Faculty Bibliography

Background: Social isolation is common among community dwelling older adults and is associated with adverse health outcomes. Its inverse, social engagement, depends on verbal communication, which can be disrupted by age-related hearing loss (AHRL). AHRL is mitigated with hearing aids, but hearing aid costs can be prohibitive for low income, under-resourced communities. As such, personal amplifiers or hearing assistance devices (HADs), are a feasible alternative that can be delivered at point-of-care to older adults with AHRL. Despite the link between social engagement and hearing, there is little research on mitigating hearing loss to improve patient-reported outcomes such as depressed mood and loneliness, particularly in low-income communities.
Method(s): This ongoing pilot study has enrolled older adults living in federally subsidized Los Angeles housing to assess the feasibility of community-based hearing assessment and provision of hearing assistance devices (HAD). We seek to understand the potential impact of HAD use on patient-reported symptoms. We measure self-reported hearing loss using the Hearing Handicap Inventory (HHI), and at baseline, one, and two months: social isolation using a 4-item instrument, depressed mood using the Patient Health Questionnaire (PHQ)-9, a 6-item loneliness score, and HAD utility using the International Outcome Inventory for Alternative Interventions (IOI-AI).
Result(s): Among 36 recruited participants in three buildings thus far, 30 (83%) reported having hearing difficulties (HHI >=10) and were given Pocket-Talkers. For those with self-reported hearing-related psychosocial difficulties, 8 (27%) endorsed social isolation (>1 of 4); 18 (60%) endorsed at least mild depression (PHQ-9 > 4); and 19 (63%) endorsed loneliness (>1 of 6). Among 16 who have completed 1-month follow-up, no changes have been noted, but 1-month scores on the IOI-AI (mean: 4; range 0-5) suggest very favorable utility.
Conclusion(s): Early results from this pilot study support this as a feasible intervention with positive impact associated with Pocket- Talker use. Further follow-up and subject enrollment is needed to determine whether this intervention improves patient-reported outcomes

OBJECTIVE:To measure the association of China's universal two child policy, announced in October 2015, with changes in births and health related birth characteristics. DESIGN:National, descriptive before-and-after comparative study. SETTING:Every county in 28 of 31 provinces of mainland China. PARTICIPANTS:Births included in two national databases: 67 786 749 births from county level monthly aggregated data between January 2014 and December 2017; and 31 786 279 deliveries from individual level delivery information records between January 2015 and December 2017. MAIN OUTCOME MEASURES:Monthly mean number of births and mean proportion of multiparous mothers and mothers aged 35 and over, preterm deliveries, and caesarean deliveries. RESULTS:The study had two phases: the baseline period (up to and including June 2016, nine months after the policy announcement) and the effective period (from July 2016 to December 2017). The estimated number of additional births attributable to the new policy between July 2016 and December 2017 was 5.40 million (95% confidence interval 4.34 to 6.46). The monthly mean percentage of multiparous mothers and mothers aged 35 and over increased by 9.1 percentage points (95% confidence interval 6.4 to 11.7) and 5.8 percentage points (5.2 to 6.4), respectively. This increase in older mothers, however, was not associated with a concurrent increase in the overall rate of preterm birth. The monthly mean caesarean delivery rate among multiparous mothers increased by 1.2 percentage points (0.8 to 1.6) from 39.7% to 40.9%, and decreased by 3.0 percentage points (-3.5 to -2.5) among nulliparous mothers from 39.6% to 36.6%. CONCLUSIONS:Since its announcement in October 2015, the universal two child policy has been associated with a rise in births in China and with changes in health related birth characteristics: women giving birth have been more likely to be multiparous, and more likely to be aged 35 and over. No evidence of concurrent worsening outcomes (that is, premature births) was seen.

BACKGROUND/OBJECTIVES/OBJECTIVE:Patient activation encompasses the knowledge, skills, and confidence that equip adults to participate actively in their healthcare. Patients with hearing loss may be less able to participate due to poor aural communication. We examined whether difficulty hearing is associated with lower patient activation. DESIGN/METHODS:Cross-sectional study. SETTING/PARTICIPANTS/METHODS:A nationally representative sample of Americans aged 65 years and older (n = 13 940) who participated in the Medicare Current Beneficiary Survey (MCBS) during the years 2011 to 2013. MEASUREMENT/METHODS:Self-reported degree of difficulty hearing ("no trouble," "a little trouble," and "a lot of trouble") and overall activation based on aggregated scored responses to 16 questions from the MCBS Patient Activation Supplement: low activation (below the mean minus 0.5 SDs), high activation (above the mean plus 0.5 SDs), and medium activation (the remainder). Sociodemographic and self-reported clinical measures were also included. RESULTS:"A little trouble" hearing was reported by 5655 (40.6%) of respondents, and "a lot of trouble" hearing was reported by 893 (6.4%) of respondents. Difficulty hearing was significantly associated with low patient activation: in analyses using multivariable multinomial logistic regression, respondents with "a little trouble" hearing had 1.42 times the risk of low vs high activation (95% confidence interval [CI] = 1.27-1.58), and those with "a lot of trouble" hearing had 1.70 times the risk of low vs high activation (95% CI = 1.29-2.11), compared with those with "no trouble" hearing. CONCLUSIONS:Nearly half of people aged 65 years and older reported difficulty hearing, and those reporting difficulty were at risk of low patient activation. That risk rose with increased difficulty hearing. Given the established link between activation and outcomes of care, and in view of the association between hearing loss and poor healthcare quality and outcomes, clinicians may be able to improve care for people with hearing loss by attending to aural communication barriers.