Loneliness is Associated With Lower Coping Self-Efficacy Among Older Adults.

To address the gap of lacking research on the association between coping self-efficacy and loneliness, this study examined this relationship to inform future research and intervention on loneliness. Using data from 151 community-dwelling older adults ages 65 and older, we estimated multivariate logistic regression models with age, race/ethnicity, sex, body mass index, chronic disease composite score, social support, coping self-efficacy, and depression symptoms. Loneliness was reported in 32.1% of participants and negatively associated with coping self-efficacy (OR = 0.68, 95% CI: 0.50-0.93) while controlling for age, race, sex, chronic disease composite score, and body mass index. Our findings suggest that coping self-efficacy may be a target for intervention involving loneliness in future research; however, the causal relationship between coping self-efficacy and loneliness should be explored further.

Improving cancer care for underserved populations in an academic and community practice setting: protocol for a community health worker pilot navigation programme.

INTRODUCTION: Delaying cancer treatment following diagnosis impacts health outcomes, including increasing patient distress and odds of mortality. Interventions to promote timely healthcare engagement may decrease patient-reported stress and improve quality of life. Community health workers (CHWs) represent an enabling resource for reducing delays in attending initial oncology treatment visits. As part of an ongoing programme evaluation coordinated by the Merck Foundation, we will implement a pilot navigation programme comprising CHW-conducted needs assessments for supporting patients and their caregivers. We aim to investigate (1) the programme's influence on patients' healthcare utilisation within the period between their first diagnosis and initial treatment visit and (2) the logistic feasibility and acceptability of programme implementation. METHODS AND ANALYSIS: We will employ a hybrid implementation design to introduce the CHW navigation programme at the Johns Hopkins Sidney Kimmel Comprehensive Cancer Center. CHW team members will use a consecutive sampling approach. Participants will complete the Problem-Checklist, Chronic Illness Distress Scale and the Satisfaction with Life Domains instruments. CHWs will provide tailored guidance by sharing information available on the Johns Hopkins Electronic Resource databases. The investigators will evaluate patients' time to initial oncology treatment and healthcare utilisation by reviewing electronic medical records at 3 and 6 months postintervention. Bivariate analyses will be completed to evaluate the relationships between receiving the programme and all outcome measures. ETHICS AND DISSEMINATION: This study's protocol was approved by the Johns Hopkins School of Medicine's institutional review board (IRB00160610). Informed consent will be obtained by phone by the CHW navigator. Dissemination planning is ongoing through regular meetings between members of the investigator team and public members of two community advisory groups. Study plans include collaborating with other experts from the Johns Hopkins Institute for Clinical and Translational Research and the Johns Hopkins Center for Health Equity for ideating dissemination strategies.

Effect of a Community Health Worker-Delivered Personal Sound Amplification Device on Self-Perceived Communication Function in Older Adults With Hearing Loss: A Randomized Clinical Trial.

