Primary Care Clinicians Neglect Hearing Loss, Survey Finds

Most adults in the United States have not been asked about their hearing by their primary care provider in the past 2 years, according to a national poll.

But asking a single question — “Do you think you have hearing loss?” — may be an efficient way to identify patients who should receive further evaluation, researchers said.

Only 20% of adults aged 50 to 80 years report that their primary care physician has asked about their hearing in the past 2 years, according to the National Poll on Healthy Aging, published online March 2. Among adults who rated their hearing as fair or poor, only 26% said they had been asked about their hearing.

Michael McKee, MD, MPH, a family medicine physician and health services researcher at Michigan Medicine, the University of Michigan’s academic medical center, and colleagues surveyed 2074 adults aged 50 to 80 years in June 2020. They asked participants about the screening and testing of hearing that they had undergone. The researchers weighted the sample to reflect population figures from the US Census Bureau.

Men were more likely than women to have been asked about their hearing (24% vs 17%), and adults aged 65 to 80 years were more likely than younger adults to have been asked about their hearing (25% vs 16%).

The survey also found that 23% of adults had undergone a hearing test by a healthcare professional; 62% felt that it was at least somewhat important to have their hearing tested at least once every 2 years.

Overall, 16% of adults rated their hearing as fair or poor. Approximately a third rated their hearing as good, and about half rated their hearing as excellent or very good. Fair or poor hearing was more commonly reported by men than women (20% vs 12%) and by older adults than younger adults (19% vs 14%).

In all, 6% used a hearing aid or cochlear implant. Of the adults who used these devices, 13% rated their hearing as fair or poor.

Those with worse physical or mental health were more likely to rate their hearing as fair or poor and were less likely to have undergone testing.

Although “screening for hearing loss is expected as part of the Medicare Annual Wellness Visit,” the data suggest that most adults aged 65 to 80 years have not been screened recently, the researchers say.

“One efficient way to increase hearing evaluations among older adults in primary care is to use a single-question screener,” McKee and coauthors write.

“The response to the question ‘Do you think you have hearing loss?’ has been shown to be highly predictive of true hearing loss…. Age-related hearing loss remains a neglected primary care and public health concern. Consistent use of screening tools and improved access to assistive devices that treat hearing loss can enhance the health and well-being of older adults,” they write.

Philip Zazove, MD, chair of the Department of Family Medicine at the University of Michigan and one of the authors of the report, noted in a news release that health insurance coverage varies widely for hearing screening by primary care providers, testing by audiologists, and hearing aids and cochlear implants.

Implementing the single-question screener is “easy to do,” Zazove told Medscape Medical News. “The major barrier is remembering, considering all the things primary care needs to do.” Electronic prompts may be an effective reminder.

If a patient answers yes, then clinicians should discuss referral for testing. Still, some patients may not be ready for further testing or treatment, possibly owing to vanity, misunderstandings, or cultural barriers, Zazove said. “Unfortunately, most physicians are not comfortable dealing with hearing loss. We get relatively little education on that in medical school and even residency,” he said.

“Hearing screening isn’t difficult,” and primary care providers can accomplish it “with one quick screening question — as the authors note,” commented Jan Blustein, MD, PhD, professor of health policy and medicine at New York University. “I believe that some providers may be reluctant to screen or make a referral because they know that many people can’t afford hearing aids…. However, I also believe that many providers just don’t appreciate how disabling hearing loss is. And many didn’t receive training in this area in medical school. Training in disability gets very short shrift at most schools, in my experience. This needs to change.”

The survey does not address whether screening practices for hearing loss has changed during the COVID-19 pandemic, though Zazove suspects that screening has decreased as a result. Even if patients are screened, some may not present for audiology testing “because of fear of COVID or the audiologist not being open,” he said.

Hearing loss is associated with increased risk for hospitalization and readmission, dementia, and depression. “We believe, though studies are needed to verify, that detection and intervention for these patients can ameliorate the adverse health, social, and economic outcomes,” Zazove said.

The report was sponsored by AARP and Michigan Medicine. Blustein has disclosed no relevant financial relationships.

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