Deriving criteria for hearing impairment in the elderly: a functional approach.
We describe a method for deriving criteria for hearing impairment in the elderly based on self-reported handicap. Using the Sickness Impact Profile (SIP) and Hearing Handicap Inventory for the Elderly - Screening (HHIE-S) version as functional measures of handicap, the analysis proceeded in five steps: 1. Audiometric thresholds at various frequencies were inter-correlated. This was done both within and between ears. 2. Better and poorer ear thresholds were determined for each frequency, and these were correlated with the HHIE-S and SIP scores. 3. Using the HHIE-S and SIP scores as dependent variables, stepwise multiple linear regressions were used to select the frequencies that explained the most variance in the functional scales. 4. Using the HHIE-S and SIP as standards, receiver operating curves were constructed for each frequency to select the threshold level that provided the best test accuracy. 5. The newly-derived criteria were then compared against four other "traditional" criteria of hearing impairment. In general, the newly-derived criteria combined a relatively low frequency with a relatively high frequency, with the low frequency being functionally more important. Depending on the functional scale used, the threshold level was in the 25 to 35-dB range for the lower frequencies and 40 to 45-dB for the higher frequencies. These features provide a suitable compromise to the current debate over which threshold levels comprise the best discrimination of aged persons who are hearing-impaired. Future research should focus on developing consensus standards for functional hearing impairment and handicap in the elderly.
Lichtenstein
M J
MJ
Division of Geriatrics and Gerontology, Audie L. Murphy Memorial Veterans Hospital, San Antonio, Texas.
Bess
F H
FH
Logan
S A
SA
Burger
M C
MC
D000367:Age Factors; D000368:Aged; D001301:Audiometry, Pure-Tone / Q000592:standards; D001309:Auditory Threshold / Q000502:physiology; D003638:Deafness / Q000145:classification / Q000175:diagnosis* / Q000503:physiopathology; D005188:False Negative Reactions; D005260:Female; D016330:Frail Elderly; D006299:Health Services for the Aged / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012647:Self-Assessment; D013069:Speech Reception Threshold Test / Q000592:standards; D011795:Surveys and Questionnaires