Despite economic, health and social costs, hearing loss is often ignored — why?

By Aylin Altan, PhD, OptumLabs; Margaret Wallhagen, GNP, PhD, University of California, San Francisco; and Samantha Noderer, MA, OptumLabs

More than 38 million Americans have hearing loss, but fewer than one in three of them treat it. Why is that?

For some, it’s the cost and inconvenience of purchasing, fitting, adjusting and maintaining hearing solution equipment. Others worry about appearing older or calling attention to their hearing loss. Many older adults don’t appreciate how significant their hearing loss is because it deteriorates gradually. Other adults don’t think it’s problematic to let their hearing loss go untreated ― but could it be? What are the consequences of missing or misinterpreting every day conversations and environmental cues?

We know from past studies that hearing loss is associated with isolation and depression. Over the last several years, we’ve also learned that those with untreated hearing loss may pay a high price in terms of health issues as well as health care costs and use of health care services.

This is an important topic for our society as more and more of us live to advanced age. We need to change the conversation about the importance of hearing ― emphasizing that hearing loss is more than just an inconvenience — in order to help individuals live healthier lives.

Over the past 18 months, OptumLabs has conducted a collaborative research initiative focused on the long-term health impacts of hearing loss. For this initiative, OptumLabs assembled clinical, health services research and observational data experts from Johns Hopkins University, AARP Services Inc., the University of California San Francisco (UCSF), the Hearing Loss Society of America and the OptumLabs research staff. We analyzed data from the OptumLabs Data Warehouse, including de-identified retrospective administrative claims, socioeconomic status and electronic health record data for privately insured and Medicare Advantage enrollees.

OptumLabs findings: The health impact of untreated hearing loss

Using OptumLabs data, the team analyzed data from adults, age 50+, who had commercial or Medicare Advantage insurance during 2000–2016. We compared those with untreated hearing loss (based on claims data) with those who had no evidence of hearing loss over two, five and 10 years. The results were published as two papers in JAMA Otolaryngology—Head & Neck Surgery. One paper focused on key comorbid conditions associated with untreated hearing loss. The other paper looked at health care costs and service utilization  associated with untreated hearing loss.

In comparison to people without hearing loss, the study found that over a period of 10 years, people with untreated hearing loss:

Had more health problems — untreated hearing loss was associated with an increased
attributable risk of dementia (3.2 per 100 persons), depression (6.9 per 100 persons) and falls (3.6 per 100 persons).

Spent more time in the hospital — those with untreated hearing loss experienced almost 50 percent more hospital stays and had a 44 percent higher risk for being readmitted to the hospital within 30 days.

Spent more money on health care — total health care costs for those with untreated hearing loss were on average 46 percent higher ($22,434 more).

This study reinforces existing data on the association between untreated hearing loss and health conditions such as depression, dementia, and falls ― where the effect increased over time. It’s also the first 10-year study of the health care costs and utilization associated with untreated hearing loss.

Something to talk about

These findings, taken with the results of other studies, can help support efforts to improve the quality of life and remove barriers to treatment for people with hearing loss. Early screening and intervention, reducing the stigma of hearing loss and making hearing loss treatments and services affordable and available are all important opportunities to consider.

Additional UCSF research has been done on the benefits of streamlined hearing loss screening and educational protocols in primary care settings. It’s been found that patients are more motivated to address their hearing loss when providers share information on ways it can be managed. Clear and empathetic communication is critical to the success of these protocols.

Miscommunication with health care providers may be more common for people with hearing loss. Low treatment adherence (for example, not taking medications appropriately or not following up with doctors) is a known downstream effect of poor patient-provider communication in the hospital or doctor’s office. This can lead to more health complications, hospitalizations and hospital readmissions.

There are things that providers can do to make sure their patients understand and remember their advice about the importance of hearing and hearing loss treatments and services. It’s also important to discuss the real concerns that patients have about stigma, aging, cost and inconvenience.

Best practices when speaking to a person with hearing loss:

• Always face a person so that they can read your lips (people with hearing loss do this instinctively).
• Eliminate as much extra background noise as possible (music, loud fans, side conversations).
• Don’t stand with your back to a bright window because your face will not be as clearly seen.
• If you’re asked to repeat yourself, try to articulate your words more instead of just talking louder (shouting doesn’t help) and try to rephrase what you said (use different words).
• Ask the person to repeat what they heard to make sure they understood it and to help them remember.
• Write information down, especially if it’s really important.

Key hearing loss topics to communicate with patients and family members:

• Address any personal concerns a patient may have about their hearing loss and hearing loss treatment, including the appearance of wearing hearing solutions, fears of aging and financial implications.
• Emphasize the importance of hearing:
  • Leaving hearing loss untreated may impact communication and relationships, and ultimately lead to more health problems (for example, depression, dementia and falls), time spent in the hospital, days spent in clinic and money spent on health care services.
  • It’s important to screen for hearing loss regularly, take steps to prevent it or modify its impact and treat it as soon as possible.
• Discuss treatment options:
  • For mild to moderate hearing loss, more affordable over-the-counter options are becoming available that consumers can adjust themselves.
  • Hearing aid and hearing services coverage varies by insurance plan. Many policy advocates are pushing for expanded coverage across commercial, Medicare and Medicaid insurance.

Discussions about why hearing matters and how to avoid the negative effects of hearing loss should start early with adults in primary care. Combined with policy efforts underway to improve access to treatments and services, the future for those with hearing loss may begin to sound more positive.

To learn more about hearing loss and how to get involved, visit the Hearing Loss Association of America.

ABOUT THE AUTHORS

• Aylin Altan, PhD, is the senior vice president of research at OptumLabs.
• Margaret Wallhagen, GNP, PhD, is a professor of gerontological nursing and a geriatric nurse practitioner at the University of California, San Francisco.
• Samantha Noderer, MA, is a communications and translation manager at OptumLabs.