Editor's Message: Audiologists, Working Holistically, Can Be the Glue that Holds Public Health Initiatives Together

Author: Brian Taylor, Au.D.

Two studies, published online by JAMA Otolaryngology on November 8th are compulsory reads for audiologists concerned about accessibility and affordability of hearing-related services. Both studies, which relied on insurance claims data from the OptumLabs Data Warehouse, a division of the for-profit UnitedHealth Group, add to the growing body of evidence demonstrating hearing loss is linked to several common, adverse conditions in older adults.

The pair of studies were conducted by researchers at John Hopkins Bloomberg School of Public Health and sponsored by AARP. In the first study, Jennifer Deal and her colleagues examined the association of age-related hearing loss with dementia, depression, accidental falls, nonvertebral fractures, heart attacks and stroke. The researchers evaluated data from adults aged 50 years and older at two, five and 10-year follow up intervals. After ensuring participants with hearing loss were carefully matched to those with no evidence of hearing loss across a wide range of possible confounding factors, they determined adults with age-related hearing loss was significantly associated with an increased 10-year risk of dementia, depression, falls and heart attack.

In the second study, Nicholas Reed and colleagues looked at the relationship between hearing loss of adult onset and overall healthcare costs per individual. In their study, they found an association between untreated hearing loss and higher healthcare costs and a higher risk for hospital readmission. Specifically, they found over a 10-year period, individuals with untreated hearing loss incurred an average of over $22,000 in additional healthcare costs compared to similar adults with normal hearing.

Over the next few years, it will be interesting to see if the UnitedHealth Group, with its many large commercial HMO and Medicare Advantage programs, leverages these findings to provide more comprehensive hearing-related benefits for their members, including, perhaps, the coverage of hearing aids.

In the meantime, considering age-related hearing loss is more prevalent than diabetes or cancer, audiologists can play a key role in the public health mission of improving the quality of life of our aging society. This task begins with creating more effective collaborative efforts with allied health colleagues.

As the still-to-be-defined role audiology plays in public health evolves, it’s important to note the professional landscape has been changing, albeit slowly, for nearly a decade. Many believe the landscape began to shift with what is now considered a landmark report in a February 2010 Ear and Hearing editorial, authored by Amy Donohue, Judy Dubno and Lucille Beck. Their editorial, titled Accessible and Affordable Hearing Health Care for Adults with Mild to Moderate Hearing Loss, laid much of the groundwork that led to the detailed June 2016 National Academy of Science Engineering and Medicine’s (NASEM) Hearing Health Care for Adults: Priorities for Improving Access and Affordability, and ultimately the 2017 OTC Hearing Aid Act.

At a time when smartphone-based hearing screening apps and automated audiometry are readily available to the general public, what role is there for the audiologist? Depending on whom you speak to, some audiologists see the implementation of automated hearing testing and the availability of OTC devices as posing a risk to the patient and a threat to our profession. This perspective is understandable given our commitment to patient safety and our gold standards of practice. It also rings true if we solely think of the hearing test and the amplification device as being synonymous with hearing “health.” However, hearing health involves more than just technology and when viewed through a public health lens, Audiologists can choose to be the glue that holds these tools together.

As Professor Kelly Tremblay at the University of Washington recently shared with me, “When thinking about older adults, hearing tests and amplification devices are key ingredients to identifying and managing age-related hearing loss. But on their own, they are likely insufficient to improve someone’s quality of life. Audiologists are involved in advising governing bodies and they have the opportunity to shape their practice in a manner that fills the gaps that technology leaves behind. They can draw upon the many support skills they learned in graduate school; skills like counseling and advocacy. It gives audiologists an opportunity to draw on the evidence-based research showing the benefits of person-centered care and it serves as a call to action to improve billing practices so that auditory rehabilitation practices can be reimbursed. It also challenges us to get creative so that alternative but professional approaches to rehabilitation can be found.” This requires an all-hands-on-deck approach that includes moving beyond the traditional four walls of the clinic and getting directly involved in dispensing high quality non-custom amplification devices in places where improved communication with a medical professional or caretaker is imperative. It also includes taking a holistic approach to managing hearing loss by deepening on knowledge of comorbidities associated with hearing loss and collaborating in more meaningful ways with other healthcare specialties.

Professor Victor Bray at Salus University is the guest editor of this issue of Audiology Practices. The articles come from a featured session at the recently concluded annual ADA meeting in Orlando, Florida. Their authors reflect much of the current thinking surrounding a more holistic approach that audiologists can implement in their clinics to improve the standing of the profession with other healthcare specialties, and more importantly, to contribute to earlier identification and treatment of hearing loss in adults. Services that are valued and thus reimbursed by third party payers.