Dr. Catherine McMahon is a Professor in the Department of Linguistics, the Director of Audiology at Macquarie University, and Director of the HEAR Centre, a World Hearing Forum member and an informal WHO collaborating centre. Her research focuses on understanding the barriers and facilitators to accessing and utilizing hearing healthcare, and the design and implementation of effective care pathways. Catherine has worked closely with the World Health Organization to develop and collate the evidence-base for the World Report on Hearing, and is a Commissioner on the Lancet Commission of Hearing Loss and chairs the “Innovation in Service Delivery” team.
Why and How to Screen Hearing in Primary and Geriatric Care
Dr. De Wet Swanepoel is Professor of Audiology at the University of Pretoria, South Africa. His research capitalises on information and communication technologies to explore, develop and evaluate innovative solutions and service-delivery models for access to ear and hearing care. Professor Swanepoel has published more than 200 peer-reviewed articles, books and book chapters. He has been a President of the International Society of Audiology (2016-2018) and serves as Editor-In-Chief of the International Journal of Audiology. He founded a digital health company called the hearX group. In 2020 he won the African Academy of Science Olusequn Obasanjo Prize for Scientific Breakthrough and/or Technological Innovation and he became a Fellow of the Academy.
Dr. Zahinoor Ismail has certification in Behavioral Neurology & Neuropsychiatry, and Geriatric Psychiatry, and his research includes: i) rating scale development and measurement-based care; ii) non-cognitive markers of dementia; iii) neuroimaging and biomarker studies; and iv) clinical trials. He is funded by Brain Canada, the Canadian Consortium on Neurodegeneration in Aging, and the Canadian Institutes of Health Research. He is Academic Chair of the Alzheimer’s Association-ISTAART Neuropsychiatric Syndromes Professional Interests Area, Chair of the Canadian Conference on Dementia, and Chair of the Canadian Consensus Conference on the Diagnosis and Treatment of Dementia, which generates Canadian dementia guidelines, the most recent iteration of which were published in 2020. Dr. Ismail led the ISTAART development of the neurobehavioural syndrome Mild Behavioural Impairment (MBI) and the MBI Checklist, and co-led development of the new research criteria for biomarker and phenotypic classification of psychosis in AD and related dementias.
Marilyn Reed is the Practice Advisor for Audiology at Baycrest, where she has worked since 1997. She graduated with a Master’s degree in Audiology from the University of Southampton in England in 1976. Since emigrating to Canada in the same year, she has worked in a variety of clinical settings, with a focus on geriatrics, rehabilitation and clinical research in the area of hearing and cognition. She is currently the principal investigator on two projects, a Centre for Aging and Brain Health Innovations (CABHI) SPARK grant ‘Enhancing visibility of hearing loss with in-office screening in a Memory Clinic’ and ‘New Brunswick HEARS’, a community-based hearing rehabilitation program for at-risk older adults funded by the New Brunswick Healthy Seniors Project.
Dr. Sherri Smith is Associate Professor in the Department of Head and Neck Surgery and Communication Sciences and is a Senior Fellow in the Center for the Study of Aging and Human Development at Duke University in Durham, North Carolina, USA. She also is a secondary faculty member in the Department of Population Health Sciences. She holds a joint appointment as a Research Audiologist at the Durham Veterans Affairs Health Care System. Dr. Smith’s research focuses on improving the assessment and treatment of hearing loss in older adults.
Kathleen Pichora-fuller, University of Toronto and Simon Fraser University, Canada
Catherine McMahon, Macquarie University, Australia
DeWet Swanepoel, Pretoria University, South Africa
Zahinoor Ismail, University of Calgary and Penny Gosselin, Alberta Health Services, Canada
Marilyn Reed, Baycrest, Canada
Sherri Smith, Duke University, USA
In this symposium, we will provide an overview of the 2021 recommendations of the World Health Organization (WHO) World Report on Hearing regarding universal hearing screening for older adults. The prevalence of hearing loss increases markedly with age. By 75 years of age, the majority of older adults live with hearing loss. Importantly, hearing loss can co-occur with and increase risk for psychological (e.g., depression, dementia), social (e.g., isolation, loneliness) and physical (e.g., falls) health issues. Consistent with the WHO Integrated Care for Older People (ICOPE) guidelines, a decline in hearing capacity, alone or in combination with other health issues, can compromise functioning and undermine aging well. Nevertheless, the delay between first noticing hearing difficulties in everyday life and help-seeking from hearing specialists often takes a decade or more. Of those who have hearing loss, only about 1/5 use hearing aids, even in high-income countries where public funding is available. It is estimated that there would be a $16 return on every $1 invested to increase timely access to hearing health care. Hearing screening during regular health checks or during assessments for associated health conditions could help to accelerate the identification of hearing loss and reduce delays in help-seeking. Given that communication is an integral aspect of functioning and participation in everyday activities, earlier provision of hearing health care should be a key factor in aging well. Implementing hearing screening for older adults will require cost-effective and feasible technologies for assessing hearing and new inter-professional collaborations between hearing specialists and those working in primary and geriatric care. The first paper provides an overview of the WHO guidance regarding a global approach to universal hearing screening for older adults. The second paper shows how new high-tech, low-touch technologies are being implemented to achieve hearing screening in South Africa. The third paper describes new Canadian geriatric guidelines for dementia assessment and treatment in primary care that include recommendations for hearing screening. The fourth paper presents the results of a study in which hearing screening was conducted at a memory clinic in-person pre-COVID-19 and using remote testing during COVID-19. The fifth paper presents the results of a study examining how encouragement by physicians and on-site hearing screening in primary care influenced help-seeking by those who failed hearing screening. The symposium will conclude with a discussion of how best to implement hearing screening in a new model of integrated care for older people.
