Clinical Manifestations

Background: Hearing loss is highly prevalent and can have significant consequences for older adults aging with cognitive impairment. However, few older adults use hearing aids and disparities in care exist by race, ethnicity, and socioeconomic position. To understand the intersection of hearing loss and cognitive impairment with the ultimate goal of developing an affordable, accessible hearing care intervention responsive to the needs of end-users, a series of semi-structured interviews was conducted.

Method: We conducted 20 semi-structured interviews with 10 participants with mild cognitive impairment (end-users) and their 10 care partners and 9 experts. End-users were recruited from the Johns Hopkins Memory and Alzheimer's Treatment Center. Experts were identified professionals with expertise in dementia, hearing, neuropsychiatric symptoms, healthcare delivery, intervention development, and program implementation and dissemination. We used a heterogeneous purposive sampling to recruit participants from diverse race/ethnicities, education, and income levels. Qualitative content analysis was used to identify themes related to the impact of hearing loss on work, relationships, family life, and neuropsychiatric symptoms along with considerations for the development of a hearing care intervention.

Result: Among end-users and care partners, 30% self-identified as African American, 45% as male, and 40% reported less than a college degree (Table 1). End-users and care partners identified barriers to accessing hearing care, including the stigma associated with hearing loss, the cost of hearing aids, the lack of availability of hearing care, and the participants' denial of hearing difficulties (Table 2). Suggested facilitators for improving access to hearing care include more affordable hearing aids and incorporating hearing screenings into routine medical care. The participants' desire to improve communication and care partner support motivate accessing hearing care. Measures of hearing intervention success include strengthened social connections, reduced tension with care partners, and increased social activity. Experts emphasize the importance of education on hearing and dementia, the role of care partners, minimizing burden, and reliance on practical, affordable technology.

Conclusion: In a diverse sample of persons living with cognitive impairment, their care partners, and experts, participants identified unique barriers, facilitators, motivators, and measures of success to guide the development of an affordable, accessible hearing care intervention.