Importance: Age-related hearing loss that impairs daily communication is associated with adverse health outcomes, but use of hearing aids by older adults is low and disparities exist. Objective: To test whether an affordable, accessible hearing care intervention, delivered by community health workers using over-the-counter hearing technology, could improve self-perceived communication function among older adults with hearing loss compared with a wait-list control. Design, Setting, and Participants: Open-label randomized clinical trial conducted between April 2018 and October 2019 with 3-month data collection completed in June 2020. The trial took place at 13 community sites, including affordable independent housing complexes (n = 10), senior centers (n = 2), and an older adult social club (n = 1) in Baltimore, Maryland. A total of 151 participants aged 60 years or older with hearing loss were randomized. Interventions: Participants were randomized to receive a community health worker-delivered hearing care intervention (n = 78) or to a wait-list control group (n = 73). The 2-hour intervention consisted of fitting a low-cost amplification device and instruction. Main Outcomes and Measures: The primary outcome was change in self-perceived communication function (Hearing Handicap Inventory for the Elderly-Screening Version [HHIE-S]; score range, 0-40; higher scores indicate poorer function) from baseline to 3 months postrandomization. The average treatment effect was estimated using the doubly robust weighted least squares estimator, which uses an outcome regression model weighted by the inverse probability of attrition to account for baseline covariate imbalance and missing data. Results: Among 151 participants randomized (mean age, 76.7 [SD, 8.0] years; 101 [67.8%] women; 65 [43%] self-identified as African American; 96 [63.6%] with low income [<$25 000 annual household income]), 136 (90.1%) completed 3-month follow-up for the primary outcome. In the intervention group, 90.5% completed the intervention session and reported at least 1 hour of daily amplification use at 3 months postrandomization. Mean scores for the HHIE-S were 21.7 (SD, 9.4) at baseline and 7.9 (SD, 9.2) at 3 months (change of -13.2 [SD, 10.3]) in the intervention group, and 20.1 (SD, 10.1) at baseline and 21 (SD, 9.1) at 3 months (change of 0.6 [SD, 7.1]) in the control group. Self-perceived communication function significantly improved in the intervention group compared with the control group, with an estimated average treatment effect of the intervention of a -12.98-point HHIE-S change (95% CI, -15.51 to -10.42). No study-related adverse events were reported. Conclusions and Relevance: Among older adults with hearing loss, a community health worker-delivered personal sound amplification device intervention, compared with a wait-list control, significantly improved self-perceived communication function at 3 months. Findings are limited by the absence of a sham control, and further research is needed to understand effectiveness compared with other types of care delivery models and amplification devices. Trial Registration: ClinicalTrials.gov Identifier: NCT03442296.

Socioeconomic position and hearing loss: current understanding and recent advances.

PURPOSE OF REVIEW: The purpose of this review is to describe recent literature examining the relationship between socioeconomic position (SEP) and hearing loss, including the impact of hearing loss on several socioeconomic outcomes over the life course. Additionally, we highlight current policy advances in recent years and review alternative models of hearing care that aim to address disparities related to SEP and hearing healthcare. RECENT FINDINGS: Applying a social epidemiologic lens to hearing health gives insight into the role of material and social contexts in understanding and improving hearing health outcomes. Recent studies investigating the intersection of SEP and hearing health highlight the disparities that exist for individuals with low SEP as well as the influence of hearing loss on SEP. Individuals with hearing loss are more likely to be unemployed, have lower educational attainment, lower income, and are less likely to use hearing aids and access hearing care. Legislation addressing cost and access to hearing care as well as transforming the current landscape of hearing care, is essential to creating equitable care for individuals, especially older adults, with low SEP. SUMMARY: With the expected rise in prevalence of hearing loss over the next 40 years, hearing care that is affordable and accessible is a public health priority. As hearing loss is associated with negative outcomes for individuals with low SEP, advances in legislation and care delivery models are necessary in order to include populations traditionally unserved by current hearing healthcare.

Foundational Approaches to Advancing Hearing Health Equity: A Primer in Social Epidemiology.

Hearing health is inextricably linked to factors beyond biology. Social, demographic, environmental, geographic, and historical influences affect hearing health, but these factors are often unmeasured within traditional biological, clinical, and epidemiological studies of hearing health. With increasing recognition of hearing health over the life course as a public health priority, there is also a growing understanding of existing hearing health inequities at the individual, community, national, and global levels. To make progress in addressing these inequities, public health disciplines, such as social epidemiology, can provide valuable frameworks. With a focus on integrating the biological and functional with social and structural factors influencing health, social epidemiology provides key concepts and approaches for filling existing research and practice gaps. In this review, we introduce the discipline of social epidemiology and its associated concepts to inspire greater cross-disciplinary collaboration for the ultimate goal of advancing hearing health equity.

Labor Force Participation and Hearing Loss Among Adults in the United States: Evidence From the National Health and Nutrition Examination Survey.