Presenter #1, Catherine McMahon
World Health Organization World Report on Hearing: Guidance for hearing screening in older adults
Adult-onset hearing loss is highly prevalent, but poorly recognized as a major public-health problem. Progressive and irreversible, it reduces quality of life, increases social isolation, and leads to economic inactivity. In most countries, the detection and treatment of hearing loss is poorly prioritized, and often not included in standard health checks across the life course, other than for newborns, despite the proven effectiveness of hearing technologies. In March 2021, the WHO launched the first ever World Report on Hearing, which urges all governments to incorporate ear and hearing care into national health plans. Using a two-stage expert Delphi study, led by the WHO, a team of hearing experts representing low-mid-income and high-income countries, sought to develop guidance for policy-makers to implement hearing screening for adults that could be tailored for different contexts. Here we present the results of the study and describe ways in which the guidance could be adapted to fit within existing health checks and contexts.
Presenter #2, De Wet Swanepoel
More accessible hearing care with high-tech, soft-touch innovation
Co-author: Penny Gosselin
Megatrends including the rise of technology and mobile connectivity have ushered in an era of digital health with unparalleled potential for preventative population-based health and democratized access. The COVID-19 pandemic has further highlighted digital solutions as essential for safe, remote and decentralized care. Innovative technologies and service-delivery models for accessible and affordable hearing care will be explored using high-tech and soft touch approaches. These include using low-cost clinical technologies on a smartphone for point-of-care diagnostics, supported by artificial intelligence, to enable decentralized community-based services. Incorporating automated testing, advanced measures of environment and test-operator quality, cloud-based surveillance and reporting, and a simple user interface allow minimally trained health workers to facilitate services at low-cost. New advances can triage at-risk patients for more in-depth investigations leaving more than 80% of adult hearing losses to potentially benefit from community-based care. Incorporating hearing aid provision within mHealth supported service-delivery models enable point-of-care hearings services and community-based support. Current examples of innovative service-delivery models in low- and middle-income countries will be presented.
Presenter #3, Zahinoor Ismail and Penny Gosselin
Screening for hearing impairment in older adults – what do Canadian Dementia Clinical Guidelines tell us?
Over 50 million people worldwide live with dementia, and this number is increasing. Prevention is paramount, but for preventative interventions to succeed they need to start earlier, with better markers to identify risk. Age-related hearing loss is the third most prevalent chronic condition amongst older adults accounting for 9% of the life-course model of modifiable risk factors for dementia. With increasing degrees of mild, moderate and severe hearing loss, risk of incident dementia increases 2-, 3- and 5-fold. Knowing more about hearing loss, and the impact of speech understanding in complex listening situations, can help target interventions. The Canadian Consensus Conference on the Diagnosis and Treatment of Dementia recently published its 5th iteration of dementia guidelines (CCCDTD5). Of the 8 themes, the non-cognitive markers of dementia theme addressed hearing. These guidelines recommend: 1) Persons with cognitive complaints, MCI, or dementia (and their care partner) should be questioned about symptoms of hearing loss to improve cognitive outcomes and risk reduction; and 2) If symptoms of hearing loss are reported, then hearing loss should be confirmed by audiometry. Here we review the development of these guidelines, and their utility for detection of dementia risk.
Presenter #4, Marilyn Reed
Use of remote hearing screening of Memory Clinic patients during the COVID-19 Pandemic
Knowledge of patients’ hearing loss could be of immediate benefit to Memory Clinic physicians as it may affect patient-provider communication, assessment, diagnosis and treatment outcomes. While not typically included in the standard test battery, reliable detection of hearing loss in Memory Clinic patients, likely to be particularly at risk for dementia, should be a beneficial component of clinic protocol. Recently developed tablet- and smartphone-based systems provide a fast, reliable method of screening for hearing loss at point of care. This presentation describes how a study employing in-office screening with the SHOEBOX QuickTest tablet-based screener pivoted to remote screening with SHOEBOX Online during the pandemic when Memory Clinic consultations were performed remotely. While Memory Clinic patients pose a particular challenge for remote screening due to their age, cognitive status and access to the required equipment, the validation study showed that hearing loss could be reliably detected in the majority of this population with 73% correctly classified with online compared with in-office screening. The project was able to be adapted for remote implementation during the pandemic, demonstrating that use of a remote screening tool is feasible for use with older adults in clinical practice if appropriate processes and practices are in place.
Presenter #5, Sherri Smith
Hearing screening in primary care: Effects of physician encouragement and on-site testing
Despite the known impacts of untreated hearing loss in older adults, hearing screenings are not routinely performed in primary care clinics in the United States due to lack of established effectiveness, time constraints, uncovered cost, and other unknown reasons. We compared compliance and follow-through using three screening protocols (N = 220 each) that differed in levels of clinic support (i.e., physician encouragement [or not] and access to in-clinic or at-home self-administered telephone screening tool). The primary outcome was the percentage of patients who completed screening. Secondary outcomes were the percentage of those who failed the screening who scheduled and completed a diagnostic evaluation and obtained a hearing aid recommendation. All participants who had provider encouragement and an in-clinic opportunity completed the screening whereas only 26.8% of those with physician encouragement completed the screening at home and 22.7% of those without physician encouragement completed the screening at home. There was no significant difference among the three screening protocols for any secondary outcome. Our results showed that physician encouragement was not effective in improving hearing screening completion, but offering a space in the clinic was more effective than screening completion at home.