The Public Health Worker Program provides a low-cost device to improve hearing in the elderly

A first-of-its-kind program that trains trusted older community health workers to fit and deliver low-cost hearing technology to peers with hearing loss significantly improved communication function among participants, according to the results of a randomized clinical trial led by Johns Hopkins Medicine researchers .

A first-of-its-kind program that trains trusted older community health workers to fit and deliver low-cost hearing technology to peers with hearing loss significantly improved communication function among participants, according to the results of a randomized clinical trial led by Johns Hopkins Medicine researchers .

According to the National Institutes of Health, two-thirds of adults 70 and older have clinically significant hearing loss, but less than 20% of adults with hearing loss use a hearing aid. 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 rates of hearing aid use among older African Americans with hearing loss.

Hearing loss isn’t just an inconvenience that comes with aging—it’s a critical public health issue that’s now the focus of national and international initiatives coming from the National Academies, the White House, and the World Health Organization. This global attention to hearing loss is the result of a growing understanding of the impact that hearing loss can have on the risk of dementia, cognitive decline, higher health care costs, and other adverse outcomes.

To address this gap in access to hearing care, Johns Hopkins Medicine researchers developed HEARS (Hearing health Equity through Accessible Research and Solutions) to train community health workers (CHWs) to work one-on-one with their peers living in affordable independent housing. CHWs, trained and supervised by local audiologists, conducted two-hour sessions with clients, counseling them on the basics of age-related hearing loss and communication strategies, and then delivered and fitted low-cost, over-the-counter amplification devices provided by the HEARS program.

Otologist Kerry Niemann, MD, MPH, core faculty at the Johns Hopkins Cochlear Center for Hearing and Public Health, first author of the clinical trial and creator of the HEARS model, said the program is not intended to replace audiologists and otolaryngologists who have specialized training. for hearing loss. The goal instead, she said, is to “recruit and train community health workers who share some of the same experiences as those without hearing care, which is the vast majority of older adults with hearing loss.” From this position, CHWs can gain trust and connect with their clients in ways that hearing care professionals like myself often cannot.”

In this study, researchers recruited 151 participants from 13 community settings in Baltimore, Maryland, which included affordable independent living complexes and senior centers. A randomized group of 78 people received a CHW-led hearing care intervention, while a waiting list control group of 73 people did not. The mean age of participants was 76.7 years, 101 participants were female, and 65 identified as African American. Two-thirds of the participants were low-income, and nearly half did not own or use a smartphone.

Communication function, a measure of the impact of hearing loss on an individual’s everyday communication, was assessed for all participants using a commonly used instrument known as the Hearing Impairment Inventory. The score on the measure ranges from zero to 40, with higher scores indicating greater difficulty communicating.

Those who received CHW assistance had a baseline mean score of 21.7 and a mean score of 7.9 at the three-month follow-up CHW visit. In contrast, the waitlist control group saw little or no change, with a baseline mean score of 20.1 and a mean score of 21 at the three-month follow-up.

Overall, the researchers said, the results of the trial, published Dec. 20 in Journal of the American Medical Association, revealed that participants reported significant improvement after a three-month follow-up compared to the control group. Results suggest that those who worked with CHWs experienced benefits from the two-hour hearing intervention session that were similar in magnitude to what has been reported in the literature for audiologist-fitted hearing aids.

“They came to us and got help from us because we’re just like them — we’re adults,” said Renee Hicks, 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 getting out of their apartments and participating in activities.”

“This trial validates a model of hearing care that empowers community health workers to reach older people with untreated hearing loss.” The HEARS program connects people with a hearing aid and the training they need,” Niemann said. “The reach of the HEARS program is expanded by new over-the-counter hearing aids that give older adults the tools they need to age well.”

Niemann says further trials of the HEARS program are planned at three sites in Maryland, and he is seeking collaborators and funding to grow the program globally.

The research team is interdisciplinary and includes Frank Lin, Joshua Betz, Emmanuel García Morales, Jonathan Suen, Jami Trumbo, Nicole Marrone, Hae-Ra Han, and Sara Santon.

Funding for this study was supported by the National Institute on Deafness and Other Communication Disorders.

Nieman and Lynn are co-founders and volunteer board members for the nonprofit organization Access HEARS.

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