PURPOSE: The purpose of this article was to study the association between hearing loss (HL) and labor force participation in the National Health and Nutrition Examination Survey (NHANES). METHOD: This cross-sectional study used data from the 1999-2000, 2001-2002, 2003-2004, 2011-2012, and 2015-2016 cycles of the NHANES. The sample was restricted to adults aged 25-65 years with complete audiometric data. HL was defined based on the pure-tone average (PTA) of 0.5-, 1-, 2-, and 4-kHz thresholds in the better hearing ear as follows: no loss (PTA < 25 dB), mild HL (25 dB < PTA < 40 dB), and moderate-to-severe HL (PTA > 40 dB). The association between HL and labor force participation was estimated using weighted logistic regression adjusted for age, sex, race/ethnicity, education, living arrangements, and health status. RESULTS: In a sample of 9,963 participants (50.6% women, 22.6% Black, 27% Hispanic), we found that compared with adults without HL, individuals with moderate-to-severe HL had greater odds of being outside of the labor force (odds ratio = 2.35; 95% confidence interval: 1.42-3.88). However, there were no differences by HL status in being employed or having a full- versus part-time job. CONCLUSIONS: Moderate-to-severe HL, but not mild HL, was associated with higher odds of not participating in the labor force. However, there were no differences by HL status in being employed or having a full- versus part-time job. Further research is needed to better characterize how HL may affect labor force participation. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.19858930.

Mitigating End-of-Life Burden: Parallel Perspectives of Physician-Patients & Family Caregivers.

CONTEXT: Patients and family caregivers perceive burden in care at the end of life differently even when the patient is a physican. OBJECTIVES: We describe how older adult physicians as prospective patients (hereafter "physician-patients") and family caregivers of physician-patients view burden in care at the end of life. METHODS: Interviews with physician-patients (n = 28) and family caregivers (n = 26) of physician-patients who had died were conducted as part of a shared decision-making study. Both groups expressed concerns with burden at the end of life. We coded and analyzed descriptions of burden using inductive and deductive approaches to coding sub-themes as in qualitative description. We then created a conceptual model depicting the relationships among the concepts, returning to the interviews to verify respective contexts. RESULTS: Unilateral actions taken at different points in the illness trajectory by both groups suggested different concerns about burden occurring in parallel. While everyone anticipated burden associated with care at the end of life, physician-patients made legal and financial arrangements to minimize this burden. Nevertheless several family caregivers described the burden that they experienced. We propose a conceptual model to guide future research and care. CONCLUSION: Physician-Patients ' clinical insights drive their attempts to alleviate burden on their families. However, family caregivers still experienced burden. Recognizing the parallel perspectives of burden may inform the type and timing of interventions to effectively minimize burden and provide compassionate care to both patients and families at the end of life.

A Community Health Worker Training Program to Deliver Accessible and Affordable Hearing Care to Older Adults.

Community leaders collaborated with human-centered design practitioners and academic researchers to co-develop a community health worker (CHW) training program for delivering community-based hearing care to fellow older adults. When implemented by CHWs, clients' communication function improved comparably with outcomes following professional interventions. Community-based models offer opportunities to advance hearing health.

Prevalence of Asymmetric Hearing Among Adults in the United States.

