Screening of hearing in elderly people: assessment of accuracy and reproducibility of the whispered voice test

Development and validation of the screening tool for age-related hearing loss in the community based on the information platform

INTRODUCTION

Currently, age-related hearing loss has become prevalent, awareness and screening rates remain dismally low. Duing to several barriers, as time, personnel training and equipment costs, available hearing screening tools do not adequately meet the need for large-scale hearing detection in community-dwelling older adults. Therefore, an accurate, convenient, and inexpensive hearing screening tool is needed to detect hearing loss, intervene early and reduce the negative consequences and burden of untreated hearing loss on individuals, families and society.

OBJECTIVES

The study harnessed "medical big data" and "intelligent medical management" to develop a multi-dimensional screening tool of age-related hearing loss based on WeChat platform.

METHODS

The assessment of risk factors was carried out by cross-sectional survey, logistic regression model and receiver operating characteristic (ROC) curve analysis. Combining risk factor assessment, Hearing handicap inventory for the elderly screening version and analog audiometry, the screening software was been developed by JavaScript language and been evaluated and verified.

RESULTS

A total of 401 older adults were included in the cross-sectional study. Logistic regression model (univariate, multivariate) and reference to literature mention rate of risk factors, 18 variables (male, overweight/obesity, living alone, widowed/divorced, history of noise, family history of deafness, non-light diet, no exercising habit, smoking, drinking, headset wearer habit, hypertension, diabetes, hyperlipidemia, cardiovascular and cerebrovascular diseases, hyperuricemia, hypothyroidism, history of ototoxic drug use) were defined as risk factors. The area under the ROC curve (AUC) of the cumulative score of risk factors for early prediction of age-related hearing loss was 0.777 [95% CI (0.721, 0.833)]. The cumulative score threshold of risk factors was defined as 4, to classify the older adults into low-risk (< 4) and high-risk (≥ 4) hearing loss groups. The sensitivity, specificity, positive predictive value, and negative predictive value of the screen tool were 100%, 65.5%, 71.8%, and 100.0%, respectively. The Kappa index was 0.6.

CONCLUSIONS

The screening software enabled the closed loop management of real-time data transmission, early warning, management, whole process supervision of the hearing loss and improve self-health belief in it. The software has huge prospects for application as a screening approach for age-related hearing loss.

Clinical Assessment Tools for the Detection of Cognitive Impairment and Hearing Loss in the Ageing Population: A Scoping Review

Objective

There is a strong association between cognitive impairment and hearing loss, both highly prevalent in the ageing population. Early detection of both hearing loss and cognitive impairment is essential in the management of these conditions to ensure effective and informed decisions on healthcare. The main objective was to identify existing and emerging cognitive and auditory assessment tools used in clinical settings (eg, memory clinics, audiology clinics), which manage the ageing population.

Methods

A scoping review of peer-reviewed publications and results were reported according to the PRISMA-ScR guidelines.

Results

A total of 289 articles were selected for data extraction. The majority of studies (76.1%) were conducted in 2017 or later. Tests of global cognitive function (ie, Mini-Mental State Exam, Montreal Cognitive Assessment) were the most commonly used method to detect cognitive impairment in hearing healthcare settings. Behavioral hearing testing (ie, pure-tone audiometry) was the most commonly used method to detect hearing loss in cognitive healthcare settings. Objective, physiological measures were seldom used across disciplines.

Conclusion

Preferences among clinicians for short, accessible tests likely explain the use of tests of global cognitive function and behavioral hearing tests. Rapidly evolving literature has identified inherent limitations of administering global cognitive function tests and pure-tone testing in an ageing population. Using electrophysiological measures as an adjunct to standard methods of assessment may provide more reliable information for clinical recommendations in those with cognitive and hearing impairment, and subsequently achieve better healthcare outcomes.

Construction and Effect of the Three-Level and Two-Stage Screening Mode for Age-Related Hearing Loss: A Study Based on the Community in Shanghai, China

Background

There is a high incidence rate of age-related hearing loss. Severe hearing loss may increase the prevalence of mental illness, cognitive impairment, and even the risk of all-cause death.

Purpose

Construction of the three-level and two-stage screening mode for age-related hearing loss of the community and to evaluate its effectiveness.

Materials and Methods

A total of 401 participants (aged 60 years or older) from five typical communities were enrolled in the study. The risk factors assessment of age-related hearing loss was completed by using a cross-sectional survey and receiver operating characteristic (ROC) curve. Multiple screening method was adopted and verified by serial and parallel tests, respectively. Based on research data, incorporate risk factors assessment, the Hearing Handicap Inventory for the Elderly Screening Version (HHIE-s) and pure tone audiometry (PTA) were used to construct the screening mode.

