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Revisiting Age-Related Hearing Loss Screening - Part 2

Weinstein, Barbara E. PhD

doi: 10.1097/01.HJ.0000511724.18465.3b
Golden Rules

Dr. Weinstein is professor of audiology and founding executive officer of the Health Sciences Doctoral Programs at the Graduate Center, City University of New York, and coauthor of the Hearing Handicap Inventory for the Elderly/Adults.

Editor's Note: This is the conclusion of a two-part article. The first part was published in the December 2016 issue.

Figure.

Figure.

Improving affordability and accessibility of hearing health care is a priority given the prevalence and negative effects of untreated hearing loss and the slow trickling down effect of mandates from government agencies. Earlier detection and referral of people with age-related hearing loss should be an upstream initiative by audiologists with relevant stakeholders in health care. Older adults wait an average of seven to 10 years before seeking treatment for hearing loss, and most do not know which health professional to consult when their hearing loss becomes intolerable and they are finally ready to take action. Not knowing how or from whom to access hearing health care services is a notable concern.

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I agree with Reavis, Tremblay, and Saunders that a “public health” model which involves community-wide efforts to prevent disease maximize health and prolong life is needed (Ear Hear. 2016;37[4]:376 http://bit.ly/2gPelvZ). Public health efforts entail engaging all sectors of society to promote hearing health needs by counseling and empowering stakeholders, mobilizing community partnerships, and designing physical environments that are more conducive to effective communication. This is synonymous with taking audiologists away from the test booth and placing them instead with health professionals to reach out to even more older adults who could benefit from their expertise. Further effort should be made in connecting with those who are at great risk from untreated age-related hearing loss, particularly older adults with multimorbidity.

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COLLABORATIONS WITH PHARMACISTS

I propose starting with community-based interventions, specifically behavioral counseling and informal screenings by non-audiologists who are in regular contact with and trusted by older adults (Ear Hear. 2016 http://bit.ly/2gPelvZ). We should coordinate and collaborate with frontline health care professionals to achieve the goal of changing hearing health behaviors among at-risk populations. A recent visit to Rite Aid and CVS where I witnessed encounters between older adults and a pharmacist solidified my view that pharmacists would be ideal health care professionals with whom to collaborate. Integral members of multidisciplinary health care teams, pharmacists offer extensive clinical services, from immunizations and health screenings to medication management, patient education, and counseling to promote medication adherence. Charged with delivering person-centered care, pharmacists bring a unique skill set, making them critical members of health care teams focused on improving the health of older adults (Chest. 2013;144[5]:1687 http://bit.ly/2gPjC6O; Ann Pharmacother. 2013;47[11]:1471 http://bit.ly/2gPlGvN).

Polypharmacy, or use of five or more medications, is the rule rather than the exception among older adults because of multi-moribidity and the possibility that multiple providers are prescribing medications (Clin Geriatr Med. 2012;28[2]:159 http://bit.ly/2gPnhlc). Interestingly, adults 65 years of age or older consume 34 percent of prescription medication and 40 percent of over-the-counter medications; hence, they spend a good deal of time in pharmacies (Clinical Geriatrics. 2006;14[7]:33 http://bit.ly/2gPqS2H). Older adults receive an average of 12 prescriptions per year (two prescriptions per visit), resulting in 365 million prescriptions written each year (Health Notes, 2003 http://bit.ly/2gLyAKW). The potential for adverse reactions is directly related to the number of medications consumed, and the non-adherence rates relate directly to the number of medications ingested (Home Healthcare Now. 2015;33[10]:524 http://bit.ly/2gPqQHN).

Alpert and Gatlin discussed strategies that could be used to prevent the negative consequences attending polypharmacy (Home Healthcare Now. 2015 http://bit.ly/2gPqQHN). Two proactive suggestions are regular medication reviews and evaluation of risk for adverse medication complications. With regard to the latter, I suspect that the adverse effects of polypharmacy may in part relate directly or indirectly to communication breakdowns between the pharmacist and older clients who are likely to have untreated hearing loss. Hearing and communication are at the heart of best practices for pharmacists who are often the go-to health professionals for older adults with questions about their health and prescription regimens. With their broadened reach, pharmacists are the ideal professionals to assist with hearing health care screenings and behavioral counseling regarding the value of routine hearing testing among at-risk older adults.

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HEARING HEALTH EDUCATION FOR PHARMACISTS

Table 1

Table 1

Audiologists should educate pharmacists regarding chronic conditions such as falls, dementia, and diabetes that place older adults at risk from hearing loss. Pharmacists should understand the behaviors exhibited by people with hearing loss, so they can recognize when an older adult is not absorbing what the pharmacist is telling them and requires hearing assistance. Pharmacists should adopt counseling strategies to maximize communication (Table 1).

Figure 1.

Figure 1.

Pharmacies should have a portable t-coil induction loop set up behind the counter to enable hearing aid users (with a t-switch) to communicate effectively. Headsets and neckloops should be made available to older adults with hearing loss who do not wear hearing aids or don't have hearing aids with t-coils. The universal hearing loop symbol (Fig. 1) should be clearly visible in pharmacies. Audiologists should inform older adults which pharmacies are accessible, and it is likely that a reciprocal relationship would ensue. The conversations I have had with pharmacists revealed that they are regularly asked about available, inexpensive personal sound amplifiers. However, they really do not feel equipped to answer the questions routinely asked by consumers seeking help. As such, educational materials—such as information cards on the signs and symptoms of hearing loss that could be placed in medication bags—should be made available to pharmacists.

Historically, the role of pharmacists has been focused on dispensing medications. Given the changes in the health care marketplace, pharmacists are becoming increasingly engaged in direct patient care, screening, and disease management. Older adults value and appreciate the attention that comes with pharmaceutical care. Thus, it is likely that older adults at risk from hearing loss would act on the recommendation to see an audiologist if the pharmacist conveys that they are susceptible to hearing loss and might benefit from a targeted hearing health care intervention. The pharmacy is one of the many community-wide innovations that can help make hearing health care more accessible to the increasing number of older adults with untreated hearing loss.

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