The effect of hearing aid treatment on health-related quality of life in older adults with hearing loss

Figures & data

Figure 1. Study flow diagram according to hearing aid (HA) experience and measurement point (baseline, two-month follow-up, and long-term (>1Y) follow-up).

Table 1. Patient characteristics according to hearing aid (HA) experience at baseline.

	Total (n = 1894)	First-time users (n = 1362)	Experienced users (n = 532)
Age (yrs)
Mean ± SD	66.5 ± 11.1	65.9 ± 10.9	67.7 ± 11.5
Range	19-94	21–94	19–89
Female (%)	41.7	42.9	39.0
Previous use of HAs (yrs), mean ± SD	NA	NA	9.6 ± 8.8
Better ear PTA-4 (dB HL), mean ± SD	35.4 ± 12.9	32.1 ± 10.9	43.6 ± 14
Better ear WRS (%), mean ± SD	92.4 ± 12.0	93.9 ± 10.99	88.5 ± 13.6
Severity of hearing loss based on better ear PTA-4^a (%)
Normal Hearing (≤19 dB HL)	8.8	11.3	2.7
Mild (20–34 dB HL)	40.5	48.3	21.2
Moderate (35–49 dB HL)	37.4	34.3	45.0
Moderate-Severe (50–64 dB HL)	10.6	5.6	23.0
Severe (65–79 dB HL)	2.2	0.4	6.9
Profound (≥80 dB HL)	0.5	0.1	1.3
HA characteristics
Average daily use time (hours), mean ± SD	8.9 ± 5.0	8.3 ± 4.9	10.3 ± 10.3
Number of HAs (%)
Unilateral	4.3	5.1	2.2
Bilateral	95.7	94.9	97.8
Place of rehabilitation (%)
The North Denmark Region	38.4	43.0	27.0
The Region of Southern Denmark	61.6	57.0	73.0
Average follow-up time (days), mean ± SD
HA fitting to two-month follow-up^b	71 ± 32	70 ± 31	75 ± 34
HA fitting to long-term follow-up^c	698 ± 298	692 ± 299	712 ± 296

^aHearing Scale according to Global Burden of Disease study, Stevens et al. (2013); WRS: Word Recognition Score; PTA-4: Pure-Tone Average of hearing thresholds at 0.5, 1, 2, and 4 kHz; HL, Hearing Level.

^bBased on hearing aid adjustment visit.

^cBased on response to 15D questionnaire.

Table 2. Mean 15D dimension scores and total score at baseline, two-month follow-up, and long-term follow-up according to hearing aid (HA) experience.

