Hearing Loss and Older Adults' Perceptions of Access to Care
Abstract and Introduction
We investigated whether hard-of-hearing older adults were more likely to report difficulties and delays in accessing care and decreased satisfaction with healthcare access than those without hearing loss. The Wisconsin Longitudinal Study (2003–2006 wave, N = 6,524) surveyed respondents regarding hearing, difficulties/delays in accessing care, satisfaction with healthcare access, socio-demographics, chronic conditions, self-rated health, depression, and length of relationship with provider/site. We used multivariate regression to compare access difficulties/delays and satisfaction by respondents' hearing status (hard-of-hearing or not). Hard-of-hearing individuals comprised 18% of the sample. Compared to those not hard-of-hearing, hard-of-hearing individuals were significantly more likely to be older, male and separated/divorced. They had a higher mean number of chronic conditions, including atherosclerotic vascular disease, diabetes and depression. After adjustment for potential confounders, hard-of-hearing individuals were more likely to report difficulties in accessing healthcare (Odds Ratio 1.85; 95% Confidence Interval 1.19–2.88). Satisfaction with healthcare access was similar in both groups. Our findings suggest healthcare access difficulties will be heightened for more of the population because of the increasing prevalence of hearing loss. The prevalence of hearing loss in this data is low and our findings from a telephone survey likely underestimate the magnitude of access difficulties experienced by hard-of-hearing older adults. Further research which incorporates accessible surveys is needed. In the meantime, clinicians should pay particular attention to assessing barriers in healthcare access for hard-of-hearing individuals. Resources should be made available to proactively address these issues for those who are hard-of-hearing and to educate providers about the specific needs of this population.
Hearing loss is prevalent in older adults and is the sixth most common chronic condition in the United States. Thirty-seven million adults in the Unites States are hard-of-hearing (have some auditory capacity) or are deaf. In Wisconsin, an estimated 46% of the population over age 47 has hearing loss. Individuals with other chronic conditions and physical disabilities report decreased access to care and are less satisfied with their health care. Both adults who are hard-of-hearing or deaf as well as the physicians who treat them report mutual communication difficulties in the health care setting (e.g., medication safety risks created by problems communicating and understanding a therapeutic plan). As patient-centered communication is an essential element of a satisfactory patient-physician relationship, these findings have implications for access to care. Better access to care and satisfaction with care are linked to several beneficial patient outcomes including increased adherence, improved receipt of preventive services, and higher quality of care.
Though individuals who are deaf are known to have difficulties and delays in accessing care, much less is known about access to health care for hard-of-hearing individuals. This group, which is increasing in size partially due to the aging of the population, may be at heightened risk for poor access to care. Older adults, a population disproportionately affected by hearing loss, have increased morbidity from other chronic conditions. This increased morbidity compounded with communication issues in the health care setting can lead to serious safety concerns. One prior study, limited to Medicare beneficiaries, found that "hard-of-hearing" and "deaf/very hard of hearing" individuals were more dissatisfied with access to care than those with no or minor hearing difficulties. However, this sample contained a number of proxy respondents, and the research analyzed as separate groups those who were "hard-of-hearing" and "deaf/very hard-of-hearing."
Our study objective was to investigate whether older adults who are hard-of-hearing are more likely than other adults to report experiencing difficulties and delays in accessing care and decreased satisfaction with access to care.