Adult-onset hearing loss is insidious and typically diagnosed and managed several years after onset. Often, this is after the loss having led to multiple negative consequences including effects on employment, depressive symptoms, and increased risk of mortality. In contrast, the use of hearing aids is associated with reduced depression, longer life expectancy, and retention in the workplace. Despite this, several studies indicate high levels of unmet need for hearing health services in older adults and poor use of prescribed hearing aids, often leading to their abandonment. In Australia, the largest component of financial cost of hearing loss (excluding the loss of well-being) is due to lost workplace productivity. Nonetheless, the Australian public health system does not have an effective and sustainable hearing screening strategy to tackle the problem of poor detection of adult-onset hearing loss. Given the increasing prevalence and disease burden of hearing impairment in adults, two key areas are not adequately met in the Australian healthcare system: (1) early identification of persons with chronic hearing impairment; (2) appropriate and targeted referral of these patients to hearing health service providers. This paper reviews the current literature, including population-based data from the Blue Mountains Hearing Study, and suggests different models for early detection of adult-onset hearing loss. 1. Introduction Adult-onset hearing loss is a highly prevalent yet relatively underrecognised health problem in the older adult Australian population [1, 2]. Because hearing loss is often progressive and gradual in its onset in most individuals, it is typically diagnosed and managed several years after its onset, often only after having led to multiple negative consequences including effects on employment, poor quality of life, social isolation, depressive symptoms, increased mortality risk, and reduced independence [3–9]. It is one of the leading causes of burden of disease prior to older age, for ages 45–64 years, in men and women . Further, as hearing loss interferes with so many of life’s activities, it may prove to be a major impediment to society’s need to have people remain longer in the workforce as the proportion of “working age” people in developed countries shrinks . In Australia, the annual cost of lost earnings due to workplace separation and early retirement from hearing loss was estimated at $6.7 billion, which is over half of the calculated economic impact of hearing loss ($11.75 billion, representing 1.4% of GDP) . Therefore
D. B. Reuben, K. Walsh, A. A. Moore, M. Damesyn, and G. A. Greendale, “Hearing loss in community-dwelling older persons: national prevalence data and identification using simple questions,” Journal of the American Geriatrics Society, vol. 46, no. 8, pp. 1008–1011, 1998.
E. M. Chia, J. J. Wang, E. Rochtchina, R. R. Cumming, P. Newall, and P. Mitchell, “Hearing impairment and health-related quality of life: the blue mountains hearing study,” Ear and Hearing, vol. 28, no. 2, pp. 187–195, 2007.
B. Gopinath, J. J. Wang, J. Schneider et al., “Depressive symptoms in older adults with hearing impairments: the blue mountains study: letters to the editor,” Journal of the American Geriatrics Society, vol. 57, no. 7, pp. 1306–1308, 2009.
I. Appollonio, C. Carabellese, E. Magni, L. Frattola, and M. Trabucchi, “Sensory impairments and mortality in an elderly community population: a six-year follow-up study,” Age and Ageing, vol. 24, no. 1, pp. 30–36, 1995.
M. J. Karpa, B. Gopinath, K. Beath et al., “Associations between hearing impairment and mortality risk in older persons: the blue mountains hearing study,” Annals of Epidemiology, vol. 20, no. 6, pp. 452–459, 2010.
S. Begg, T. Vos, B. Barker, C. Stevenson, L. Stanley, and A. D. Lopez, The Burden of Disease and Injury in Australia 2003, PHE 82, Australian Institute of Health and Welfare, Canberra, Australia, 2007.
J. P. Gagnè, “What is treatment evaluation research? What is its relationship to the goals of audiological rehabilitation? Who are the stakeholders of this type of research?” Ear and Hearing, vol. 21, no. 4, supplement, pp. 60S–73S, 2000.
I. Appollonio, C. Carabellese, L. Frattola, and M. Trabucchi, “Effects of sensory aids on the quality of life and mortality of elderly people: a multivariate analysis,” Age and Ageing, vol. 25, no. 2, pp. 89–96, 1996.
S. M. Cohen, R. F. Labadie, M. S. Dietrich, and D. S. Haynes, “Quality of life in hearing-impaired adults: the role of cochlear implants and hearing aids,” Otolaryngology, vol. 131, no. 4, pp. 413–422, 2004.
A. Davis, P. Smith, M. Ferguson, D. Stephens, and I. Gianopoulos, “Acceptability, benefit and costs of early screening for hearing disability: a study of potential screening tests and models,” Health Technology Assessment, vol. 11, no. 42, pp. 1–294, 2007.
D. S. Dalton, K. J. Cruickshanks, B. E. K. Klein, R. Klein, T. L. Wiley, and D. M. Nondahl, “The impact of hearing loss on quality of life in older adults,” Gerontologist, vol. 43, no. 5, pp. 661–668, 2003.
B. Gopinath, E. Rochtchina, J. J. Wang, J. Schneider, S. R. Leeder, and P. Mitchell, “Prevalence of age-related hearing loss in older adults: blue mountains study,” Archives of Internal Medicine, vol. 169, no. 4, pp. 415–416, 2009.