15D dimension	HA exp	Baseline		Two-month follow-up (71 ± 32 d)		Long-term follow-up (698 ± 298 d)
		n(exp) = 532, n(first-time) = 1362		n(exp) = 477, n(first-time) = 1182		n(exp) = 418, n(first-time) = 1027
1. Mobility	1st time	0.93	(0.92; 0.94)	0.94**	(0.93; 0.95)	0.93	(0.92; 0.94)
	Exp	0.93	(0.92; 0.95)	0.92	(0.91; 0.94)	0.92*	(0.91; 0.94)
2. Vision	1st time	0.95	(0.94. 0.95)	0.96*	(0.95; 0.96)	0.94	(0.94; 0.95)
	Exp	0.95	(0.94; 0.96)	0.95	(0.94; 0.96)	0.95	(0.93; 0.96)
3. Hearing	1st time	0.72	(0.71; 0.73)	0.82***	(0.81; 0.83)	0.81***	(0.80; 0.82)
	Exp	0.68	(0.66; 0.70)	0.76***	(0.74; 0.78)	0.74***	(0.72; 0.76)
4. Breathing	1st time	0.90	(0.89; 0.91)	0.91	(0.90; 0.91)	0.89	(0.88; 0.90)
	Exp	0.91	(0.89; 0.92)	0.89	(0.88; 0.91)	0.90	(0.88; 0.91)
5. Sleeping	1st time	0.86	(0.85; 0.87)	0.86	(0.85; 0.87)	0.86	(0.84; 0.87)
	Exp	0.86	(0.84; 0.87)	0.87	(0.85; 0.88)	0.86	(0.85; 0.88)
6. Eating	1st time	1.00	(1.00; 1.00)	1.00	(0.99; 1.00)	1.00	(0.99; 1.00)
	Exp	0.99	(0.99; 1.00)	0.99	(0.99; 1.00)	0.99	(0.99; 1.00)
7. Speech	1st time	0.97	(0.97; 0.98)	0.97	(0.97; 0.98)	0.97	(0.96; 0.98)
	Exp	0.97	(0.97; 0.98)	0.97	(0.96; 0.98)	0.97	(0.96; 0.98)
8. Excretion	1st time	0.91	(0.90; 0.92)	0.91	(0.90; 0.92)	0.89***	(0.88; 0.90)
	Exp	0.91	(0.89; 0.92)	0.90	(0.89; 0.92)	0.89***	(0.87; 0.90)
9. Usual activities	1st time	0.90	(0.89; 0.91)	0.90	(0.89; 0.91)	0.88***	(0.87; 0.89)
	Exp	0.89	(0.88; 0.91)	0.89	(0.87; 0.90)	0.88*	(0.86; 0.90)
10. Mental function	1st time	0.92	(0.91; 0.93)	0.92	(0.91; 0.93)	0.92	(0.91; 0.93)
	Exp	0.93	(0.92; 0.94)	0.92	(0.91; 0.94)	0.92	(0.90; 0.93)
11. Discomfort	1st time	0.90	(0.89; 0.91)	0.90	(0.89; 0.91)	0.90	(0.89; 0.91)
	Exp	0.92	(0.91; 0.94)	0.91	(0.89; 0.92)	0.91	(0.89; 0.92)
12. Depression	1st time	0.94	(0.93; 0.95)	0.94	(0.93; 0.95)	0.93*	(0.92; 0.94)
	Exp	0.94	(0.93; 0.95)	0.94	(0.93; 0.95)	0.94	(0.93; 0.95)
13. Distress	1st time	0.93	(0.92; 0.94)	0.93	(0.92; 0.94)	0.92	(0.92; 0.93)
	Exp	0.94	(0.93; 0.95)	0.93	(0.92; 0.95)	0.94	(0.93; 0.95)
14. Vitality	1st time	0.89	(0.88; 0.90)	0.88	(0.88; 0.89)	0.87***	(0.86; 0.88)
	Exp	0.90	(0.89; 0.91)	0.89*	(0.87; 0.90)	0.88***	(0.87; 0.90)
15. Sexual activity	1st time	0.87	(0.85; 0.88)	0.85**	(0.84; 0.86)	0.83***	(0.81; 0.84)
	Exp	0.86	(0.84; 0.88)	0.84	(0.82; 0.86)	0.82***	(0.80; 0.85)
Total 15D score	1st time	0.907	(0.902; 0.911)	0.915***	(0.910; 0.919)	0.906*	(0.900; 0.911)
	Exp	0.907	(0.901; 0.914)	0.908	(0.901; 0.915)	0.905***	(0.897; 0.913)

Significant changes in 15D dimension score and total score from baseline to two-month follow-up and from baseline to long-term follow-up were tested using mixed models; *p < 0.05, **p < 0.01. ***p < 0.001.

Figure 2. 15D Individual dimension scores at baseline, two-month, and long-term (>1Y) follow-up (F/U). Move: mobility; See: vision; Hear: hearing; Breath: breathing; Sleep: sleeping; Eat: eating; Excret: excretion; Uact: usual activities; Mental: mental function; Discom: discomfort; Depr: depression; Distr: distress; Vital: vitality; Sex: sexual activity.

Table 3. Classification of the change in 15D total scores from baseline to two-month and long-term follow-up into global assessment scale (GAS) categories according to hearing aid experience.

