Use and Satisfaction of Older Adults Using Hearing Aids

One goal of the U.S. Food and Drug Administration’s (FDA) authorization of over-the-counter (OTC) hearing aids in October 2022 was to reduce the cost of hearing instruments, thereby increasing their access and availability to individuals with perceived mild to moderate hearing loss.1 Since hearing aid uptake is reportedly low in the aging population, we were interested in determining whether OTC hearing aids had an impact on hearing aid purchase in this group and, if so, whether these OTC aids were providing subjective benefit to users in terms of improved auditory access and communicative function.2–4 The purpose of this study was to assess, via questionnaire, the impressions of a group of older hearing aid users who were residents of a continuing care retirement community about the hearing health care they had received and of the amplification devices (OTC and prescriptively-fit hearing aids) they used.Figure 1: Where Devices Were Obtained.The survey questions were intended to address participants’ general knowledge about hearing aids. Questions targeted how and where the devices were obtained, the factors determining purchase, whether 1 or 2 devices were used, wearing time, post-purchase adjustment and concerns, as well as the participants’ overall satisfaction with the devices. Questions also addressed their self-perceptions of psychosocial and emotional changes related to hearing aid use (e.g., memory, fatigue, socialization). The survey and the study parameters were approved by the university’s Institutional Review Board of the authors’ university. STUDY Participants were solicited via flyers, which were placed on a table in the facility mailroom. As an incentive to participate, volunteers were offered entry into a lottery to receive a cash gift of $50.00. A total of 29 older (ages 65 and above) hearing aid users took part in the study after completing an informed consent form. The questionnaire was then distributed to each participant, some of whom took them home to complete on their own and some of whom were assisted by a member of the Environmental Committee at the facility. The survey results concerning the impact of OTC hearing aids on hearing aid uptake are shown in Figure 1, revealed that 3 users out of 29 (10.3%) chose them. Two of the 3 OTC users (67%) reported having had a hearing test prior to obtaining the aids and indicated that identification of hearing loss was the determining factor in purchase; the third OTC user reported that cost was the determining factor in purchasing the aids. Of the 26 users of prescriptively-fit hearing aids, all of whom received a hearing test prior to obtaining the aids, only 2 mentioned cost as a factor. One of the 2 reported that ease of operation was also a factor and the other stated that cheaper aids had been used previously and had not been effective. The desire to improve hearing was the major factor driving hearing aid purchase, with 12 participants (2 OTC and 10 prescriptively-fit) of 29 reporting this (including the 1 mentioned above who found that her prior cheaper hearing aids did not work). Four participants reported that the features of the hearing aid (e.g., easy insertion and removal, multiple settings, rechargeability) were the factors of most interest to them. One interesting result emerging from this question was that 26 of 29 participants (90%) reported that their interest in obtaining amplification was self-motivated; only 3 respondents indicated that others (family and friends) urged them to seek hearing-help. The results for the question concerning where and how the devices were obtained are displayed in Figure 1 which shows that 15 hearing aids (all prescriptively-fit) were dispensed by audiologists in private practice. Seven aids (4 prescriptively-fit and 3 OTC) were purchased at a big-box store, while 4 aids (prescriptively-fit) were obtained in a physician’s office. Two (prescriptively-fit) were obtained from a hearing aid specialist, and 1 user was unable to recall where the hearing aid was purchased. As to a binaural versus monaural fitting, all participants were recommended to receive 2 hearing aids and all of them purchased 2; however, 1 user of prescriptively-fit aids chose to wear only 1, reporting that wearing the second aid was too loud. Results of the question related to wearing time indicated that 21 respondents (2 OTC and 19 prescriptive) wore their instruments 12 or more hours per day, while the remaining 8 (1 OTC and 7 prescriptive) typically wore their aids less than 12 hours per day. Results for the questions regarding post-purchase adjustment and concerns, including issues surrounding fit and placement of the instruments, covered whether instructions and troubleshooting techniques were provided by the dispenser; whether information concerning a trial period and warranty was given; and the availability of support services indicated general satisfaction from all respondents. Minor concerns regarding insertion and removal of the aids were reported by only 3 (prescriptively-fit) of the 29 respondents. Of the 15 respondents who were able to recall whether they needed time to adjust to their hearing aids, only 2 prescriptively-fit users reported difficulty lasting more than 3 months; most (10 respondents) indicated an adjustment period of 2 weeks or less. For the question concerning any post-fitting issues: 17 respondents (3 OTC and 14 prescriptive) reported no problems, 10 respondents (all prescriptive) indicated some problems, and 2 respondents (prescriptive) did not answer. Of those reporting problems, all indicated that the issues were resolved by their dispensers quickly and adequately. All 3 OTC users reported receiving verbal instructions on use and care of the instrument; 23 of the prescriptively-fit users reported receiving verbal, written, and/or both instructions. Two of the prescriptively-fit users could not recall whether instructions had been provided and 1 did not respond. When responding to the question concerning whether troubleshooting techniques had been provided by the dispenser, 