Adult Hearing Screening: An Undemanded Need

More than 45% of persons over the age of 60 years and as many as 83% older than 70 years experience some degree of hearing loss. Age-related hearing loss typically develops over years and decades, and often does produce a sort of slow habituation to the impairment. Hearing impaired people wait, on average, about ten years before seeking treatment and tend to live with their hearing problems until they experience severe handicap and disability. There are substantial unmet needs not just from mild cases but across all severities. As a result, age-related hearing loss is still largely underdetected, particularly in older adults and in people with multiple chronic conditions. Hearing impairment adds a significant burden to the individual and can lead to communication breakdown, loneliness, isolation, depression, and loss of independence. These consequences of auditory dysfunctions are still largely underestimated by the society, by senior citizens as well as by health care professionals. Incorporating hearing care into a comprehensive strategy that is not disease specific but, rather, deals with hearing impairment, communication ability as well as cognitive decline and co-morbidities, shows promise in the older population and could contribute to better outcomes, improved quality of life and more sustained self-sufficiency. Early identification and treatment of older adults with hearing loss can open the way to their collaborative engagement in communication, enhance their participation in family needs and social life, improve their personal well-being and quality of life. This could also lead to multiple benefits for the medical management of the patient, such as enhancing patient awareness and motivation, improving self-confidence, promoting more positive attitudes, mutual exchange with physicians and involvement in decision-making. The potential of hearing screening for initiating this process is clear-cut. During the past few years, a number of initiatives and studies have promoted the definition and implementation of effective programs of hearing screening and hearing care for adults and older adults and have demonstrated the advantages of delivering opportunistic or targeted hearing screening programs in terms of increased awareness, improved follow-up, and cost-effectiveness. A variety of novel methods have been specifically developed in the recent years for adult screening and are being increasingly used in a number of local and national campaigns. The availability of reliable methods to identify hearing problems is a crucial prerequisite for the implementation of effective programs. A screening test which is fast, accurate, and easy-to-use can be a powerful means to deliver quality services. The concept of screening adults is gradually evolving to include, in addition to conventional measures of hearing sensitivity (thresholds) and self-perceived hearing handicap/disability (questionnaires) also measures of hearing acuity, i.e. supra-threshold performances such as speech understanding in noise. This is because the more relevant listening difficulties experienced by adults and older adults are typically with speech communication, particularly in challenging listening situations (e.g., background noise, crowded places, ...). As a matter of fact, most - if not all - these new screening methods are speech-in-noise tests. Some of these novel, promising approaches will be examined and their advantages for adult screening will be illustrated. Important contributions in this field emerged within the European project "AHEAD III: Assessment of Hearing in the Elderly: Aging and Degeneration - Integration through Immediate Intervention" (http://www.ahead.polimi.it/). This coordination action funded by the EC under the FP7 started in 200