GAS category	Limits for change in 15 D score^a	Distribution of patients (%)
		All participants		First-time users		Experienced users
		Two-month	Long-term	Two-month	Long-term	Two-Month	Long-term
1. Much better	>0.035	18.9	18.2	20.0	19.3	16.0	15.7
2. Slightly better	0.015–0.035	14.8	12.6	15.4	12.8	13.4	12.2
3. No change	> −0.15 and <0.15	38.3	33.7	39.3	33.5	35.6	34.1
4. Slightly worse	−0.015 to −0.035	12.7	12.3	11.9	11.8	14.7	13.4
5. Much worse	< −0.035	15.4	23.2	13.4	22.6	20.3	24.6

^aLimits and intervals suggested by Alanne et al. (2015, in Table 5); Minimal important change is defined as ±0.015.

Table 4. Correlates of 15D total score and 15D-3 hearing dimension score in first-time and experienced hearing aid (HA) users.

	Outcome: 15D total score
	1st time HA users (n = 1178)			Experienced HA users (n = 455)
Predictors	β	95% CI	p-value	β	95% CI	p-value
Measurement time
Two-month follow-up vs. baseline	0.006	(0.003; 0.009)	0.01	0.0001	(−0.005; 0.005)	0.98
Long-term follow-up vs. baseline	−0.004	(−0.007; −0.001)	<0.001	−0.01	(−0.012; −0.002)	0.01
Covariates
Baseline SSQ12 total score	0.014	(0.01; 0.02)	<0.001	0.01	(0.008; 0.016)	<0.001
Best ear WRS (%)	0.001	(2 × 10^−4; 0.001)	0.01	0.001	(5.71 × 10^−6; 0.001)	0.05
Best ear PTA-4 (dB HL)	2 × 10^-4	(−3 × 10^−4; 6 × 10^−4)	0.47	0.0003	(−3 × 10^−4; 6 × 10^−4)	0.28
Hearing aid use time (hour/day)	0.001	(6 × 10^−4; 0.002)	0.001	0.001	(−10^−5; 0.003)	0.05
	Outcome: 15D-3 hearing dimension score
	1st time HA users (n = 1192)			Experienced HA users (n = 465)
Predictors	β	95% CI	p-value	β	95% CI	p-value
Measurement time
Two-month follow-up vs. baseline	0.102	(0.09; 0.11)	<0.001	0.085	(0.07; 0.10)	<0.001
Long-term follow-up vs. baseline	0.090	(0.08; 1.02)	<0.001	0.059	(0.04; 0.08)	<0.001
Covariates
Baseline SSQ12 total score	0.028	(0.02; 0.03)	<0.001	0.033	(0.03; 0.04)	<0.001
Best ear WRS (%)	0.001	(4 × 10^−4; 0.002)	0.003	0.001	(−2 × 10^−4; 0.002)	0.11
Best ear PTA-4 (dB HL)	−0.002	(−0.003; −0.002)	<0.001	−0.003	(−0.004; −0.002)	<0.001
Hearing aid use time (hour/day)	0.002	(5 × 10^−4; 0.003)	0.008	0.001	(−0.002; 0.003)	0.67

Statistical method: mixed model; all models were additionally adjusted for age and sex; statistically significant differences shown in bold. SSQ12: Speech, Spatial, and Qualities of Hearing scale (the short form); WRS: Word Recognition Score; PTA-4: Pure-Tone Average of hearing thresholds at 0.5, 1, 2, and 4 kHz; HL: Hearing Level.

Stevens, G., S. Flaxman, E. Brunskill, M. Mascarenhas, C. D. Mathers, and M. Finucane. 2013. “Global and Regional Hearing Impairment Prevalence: An Analysis of 42 Studies in 29 Countries.” European Journal of Public Health 23 (1):146–152. doi:10.1093/eurpub/ckr176.

 PubMed Web of Science ®Google Scholar

Alanne, S., R. P. Roine, P. Räsänen, T. Vainiola, and H. Sintonen. 2015. “Estimating the Minimum Important Change in the 15D Scores.” Quality of Life Research 24 (3):599–606. doi:10.1007/s11136-014-0787-4.

 PubMed Web of Science ®Google Scholar