Community health worker program delivers low-cost device to improve hearing in older adults
A first-of-its-kind program training trusted older community health workers to fit and deliver low-cost hearing technology to peers with hearing loss significantly improved communication function between participants, according to clinical trial results randomized trial run by Johns Hopkins Medicine. researchers
A first-of-its-kind program training trusted older community health workers to fit and deliver low-cost hearing technology to peers with hearing loss significantly improved communication function between participants, according to clinical trial results randomized trial run by Johns Hopkins Medicine. researchers
According to the National Institutes of Health, two-thirds of adults age 70 and older have clinically significant hearing loss, but less than 20% of adults with hearing loss use hearing aids. Hearing aid use rates are even lower among low-income adults, often due to the high cost of the devices, limited insurance coverage, and inadequate access to hearing care professionals. Racial and ethnic health disparities also contribute to low levels of hearing aid use among older African Americans with hearing loss.
Hearing loss is not just a problem that arises with aging, it is a critical public health problem that is now the focus of national and international initiatives coming from the northNational Academies, the White House and the World Health Organization. This global attention to hearing loss is the result of the growing understanding of the impact hearing loss can have on the risk of dementia, cognitive decline, increased health care costs, and other adverse outcomes.
To close this gap in access to hearing care, Johns Hopkins Medicine researchers developed HEARS (Hearing Health Equity Through Research and Accessible Solutions) to train community health workers (CHWs) to work one-on-one with their peers who live in independent affordable housing. CHWs, trained and supervised by local audiologists, conducted two-hour sessions with clients, advising them on the basics of age-related hearing loss and communication strategies, and then issuing and fitting them with hearing aids. low-cost and over-the-counter amplification. provided by the HEARS program.
Otologist Carrie Nieman, MD, MPH, senior faculty at the Johns Hopkins Cochlear Center for Hearing and Public Health, first author of the clinical trial and co-creator of the HEARS model, said the program is not intended to replace audiologists and otolaryngologists who have Specialized training in hearing loss. Instead, he said, the goal is to “recruit and train community health workers who share some of the same lived experiences as those without hearing care, representing the vast majority of older adults with hearing loss. Since this position, CHWs can gain confidence and connect with their clients in ways that hearing care professionals, like me, often can’t.”
In this trial, the researchers recruited 151 participants from 13 community sites in Baltimore, Maryland, including independent affordable housing complexes and senior centers. A randomized group of 78 people received a CHW-led hearing care intervention, whereas a waiting list control group of 73 people did not. The average age of the participants was 76.7 years, 101 participants were female, and 65 identified as African American. Two-thirds of the participants were in the low-income group, and almost half did not own or use a smartphone.
Communication function, a measure of the impact of hearing loss on an individual’s daily communication, was assessed for all participants through a commonly used tool known as the Hearing Impairment Inventory. Scores on the measure range from zero to 40, with higher scores indicating greater communication difficulty.
Those who received help from a CHW had a baseline median score of 21.7 and a median score of 7.9 at a 3-month follow-up visit with the CHW. By contrast, the waiting list control group saw little or no change, with a mean baseline score of 20.1 and a mean score of 21 at three-month follow-up.
Overall, the researchers say, the trial results, published December 20 in the Journal of the American Medical Association, revealed that participants reported a significant improvement after a three-month follow-up compared to the control group. The results suggest that those who worked with a CHW experienced benefits from the two-hour hearing intervention session that were similar in magnitude to what is reported in the literature for hearing aids fitted by an audiologist.
“They came to us and got our help because we’re just like them: we’re seniors,” said Renee Hicks, a CHW who provided hearing aids and education to her peers. “They would learn from us because we lived in the same community. It also helped in terms of health, people were coming out of their apartments and participating in activities.”
“This trial validates a model of hearing care that empowers community health workers to reach older adults with untreated hearing loss. The HEARS program connects people with a hearing device and the education they need,” said Nieman. “The reach of the HEARS program is expanded with newly available over-the-counter hearing aids, giving older adults the tools they need to age well.”
Nieman says more trials of the HEARS program are planned at three sites in Maryland, and he is seeking partners and funding to grow the program globally.
The research team is interdisciplinary and includes Frank Lin, Joshua Betz, Emmanuel Garcia Morales, Jonathan Suen, Jami Trumbo, Nicole Marrone, Hae-Ra Han, and Sarah Szanton.
Funding for this study was supported by the National Institute on Deafness and Other Communication Disorders.
Nieman and Lin are co-founders and volunteer board members of the nonprofit organization Access HEARS.