Results

Multiple screening series testing and multiple screening parallel testing, including risk factors assessment, HHIE-s, and PTA, were used for verification: the sensitivity, specificity, and Kappa index were 70.5% and 9.2%, 95.0% and 71.6%, 0.26 and 0.63, respectively. Finally, the three-level and two-stage screening mode for age-related hearing loss was established. "Three-level" was defined as the risk factors assessment/HHIE-s (high-risk population), PTA (suspect population), and comprehensive hearing loss assessment (confirmed population). "Two-stage" was defined as the population screening by general practitioner in the community and target screening by otolaryngologist of the tertiary hospitals.

Conclusion

The three-level and two-stage screening mode for age-related hearing loss consists of the following framework: from population screening to target screening, from suspicious diagnosis to accurate diagnosis, from primary health care to tertiary hospitals. The study objective is to structure a new secondary prevention and treatment mode for age-related hearing loss with primary health care as the core, so as to help the front-end management of healthy aging.

Sensitivity and specificity of hearing tests for screening hearing loss in older adults

Objectives

The study aimed to determine the most appropriate hearing screening test to identify disabling hearing loss for adults aged 65 years or older.

Methods

This study included 577 older adults. Four hearing screening tests were considered in the study, including the Hearing Handicap Inventory for Elderly Screening (HHIE-s), three single question tests, the whisper test, and the finger rub test. The sensitivity and specificity of these tests referenced to the hearing threshold of disabling hearing loss were estimated.

Results

Among all tests, only the single self-perception question (0.7064 for sensitivity; 0.7225 for specificity) and whisper test (0.7833 for sensitivity; 0.7708 for specificity) could obtain both sensitivity and specificity higher than 70% for adults aged ≥65 years.

Conclusion

Overall, we suggest using the whisper test to identify disabling hearing loss (>40 dB HL at the better ear) for adults aged 65 years or older. However, if the conditions do not permit, the single self-perception question is also acceptable. Moreover, HHIE-s might not be a good test to detect disabling hearing loss for adults aged 80 years or older.

Validez, precisión diagnóstica y fiabilidad del Test de Palabras Parónimas Susurradas para la detección rápida de la presbiacusia

El objetivo de este trabajo es determinar la validez, la precisión diagnóstica y la fiabilidad del Test de Palabras Parónimas Susurradas (TPPS) para la detección de presbiacusia. La muestra estuvo configurada por 156 personas mayores de 65 años y por 36 jóvenes, de entre 18 a 26 años, sin problemas auditivos. La sensibilidad auditiva se evaluó mediante la audiometría de tonos puros y el TPPS. Utilizando esta prueba, a 94 personas del grupo de más de 65 años se les detectó presbiacusia, lo que correlacionó significativamente con los datos obtenidos a través de la audiometría de tonos puros [r = -0,84 (p < 0,001)]. La comparación de estos valores con los obtenidos en la misma prueba por el grupo de jóvenes también arrojó una alta significación estadística (p < .00). Por otra parte, se registró la capacidad diagnóstica de esta prueba a partir de la curva ROC ( .93). A partir de aquí, se fijó en los 8 puntos, sobre una puntuación máxima de 10, el punto de corte óptimo para determinar si el paciente puede presentar presbiacusia (sensibilidad = 94% y especificidad 62%). Para finalizar el estudio, se evaluó la fiabilidad de la prueba mediante una rho de Spearman (=.96). Por todo ello, se podría concluir que el TPPS puede ser efectivo como prueba de cribado para la detección de la presbiacusia.

HospitalElder Life Program na unidade de urgência e emergência de um hospital público universitário: um programa de intervenção multicomponente para prevenção de delirium

Resumo Objetivo Avaliar a viabilidade da implementação de uma adaptação do Hospital Elder Life Program (HELP) com a participação de cuidadores familiares em hospital público universitário. Método Estudo piloto descritivo exploratório desenvolvido com 30 pacientes internados e seus cuidadores. Os Formulários de Registro foram aplicados para identificar fatores de risco para delirium, selecionar protocolos de intervenção e acompanhar a implementação. Nível de satisfação dos participantes e barreiras para implementar o programa foram avaliados por meio de entrevistas qualitativas. Resultados secundários foram coletados dos prontuários médicos. Análise estatística descritiva foi realizada para caracterizar a amostra e análise de conteúdo foi usada para analisar dados qualitativos. Resultados A maioria dos pacientes era do sexo feminino (60%), com idade média de 74,3 anos, ensino fundamental incompleto (60%), viúvo/divorciado (56,7%) e morava com familiares (83,3%) em casa (93,3%). Haviam sido hospitalizados 56,7% no último ano e 93,3% tinham pelo menos um fator de risco para delirium. Assistência alimentar e reposição de líquidos foi o protocolo com maior adesão (96,2%) e orientação (76,5%) com menor. Os participantes ficaram satisfeitos e acreditam que o HELP contribuiu para melhorar os resultados dos pacientes. Os motivos para não realização da intervenção proposta estavam relacionados à estrutura ou organização hospitalar, ao paciente e ao acompanhante. Conclusão Nossos resultados sugerem que ter membros da família atuando como “voluntários” é uma estratégia viável para implementar o HELP. Essa estratégia pode promover sua implementação em hospitais públicos de países de baixa e média renda.