OBJECTIVE: To estimate the national prevalence of asymmetric hearing among adults through applying two distinct audiometric criteria. STUDY DESIGN: National cross-sectional survey. SETTING: Ambulatory examination centers within the National Health and Nutrition Examination Survey (NHANES). PATIENTS: Non-institutionalized adults in the United States from the 2001 to 2012 cycles of NHANES aged 20 years and older with pure tone audiometric and tympanometric data (n = 6,190). INTERVENTION: Standardized protocol for pure tone audiometry and tympanometry. MAIN OUTCOME MEASURE: Proportion of asymmetric hearing according to two distinct audiometric criteria. One criterion (American Academy of Otolaryngology-Head and Neck Surgery [AAO-HNS]) specifies asymmetry as a difference between pure tone averages (PTA) greater than 15 dB, and the other (Veterans Affairs [VA]) specifies asymmetry as a difference greater than/equal to 20 dB across two contiguous frequencies or 10 dB across three contiguous frequencies. Analyses included sampling weights to account for the epidemiologic survey's complex sampling design. RESULTS: Using a definition from the AAO-HNS, overall prevalence was 2.77 and 9.46% when calculating the PTA with 0.5 to 4 kHz and 4 to 8 kHz, respectively. In contrast, through a working definition used within the VA, overall prevalence was 25.05% across 0.5 to 8 kHz. Estimates differed across sex and age, with men and older age cohorts exhibiting higher prevalence. CONCLUSIONS: A nationally-representative sample of US adults indicates higher prevalence of asymmetric hearing among men and older adult cohorts. There is currently no standard audiometric criterion for defining asymmetry, and prevalence estimates vary markedly depending on which audiometric criteria is used. Given the potentially high prevalence of asymmetry depending on criterion, clinicians should also consider other supplementary clinical data when recommending medical referral.

Hearing Loss, Loneliness, and Social Isolation: A Systematic Review.

OBJECTIVE: Social isolation and loneliness are associated with increased mortality and higher health care spending in older adults. Hearing loss is a common condition in older adults and impairs communication and social interactions. The objective of this review is to summarize the current state of the literature exploring the association between hearing loss and social isolation and/or loneliness. DATA SOURCES: PubMed, Embase, CINAHL Plus, PsycINFO, and the Cochrane Library. REVIEW METHODS: Articles were screened for inclusion by 2 independent reviewers, with a third reviewer for adjudication. English-language studies of older adults with hearing loss that used a validated measure of social isolation or loneliness were included. A modified Newcastle-Ottawa Scale was used to assess the quality of the studies included in the review. RESULTS: Of the 2495 identified studies, 14 were included in the review. Most of the studies (12/14) were cross-sectional. Despite the heterogeneity of assessment methods for hearing status (self-report or objective audiometry), loneliness, and social isolation, most multivariable-adjusted studies found that hearing loss was associated with higher risk of loneliness and social isolation. Several studies found an effect modification of gender such that among women, hearing loss was more strongly associated with loneliness and social isolation than among men. CONCLUSIONS: Our findings that hearing loss is associated with loneliness and social isolation have important implications for the cognitive and psychosocial health of older adults. Future studies should investigate whether treating hearing loss can decrease loneliness and social isolation in older adults.

Hearing care across the life course provided in the community.

Untreated hearing loss is recognized as a growing global health priority because of its prevalence and harmful effects on health and well-being. Until recently, little progress had been made in expanding hearing care beyond traditional clinic-based models to incorporate public health approaches that increase accessibility to and affordability of hearing care. As demonstrated in numerous countries and for many health conditions, sharing health-care tasks with community health workers (CHWs) offers advantages as a complementary approach to expand health-service delivery and improve public health. This paper explores the possibilities of task shifting to provide hearing care across the life course by reviewing several ongoing projects in a variety of settings - Bangladesh, India, South Africa and the United States of America. The selected programmes train CHWs to provide a range of hearing-care services, from childhood hearing screening to management of age-related hearing loss. We discuss lessons learnt from these examples to inform best practices for task shifting within community-delivered hearing care. Preliminary evidence supports the feasibility, acceptability and effectiveness of hearing care delivered by CHWs in these varied settings. To make further progress, community-delivered hearing care must build on established models of CHWs and ensure adequate training and supervision, delineation of the scope of practice, supportive local and national legislation, incorporation of appropriate technology and analysis of programme costs and cost-effectiveness. In view of the growing evidence, community-delivered hearing care may now be a way forward to improve hearing health equity.