M. M. Popelka, K. J. Cruickshanks, T. L. Wiley, T. S. Tweed, B. E. K. Klein, and R. Klein, “Low prevalence of hearing aid use among older adults with hearing loss: the epidemiology of hearing loss study,” Journal of the American Geriatrics Society, vol. 46, no. 9, pp. 1075–1078, 1998.
T. Tay, J. W. Jie, A. Kifley, R. Lindley, P. Newall, and P. Mitchell, “Sensory and cognitive association in older persons: findings from an older Australian population,” Gerontology, vol. 52, no. 6, pp. 386–394, 2006.
S. D. G. Stephens, D. E. Callaghan, S. Hogan, R. Meredith, A. Rayment, and A. C. Davis, “Hearing disability in people aged 50–65: effectiveness and acceptability of rehabilitative intervention,” British Medical Journal, vol. 300, no. 6723, pp. 508–511, 1990.
M. I. Wallhagen, W. J. Strawbridge, S. J. Shema, and G. A. Kaplan, “Impact of self-assessed hearing loss on a spouse: a longitudinal analysis of couples,” Journals of Gerontology B, vol. 59, no. 3, pp. S190–S196, 2004.
D. Hartley, E. Rochtchina, P. Newall, M. Golding, and P. Mitchell, “Use of hearing aids and assistive listening devices in an older australian population,” Journal of the American Academy of Audiology, vol. 21, no. 10, pp. 642–653, 2010.
D. C. Garstecki and S. F. Erler, “Hearing loss, control, and demographic factors influencing hearing aid use among older adults,” Journal of Speech, Language, and Hearing Research, vol. 41, no. 3, pp. 527–537, 1998.
P. B. Kricos, “Audiologic management of older adults with hearing loss and compromised cognitive/psychoacoustic auditory processing capabilities,” Trends in Amplification, vol. 10, no. 1, pp. 1–28, 2006.
P. A. Gosselin and J. P. Gagné, “Older adults expend more listening effort than young adults recognizing speech in noise,” Journal of Speech, Language, and Hearing Research, vol. 54, no. 3, pp. 944–958, 2011.
C. Humphrey, K. G. Herbst, and S. Faurqi, “Some characteristics of the hearing-impaired elderly who do not present themselves for rehabilitation,” British Journal of Audiology, vol. 15, no. 1, pp. 25–30, 1981.
B. Yueh, N. Shapiro, C. H. MacLean, and P. G. Shekelle, “Screening and management of adult hearing loss in primary care: scientific review,” Journal of the American Medical Association, vol. 289, no. 15, pp. 1976–1985, 2003.
J. L. Smith, P. Mitchell, J. J. Wang, and S. R. Leeder, “A health policy for hearing impairment in older Australians: what should it include?” Australia and New Zealand Health Policy, vol. 2, no. 1, article 31, 2005.
M. J. Lichtenstein, F. H. Bess, and S. A. Logan, “Validation of screening tools for identifying hearing-impaired elderly in primary care,” Journal of the American Medical Association, vol. 259, no. 19, pp. 2875–2878, 1988.
M. J. Lichtenstein, F. H. Bess, and S. A. Logan, “Diagnostic performance of the hearing handicap inventory for the elderly (screening version) against differing definitions of hearing loss,” Ear and Hearing, vol. 9, no. 4, pp. 208–211, 1988.
B. Yueh, M. P. Collins, P. E. Souza et al., “Long-term effectiveness of screening for hearing loss: the screening for auditory impairment—which hearing assessment test (SAI-WHAT) randomized trial,” Journal of the American Geriatrics Society, vol. 58, no. 3, pp. 427–434, 2010.
A. Davis, D. Stephens, A. Rayment, and K. Thomas, “Hearing impairments in middle age: the acceptability, benefit and cost of detection (ABCD),” British Journal of Audiology, vol. 26, no. 1, pp. 1–14, 1992.
C. May, G. Allison, A. Chapple et al., “Framing the doctor-patient relationship in chronic illness: a comparative study of general practitioners' accounts,” Sociology of Health and Illness, vol. 26, no. 2, pp. 135–158, 2004.
E. L. Harvey, A. Glenny, S. F. Kirk, and C. D. Summerbell, “Improving health professionals' management and the organisation of care for overweight and obese people,” Cochrane Database of Systematic Reviews, no. 2, Article ID CD000984, 2001.
D. A. Cook, A. J. Levinson, S. Garside, D. M. Dupras, P. J. Erwin, and V. M. Montori, “Internet-based learning in the health professions: a meta-analysis,” Journal of the American Medical Association, vol. 300, no. 10, pp. 1181–1196, 2008.
L. Forsetlund, A. Bj？rndal, A. Rashidian et al., “Continuing education meetings and workshops: effects on professional practice and health care outcomes,” Cochrane Database of Systematic Reviews, no. 2, Article ID CD003030, 2009.
C. Meyer, L. Hickson, A. Khan, D. Hartley, H. Dillon, and J. Seymour, “Investigation of the actions taken by adults who failed a telephone-based hearing screen,” Ear and Hearing, vol. 32, no. 6, pp. 720–731, 2011.
N. W. Wilson, I. D. Couper, E. De Vries, S. Reid, T. Fish, and B. J. Marais, “A critical review of interventions to redress the inequitable distribution of healthcare professionals to rural and remote areas,” Rural and Remote Health, vol. 9, no. 2, p. 1060, 2009.