A number of observational studies have reported that hearing loss negatively impacts quality of life (QOL).1–5 Among the participants in the Epidemiology of Hearing Loss Study (EHLS), significant relationships between severity of hearing loss and impaired physical and social functioning were found.1 Furthermore, additional studies have reported a positive influence of hearing aid usage on QOL.6–12 A systematic review and meta-analysis of studies related to hearing aids and QOL, concluded that aid usage in adults was associated with improvements in psychological, social, and emotional well-being when hearing and communication-specific measures were used for QOL assessment.6 In a randomized trial among older patients at Veterans Affairs clinics, results suggested that hearing aid use led to significant improvements in social and emotional functioning, communication, cognition and depression with all effects except cognition being sustained for at least one year.7,8
Despite the psycho-social benefits of hearing aid use, it has been estimated that just 20–25% of hearing impaired individuals use hearing aids.13–15 Focusing on older adults (70 years of age and older), it has been reported that in 1995, only about one-third of subjects with a reported hearing problem had used hearing aids within the past year.16
Previous work evaluating characteristics related to seeking help for a hearing loss and obtaining hearing aids has been conducted through clinic-based investigations and cross-sectional population studies and surveys. In general, the factors found to have an influence on the decision to seek help include a lowered self-perception of hearing ability or decline in hearing sensitivity, negative impact of hearing quality on daily life, and comments/encouragement from others.17–20 Conversely, studies investigating characteristics associated with not seeking treatment for a hearing loss, have found that denial of the loss, self-image implications, the fear of social consequences and aging, the acceptance of a hearing loss as a normal part of the aging process, and lack of social pressure play a role.18,21 Hearing aids in particular are not sought because of concerns regarding cost, effectiveness, stigma and discomfort.18,21,22
Prior studies have not been population-based and prospective in nature and have not evaluated multiple factors simultaneously, including demographic characteristics, standard measures of hearing ability, and self-perception of hearing quality and handicap. Some studies have been conducted in clinical populations in which subjects have already made a decision to seek help for a perceived hearing loss.17,20 Factors influencing the decision to acquire a hearing aid may differ among patients seen at an audiology clinic versus participants in a population-based study of aging. Investigators in the Netherlands have conducted population studies but these have been cross-sectional in design and in the Netherlands the cost of a hearing aid may be partially reimbursed, either through public funding or the employer.18,19 Since cost may be an important factor in the decision to acquire a hearing aid, the results of the studies conducted in the Netherlands may be expected to differ from studies conducted in the United States where hearing aids are not universally covered by private health insurance or by Medicare. Survey work investigating the prevalence of hearing aid use in the United States relied on self-reported hearing loss or hearing difficulty which may introduce error and prevents any adjustment for measured hearing loss.21,22 In addition, the survey work is subject to response bias and may not be representative of the general population. The objective of this population-based study was to estimate, for the first time, the 10-year incidence of hearing aid acquisition among subjects with a demonstrated hearing loss and to determine the factors which predicted hearing aid purchase.