La perte de l'acuité auditive non traitée est considérée comme une priorité sanitaire de plus en plus importante à l'échelle mondiale en raison de sa prévalence et de ses effets nocifs sur la santé et le bien-être. Jusqu'à récemment, peu de progrès avaient été accomplis pour développer les soins auditifs en dehors des modèles cliniques traditionnels de façon à intégrer des approches de santé publique permettant d'accroître l'accessibilité, notamment économique, des soins auditifs. Comme cela a été démontré dans de nombreux pays et pour de multiples problèmes de santé, transférer des tâches de soins de santé aux agents sanitaires des collectivités présente des avantages en tant qu'approche complémentaire permettant d'étendre la prestation des services de santé et d'améliorer la santé publique. Cette publication étudie les possibilités de transfert de tâches pour dispenser des soins auditifs tout au long de la vie en examinant plusieurs projets en cours à différents endroits ­ Bangladesh, Inde, Afrique du Sud et États-Unis d'Amérique. Les programmes sélectionnés apprennent aux agents sanitaires des collectivités à dispenser divers services de soins auditifs, du dépistage auditif chez les enfants à la gestion de la perte de l'acuité auditive liée à l'âge. Nous évoquons les leçons tirées de ces exemples pour définir les pratiques optimales concernant le transfert des tâches dans le cadre des soins auditifs dispensés dans des structures de proximité. Les observations préliminaires étayent la faisabilité, l'acceptabilité et l'efficacité des soins auditifs dispensés par les agents sanitaires des collectivités dans ces différents contextes. Pour continuer à progresser, les soins auditifs dispensés dans des structures de proximité doivent s'appuyer sur des modèles éprouvés d'agents sanitaires des collectivités. Il convient par ailleurs d'assurer une formation et une supervision adéquates, de délimiter le champ de pratique, d'adopter une législation locale et nationale favorable, d'intégrer une technologie appropriée et d'analyser les coûts du programme et le rapport coût-efficacité. Compte tenu du nombre croissant d'éléments d'appréciation, les soins auditifs dispensés dans des structures de proximité peuvent désormais constituer une solution pour améliorer l'équité en matière de santé auditive.

La pérdida de audición no tratada se reconoce como una prioridad sanitaria mundial cada vez mayor debido a su prevalencia y a sus efectos perjudiciales para la salud y el bienestar. Recientemente, se había avanzado poco en la expansión de la asistencia auditiva más allá de los modelos tradicionales basados en clínicas para incorporar enfoques de salud pública que aumenten la accesibilidad y asequibilidad de la asistencia auditiva. Como se ha demostrado en numerosos países y para muchas condiciones sanitarias, delegar las tareas de atención sanitaria a los trabajadores sanitarios de la comunidad (CHW) ofrece ventajas como enfoque complementario para ampliar la prestación de servicios sanitarios y mejorar la salud pública. Este documento explora las posibilidades de la delegación de funciones para ofrecer atención auditiva a lo largo de toda la vida mediante la revisión de distintos proyectos en curso en una variedad de entornos: Bangladesh, Estados Unidos de América, India y Sudáfrica. Los programas seleccionados capacitan a los CHW para que ofrezcan una amplia gama de servicios de atención auditiva, desde exámenes auditivos para la infancia hasta el tratamiento de la pérdida de audición relacionada con la edad. Discutimos las lecciones aprendidas de estos ejemplos para informar las mejores prácticas sobre la delegación de funciones dentro de la atención auditiva proporcionada en la comunidad. La evidencia preliminar apoya la factibilidad, aceptabilidad y efectividad de la atención auditiva proporcionada por los CHW en estos variados entornos. Para seguir avanzando, la atención auditiva proporcionada en la comunidad debe basarse en modelos establecidos de los CHW y garantizar una formación y supervisión adecuadas, la delimitación del campo de aplicación, el apoyo de la legislación local y nacional, la incorporación de la tecnología adecuada y el análisis de los costes de los programas y la relación coste-eficacia. En vista de las pruebas cada vez más numerosas, la atención auditiva proporcionada en la comunidad puede ser ahora una solución para mejorar la equidad en la salud auditiva.