Modified Hospital Elder Life Program in the emergency department of a public university hospital: a multicomponent intervention program for preventing delirium

Abstract Objective To evaluate the feasibility of implementing an adaptation of the Hospital Elder Life Program (HELP) with the participation of family caregivers in a public university hospital. Method Descriptive exploratory pilot study developed with 30 hospitalized patients and their caregivers. Registration Forms were applied to identify risk factors for delirium, to select intervention protocols, and track implementation. Participants' level of satisfaction and barriers to implementing the program were assessed through qualitative interviews. Secondary results were collected from medical records. Descriptive statistical analysis was performed to characterize the sample and content analysis was used to analyze qualitative data. Results Most patients were female (60%), with a mean age of 74.3 years, incomplete elementary school (60%), widowed/divorced (56.7%) and living with family members (83.3%) at home (93.3%). 56.7% had been hospitalized in the last year and 93.3% had at least one risk factor for delirium. Food assistance and fluid replacement was the protocol with the highest adherence (96.2%) and guidance (76.5%) with the lowest. Participants were satisfied and believe that HELP contributed to improving patient outcomes. The reasons for not performing the proposed intervention were related to the hospital structure or organization, the patient and the companion. Conclusion Our results suggest that having family members act as “volunteers” is a viable strategy to implement HELP. This strategy can promote its implementation in public hospitals in low and middle-income countries.

Hearing function, perception of disability (handicap) and cognition in the elderly: a relation to be elucidated

PURPOSE

To analyze auditory perception, hearing and cognition in the elderly referred for audiological evaluation and search for correlations between hearing and cognitive abilities.

METHOD

An observational and descriptive study, carried out with 135 elderly people. The participants did the auditory (tonal audiometry, speech audiometry, immittance measures, HHIE Questionnaire - Hearing Handicap Inventory for the Elderly) and the cognitive (MMSE - Mini Mental State Examination) assessments.

RESULTS

There is a high prevalence of hearing complaints (91.85%) and hearing loss (91.85%) in the elderly referred for audiological assessment, but there was no relation between the degree of hearing loss (p = 0.537) and the auditory perception (p = 0.930) in relation to cognitive performance.

CONCLUSION

In this study, the degree of hearing loss did not influence the cognitive performance of the elderly, and the auditory handicap perception did not differ between individuals with normal or altered cognition.

Analysis of the cognitive aspects of elderly people considering the practice of regular physical exercises and associated factors

Abstract Objective: The objective of this study was to compare the cognitive performance of elderly who are enrolled in a physical activity (PA) program with those who are not, considering some sociodemographic variables that are related to the practice of cognitive activities. Method: 59 elderly people participated in this study divided into control group (CG) and gymnastics group (GG). The Vienna Test System® was used to estimate the attention and concentration capacities, simple reaction time and peripheral perception. To test the normality of the data it was used the Shapiro Wilk Test. The association between PA and socioeconomic variables was verified by Chi-Square Test and Fisher Exact Test. To compare of differences between groups the Mann Whitney U-test for variables with non-parametric distribution and the Student T-test for independent samples for other variables were used. Result: There were no significant differences in the performance of the groups, except in the capacity of attention and concentration in which CG presented best performance (p=0.01). Factors as schooling (p=0.02), income (p=0.001) and regular practice of handcrafts (p=0.06) can explain the best performance of CG. Conclusion: This study found no evidence that the practice of physical activity can generate some cognitive benefit in the elderly when compared to the elderly who did not practice regular physical activity. However, we perceive the existence of other aspects that influence on the cognition, such as schooling, sociocultural level and the reading habit, that have a significant importance degree in the analysis.

Screening Methods for Age-Related Hearing Loss in Older Patients with Cancer: A Review of the Literature

As people grow older, they may experience loss in hearing sensitivity. Age-related hearing loss may negatively affect the patient’s quality of life as it may lead to social isolation. In older patients with cancer, hearing loss can seriously interfere with the patient’s ability to deal properly with all aspects of their disease, and may have a cumulative effect on their already decreased quality of life. Therefore, the proper screening of those conditions is essential in order to optimise the patient’s comfort during and after treatment. This review article aims at providing a concise image of the nature of age-related hearing loss, and provides an overview of the screening methods that could be used in older patients with cancer.