14 respondents (1 OTC and 13 prescriptive) indicated “yes” and 6 (prescriptive) indicated “no”; 9 users (2 OTC and 7 prescriptively-fit) did not respond or could not recall. Responses to the question about a trial period indicated that 19 participants (prescriptive) were provided with information; 4 (1 OTC and 3 prescriptive) were not; and 6 (2 OTC and 4 prescriptive) did not answer or did not remember. For the question concerning the provision of warranty information, 19 respondents (1 OTC and 9 prescriptive) indicated they received information and the remaining 10 (2 OTC and 8 prescriptive) did not know or failed to respond. Regarding availability of support services, all (29/29) respondents indicated that they had easy access to their dispensers through personal appointments, phone calls, or the internet. One striking finding in this series of questions was that all participants kept and used their hearing instruments after purchase, regardless of manufacturer, dispenser, adjustment period, and access to information. For the question concerning improvements in communication ability with the hearing aids, 25 respondents reported “yes,” many resoundingly; 3 respondents reported some benefit, and 1 participant did not respond. The question about impressions of increased sociability after using the hearing aids indicated that 7 respondents agreed, 9 felt their socialization was about the same, 12 indicated no real socialization benefit, and 1 did not respond. When responding to the questions about improvements in attention and reduced auditory fatigue when wearing the hearing aids, 19 participants indicated positive changes, 5 indicated no change, and 5 did not respond. The questions about communication, socialization, and listening fatigue yielded predictable comments about difficulties in group settings, with certain speakers, and in background noise situations. This was supported by the responses to the survey question about difficult listening situations, with 19 responders indicating problems, 9 indicating no problematic situations, and 1 participant not responding. Situations specifically identified were, again unsurprisingly, in crowds, on the phone, watching television, at dinner, and with speakers at a distance or with an unfamiliar accent. DISCUSSION A limitation of this study is that the small sample size drawn from a very restricted community. However, we believe our findings have relevance to the broader population of older adults with hearing loss, particularly those residing in continuing care retirement settings. Based on the results, OTC hearing aids have had an impact on hearing aid uptake in the older community, with 10.3% of our respondents purchasing them. Whether these individuals would have obtained amplification had OTC instruments not been available is unknown. For both the OTC and prescriptively-fit users, results indicate that a desire to hear better was the main driver of hearing aid purchase; cost was rarely a consideration. Moreover, the vast majority (90%) of participants indicated that their interest in obtaining amplification was self-motivated, not because of outside influences. This finding is consistent with those of Vestergaard Knudsen et al. who reported that the only factor positively affecting hearing help-seeking, hearing aid uptake, use, and satisfaction was self-reported hearing disability.5 Findings regarding where hearing devices were obtained indicate that respondents used a variety of outlets. Of the 28 respondents who could recall where their hearing aids were purchased, the majority (54%) received their hearing aids from private practice audiologists, while 25% received their aids from big-box outlets, 14% received their aids from a physician’s office, and 7% obtained their aids from a hearing aid specialist. Without exception, respondents were satisfied with the information, service, and care they received from their dispensers and kept the instruments they received. Most respondents had little or no trouble adjusting to their aids and when minor problems arose, they found their dispensers able to rectify the problems in a speedy and satisfactory manner. Binaural amplification was used by 97% of respondents and most (72%) wore their aids for at least 12 hours per day. Many of the remaining respondents wore their aids 8 to 12 hours per day, while several reported using the aids only when they went out or were in specific listening situations. All respondents indicated at least some improvement in communication ability with their hearing aids. Many of the respondents strongly identified this in their comments. Similarly, most (79%) of the responding participants to the question about improved auditory attention and reduced auditory fatigue when using the aids answered positively. While socialization was only reported to have improved in 25% of those responding, many of the participants indicated that their social activity was always high regardless of hearing aids. As stated above, the situations which remained problematic for our respondents were those typically reported by hearing aid users: noisy backgrounds, unfamiliar, soft-spoken, or distant speakers as well as telephone and television use. As mentioned earlier, the sample for this study was drawn from 1 continuing care retirement community. One interesting finding was that the residents were more than willing to share their experiences about their hearing aids nearly all of them positive, regardless of manufacturer or dispenser. They were all quite genuine and forthcoming, supporting the earlier observation about socialization. Anecdotally, they indicated they had ready access to their dispensers, who were all within close proximity to the facility, and they also reported receiving hearing support and advice from their peers. It is possible the interaction and positivity within the shared community was a major factor in their use and satisfaction with amplification. The authors hope to investigate this question further in a future study, as well as to try to obtain objective measures of speech recognition performance in this population.