Estimating the prevalence of hearing loss in people with dementia
Research type
Research Study
Full title
Estimating the prevalence of hearing loss in people with dementia: A feasibility study
IRAS ID
334240
Contact name
Hannah Cross
Contact email
Sponsor organisation
University of Manchester
Clinicaltrials.gov Identifier
N/A, N/A
Duration of Study in the UK
0 years, 11 months, 2 days
Research summary
Research Summary
As we age, the risk of experiencing both dementia and hearing issues rises. Untreated hearing loss in individuals with dementia can worsen confusion, depression, and loneliness and exacerbate dementia symptoms. It is unknown how common (prevalent) hearing loss is in people with dementia in the UK.
In the future, we aim to conduct a large UK-wide study to determine the prevalence of hearing loss in people with dementia and understand why some cases go unnoticed or untreated. Before launching this study, we are conducting feasibility testing, addressing key questions:
Are at-home hearing tests using Pure Tone Audiometry (PTA; responding when able to hear a tone) acceptable for people with dementia? and if not, how can we improve the tests?
Can we reliably test the hearing of people with dementia ('test-retest reliability') using PTA?
How likely is it to find and retain participants with dementia for the study?
How many participants in our sample have hearing loss?
Why might hearing loss go unnoticed or untreated in people with dementia, informing methods to improve hearing care for this population?
To answer these questions, approximately 35 people with dementia will be recruited through their NHS trust or
undergo two 1 hour at-home standard hearing tests, including case history discussions, ear inspections, earwax removal if required and PTA. Participants can end the test at any time for any reason and the audiologist will be dementia-aware. The test will be adapted to the person's needs and abilities.
One-time telephone/zoom interviews (1 hour) will be conducted with around 45 people, including people with dementia, caregivers, and hearing healthcare professionals. People with any type of dementia living in the community or care homes, of any age and hearing ability, will be eligible.This research is funded by the National Institute for Health and Care Research's Manchester Biomedical Centre.
Summary of Results
Stage 1: Hearing Assessments:
- 33 participants were recruited from their local NHS Memory services.
- Demographics: 61% male, mean age = 78 years old, 91% lived in their own home. 97% were White British, 3% were Black/ Black British.
Mild (58%), questionable (18%), moderate (24%) dementia, classified using the Clinical Dementia Rating scale. 85% of participants had the mental capacity to consent to the study, the remaining had a consultee on their behalf. Dementia subtype varied: Alzheimer's: 67%, Mixed: 21%, Vascular: 6%, Frontotemporal: 3%.
- Out of 33 recruited, 1 participant died, and 8 cancelled at least one of their hearing assessment.
- We had aimed to recruit at least 25 (70% of the target sample) participants within 3 months of the study opening, which was not achieved. To recruit 70%, it took 4 months and 10 days. However, there were delays due to contractual and admin issues.
- Dropout rate was higher than we anticipated (27%).
- We compared our recruited sample with national datasets and estimates of people with dementia in the UK. Although we matched general trends of dementia diagnoses, we had oversampled people with Alzheimer's, and Mixed dementia, and undersampled people with Vascular dementia. We had oversampled White British participants, and those living in their own home compared to a care home. We had also oversampled males in our study.-Of those attending hearing assessments:
100% were able to have their ears inspected.
100% were able to wear the headphones during testing.
100% responded consistently and reliably to tones during Pure Tone Audiometry (PTA) testing.
-Test-retest reliability between the two hearing assessments (PTA) was excellent (ICC3,1 = 0.99, p<.001).
- Few adaptations were needed.
This suggests that the hearing assessments were acceptable and reliable for our sample with dementia.- Earwax: 38% had at least partially obstructed ears.
- Self-reported hearing difficulties: 48% believed that they had a hearing loss.
- Actual hearing difficulties were much higher: Normal (4%), Mild (8%), Mild-Moderate (73%), Moderate-Severe (15%). 96% of participants had some degree of hearing loss according to their Pure-Tone Audiometry test.
- Wears a hearing aid: 33%.Hearing loss was an under-identified and under-addressed issue in our sample of people with dementia, warranting further exploration with a larger-scale study.
Stage 2: Interviews:
We interviewed twelve audiologists with varied backgrounds and clinical experience. Four COM-B domains were identified as most prominent: psychological capability, reflective motivation, social opportunity, and physical opportunity. Seven themes were generated to explore barriers and facilitators to conducting hearing assessments with people with dementia: Communication and consent challenges (barrier), navigating best interests (barrier), the care network (barrier and facilitator), training gaps and reliance on experience (barrier and facilitator), the clinical environment (barrier and facilitator), flexibility and adaptive skillset (facilitator), and compassion-driven care (facilitator).We also interviewed 10 caregivers and 5 people with dementia on barriers and facilitators to hearing assessments. Preliminary results show that people with dementia can be ambivalent about having their hearing tested, however, after doing so, there can be significant improvements in outcomes for them and their family. Convenient testing, such as that done in their own home, facilitates attendance at assessments and reduces worry or distress. However, cognitive challenges such as understanding testing instructions or explaining health history were a prominent difficulty for people with dementia during hearing assessments. Family involvement in arranging and attending hearing assessments, and managing hearing aids post-assessment was essential for many people with dementia.
REC name
Wales REC 3
REC reference
24/WA/0076
Date of REC Opinion
18 Mar 2024
REC opinion
Favourable Opinion