Improving access to hearing services for people with low vision: piloting a "hearing screening and education model" of intervention.
OBJECTIVE
The aims of this study were to investigate the potential unmet need for hearing services among older people attending low-vision rehabilitation, and pilot a "Hearing Screening and Education Model" (HSEM) of intervention to promote use of hearing services and aids among these individuals.


METHODS
In the Vision-Hearing project, 300 clients attending low-vision clinics in Sydney, Australia, participated in baseline interviews and the HSEM (2010-2011). The HSEM consisted of: (1) standard pure-tone audiometry; (2) discussion of hearing loss and implications of dual sensory impairment; and (3) provision of information on hearing services and facilitated referral. Those with hearing loss who did not own hearing aids, reported low use (<1 hr/day), or used a single aid with bilateral loss were referred for full assessment by an audiologist and to the follow-up arm of the study (n = 210). Follow-up interviews were conducted within 12 months to ascertain actions taken and audiological and other health outcomes.


RESULTS
Of 169 participants in the follow-up study, 68 (40.2%) sought help for hearing loss within 12 months. Help-seekers had higher mean hearing handicap scores at baseline compared with non-help-seekers. The majority of help-seekers (85.3%) underwent a complete hearing assessment. Fifty-four percent (n = 37) were recommended hearing aids and the majority of these (n = 27) obtained new hearing aids. Seven participants had existing aids adjusted, and 3 obtained alternate assistive listening devices. Almost half of those receiving new aids or adjustments to hearing aids reported low use (<1 hr/day) at follow-up. Among help-seekers, 40% were unsure or did not believe their audiologist knew of their visual diagnosis. Of concern, 60% of participants did not seek help largely due to perceptions their hearing loss was not bad enough; the presence of competing priorities; concerns over dealing with vision loss and managing hearing aids with poor vision.


CONCLUSIONS
Hearing- and vision-rehabilitation services need to better screen for, and take account of, dual sensory impairment among their older clients. If audiologists are made more aware of visual conditions affecting their clients, they may be better placed to facilitate access to appropriate technologies and rehabilitation, which may improve aid retention and benefit.
1Menzies Centre for Health Policy, University of Sydney, New South Wales, Australia; 2Centre for Language Sciences, Linguistics Department, Macquarie University, New South Wales, Australia. 3HEARing Co-operative Research Centre, Victoria, Australia; and 4Centre for Vision Research, Westmead Millennium Institute, University of Sydney, Westmead Hospital, New South Wales, Australia.
Julie
J
Schneider
Moira
M
Dunsmore
Catherine M
CM
McMahon
Bamini
B
Gopinath
Annette
A
Kifley
Paul
P
Mitchell
Stephen R
SR
Leeder
Jie Jin
JJ
Wang
D000368:Aged; D000369:Aged, 80 and over; D001301:Audiometry, Pure-Tone; D001315:Australia; D005260:Female; D006297:Health Services Accessibility / Q000458:organization & administration*; D034381:Hearing Loss / Q000150:complications / Q000175:diagnosis* / Q000534:rehabilitation; D006801:Humans; D008297:Male; D008403:Mass Screening; D020380:Needs Assessment / Q000458:organization & administration; D010353:Patient Education as Topic; D012017:Referral and Consultation / Q000458:organization & administration; D015354:Vision, Low / Q000150:complications / Q000534:rehabilitation*