation of an algofunctional index for osteoarthritis of the hand. Rev Rhum Engl Ed 1995; 62 (06, Suppl 1): 43S-53S
    PubMedGoogle Scholar
  • 37 Poole JL. Measures of hand function: Arthritis Hand Function Test (AHFT), Australian Canadian Osteoarthritis Hand Index (AUSCAN), Cochin Hand Function Scale, Functional Index for Hand Osteoarthritis (FIHOA), Grip Ability Test (GAT), Jebsen Hand Function Test (JHFT), and Michigan Hand Outcomes Questionnaire (MHQ). Arthritis Care Res (Hoboken) 2011; 63 (Suppl. 11) S189-S199
    CrossrefPubMedGoogle Scholar
  • 38 Lafayette Instruments. Grooved Pegboard Test. Model 32025 Grooved Pegboard Test User Instructions. 2002 . Accessed March 10, 2020 at: https://www.advys.be/docs/GroovedPegboardTestManual.pdf
    PubMedGoogle Scholar
  • 39 Haegerstrom-Portnoy G, Brabyn J, Schneck ME, Jampolsky A. Smith-Kettlewell Institute Low Luminance. The SKILL card. An acuity test of reduced luminance and contrast. Invest Ophthalmol Vis Sci 1997; 38 (01) 207-218
    PubMedGoogle Scholar
  • 40 Long DT, Beck RW, Moke PS. et al; Smith-Kettlewell Institute Low Luminance. Optic Neuritis Study Group. The SKILL card test in optic neuritis: experience of the Optic Neuritis Treatment Trial. J Neuroophthalmol 2001; 21 (02) 124-131
    CrossrefPubMedGoogle Scholar
  • 41 Wilson BA, Greenfield E, Clare L. et al. Rivermead Behavioural Memory Test. 3rd ed.. (RBMT-3). London: Pearson Education Ltd; 2008
    Google Scholar
  • 42 Brookshire RH, Nicholas LE. The Discourse Comprehension Test. 2nd ed.. Albuquerque, NM: PICA Programs;
    Google Scholar
  • 43 Baker DW, Williams MV, Parker RM, Gazmararian JA, Nurss J. Development of a brief test to measure functional health literacy. Patient Educ Couns 1999; 38 (01) 33-42
    CrossrefPubMedGoogle Scholar
  • 44 Baker DW, Gazmararian JA, Sudano J, Patterson M. The association between age and health literacy among elderly persons. J Gerontol B Psychol Sci Soc Sci 2000; 55 (06) S368-S374
    CrossrefPubMedGoogle Scholar
  • 45 Cox RM, Alexander GC. The International Outcome Inventory for Hearing Aids (IOI-HA): psychometric properties of the English version. Int J Audiol 2002; 41 (01) 30-35
    CrossrefPubMedGoogle Scholar
  • 46 Saunders GH, Morse-Fortier C, McDermott DJ. et al. Description, normative data and utility of the Hearing Aid Skills and Knowledge test. J Am Acad Audiol 2018; 29 (03) 233-242
    Article in Thieme ConnectPubMedGoogle Scholar
  • 47 Chew LD, Griffin JM, Partin MR. et al. Validation of screening questions for limited health literacy in a large VA outpatient population. J Gen Intern Med 2008; 23 (05) 561-566
    CrossrefPubMedGoogle Scholar
  • 48 Clason D. Hearing loss statistics at a glance. Healthy Hearing. 2019 . Accessed February 28, 2020 at: https://www.healthyhearing.com/report/52814-Hearing-loss-statistics-at-a-glance
    PubMedGoogle Scholar
  • 49 Simpson AN, Matthews LJ, Cassarly C, Dubno JR. Time from hearing aid candidacy to hearing aid adoption: a longitudinal cohort study. Ear Hear 2019; 40 (03) 468-476
    CrossrefPubMedGoogle Scholar
  • 50 Holst-Wolf J, Tseng YT, Konczak J. The Minnesota Haptic Function Test. Front Psychol 2019; 10: 818
    CrossrefPubMedGoogle Scholar
  • 51 Saunders GH. Photo-sharing as an audiological rehabilitation tool. Hear J 2019; 72 (09) 16-17
    CrossrefGoogle Scholar
  • 52 Morrell RW, Echt KV. Presenting information to older adults: considering age-related changes in vision and cognition. J Mus Educ 2001; 26 (01) 10-12
    CrossrefGoogle Scholar
  • 53 White M, Garbez R, Carroll M, Brinker E, Howie-Esquivel J. Is “teach-back” associated with knowledge retention and hospital readmission in hospitalized heart failure patients?. J Cardiovasc Nurs 2013; 28 (02) 137-146
    CrossrefPubMedGoogle Scholar
  • 54 Badaczewski A, Bauman LJ, Blank AE. et al. Relationship between Teach-back and patient-centered communication in primary care pediatric encounters. Patient Educ Couns 2017; 100 (07) 1345-1352
    CrossrefPubMedGoogle Scholar
  • 55 Ha Dinh TT, Bonner A, Clark R, Ramsbotham J, Hines S. The effectiveness of the teach-back method on adherence and self-management in health education for people with chronic disease: a systematic review. JBI Database Syst Rev Implement Reports 2016; 14 (01) 210-247
    CrossrefPubMedGoogle Scholar
  • 56 Centers for Disease Control and Prevention Heath Literacy Guidelines and Tools. 2019 . Accessed February 28, 2020 at: https://www.cdc.gov/healthliteracy/developmaterials/guidancestandards.html
    PubMed
  • 57 Centers for Medicare and Medicaid Services. Toolkit for Making Written Material Clear and Effective. 2020 . Accessed February 28, 2020 at: https://www.cms.gov/Outreach-and-Education/Outreach/WrittenMaterialsToolkit/index?redirect=/WrittenMaterialsToolkit
    PubMedGoogle Scholar
  • 58 Deussing EC, Jankosky CJ, Clark LL, Otto JL. Estimated incidence of multiple sclerosis among United States Armed Forces personnel using the Defense Medical Surveillance System. Mil Med 2012; 177 (05) 594-600
    CrossrefPubMedGoogle Scholar
  • 59 Liu Y, Sayam S, Shao X. et al. Prevalence of and trends in diabetes among Veterans, United States, 2005-2014. Prev Chronic Dis 2017; 14: E135
    PubMedGoogle Scholar