A Primary Health Care Approach for Hearing Health and its Importance in Maximising Wellbeing Across the Life-course

Conference:

SAPC ASM 2020 - cancelled due to pandemic

Talk Code:

G.4

Presenter:

Dalia Tsimpida

Twitter:

@DaliaTsimpida

Co-authors:

Dalia Tsimpida [1,2], Prof Evan Kontopantelis [2], Prof Darren Ashcroft [3], Dr Maria Panagioti [1,3]

Author institutions:

[1] Centre for Primary Care and Health Services Research, The University of Manchester [2] Institute for Health Policy and Organisation (IHPO), [3] NIHR Greater Manchester Patient Safety Translational Research Centre (PSTRC)

Problem

Hearing loss (HL) constitutes a major public health challenge, affecting over 12 million people in the UK. The help-seeking behaviour for HL starts with the self-diagnosis and the initiation of contact with a health provider in primary care. However, little is known about the patterns of diagnosis of HL in primary care and referral to secondary care. Also, the consequences of HL in older adults’ mental health are relatively unknown. We aimed to examine: (a) the accuracy of self-reported measures of hearing difficulty in comparison to objective hearing data, and (b) the relationship between HL and depressive symptoms in later life.

Approach

We used data from the English Longitudinal Study of Ageing (ELSA), which is a large population-based prospective cohort study. We examined cross-sectionally 8,529 individuals that had an assessment in their hearing by both self-reported measures and consented for assessment via a handheld audiometric screening device (HearCheck™ Screener). Multiple logistic regression models examined the validity of self-reported measures of hearing and their potential drivers across different population subgroups. Also, we applied a novel structural equation modelling (SEM) approach to examine the longitudinal association between the HL and clinically significant depressive symptoms of participants (CES Depression Scale), across the 8 Waves of ELSA Dataset.

Findings

A large percentage (30.2%) of individuals with HL were not detected by the self-report measure. Statistically significant predictors of misreporting hearing difficulties (while they had objectively measured HL >35dBHL at 3.0kHz, in the better-hearing ear) were: female gender (OR 1.97, 95%CI 1.18-3.28), no educational qualifications (OR 1.37, 95%CI 1.26-2.55), routine/manual occupation (OR 1.43, 95%CI 1.28-2.61), tobacco consumption (OR 1.14, 95%CI 1.08-1.90), harmful use of alcohol (OR 1.13, 95%CI 1.11-2.34), and lack of moderate physical activity (OR 1.25, 95%CI 1.03-1.42). The relative risk for depressive symptoms was higher for those who had reported HL than for those who had not reported HL, ranging from 1.40 (Wave 1) to 1.58 (Wave 8).

Consequences

Up to one-third of adults with HL in England may remain undiagnosed and therefore not referred to ear specialists or given access to hearing aids. People belonging in high-risk groups for HL, such as older and less educated people that face socioeconomic inequalities and adopt an unhealthy lifestyle, are the least likely to be accurately identified. These findings provide novel insights into clinical practice and reinforce the importance of an effective and sustainable HL screening strategy in primary care, for the early detection and intervention for HL in older adults. Importantly, as our findings are consistent with the hypothesis that the early detection of HL could largely prevent or delay the onset of depression, a Primary Health Care approach for hearing health is crucial in maximising wellbeing for people across their life course.

Submitted by:

Dalia Tsimpida

Funding acknowledgement:

This research was funded by the NIHR Manchester Biomedical Research Centre (PhD Studentship). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.