Translating Public Health Practices: Community-Based Approaches for Addressing Hearing Health Care Disparities.

Epidemiologic studies reveal disparities in hearing health care with lower prevalence of hearing aid use among older adults from racial/ethnic minority groups and lower socioeconomic positions. Recent national reports recommend exploring innovative delivery models to increase the accessibility and affordability of hearing health care, particularly for underserved and vulnerable populations. With an expected rise in the prevalence of age-related hearing loss over the next four decades due to a rapidly aging population, the condition is a growing public health imperative. This review describes key public health practices for developing and delivering community-based care that characterizes an emerging area of research in novel approaches of hearing loss management programs to reach underserved populations. With evolving technologies that enable care to extend beyond the clinic, adapting a long-utilized community health worker approach presents a strategy for the field of hearing health care to be actively involved in designing and leading initiatives for achieving hearing health equity. Principles from community-based participatory research offer a paradigm for the field to integrate into its research endeavors for addressing disparities. An interdisciplinary approach for engaging these challenges offers hearing health care researchers and providers an opportunity to advance the field and delivery of care.

The effect of brief subway station noise exposure on commuter hearing.

OBJECTIVE: To demonstrate that brief exposure to subway noise causes temporary threshold shift and is preventable with noise protection. METHODS: The study was conducted as a randomized crossover trial. Twenty subjects were randomly assigned to two groups, one with hearing protection and one without. Subjects were exposed to subway platform noise for 15 minutes. Pre- and post-exposure pure tone audiometry (PTA) and otoacoustic emissions were compared. After a washout period, subjects switched hearing protection groups and repeated the process. RESULTS: A statistically significant reduction in PTA thresholds after subway noise exposure was identified, for subjects with and without hearing protection (P < .001). For exposure without hearing protection, the mean threshold was 5.19 dB pre-exposure and 3.91 dB post-exposure (decrease of 1.28 dB; 95% confidence interval, 0.82-1.74). For exposure with hearing protection, the mean threshold was 4.81 dB pre-exposure and 3.47 dB post-exposure (decrease of 1.34 dB; 95% confidence interval, 0.89-1.79). CONCLUSION: Brief exposure to subway noise did not cause hearing loss with or without noise protection. Though clinically insignificant, the unexpected finding of reduction in PTA suggests that there are complex heterogeneous short- and long-term cochlear responses to noise exposure that should be further explored. LEVEL OF EVIDENCE: 1b.

The influence of subway station design on noise levels.

OBJECTIVES/HYPOTHESIS: To investigate the impact of subway station design on platform noise levels. STUDY DESIGN: Observational. METHODS: Continuous A-weighted decibel (dBA) sound levels were recorded in 20 New York City subway stations, where trains entered on either a straight track or curved track in 10 stations each. Equivalent continuous noise levels (Leq ) at various locations on the boarding platform (inbound end, midplatform, and outbound end) during train entry and exit were compared between the straight and curved stations in broadband as well as narrow one-third octave bands. RESULTS: Overall, curved stations trended louder than straight stations, although the difference in broadband Leq did not reach statistical significance (curve, 83.4 dBA; straight, 82.6 dBA; P = .054). Noise levels were significantly louder at the inbound end of the platform during train entry (inbound, 89.7 dBA; mid, 85.5 dBA; outbound, 78.7 dBA; P < .001) and at the outbound end during train exit (inbound, 79.7 dBA; mid, 85.3 dBA; outbound, 89.1 dBA; P < .001). Narrow band analysis showed that curved stations were significantly louder than straight stations at 100 Hz and high frequencies from 8 to 20 kHz. Peak impact levels ranged from 104 to 121 dBA. CONCLUSIONS: Curved stations have a different noise profile compared to straight stations and are significantly louder than straight stations at high frequencies. Designing stations with straight tracks within the platform can help reduce commuter noise exposure. LEVEL OF EVIDENCE: NA Laryngoscope, 127:1169-1174, 2017.